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Urinary System > Presentation of Diseases of the Kidney and Urinary Tract > Flashcards

Presentation of Diseases of the Kidney and Urinary Tract Flashcards

1
Q

What are urinary tract disease classed as?

A

Upper or lower

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2
Q

Upper urinary tract diseases include diseases of what?

A

Kidneys - parenchyma, pelvic-calyceal system

Ureters - pelvis-ureteric junction, ureter, vesico-ureteric junction

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3
Q

Lower urinary tract diseases include diseases of what?

A

Bladder
Bladder outflow tract - bladder neck, prostate, external urethral sphincter/pelvic floor, urethra, urethral meatus, foreskin

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4
Q

What are the dividing causes listed in the surgical sieve?

A 
Infection 
Inflammation 
Iatrogenic 
Neoplasia 
Trauma 
Degenerative 
Congenital 
Genetic/hereditary 
Vascular 
Endocrine 
Failure 
Idiopathic
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5
Q

What is oliguria?

A

Urine output < 0.5ml/kg/hour, usually indicative of renal dysfunction/failure

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6
Q

What is anuria?

A

Absolute anuria - no urine output

Relative anuria - < 100ml/24 hours

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7
Q

What is polyuria?

A

Urine output > 3l/24 hours

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8
Q

What is nocturne?

A

Waking up at night on one or more occasion to micturate

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9
Q

What is nocturnal polyuria?

A

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

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10
Q

What are the different natures of renal diseases?

A

Infection e.g. pyelonephritis
Inflammation e.g. glomerulonephritis, tubulointerstitial nephritis
Iatrogenic e.g. nephrotoxicity
Neoplasia e.g. renal tumours, collecting system tumours
Trauma
Vascular e.g. atherosclerosis, hypertension
Hereditary e.g. polycystic kidney disease, nephrotic syndrome

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11
Q

What are the main presentations of renal diseases?

A 
Pain 
Pyrexia 
Haematuria 
Proteinuria 
Pyuria 
Mass on palpation 
Renal failure
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12
Q

What are the components of the RIFLE staging criteria?

A 
Risk 
Injury 
Failure 
Loss 
End-stage kidney disease
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13
Q

According to the RIFLE staging criteria, what indicates risk of acute renal failure?

A

Increase in serum creatinine level (1.5x)
Decrease in GFR by 25%
UO < 0.5 ml/kg/hour for 6 hours

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14
Q

According to the RIFLE staging criteria, what indicates acute renal injury?

A

Increase in serum creatinine level (2.0x)
Decrease in GFR by 50%
UO < 0.5 ml/kg/hour for 12 hours

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15
Q

According to the RIFLE staging criteria, what indicates acute renal failure?

A

Increase in serum creatinine level (3.0x)
Decrease in GFR by 75%
UO < 0.3 ml/kg/hour for 24 hours, or anuria for 12 hours
Serum creatinine level > 355 umol/l with acute increase of > 44 umol/l

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16
Q

According to the RIFLE staging criteria, what indicates acute renal failure?

A

Persistent acute renal failure or complete loss of kidney function > 4 weeks

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17
Q

According to the RIFLE staging criteria, what indicates end-stage kidney disease?

A

Complete loss of kidney function > 3 months

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18
Q

What is the presentation of chronic renal failure in terms of body fluid homeostasis?

A

Fluid overload
Peripheral oedema
Congestive cardiac failure
Pulmonary oedema

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19
Q

What is the function of the kidneys in relation to regulation of vascular tone?

A

Regulation of blood pressure

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20
Q

What is the excretory function of the kidneys?

A

Physiological waste excretion, especially urea

Excretion of drugs

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21
Q

What are the endocrine functions of the kidneys?

A

Erythropoietin
Vitamin D metabolism
Renin

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22
Q

What is the presentation of chronic renal failure?

A 
Asymptomatic - may be found coincidentally 
Fatigue 
Anaemia 
Oedema 
Hypertension 
Bone pain due to renal bone disease
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23
Q

What is the presentation of advanced renal failure?

A 
Pruritis
Nausea/vomiting 
Dyspnoea 
Pericarditis 
Neuropathy 
Coma in untreated advanced renal failure
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24
Q

What are the natures of ureteric diseases?

A

Infection e.g. ureteritis
Iatrogenic/trauma e.g. accidental damage in hysterectomy
Neoplasia e.g. urothelial carcinoma
Hereditary e.g. PUJ obstruction
Obstruction - intra-luminal (stone, clot), intra-mural (scar tissue), extra-luminal (pelvic mass)

25
What is the presentation of ureteric diseases?
``` Pain Pyrexia Haematuria Palpable mass (hydronephrosis) Renal failure (if there is bilateral obstruction or a single functioning kidney) ```
26
What are the natures of bladder diseases?
Infection e.g. cystitis Inflammation e.g. interstitial cystitis Iatrogenic/trauma e.g. bladder rupture, bladder injury from hysterectomy Neoplasia e.g. transitional cell carcinoma Idiopathic e.g. overactive bladder syndrome Degenerative e.g. chronic urinary retention Neurological e.g. neurogenic bladder dysfunction
27
What is the presentation of bladder diseases?
``` Pain (suprapubic) Pyrexia Haematuria Lower urinary tract symptoms - storage LUTS e.g. frequency, or voiding LUTS e.g. poor flow Incontinence Recurrent UTIs Chronic urinary retention Urinary leak from vagina i.e. vesico-vaginal fistula Pneumaturia i.e. coli-vesical fistula ```
28
What are the lower urinary tract symptoms?
Storage - frequency - nocturia - urgency - urge incontinence Voiding - poor flow - intermittency - terminal dribbling due to underachieve bladder
29
What are the main causes of lower urinary tract symptoms?
Bladder pathology e.g. overactive bladder, UTI Bladder outflow obstruction Pelvic floor dysfunction Neurological causes Systemic disorders e.g. cardiac failure, CRF
30
What are the neurological causes of lower urinary tract symptoms?
Supra-pontine lesions e.g. stroke, Alzheimer's disease, Parkinson's disease Infra-pontine supra-sacral lesions e.g. spinal cord injury, disc prolapse Intra-sacral e.g. MS, diabetes, cauda equina compression
31
What are the components of micturition control?
Cortical centre - bladder sensation and conscious inhibition of micturition Pons - micturition centre Sacral segments S2-S4 - micturition reflex, relaxation of internal urethral sphincter Micturition cycle - storage phase, voiding phase
32
What are the natures of bladder outflow tract diseases?
Infection/inflammation e.g. prostatitis, balanitis Iatrogenic/trauma e.g. pelvic floor damage after vaginal delivery, urethral injury from catheterisation Neoplasia e.g. prostate/penile cancer Idiopathic e.g. chronic pelvic pain syndrome Obstruction e.g. benign prostatic enlargement, urethral stricture
33
What is the presentation of bladder outflow tract diseases?
``` Pain - suprapubic or perineal Pyrexia Haematuria Lower urinary tract symptoms Recurrent UTIs Acute urinary retention Chronic urinary retention ```
34
What is required to make a diagnosis of urinary tract infection?
Microbiological evidence and symptoms/signs Microbiological evidence - bacterial count of 10^4 cfu/ml from MSSU specimen with no more than two species of micro-organism Symptoms/signs - at least one of: - fever > 38 degrees celsius - loin/flank pain or tenderness - suprapubic pain or tenderness - urinary frequency - urinary urgency - dysuria
35
What are the two types of UTI?
Complicated and uncomplicated
36
Who typically gets uncomplicated UTIs?
Young, sexually active females with a clear relation to sexual activity
37
What factors should be considered when differentiating between complicated and uncomplicated UTI?
Age Sexual activity in females Gender Co-morbidities e.g. immunosuppression, renal failure Abnormal renal tract e.g. stones, renal outflow obstruction Foreign body e.g. catheter, ureteric stent Type of organisms e.g. common vs uncommon
38
What is the specific name for a urinary tract infection involving the: - bladder - prostate - kidney - testis
Bladder - cystitis Prostate - prostatitis Kidney - pyelonephritis Testis - orchitis
39
What is a recurrent UTI?
Defined as > 3 UTIs per year or > 2 in 6 months
40
What is a relapsing UTI?
Defined as UTI caused by the same organism within 2 weeks of the preceding UTI, usually indicative of inadequately treated UTI
41
What are the potential complications of UTI?
``` Infective - sepsis, perinephric abscess Renal failure - scarring Bladder malignancy Acute urinary retention Frank haematuria Bladder or renal stones ```
42
What are the investigations that can be done for UTI?
MSSU/CSU Lower tract - flow studies, residual bladder scan, cystoscopy Upper tract - USS kidneys, IVU/CT KUB, MAG-3 renogram, DMSA scan
43
What is the treatment of UTI?
Appropriate antibiotics | Treat any underlying cause and complications
44
What is acute urinary retention?
Defined as a painful inability to void with a palpable and permissible bladder
45
What is the variation in residuals in acute urinary retention?
From 500ml to > 1L, depending on time taken to seek medical attention
46
What is the main risk factor of acute urinary retention?
Benign prostatic obstruction It can also occur independently of this e.g. in UTIs, urethral stricture, alcohol excess, post-operatively, acute surgical/medical problems etc.
47
How does acute urinary retention occur with benign prostatic obstruction?
Can occur spontaneously i.e. as a natural progression or can be triggered by an unrelated event e.g. constipation, alcohol excess
48
What is the treatment of acute urinary retention?
Immediate treatment is catheterisation If a trigger is present this should be treated If due to BPE and no renal failure is present then alpha-blocker should be started immediately and catheter removed in 2 days (60% will void successfully at this point), if there is still a failure to void then re-catheterisation should be done and TURP organised
49
What complications might develop if acute urinary retention is left untreated?
``` UTI Post-decompression haematuria Pathological diuresis Renal failure Electrolyte abnormalities ```
50
What is chronic urinary retention?
Defined as painless, palpable and permissible bladder after voiding Patients are often able to void but have residuals ranging from 400ml to > 2 litres, depending on the stage of their condition
51
What is the main etiological factor in chronic urinary retention?
Detrusor muscle under activity, which can be primary or secondary
52
How does chronic urinary retention present?
As lower urinary tract symptoms or as complications
53
What complications occur at the severe end of the spectrum of chronic urinary retention?
Overflow incontinence | Renal failure
54
What are the features of the severe end of the spectrum of chronic urinary retention?
Bladder capacity is reached and bladder pressure is in excess of 25cm water i.e. decompensated chronic urinary retention or acute-on-chronic urinary retention or chronic high-pressure urinary retention
55
What is the treatment of chronic urinary retention?
Immediate treatment is catheterisation, either urethral or suprapubic initially, followed by CISC Subsequent treatment is with either long-term urethral or suprapubic catheter, CISC or TURP if due to BPE
56
What are the complications of chronic urinary retention?
UTI Post-decompression haematuria Pathological diuresis Electrolyte abnormalities e.g. hyponatraemia, hyperkalaemia, metabolic acidosis Persistent renal function due to acute tubular necrosis
57
What are the features of pathological diuresis?
Urine output > 200ml/hour Postural hypotension Weight loss electrolyte abnormalities
58
What is the management of pathological diuresis?
Manage with IV fluids and close monitoring
59
What are the common clinical emergencies related to urinary tract diseases?
Acute renal failure Sepsis due to UTI +/- upper or lower urinary tract obstruction Renal colic Severe haematuria causing haemorrhagic shock Metastatic diseases causing metabolic derangements Acute urinary retention Chronic high-pressure urinary retention Iatrogenic injury/trauma to upper or lower urinary tracts, penis and testes Testicular torsion Paraphimosis Priapism

Urinary System (22 decks)

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