Presentation of diseases of Kidneys and Urinary Tract & Urinary Retention Flashcards
What structures consist of the upper urinary tract?
Kidneys and ureters
What is responsible for preventing back flow of urine from the bladder into the ureters?
Vesico-ureteric junction
What drugs can cause nephrotoxicity?
NSAIDS
Antibiotics i.e. gentamicin
What are the presentations/symptoms of renal diseases?
Pain Pyrexia Haematuria Proteinuria Pyuria Mass on palpation Renal failure
What cells are present in pyuria?
Leukocytes (pus cells)
Name 2 inflammatory renal diseases.
Glomerulonephritis
Tubulointerstitial nephritis
What is the definition of proteinuria?
Urinary protein excretion > 150mg/day
What are the types of haematuria?
3 types
Macorscopic - visible
Microscopic - only dipstick visible & non-visible
What is the definition of microscopic haematuria?
Greater than or equal to 3 RBC per high power field
What is the definition of oliguria?
Urine output < 0.5ml/kg/hour
What si the name for no urine output?
Absolute anuria
What is relative anuria?
Decreased urine output < 100ml/24hrs
What is the definition of polyuria?
Urine output > 3l/24 hrs
What is the definition of nocturia?
Wakening up through the nigh > 1 time
What is nocturnal polyuria?
Wakening up through the night with urine output > 1/3 total urine output i.e. > 600mls
How would you investigate if someone is presenting with nocturia or nocturnal polyuria?
Frequency volume chart (bladder chart)
What staging is used to assess the extent of acute kidney injury?
RIFLE Risk Injury Failure Loss End-stage kidney disease
What is defined as end stage kidney disease?
Complete loss of kidney function > 3months
What si the levels of creatinine, urine output and GFR in the risk, injury and failure stages of acute kidney injury?
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
What are the functions of the kdiney?
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)
What is the presentation/symptoms of chronic renal failure?
Asymptomatic Tiredness Anaemia Oedema High aBP Bone pain due to renal bone disease
What are the presentations/symptoms of advanced chronic renal failure?
Pruritis Nausea/vomiting Dyspnoea Pericarditis Neuropathy Coma
What is the presentation of ureteric diseases?
Pain Pyrexia Haematuria Palpable mass Renal failure
What ureteric disease will present with a palpable mass?
Hydronephrosis
What are the different ureteric diseases?
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
What are the types of obstruction that can lead to ureteric diseases?
Intra luminal i.e. blood clot, stone
Extra luminal i.e. pelvic mass, lymphadenopathy
Intra mural i.e. scar tissue, TCC
What are the presentations of bladder diseases?
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
What is the term for gas in the urine and what could it be a sign of?
Pneumaturia
Colo-vesico fistula caused by diverticular disease, crohns, colonic or bowel cancer
What is the presentation of bladder outflow tract diseases?
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
Why may over flow incontinence occur as a result of a bladder outflow tract disease?
High pressure chronic urinary retention
Where is the micturition center located?
Pons
What is responisble for our conscious inhibition of micturition?
Cortical center
Sympathetic via hypogastric nerve T10-L2
What nerve supply is responsible for voiding phase of micturition?
Sacral segments S2-S4
what is acute urinary retention?
painful inability to void with a palpable and percussible bladder
what is chronic urinary retention?
painless, palpable and percussible bladder after voiding
high residual volume after voiding
what is responsible for the high residual volume after voiding in chronic urinary retention?
weakness of the detrusor muscle
what is the presentation of chronic urinary retention?
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
what is the immediate treatment for chronic urinary retention?
catheterisation
what are the treatments for chronic urinary retention if it is caused by benign prostate enlargement?
clean intermittent self catheterisation
transurethral resection of the prostate
what is the treatment for chronic urinary retention if it caused by something other than prostate enlargement?
urethral or suprapubic catheter
what are the complications of chronic urinary retention?
UTI
post-decompression haematuria
pathological diuresis
electrolyte abnormalities - hyponatraemia, hyperkalaemia, metabolic acidosis
renal dysfunction due to tubular necrosis
what are the causes of acute urinary retention?
benign prostate enlargement UTI urethral stricture alcohol excess post operative causes acute surgical or medical problems
what is the treatment for acute urinary retention?
catheterisation
treat underlying trigger
