Presentation of Diseases of the Kidneys and Urinary Tract

Question 1

What does the upper urinary tract consist of?

Answer 1

Kidneys

Ureters

Question 2

What does the lower urinary tract consist of?

Answer 2

Bladder

Bladder outflow tract (bladder neck to foreskin)

Question 3

What are the presenting symptoms found in renal disease?

Answer 3

Pain 
Pyrexia 
Haematuria 
Proeteinuria 
Pyuria 
Mass on palpation 
Renal failure

Question 4

What is the definition of oliguria?

Answer 4

Urine output <0.5ml/kg/hour

Question 5

What is the definition of anuria?

Answer 5

<100ml/24 hours

Question 6

What is the definition of polyuria?

Answer 6

Urine output >3L/24 hours

Question 7

What is the definition of nocturia?

Answer 7

Waking up at night more than once to micturate

Question 8

What is the definition of nocturnal polyuria?

Answer 8

Nocturnal urine output >1/3 of total urine output in 24 hours

Question 9

What is the presentation of chronic renal failure?

Answer 9

Tiredness 
Anaemia
Oedema 
Hypertension 
Bone pain 
Pruritus 
Nausea/vomiting

Question 10

What is the presentation of ureteric diseases?

Answer 10

Pain 
Pyrexia 
Haematuria 
Palpable mass 
Renal failure

Question 11

What is the presentation of bladder diseases?

Answer 11

Pain 
Pyrexia 
Haematuria 
Recurrent UTIs 
Chronic urinary retention 
Lower urinary tract symptoms 
Urinary leak from vagina 
Pneumaturia

Question 12

What is the presentation of bladder outflow diseases?

Answer 12

Pain 
Pyrexia 
Haematuria 
Lower urinary tract symptoms 
Recurrent UTIs 
Acute and chronic urinary retention

Question 13

What are the possible causes of renal disease?

Answer 13

Renal tumours 
Blunt tumours 
Glomerulonephritis 
Polycystic kidney disease 
Nephrotic syndrome 
Nephrotoxicity 
Diabetes 
Hypertension

Question 14

What are the possible causes of ureteric disease?

Answer 14

Ureteritis 
PUJ obstruction 
VUJ reflux 
Obstruction (stone, clot, scar tissue) 
TCC of ureter, bladder
Pelvic malignancy

Question 15

What are the possible causes of bladder diseases?

Answer 15

Cystitis 
TCC of bladder, SCC of bladder 
Interstitial cystitis 
Colo-vesical fistula 
Overactive bladder syndrome 
Chronic urinary retention

Question 16

What are the possible causes of bladder outflow diseases?

Answer 16

Prostatitis 
Balanitis 
Prostate cancer 
Penile cancer 
Chronic pelvic pain syndrome 
Primary bladder neck obstruction 
Phimosis 
Meatal stenosis 
Urethral stricture 
Benign prostatic enlargement

Question 17

What is the definition of acute urinary retention?

Answer 17

Painful inability to void with a palpable and permissible bladder

Question 18

What is the main risk factor for acute urinary retention?

Answer 18

BPO

Question 19

What is the treatment for acute urinary retention?

Answer 19

Catheterisation

TURP (if due to BPE)

Question 20

What are the complications of acute urinary retention?

Answer 20

UTI 
Post-decompression haematuria 
Pathological diuresis 
Renal failure 
Electrolyte abnormalities

Question 21

What is the definition of chronic urinary retention?

Answer 21

Painless, palpable and permissible bladder after voiding

Question 22

What is the aetiological factor of chronic urinary retention?

Answer 22

Detrusor under activity

Question 23

What is the treatment for chronic urinary retention?

Answer 23

Catheterisation

TURP (if due to BPE)

Question 24

What are the complications of chronic urinary retention?

Answer 24

UTI 
Post-decompression haematuria 
Pathological diuresis 
Electrolyte abnormalities 
Persistent renal dysfunction

Question 25

How is pathological diuresis managed?

Answer 25

IV fluids and monitor closely

Question 26

What are the symptoms of UTI?

Answer 26

``` Fever >38C Loin/flank pain or tenderness Suprapubic pain or tenderness Urinary frequency and urgency Dysuria ```

Question 27

What are the types of UTIs?

Answer 27

Complicated | Uncomplicated

Question 28

What is the definition of recurrent UTI?

Answer 28

>3 UTIs per year

Question 29

What is the definition of relapsed UTI?

Answer 29

UTI by same organisms within 2 weeks of preceding UTI

Question 30

What are the complications of UTIs?

Answer 30

``` Sepsis Renal failure Bladder malignancy Acute urinary retention Frank haematuria ```

Question 31

What are the investigations for UTI?

Answer 31

``` MSSU/CSU Flow studies Cystoscopy Residual bladder scan USS kidneys IVU/CT-KUB ```

Question 32

What is the treatment for UTI?

Answer 32

Appropriate antibiotic therapy | Treat complications and cause

Question 33

What are emergencies related to urinary tract diseases?

Answer 33

``` Acute renal failure Renal colic Sepsis Severe haematuria causing haemorrhage Testicular torsion Chronic high pressure urinary retention ```