Presentation of Diseases of the Kidneys and Urinary Tract Flashcards
What does the upper urinary tract consist of?
Kidneys
Ureters
What does the lower urinary tract consist of?
Bladder
Bladder outflow tract (bladder neck to foreskin)
What are the presenting symptoms found in renal disease?
Pain Pyrexia Haematuria Proeteinuria Pyuria Mass on palpation Renal failure
What is the definition of oliguria?
Urine output <0.5ml/kg/hour
What is the definition of anuria?
<100ml/24 hours
What is the definition of polyuria?
Urine output >3L/24 hours
What is the definition of nocturia?
Waking up at night more than once to micturate
What is the definition of nocturnal polyuria?
Nocturnal urine output >1/3 of total urine output in 24 hours
What is the presentation of chronic renal failure?
Tiredness Anaemia Oedema Hypertension Bone pain Pruritus Nausea/vomiting
What is the presentation of ureteric diseases?
Pain Pyrexia Haematuria Palpable mass Renal failure
What is the presentation of bladder diseases?
Pain Pyrexia Haematuria Recurrent UTIs Chronic urinary retention Lower urinary tract symptoms Urinary leak from vagina Pneumaturia
What is the presentation of bladder outflow diseases?
Pain Pyrexia Haematuria Lower urinary tract symptoms Recurrent UTIs Acute and chronic urinary retention
What are the possible causes of renal disease?
Renal tumours Blunt tumours Glomerulonephritis Polycystic kidney disease Nephrotic syndrome Nephrotoxicity Diabetes Hypertension
What are the possible causes of ureteric disease?
Ureteritis PUJ obstruction VUJ reflux Obstruction (stone, clot, scar tissue) TCC of ureter, bladder Pelvic malignancy
What are the possible causes of bladder diseases?
Cystitis TCC of bladder, SCC of bladder Interstitial cystitis Colo-vesical fistula Overactive bladder syndrome Chronic urinary retention
What are the possible causes of bladder outflow diseases?
Prostatitis Balanitis Prostate cancer Penile cancer Chronic pelvic pain syndrome Primary bladder neck obstruction Phimosis Meatal stenosis Urethral stricture Benign prostatic enlargement
What is the definition of acute urinary retention?
Painful inability to void with a palpable and permissible bladder
What is the main risk factor for acute urinary retention?
BPO
What is the treatment for acute urinary retention?
Catheterisation
TURP (if due to BPE)
What are the complications of acute urinary retention?
UTI Post-decompression haematuria Pathological diuresis Renal failure Electrolyte abnormalities
What is the definition of chronic urinary retention?
Painless, palpable and permissible bladder after voiding
What is the aetiological factor of chronic urinary retention?
Detrusor under activity
What is the treatment for chronic urinary retention?
Catheterisation
TURP (if due to BPE)
What are the complications of chronic urinary retention?
UTI Post-decompression haematuria Pathological diuresis Electrolyte abnormalities Persistent renal dysfunction
How is pathological diuresis managed?
IV fluids and monitor closely
What are the symptoms of UTI?
Fever >38C Loin/flank pain or tenderness Suprapubic pain or tenderness Urinary frequency and urgency Dysuria
What are the types of UTIs?
Complicated
Uncomplicated
What is the definition of recurrent UTI?
> 3 UTIs per year
What is the definition of relapsed UTI?
UTI by same organisms within 2 weeks of preceding UTI
What are the complications of UTIs?
Sepsis Renal failure Bladder malignancy Acute urinary retention Frank haematuria
What are the investigations for UTI?
MSSU/CSU Flow studies Cystoscopy Residual bladder scan USS kidneys IVU/CT-KUB
What is the treatment for UTI?
Appropriate antibiotic therapy
Treat complications and cause
What are emergencies related to urinary tract diseases?
Acute renal failure Renal colic Sepsis Severe haematuria causing haemorrhage Testicular torsion Chronic high pressure urinary retention
