Presentation of Diseases of the Kidney and Urinary Tract Flashcards
What is the most important muscle of the bladder?
Detrusor muscle
What is the innervation of the bladder?
Both sympathetic and parasympathetic
What innervation causes contraction of the bladder?
Parasymp.
Describe the bladder outflow tract
Bladder neck Prostate External urethral sphincter Urethra Urethral meatus Foreskin
What is typical presentation of renal disease?
Pain Pyrexia Haematuria Proteinuria Pyruria Mass on palpation Renal failure
What is defined as oliguria?
Urine output <0.5ml/kg/hour
What is defined as anuria?
No urine output
<100ml in 24 hours
What is defined as polyuria?
Urine output >3L/24 hrs
What is defined as nocturia/
Waking up at night >1 to pee
What is defined as nocturnal polyuria?
Nocturnal urine output is >1/3 of total urine output for 24 hrs
Describe the RIFLE staging criteria for AKI?
.Risk - Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours
- Injury - Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours
- Failure - Increase in serum creatinine level (3.0x), or decrease in GFR by 75%, UO <0.3 mL/kg/h for 24 hours, or anuria for 12 hours
- Loss - Persistent ARF or complete loss of kidney function >4 weeks
- End-stage kidney disease - complete loss of kidney function >3 months
What can chronic renal failure presentation be
Asymptomatic Tiredness Anaemia Oedema Hypertension Bone pain (due to renal bone disease) Pruritis Nausea/vomiting Dysponea Neuropathy
What ureteritis?
Infection of the ureters
When can iatrogenic ureteric disease occur?
Can be inadvertently cut or tie during hysterectomy or colon resection
What can obstruct the ureters intra-luminal?
Stone, blood clot
What can obstruct the ureters intra-mural?
Stricture- (from scar tissue)
What can obstruct the ureters extra-luminal?
Pelvic mass
Pregnancy
What are common presentations of ureteric disease?
Pain Pyrexia Haematuria Palpable mass Renal failure
What is cystitis?
Infection of the bladder
What are examples of inflammatroy bladder disease?
interstitial cystitis,
colonic diverticulitis
What is an example of a cancer of the baladder?
Squamous cell carcinoma
What causes overactive badder syndrome?
Idiopathic
Unknown
Give an example of a degenerative bladder disease?
Chronic urinary retention
Give an example of a neurological bladder disease?
Neurogenic bladder dysfunction
Give an example of neoplastic diseases affecting the ureters?
TCC of ureter
TCC of bladder obstructing VUJ
Prostate cancer
Give example of hereditary diseases that affect the ureters?
PUJ obstruction
VUJ reflux
Give example of inflammatory diseases of the kidneys?
Glomerulonephritis
Tubulointerstitial nephritis
Give an example of an iatrogenic disease of the kidneys?
Nephrotoxicity
Which drugs are known to be nephrotoxic?
ACE inhi
Gentamicin
What type of neoplasia is commonly found in the kidney?
Clear cell carcinoma
Give an example of vascular diseases of the kidneys?
Atherosclerosis
Hypertension
DM
Give an example of a hereditary disease that affects the kidneys?
Polycystic kidney disease
What is the common presentation of bladder diseases/
Pain (suprapubic)
Pyrexia
Haematuria
Storage (frequency, nocturia, urgency, urge incontinence)
Voiding (poor flow, intermittency, terminal dribbling)
Incontinence ( stress, urge, mixed, neurogenic)
Recurrent UTIs
Chronic urinary retention
Vesico-vaginal fistula
What are the 2 stages of the micturition cycle?
Storage or filling phase
Voiding phase
What controls the relaxation of the internal urethral sphincter?
Autonomic - sympathetic supply
What controls the relaxation of the external urethral sphincter?
Somatic
Voluntary
Give an example of infection or inflammatory diseases of the bladder outlfow tract?
Prostatitis
Give an example of a neoplasia of the bladder outflow tract?
Prostate cancer
Penile cancer
Give an example of a obstructive bladder outflow tract?
Primary bladder neck obstruction
Benign prostatic enlargement
Urethral stricture
Phimosis
How do bladder outflow tract disease present?
Pain Pyrexia Haematuria Voiding Stress urinary incontinence Recurrent UTIs Acute urinary retention Chronic urinary retention
What is acute urinary retention?
Painful inability to void with a palpable and percussible bladder
What is the main risk factor of acute urinary retention?
Benign prostatic obstruction
What is the immediate treatment for acute urinary retention?
Catheterisation
What is chronic urinary retention?
Painless, palpable and percussible bladder after voiding
What is the main aetiological factor of chronic urinary retention?
Detrusor underactivity
What are UTIs?
Infections affecting the urinary tract
How do you diagnose UTIs?
Microbiological evidence and symptoms
What microbiological evidence must be present for UTI diagnosis?
bacterial count of 10 to power of 5
for MSSU specimen
with more than 2 species of micr-organisms
What is commonly an uncomplicated UTI presentation?
Young sexually active females only with clear relation to sexual activity
What are investigations for UTI?
MSSU
Lower tract: flow studies, residual bladder scan, cystoscopy
Upper tract: USS kidneys, IVU/CT urogram
What is the treatment for UTIs?
Appropriate AB therapy
Treat complications and cause
What are some complications of UTI?
Infective (sepsis) Renal failure Bladder malignancy Acute urinary retention Frank haematuria Bladder or renal stones
What is the most common cause of chronic urinary retention?
Bladder outlet obstruction
What are potential complications of chronic urinary retention?
UTI
Post-decompression haematuria
Electrolyte abnormalities
What is the common presentation of UTI?
Fever Loin/flank pain Tenderness Urinary frequency Urinary urgency Dysuria
