Presentation of diseases of kidneys + urinary tract

Question 1

Upper urinary tract is everything above the

Answer 1

bladder

Question 2

How does prostate serve as a barrier to UTIs

Answer 2

secretes bacteriostatic substances like zinc, females obviously lack this

Question 3

Nephrotoxic drugs

Answer 3

Antibiotics

NSAIDs

Question 4

Define oliguria

Answer 4

Decreased urine output to <0.5ml/kg/hour

Question 5

Define anuria

Answer 5

No urine output

Question 6

Define polyuria

Answer 6

Increased urine output >3l/24 hrs

Question 7

Define nocturia

Answer 7

Waking up at night once or more to pee

Question 8

Define nocturnal polyuria

Answer 8

Nocturnal urine output >1/3 of total urine output in 24 hours

Question 9

Presentation of renal diseases (6)

Answer 9

Pain
Pyrexia
Haematuria
Proteinuria
Pyuria
Mass on palpation

Question 10

Define proteinuria

Answer 10

urinary protein excretion >150mg/day

Question 11

Functions of the kidney (7)

Answer 11

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

Question 12

Presentation of chronic renal failure/chronic kidney disease

Answer 12

ASYMPTOMATIC (majority) -

Question 13

BIG risk factors of chronic kidney disease/renal failure

Answer 13

DM - biggest

Hypertension

Question 14

Symptoms (3) /signs (2) of chronic kidney disease

Answer 14

Majority asymptomatic - 
Symptoms
-Fatigue
-Nausea +/- vomiting (in advanced renal failure)
-Pruritus (in advanced renal failure)

Signs

• Oedema - periorbital and peripheral
• hypertension

Question 15

Presentation of ureteric diseases

Answer 15

Pain, e.g. renal colic
Pyrexia
Haematuria
Palpable kidney
Renal failure

Question 16

Presentation of bladder diseases (7)

Answer 16

Suprapubic pain
Pyrexia
Haematuria
Lower urinary tract symptoms (see other flashcard)
Recurrent UTIs
Urinary retention
Urinary leak from vagina

Question 17

What are the ‘lower urinary tract symptoms’ (5)

Answer 17

Voiding LUTS - frequency, nocturia, urgency

Storage LUTS - poor flow, dribbling

Incontinence - stress, urge etc

Question 18

Types of urinary incontinence

Answer 18

Stress - weak urethral sphincter
Urge - due to overactive bladder
Overflow - poor bladder contraction

Question 19

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)

Answer 19

bladder

Question 20

Define acute urinary retention

Answer 20

painful inability to void with a palpable and percussible bladder

Question 21

In acute urinary retention, how much residual volume is in bladder

Answer 21

500ml - 1000ml but usually <1000

Question 22

Main risk factor of acute urinary retention

Answer 22

Benign prostatic obstruction - obstructs urethra due to enlargement of prostate

Question 23

Immediate treatment of acute urinary retention

Answer 23

Catheterisation

Question 24

Define chronic urinary retention

Answer 24

painless, palpable and percussible bladder after voiding

Question 25

In chronic urinary retention, what is the residual volume in the bladder

Answer 25

400ml - 2000+ ml

Question 26

Main cause of chronic urinary retention

Answer 26

Detrusor underactivity/weakness primary to bladder failure or secondary to BPO

Question 27

Chronic urinary retention presents with what symptoms

Answer 27

LUTS - frequency, urgency, nocturia, poor flow, dribbling incontinence

Question 28

Chronic urinary retention may present with what complications

Answer 28

UTI Bladder stones Overflow incontinence - if retention severe Renal failure - if retention severe

Question 29

Immediate treatment of symptomatic chronic urinary retention + subsequent treatment

Answer 29

Catheterisation long term catheter or TURP (transurethral resection of prostate)

Question 30

Diagnosis of a UTI requires microbiological evidence AND symptoms/signs - describe the specifics of this

Answer 30

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

Question 31

2 types of UTI

Answer 31

Uncomplicated UTIs (young sexually active females only with clear relation to sexual activity) Complicated UTIs (everyone else)

Question 32

What are the 3 endocrine functions of the kidney

Answer 32

Produce erythropoietin - stimulates RBC production Convert vitamin D into active form Produce renin (JG cells)

Question 33

Acute urinary retention should be treated immediately with catheterisation, what medical treatment should be started immediately if no renal failure

Answer 33

alpha blocker - to relax bladder muscle tone