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MBChB - Y2 - Systems - Urinary > Presentation of Diseases of the Kidneys and Urinary Tract > Flashcards

Presentation of Diseases of the Kidneys and Urinary Tract Flashcards

1
Q

Define upper urinary tract

A

Kidneys

Ureters

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2
Q

Define lower urinary tract

A

Bladder

Bladder outflow tract

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3
Q

What are the different nature of renal diseases?

A

Infection

Inflammation

Iatrogenic

Neoplasma

Trauma

Vascular

Hereditary

(I, I, I, Now Try Very Hard)

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4
Q

Give an example for each (IIINTVH)

A
  • Infection - pyelonephritis
  • Inflammation - glomerulonephritis, tubulointerstitial nephritis
  • Iatrogenic - nephrotoxicity, PCNL (percutaneous nephrolithotomy - the removal of kidney stones)
  • Neoplasia - renal tumours, collecting system tumours
  • Trauma - blunt trauma
  • Vascular - atherosclerosis, hypertension, diabetes
  • Hereditary - polycystic kidney disease, nephrotic syndrome
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5
Q

What is the presentation of renal disease?

A
  • Pain
  • Pyrexia
  • Haematuria
  • Proteinuria
  • Pyuria (pus in urine)
  • Mass on palpation
  • Renal failure

(Peter, Piper, Previously, Made, Hillarious, Russian, Patter)

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6
Q

What is the definition of proteinuria?

A

Presence of protein in the urine

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7
Q

What are the types of haematuria?

A

Frank (Gross)

Microscopic

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8
Q

What is the definition of microscopic haematuria?

A

Less than or equal to 3 red blood cells per high power field

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9
Q

What is the definition of oliguria, anuria, polyuria, nocturia, nocturnal polyuria

A
  1. Oliguria: Urine output <0.5ml/kg/hour
  2. Anuria: Absolute anuria - No urine output; Relative anuria - <100ml/24 hours
  3. Polyuria: Urine output >3L/24 hours
  4. Nocturia: Waking up at night ≥1 occasion to micturate
  5. Nocturnal polyuria: Nocturnal urine output >1/3 of total urine output in 24 hours
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10
Q

What are the stages of acute kidney injury?

A
  1. 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%, or serum creatinine level >355μmol/L with acute increase of >44μmol/L; or 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
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11
Q

What are the functions of the kidney?

A

Body fluid homeostasis

Electrolyte homeostasis

Acid-base-homeostasis

Regulation of vascular tone

Excretory function

Endocrine function

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12
Q

What are the endocrine functions of the kidney?

A

Erythropoetin

Vitamin D metabolism

Renin

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13
Q

What are the excretory functions of the kidney?

A

Physiological waste (urea)

Drugs

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14
Q

What is the body fluid homeostasis role of the kidney?

A

Fluid overload (peripheral oedema, congestive heart failure, pulmonary oedema)

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15
Q

What electrolytes are controlled by the kidney?

A

Sodium

Potassium

Chlorine

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16
Q

What are the acid base homeostasis functions of the kidney?

A

Excrete hydrogen

Generate HCO3

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17
Q

What is the presentation of chronic renal failure?

A
  • Asymptomatic (found on blood and urine testing)
  • Tiredness
  • Anaemia
  • Oedema
  • High blood pressure
  • Bone pain due to renal bone disease
  • Pruritus (in advanced renal failure)
  • Nausea/vomiting (in advanced renal failure)
  • Dyspnoea (in advanced renal failure)
  • Pericarditis (in advanced renal failure)
  • Neuropathy (in advanced renal failure)
  • Coma (untreated advanced renal failure)
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18
Q

What are the differing natures of ureteric diseases - give examples

A
  • Infection - ureteritis
  • Iatrogenic/Trauma - inadvertently cut or tied during hysterectomy or colon resection
  • Neoplasia - TCC (transitional cell carcinoma) of ureter, TCC of bladder obstructing VUJ (vesico - ureteric junction), prostate cancer obstructing VUJ, pelvic malignancy, pelvic or para-aortic lymphadenopathy
  • Hereditary - PUJ obstruction, VUJ reflux
  • Obstruction - intra-luminal (stone, blood clot)
  • intra-mural (scar tissue, TCC)
  • extra-luminal (pelvic mass, lymph nodes)
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19
Q

What is the presentation of ureteric diseases?

A
  • Pain (eg. renal colic)
  • Pyrexia
  • Haematuria
  • Palpable mass (ie. hydronephrosis)
  • Renal failure (only if bilateral obstruction or single functioning kidney)
20
Q

What is the nature of bladder disease?

A
  • Infection - cystitis
  • Inflammation - interstitial cystitis, colonic diverticulitis resulting in colo-vesical fistula
  • Iatrogenic/Trauma - bladder rupture, bladder injury from hysterectomy (resulting in vesico-vaginal fistula)
  • Neoplasia - TCC of bladder, squamous cell carcinoma of bladder
  • Idiopathic - overactive bladder syndrome
  • Degenerative - chronic urinary retention
  • Neurological - neurogenic bladder dysfunction
21
Q

What is the presentation of bladder disease?

A
  • Pain (suprapubic)
  • Pyrexia
  • Haematuria
  • Lower urinary tract symptoms (LUTS)
  • storage LUTS (i.e. frequency, nocturia, urgency, urge incontinence)
  • voiding LUTS (i.e. poor flow, intermittency, terminal dribbling) – due to underactive bladder
  • incontinence (stress, urge, mixed, overflow, neurogenic, dribbling, etc.)
  • Recurrent UTIs
  • Chronic urinary retention (due to bladder underactivity)
  • Urinary leak from vagina (i.e. vesico-vaginal fistula)
  • Pneumaturia (i.e. colo-vesical fistula)
22
Q

What are lower urinary tract symptoms?

A

Lower urinary tract symptoms (LUTS)refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra, and, in men, the prostate.

23
Q

What are the storage LUTS?

A

Increased frequency of urination

Increased urgency of urination

Painful urination

Excessive passage of urine at night

24
Q

What are the voiding LUTS?

A

Poor stream (unimproved by straining)

Hesitancy (worsened if bladder is very full)

Terminal dribbling

Incomplete voiding

Urinary retention

Overflow incontinence (occurs in chronic retention)

Episodes of near retention

25
Q

What are the causes of LUTS?

A

Bladder pathology

Bladder outflow obstruction

Pelvic floor dysfunction

Neurological causes - neurogenic bladder dysfunction

Systemic disorders - chronic renal failure, cardiac failure, diabetes mellitus, diabetes insipidus

26
Q

What aspects of micturition is the cortical centre responsible for?

A

Bladder sensation

Inhibition of micturition

27
Q

What part of the brain is described as the micturition centre?

A

The pons

28
Q

What is the nature of bladder outflow tract diseases?

A
  • Infection/Inflammation - prostatitis, balanitis
  • Iatrogenic/Trauma - pelvic floor damage after traumatic vaginal delivery or hysterectomy, urethral injury from catheterisation or pelvic fracture
  • Neoplasia - prostate cancer, penile cancer
  • Idiopathic - chronic pelvic pain syndrome
  • Obstruction - primary bladder neck obstruction
  • benign prostatic enlargement (BPE) causing obstruction
  • urethral stricture
  • meatal stenosis
  • phimosis
29
Q

What is the presentation of bladder outflow tract diseases?

A
  • Pain (suprapubic or perineal)
  • Pyrexia
  • Haematuria
  • Lower urinary tract symptoms (LUTS)
  • voiding LUTS (i.e. hesitancy, intermittency, poor flow, terminal dribbling, incomplete bladder emptying) due to Bladder Outflow Obstruction (BOO)
  • overflow incontinence (high-pressure chronic urinary retention)
  • stress urinary incontinence
  • Recurrent UTIs
  • Acute urinary retention
  • Chronic urinary retention
30
Q

What is acute urinary retention and what is the primary risk factor?

A

Painful inability to void with a palpable and percussible liver

Benign prostatic obstruction is the main risk factor (others include UTI, urethral stricture)

31
Q

What can trigger benign prostatic obstruction?

A

Can happen simultaneously or can be triggered

Triggered by constipation, alcohol excess, post-operative, urological procedure

32
Q

What is the treatment for urinary retention?

A

Catheterisation

33
Q

What are the complications of acute urinary retention?

A

UTI

Post - decompression haematuria

Pathological diuresis

Renal failure

Electrolyte abnormalities

34
Q

What is chronic urinary retention described as?

A
  • Defined as ‘painless, palpable and percussible bladder after voiding’
  • Patients often able to void but with residuals ranging from 400ml to >2 litres depending on stage of condition (i.e. wide spectrum)
35
Q

What causes chronic urinary retention?

A

Either primary bladder failure (failure of contraction of the detrusor muscle)

OR

As a result of bladder outflow obstruction - BPO, urethral stricture

36
Q

What is the presentation of chronic urinary retention?

A
  • Presents as LUTS or complications (e.g. UTI, bladder stones, overflow incontinence, post-renal or obstructive renal failure) or incidental finding
  • Overflow incontinence and renal failure occur at severe end of spectrum, when bladder capacity is reached and bladder pressure is in excess of 25cm water (i.e. chronic high-pressure urinary retention)
37
Q

What is the treatment for chronic urinary retention?

A

Catheterisation (urethral or suprapubic) followed by CISC if appropriate

Clean, intermittant, self cathaterisation

Treatment for chronic urinary retention caused by BPO is TURP - Transurethral resection of the prostate

38
Q

What are the complications of chronic urinary retention?

A

•Complications: UTI, post-decompression haematuria, pathological diuresis, electrolyte abnormalities (hyponatraemia, hyperkalaemia, metabolic acidosis), persistent renal dysfunction due to acute tubular necrosis

39
Q

What is the definition of a UTI?

A

•Defined as infection affecting urinary tract (including kidneys, bladder, prostate, testis and epididymis)

40
Q

How is the diagnosis of a UTI made?

A

Microbiological evidence: Bacterial count of 105 cfu/ml from MSSU specimen with

no more than two species of micro-organisms

ii. Symptoms/signs: At least one of the following: Fever >38ºC; loin/flank pain or

tenderness; suprapubic pain or tenderness; urinary frequency; urinary urgency; dysuria

41
Q

What are the two types of UTI?

A

•Two types:

i. Uncomplicated UTIs (young sexually active females only with clear relation to sexual activity)
ii. Complicated UTIs (everyone else!)

•Complicated UTIs always need to be investigated

42
Q

What are the complications of UTI?

A
  • infective: sepsis (esp. pyelonephritis), perinephric abscess
  • renal failure (scarring)
  • bladder malignancy (squamous cell carcinoma)
  • acute urinary retention
  • frank haematuria
  • bladder or renal stones
43
Q

What are the investigations for UTI?

A

MSSU/CSU (mid stream specimen urine/catheter specimen urine)

  • lower tract: flow studies, residual bladder scan, cystoscopy
  • upper tract: USS kidneys, IVU/CT-KUB, MAG-3 renogram, DMSA scan
44
Q

What is the treatment of UTI?

A

Appropriate antibiotic therapy (type? duration? route?) - usually trimethoprim

  • Treat complications and cause
45
Q

What are 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 disease causing metabolic derangements (eg. hypercalcaemia from bony metastases), spinal cord compression from vertebral metastases, etc.
  • Acute urinary retention
  • Chronic high-pressure urinary retention
  • Iatrogenic injury/Trauma to upper or lower urinary tracts, penis and testis
  • Testicular torsion
  • Paraphimosis - foreskin of the penis, once retracted, cannot return to its original location
  • Priapism - painful and persistent erection of the penis

MBChB - Y2 - Systems - Urinary (28 decks)

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