Presentation of Diseases of the Kidney and Urinary Tract

Question 1

What is the most important muscle of the bladder?

Answer 1

Detrusor muscle

Question 2

What is the innervation of the bladder?

Answer 2

Both sympathetic and parasympathetic

Question 3

What innervation causes contraction of the bladder?

Answer 3

Parasymp.

Question 4

Describe the bladder outflow tract

Answer 4

Bladder neck 
Prostate 
External urethral sphincter 
Urethra
Urethral meatus 
Foreskin

Question 5

What is typical presentation of renal disease?

Answer 5

Pain 
Pyrexia 
Haematuria 
Proteinuria 
Pyruria  
Mass on palpation 
Renal failure

Question 6

What is defined as oliguria?

Answer 6

Urine output <0.5ml/kg/hour

Question 7

What is defined as anuria?

Answer 7

No urine output

<100ml in 24 hours

Question 8

What is defined as polyuria?

Answer 8

Urine output >3L/24 hrs

Question 9

What is defined as nocturia/

Answer 9

Waking up at night >1 to pee

Question 10

What is defined as nocturnal polyuria?

Answer 10

Nocturnal urine output is >1/3 of total urine output for 24 hrs

Question 11

Describe the RIFLE staging criteria for AKI?

Answer 11

.Risk - Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours

2. Injury - Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours
3. 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
4. Loss - Persistent ARF or complete loss of kidney function >4 weeks
5. End-stage kidney disease - complete loss of kidney function >3 months

Question 12

What can chronic renal failure presentation be

Answer 12

Asymptomatic 
Tiredness
Anaemia 
Oedema 
Hypertension 
Bone pain (due to renal bone disease)
Pruritis 
Nausea/vomiting 
Dysponea 
Neuropathy

Question 13

What ureteritis?

Answer 13

Infection of the ureters

Question 14

When can iatrogenic ureteric disease occur?

Answer 14

Can be inadvertently cut or tie during hysterectomy or colon resection

Question 15

What can obstruct the ureters intra-luminal?

Answer 15

Stone, blood clot

Question 16

What can obstruct the ureters intra-mural?

Answer 16

Stricture- (from scar tissue)

Question 17

What can obstruct the ureters extra-luminal?

Answer 17

Pelvic mass

Pregnancy

Question 18

What are common presentations of ureteric disease?

Answer 18

Pain 
Pyrexia 
Haematuria 
Palpable mass
Renal failure

Question 19

What is cystitis?

Answer 19

Infection of the bladder

Question 20

What are examples of inflammatroy bladder disease?

Answer 20

interstitial cystitis,

colonic diverticulitis

Question 21

What is an example of a cancer of the baladder?

Answer 21

Squamous cell carcinoma

Question 22

What causes overactive badder syndrome?

Answer 22

Idiopathic

Unknown

Question 23

Give an example of a degenerative bladder disease?

Answer 23

Chronic urinary retention

Question 24

Give an example of a neurological bladder disease?

Answer 24

Neurogenic bladder dysfunction

Question 25

Give an example of neoplastic diseases affecting the ureters?

Answer 25

TCC of ureter TCC of bladder obstructing VUJ Prostate cancer

Question 26

Give example of hereditary diseases that affect the ureters?

Answer 26

PUJ obstruction | VUJ reflux

Question 27

Give example of inflammatory diseases of the kidneys?

Answer 27

Glomerulonephritis | Tubulointerstitial nephritis

Question 28

Give an example of an iatrogenic disease of the kidneys?

Answer 28

Nephrotoxicity

Question 29

Which drugs are known to be nephrotoxic?

Answer 29

ACE inhi | Gentamicin

Question 30

What type of neoplasia is commonly found in the kidney?

Answer 30

Clear cell carcinoma

Question 31

Give an example of vascular diseases of the kidneys?

Answer 31

Atherosclerosis Hypertension DM

Question 32

Give an example of a hereditary disease that affects the kidneys?

Answer 32

Polycystic kidney disease

Question 33

What is the common presentation of bladder diseases/

Answer 33

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

Question 34

What are the 2 stages of the micturition cycle?

Answer 34

Storage or filling phase | Voiding phase

Question 35

What controls the relaxation of the internal urethral sphincter?

Answer 35

Autonomic - sympathetic supply

Question 36

What controls the relaxation of the external urethral sphincter?

Answer 36

Somatic | Voluntary

Question 37

Give an example of infection or inflammatory diseases of the bladder outlfow tract?

Answer 37

Prostatitis

Question 38

Give an example of a neoplasia of the bladder outflow tract?

Answer 38

Prostate cancer | Penile cancer

Question 39

Give an example of a obstructive bladder outflow tract?

Answer 39

Primary bladder neck obstruction Benign prostatic enlargement Urethral stricture Phimosis

Question 40

How do bladder outflow tract disease present?

Answer 40

``` Pain Pyrexia Haematuria Voiding Stress urinary incontinence Recurrent UTIs Acute urinary retention Chronic urinary retention ```

Question 41

What is acute urinary retention?

Answer 41

Painful inability to void with a palpable and percussible bladder

Question 42

What is the main risk factor of acute urinary retention?

Answer 42

Benign prostatic obstruction

Question 43

What is the immediate treatment for acute urinary retention?

Answer 43

Catheterisation

Question 44

What is chronic urinary retention?

Answer 44

Painless, palpable and percussible bladder after voiding

Question 45

What is the main aetiological factor of chronic urinary retention?

Answer 45

Detrusor underactivity

Question 46

What are UTIs?

Answer 46

Infections affecting the urinary tract

Question 47

How do you diagnose UTIs?

Answer 47

Microbiological evidence and symptoms

Question 48

What microbiological evidence must be present for UTI diagnosis?

Answer 48

bacterial count of 10 to power of 5 for MSSU specimen with more than 2 species of micr-organisms

Question 49

What is commonly an uncomplicated UTI presentation?

Answer 49

Young sexually active females only with clear relation to sexual activity

Question 50

What are investigations for UTI?

Answer 50

MSSU Lower tract: flow studies, residual bladder scan, cystoscopy Upper tract: USS kidneys, IVU/CT urogram

Question 51

What is the treatment for UTIs?

Answer 51

Appropriate AB therapy | Treat complications and cause

Question 52

What are some complications of UTI?

Answer 52

``` Infective (sepsis) Renal failure Bladder malignancy Acute urinary retention Frank haematuria Bladder or renal stones ```

Question 53

What is the most common cause of chronic urinary retention?

Answer 53

Bladder outlet obstruction

Question 54

What are potential complications of chronic urinary retention?

Answer 54

UTI Post-decompression haematuria Electrolyte abnormalities

Question 55

What is the common presentation of UTI?

Answer 55

``` Fever Loin/flank pain Tenderness Urinary frequency Urinary urgency Dysuria ```