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Urinary clinical conditions > Presentation of diseases of Kidneys and Urinary Tract & Urinary Retention > Flashcards

Presentation of diseases of Kidneys and Urinary Tract & Urinary Retention Flashcards

1
Q

What structures consist of the upper urinary tract?

A

Kidneys and ureters

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2
Q

What is responsible for preventing back flow of urine from the bladder into the ureters?

A

Vesico-ureteric junction

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3
Q

What drugs can cause nephrotoxicity?

A

NSAIDS

Antibiotics i.e. gentamicin

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4
Q

What are the presentations/symptoms of renal diseases?

A 
Pain
Pyrexia
Haematuria
Proteinuria
Pyuria 
Mass on palpation
Renal failure
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5
Q

What cells are present in pyuria?

A

Leukocytes (pus cells)

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6
Q

Name 2 inflammatory renal diseases.

A

Glomerulonephritis

Tubulointerstitial nephritis

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7
Q

What is the definition of proteinuria?

A

Urinary protein excretion > 150mg/day

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8
Q

What are the types of haematuria?

A

3 types
Macorscopic - visible
Microscopic - only dipstick visible & non-visible

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9
Q

What is the definition of microscopic haematuria?

A

Greater than or equal to 3 RBC per high power field

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10
Q

What is the definition of oliguria?

A

Urine output < 0.5ml/kg/hour

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11
Q

What si the name for no urine output?

A

Absolute anuria

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12
Q

What is relative anuria?

A

Decreased urine output < 100ml/24hrs

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13
Q

What is the definition of polyuria?

A

Urine output > 3l/24 hrs

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14
Q

What is the definition of nocturia?

A

Wakening up through the nigh > 1 time

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15
Q

What is nocturnal polyuria?

A

Wakening up through the night with urine output > 1/3 total urine output i.e. > 600mls

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16
Q

How would you investigate if someone is presenting with nocturia or nocturnal polyuria?

A

Frequency volume chart (bladder chart)

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17
Q

What staging is used to assess the extent of acute kidney injury?

A 
RIFLE
Risk
Injury
Failure
Loss
End-stage kidney disease
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18
Q

What is defined as end stage kidney disease?

A

Complete loss of kidney function > 3months

19
Q

What si the levels of creatinine, urine output and GFR in the risk, injury and failure stages of acute kidney injury?

A

Risk - increased serum creatinine (1.5x) or decreased GFR by 25% or urine output < 0.5ml/kg/h for 6 hrs
Injury - creatinine (2x) or GFR by 50% or UO < 0.5ml/kg/h for 12 hours
Failure - creatinine (3x) or GFR by 75% or UO < 0.3ml/kg/h for 24 hours

20
Q

What are the functions of the kdiney?

A

Body fluid homeostasis
Electrolyte homeostasis
Endocrine function i.e. erythropoetin, vitamin D synthesis, renin
Extretory function of physiological waste and drugs
Regulation of vascular tone - BP
Acid base homeostasis (excretion of H and generation of HC03)

21
Q

What is the presentation/symptoms of chronic renal failure?

A 
Asymptomatic 
Tiredness
Anaemia
Oedema
High aBP
Bone pain due to renal bone disease
22
Q

What are the presentations/symptoms of advanced chronic renal failure?

A 
Pruritis 
Nausea/vomiting
Dyspnoea
Pericarditis
Neuropathy
Coma
23
Q

What is the presentation of ureteric diseases?

A 
Pain
Pyrexia
Haematuria
Palpable mass
Renal failure
24
Q

What ureteric disease will present with a palpable mass?

A

Hydronephrosis

25
Q

What are the different ureteric diseases?

A

Infection - ureteritis
Iatrogenic - inadvertedly cut or ties duringcolon resection or hysterectomy
Neoplasia - TCC of bladder or ureter, prostate cancer obstructing VUJ, pelvic malignancy, pelvic or para-aortic lymphadenopathy
Hereditary - PUJ obstruction, VUJ reflux
Obstruction - stone, blood clot, scar tissue, TCC, pelvic mass

26
Q

What are the types of obstruction that can lead to ureteric diseases?

A

Intra luminal i.e. blood clot, stone
Extra luminal i.e. pelvic mass, lymphadenopathy
Intra mural i.e. scar tissue, TCC

27
Q

What are the presentations of bladder diseases?

A 
Pain (suprapubic)
Pyrexia
Haematuria
LUT symptoms;
- freuqency, urgency, dribbling, incontinence, urge, poor flow, intermittendency

Recurrent UTI’s
Chronic urinary retention
Urinary leak form vagina (fistula)
Pneumaturia

28
Q

What is the term for gas in the urine and what could it be a sign of?

A

Pneumaturia

Colo-vesico fistula caused by diverticular disease, crohns, colonic or bowel cancer

29
Q

What is the presentation of bladder outflow tract diseases?

A 
Pain
Pyrexia 
Haematuria
LUT symptoms;
- hesistancy, intermittency, poor flow, terminal dribbling, incomplete emptying
- over flow incontinence
- stress urinary incontinence 
Recurrent UTI’s
Acute or chronic urinary retention
30
Q

Why may over flow incontinence occur as a result of a bladder outflow tract disease?

A

High pressure chronic urinary retention

31
Q

Where is the micturition center located?

A

Pons

32
Q

What is responisble for our conscious inhibition of micturition?

A

Cortical center

Sympathetic via hypogastric nerve T10-L2

33
Q

What nerve supply is responsible for voiding phase of micturition?

A

Sacral segments S2-S4

34
Q

what is acute urinary retention?

A

painful inability to void with a palpable and percussible bladder

35
Q

what is chronic urinary retention?

A

painless, palpable and percussible bladder after voiding

high residual volume after voiding

36
Q

what is responsible for the high residual volume after voiding in chronic urinary retention?

A

weakness of the detrusor muscle

37
Q

what is the presentation of chronic urinary retention?

A

presents as lower urinary tract symptoms i.e. frequency, urgency, dribbling, nocturia etc
can present with complications;
- UTI
- bladder stones
- overflow incontinence
- post renal or obstructive renal failure

38
Q

what is the immediate treatment for chronic urinary retention?

A

catheterisation

39
Q

what are the treatments for chronic urinary retention if it is caused by benign prostate enlargement?

A

clean intermittent self catheterisation

transurethral resection of the prostate

40
Q

what is the treatment for chronic urinary retention if it caused by something other than prostate enlargement?

A

urethral or suprapubic catheter

41
Q

what are the complications of chronic urinary retention?

A

UTI
post-decompression haematuria
pathological diuresis
electrolyte abnormalities - hyponatraemia, hyperkalaemia, metabolic acidosis
renal dysfunction due to tubular necrosis

42
Q

what are the causes of acute urinary retention?

A 
benign prostate enlargement
UTI
urethral stricture
alcohol excess
post operative causes
acute surgical or medical problems
43
Q

what is the treatment for acute urinary retention?

A

catheterisation

treat underlying trigger

Urinary clinical conditions (17 decks)

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