Presentation of diseases of kidneys + urinary tract Flashcards
Upper urinary tract is everything above the
bladder
How does prostate serve as a barrier to UTIs
secretes bacteriostatic substances like zinc, females obviously lack this
Nephrotoxic drugs
Antibiotics
NSAIDs
Define oliguria
Decreased urine output to <0.5ml/kg/hour
Define anuria
No urine output
Define polyuria
Increased urine output >3l/24 hrs
Define nocturia
Waking up at night once or more to pee
Define nocturnal polyuria
Nocturnal urine output >1/3 of total urine output in 24 hours
Presentation of renal diseases (6)
Pain Pyrexia Haematuria Proteinuria Pyuria Mass on palpation
Define proteinuria
urinary protein excretion >150mg/day
Functions of the kidney (7)
Filtration + excretion Acid base balance Electrolyte balance Blood pressure regulation Body fluid balance Produce erythropoietin (hormone that stimulates RBC production) Convert vitamin D into active form
Presentation of chronic renal failure/chronic kidney disease
ASYMPTOMATIC (majority) -
BIG risk factors of chronic kidney disease/renal failure
DM - biggest
Hypertension
Symptoms (3) /signs (2) of chronic kidney disease
Majority asymptomatic - Symptoms -Fatigue -Nausea +/- vomiting (in advanced renal failure) -Pruritus (in advanced renal failure)
Signs
- Oedema - periorbital and peripheral
- hypertension
Presentation of ureteric diseases
Pain, e.g. renal colic Pyrexia Haematuria Palpable kidney Renal failure
Presentation of bladder diseases (7)
Suprapubic pain Pyrexia Haematuria Lower urinary tract symptoms (see other flashcard) Recurrent UTIs Urinary retention Urinary leak from vagina
What are the ‘lower urinary tract symptoms’ (5)
Voiding LUTS - frequency, nocturia, urgency
Storage LUTS - poor flow, dribbling
Incontinence - stress, urge etc
Types of urinary incontinence
Stress - weak urethral sphincter
Urge - due to overactive bladder
Overflow - poor bladder contraction
Someone presenting with frank haematuria is more likely to be presenting with bladder or renal cancer (could be neither but just for comparison between these 2 cancers)
bladder
Define acute urinary retention
painful inability to void with a palpable and percussible bladder
In acute urinary retention, how much residual volume is in bladder
500ml - 1000ml but usually <1000
Main risk factor of acute urinary retention
Benign prostatic obstruction - obstructs urethra due to enlargement of prostate
Immediate treatment of acute urinary retention
Catheterisation
Define chronic urinary retention
painless, palpable and percussible bladder after voiding
In chronic urinary retention, what is the residual volume in the bladder
400ml - 2000+ ml
Main cause of chronic urinary retention
Detrusor underactivity/weakness primary to bladder failure or secondary to BPO
Chronic urinary retention presents with what symptoms
LUTS - frequency, urgency, nocturia, poor flow, dribbling incontinence
Chronic urinary retention may present with what complications
UTI
Bladder stones
Overflow incontinence - if retention severe
Renal failure - if retention severe
Immediate treatment of symptomatic chronic urinary retention
+ subsequent treatment
Catheterisation
long term catheter or TURP (transurethral resection of prostate)
Diagnosis of a UTI requires microbiological evidence AND symptoms/signs - describe the specifics of this
Microbiological evidence - bacterial count of 10^4/ml from MSSU with no more than 2 species
Symptoms/signs - at least one of fever, flank pain, suprapubic pain, frequency, urgency, dysuria
2 types of UTI
Uncomplicated UTIs (young sexually active females only with clear relation to sexual activity)
Complicated UTIs (everyone else)
What are the 3 endocrine functions of the kidney
Produce erythropoietin - stimulates RBC production
Convert vitamin D into active form
Produce renin (JG cells)
Acute urinary retention should be treated immediately with catheterisation, what medical treatment should be started immediately if no renal failure
alpha blocker - to relax bladder muscle tone
