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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
Q

What is the presentation of ureteric diseases?

A 
Pain 
Pyrexia 
Haematuria 
Palpable mass (hydronephrosis) 
Renal failure (if there is bilateral obstruction or a single functioning kidney)
26
Q

What are the natures of bladder diseases?

A

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
Q

What is the presentation of bladder diseases?

A 
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
Q

What are the lower urinary tract symptoms?

A

Storage

  • frequency
  • nocturia
  • urgency
  • urge incontinence

Voiding

  • poor flow
  • intermittency
  • terminal dribbling due to underachieve bladder
29
Q

What are the main causes of lower urinary tract symptoms?

A

Bladder pathology e.g. overactive bladder, UTI
Bladder outflow obstruction
Pelvic floor dysfunction
Neurological causes
Systemic disorders e.g. cardiac failure, CRF

30
Q

What are the neurological causes of lower urinary tract symptoms?

A

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
Q

What are the components of micturition control?

A

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
Q

What are the natures of bladder outflow tract diseases?

A

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
Q

What is the presentation of bladder outflow tract diseases?

A 
Pain - suprapubic or perineal 
Pyrexia 
Haematuria 
Lower urinary tract symptoms 
Recurrent UTIs
Acute urinary retention 
Chronic urinary retention
34
Q

What is required to make a diagnosis of urinary tract infection?

A

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
Q

What are the two types of UTI?

A

Complicated and uncomplicated

36
Q

Who typically gets uncomplicated UTIs?

A

Young, sexually active females with a clear relation to sexual activity

37
Q

What factors should be considered when differentiating between complicated and uncomplicated UTI?

A

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
Q

What is the specific name for a urinary tract infection involving the:

  • bladder
  • prostate
  • kidney
  • testis
A

Bladder - cystitis
Prostate - prostatitis
Kidney - pyelonephritis
Testis - orchitis

39
Q

What is a recurrent UTI?

A

Defined as > 3 UTIs per year or > 2 in 6 months

40
Q

What is a relapsing UTI?

A

Defined as UTI caused by the same organism within 2 weeks of the preceding UTI, usually indicative of inadequately treated UTI

41
Q

What are the potential complications of UTI?

A 
Infective - sepsis, perinephric abscess
Renal failure - scarring 
Bladder malignancy 
Acute urinary retention 
Frank haematuria 
Bladder or renal stones
42
Q

What are the investigations that can be done for UTI?

A

MSSU/CSU
Lower tract - flow studies, residual bladder scan, cystoscopy
Upper tract - USS kidneys, IVU/CT KUB, MAG-3 renogram, DMSA scan

43
Q

What is the treatment of UTI?

A

Appropriate antibiotics

Treat any underlying cause and complications

44
Q

What is acute urinary retention?

A

Defined as a painful inability to void with a palpable and permissible bladder

45
Q

What is the variation in residuals in acute urinary retention?

A

From 500ml to > 1L, depending on time taken to seek medical attention

46
Q

What is the main risk factor of acute urinary retention?

A

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
Q

How does acute urinary retention occur with benign prostatic obstruction?

A

Can occur spontaneously i.e. as a natural progression or can be triggered by an unrelated event e.g. constipation, alcohol excess

48
Q

What is the treatment of acute urinary retention?

A

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
Q

What complications might develop if acute urinary retention is left untreated?

A 
UTI 
Post-decompression haematuria 
Pathological diuresis 
Renal failure 
Electrolyte abnormalities
50
Q

What is chronic urinary retention?

A

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
Q

What is the main etiological factor in chronic urinary retention?

A

Detrusor muscle under activity, which can be primary or secondary

52
Q

How does chronic urinary retention present?

A

As lower urinary tract symptoms or as complications

53
Q

What complications occur at the severe end of the spectrum of chronic urinary retention?

A

Overflow incontinence

Renal failure

54
Q

What are the features of the severe end of the spectrum of chronic urinary retention?

A

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
Q

What is the treatment of chronic urinary retention?

A

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
Q

What are the complications of chronic urinary retention?

A

UTI
Post-decompression haematuria
Pathological diuresis
Electrolyte abnormalities e.g. hyponatraemia, hyperkalaemia, metabolic acidosis
Persistent renal function due to acute tubular necrosis

57
Q

What are the features of pathological diuresis?

A

Urine output > 200ml/hour
Postural hypotension
Weight loss
electrolyte abnormalities

58
Q

What is the management of pathological diuresis?

A

Manage with IV fluids and close monitoring

59
Q

What are the common clinical emergencies related to urinary tract diseases?

A

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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