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urinary > presentation of diseases of the kidney and urinary tract > Flashcards

presentation of diseases of the kidney and urinary tract Flashcards

1
Q

What are the parts of the upper urinary tract

A

Kidneys and ureters

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2
Q

What is part of the lower urinary tract

A

Below the ureters e.g bladder and urethra

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3
Q

How do renal diseases present

A

Pain
Pyrexia
Haematuria
Proteinuria
Pyuria - sign of inflammation which is caused by infection
Mass on palpation
Renal failure

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4
Q

what is the definition of proteinuria

A

Excreting more than 150mg of protein in urine per day

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5
Q

How many types of haematuria are there and what are they

A

3:
Microscopic
Macroscopic
Dipstick haematuria

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6
Q

What is the definition of microscopic haematuria

A

More than 3 blood cells per high power field

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7
Q

What is oliguria

A

low urine output - <0.5mg/kg/hour

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8
Q

What is relative anuria

A

Urine output less than 100ml per day

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9
Q

What is absolute anuria

A

No urine output per day

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10
Q

What is polyuria

A

Excess urine output - >3L per day

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11
Q

What is nocturia

A

Waking up more than once in the night to micturate

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12
Q

What is nocturnal polyuria

A

The urine output in the night is greater than 1/3 of the total daily urine output

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13
Q

Why is micturition less common in the night

A

Because ADH production is increased which causes more reabsorption of water so less volume of urine to be excreted

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14
Q

What do we use to define acute kidney disease in terms of staging

A

R - risk
I - injury
F - failure
L - loss
E - end-stage kidney disease

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15
Q

Describe R in ‘RIFLE’ for AKI

A

R- risk - increase in serum creatinine x1.5 or decrease in GFR by 25%. or urine output less than 0.5ml/kg/hour for 6 hours (oliguria)

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16
Q

Describe I in ‘RIFLE’ for AKI

A

Injury - increase in serum creatinine x2 or decrease in GFR by 50% or oliguria 12 hours

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17
Q

Describe F in ‘RIFLE’ for AKI

A

Failure - increase in serum creatinine x3 - decrease in GFR by 75& or urine output less than 0.3mg/kg/hour or anuria for 12 hours

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18
Q

Describe L in ‘RIFLE’ for AKI

A

Loss - persistent acute renal failure or complete loss of kidney function for more than 4 weeks

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19
Q

Describe E in ‘RIFLE’ for AKI

A

End-stage kidney disease - complete loss of kidney function for more than 3 months

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20
Q

Presentation of chronic renal failure

A

Asymptomatic
Tired
anaemic
oedema
High Bp
Bone pain due to renal bone disease
Pruritus - unpleasant feeling making you want to scratch
Nausea/vomiting
Dyspnoea
Neuropathy
Coma

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21
Q

What do infections cause at the ureters

A

Ureteritis

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22
Q

What are Iatrogenic causes of ureteric diseases

A

Ureters are close to the GI so can be cut during surgery

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23
Q

What kind of cancers are in the urinary system

A

Transitional cell carcinoma (carcinoma of the uroepithelium)

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24
Q

What are hereditary issues associated with the ureters

A

PUJ obstruction - pelvic ureteric junction obstruction

VUJ - vesiculo-ureteric junction

25
What are the presentations of ureteric diseases
Pain Pyrexia Haematuria Palpable mass Renal failure - only if bilateral obstruction or one kidney is functioning
26
What do infections of the bladder cause
Cystitis
27
28
What are the common types of neoplasia for cancer
Transitional cell cancer of the bladder or squamous cell carcinoma
29
How do bladder diseases present
Pain (suprapubic) Pyrexia Haematuria Lower urinary tract symptoms Recurrent UTI Chronic urinary retention Pneumaturia - air bubbles - connection to the bowel
30
What are storage LUTS
Frequency, nocturia, urgency and can cause urge incontinence Related to bladder function
31
What are voiding LUTS
Poor flow, intermittency, terminal dribbling Related to obstruction
32
What is the risk of bladder cancer in a patient with macroscopic (visible) haematuria
25-30%
33
What is the risk of renal cancer in a patient who presents with macroscopic (visible) haematuria
0.5-1%
34
What are symptoms of the bladder
Lower urinary tract symptoms (LUTS) - voiding LUTS, storage LUTS, incontinence, polyuria...
35
What are the 3 levels of neurological causes of bladder issues
Supra-pontine lesions (above the pons) - caused by stroke, alzheimers... Infra-pontine supra-sacral lesion - e.g spinal cord injury Infra-sacral - e.g MS, cauda equina
36
What part of the brain is known as the micturition centre
The pons
37
How is micturition controlled
Cortical centre - bladder sensation and conscious inhibition of micturition Then the Pons (micturition centre) Then the sacral segments (S2-4) - micturition reflex Micturition cycle: storage (filling) phase and voiding phase
38
describe the micturition reflex
Sympathetic nerves cause relaxation of the internal urethral sphincter Relaxation of the external urethral sphincter is voluntary Contraction of the detrusor muscle is controlled by sympathetic nerves
39
What is balantis
Inflammation of the glans (head of the penis)
40
What are presentations of the bladder outflow tract diseases
Pain (suprapubic or perineal) Pyrexia haematuria LUTS Recurrent UTI Acute or chronic urinary retention
41
What usually causes voiding LUTS (hesitancy, intermittency, poor flow, terminal dribbling, incomplete emptying of the bladder)
BOO - Bladder outflow obstruction
42
Define acute urinary retention
Painful inability to void with a palpable and percussible bladder
43
What is the main risk factor for acute urinary retention
BPO - benign prostate obstruction
44
What is the immediate treatment of acute urinary retention
Catheterisation
45
Define chronic urinary retention
Painless, palpable and percussible bladder after voiding
46
What is the main factor which can cause chronic urinary retention
Detrusor underactivity
47
how does chronic urinary retention present
LUTS or complications like UTI, bladder stones or renal failure
48
How does obstruction cause chronic urinary retention
Obstruction means the bladder has to pump harder to push urine out through the urethra past the obstruction and overtime this weakens the bladder
49
When do you give treatments to patients with chronic urinary retention
If they have symptoms or complications
50
What is the immediate treatment of chronic urinary retention and then subsequent treatment
immediate treatment is catheterisation - but can put at risk of UTI Subsequent treatment is long term urethral or suprapubic catheter but CISC or TURP if due to BPO
51
What is TURP
Trans-urethral resection of prostate
52
How is the prostate meant to look on a cystoscope
The prostate should look like an open tunnel
53
What is the difference between complicated and uncomplicated UTI'S
Uncomplicated UTI - young sexually active female with clear relation to sexual activity Complicated UTI - everything else
54
What is required to diagnose a UTI
Microbiological evidence and symptoms/signs
55
What symptoms do you need at least one of to diagnose UTI with microbiology
Fever>38 , flank pain, suprapubic pain, urinary frequency, urgency and dysuria
56
What are complications of UTI
Sepisis Renal failure Bladder malignancy Acute urinary retention Frank (visible) haematuria calculi
57
What investigations are done for patients with UTI
MSSU Flow studies, cystoscopy USS - ultrasound scan , IVU/CT-KUB - kidneys, ureters and bladder
58
What is the treatment for UTI
Appropriate antibiotic therapy
59

urinary (24 decks)

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