Presentation of diseases of the kidneys and urinary tract Flashcards
What makesort up the UUT and LUT
UUT - Kidneys, ureter
LUT - bladder, urethra
Nature of renal diseases and example of each
Infection - Pyelonephritis Inflammation - Glomerulonephritis Iatrogenic - Nephrotoxicity Neoplasia - Renal or collecting system tumours Trauma - Blunt trauma Vascular - Diabetes, hypertention Hereditary - Polycystic Kidney disease
7 presentations of renal disease
Pain Pyrexia Haematuria Proteinuria Pyuria Mass on palpation Renal failure
What is pyuria
The presence of pus in urine, usually from bacterial infection
What is; Oliguria Anuria Polyuria Nocturia Nocturnal Polyuria
Oliguria - Low urine output Anuria - No urine output Polyuria - High Urine output Nocturia - Waking up to micturate Nocturnal Polyuria - High Urine output at night >1/3 of daily output
Five stages of kidney injury
- Risk
- Injury
- Failure
- Loss
- End stage
Presentation of chronic renal failure
Asymptomatic (found on blood and urine testing) Tiredness Anaemia Oedema High blood pressure Bone pain due to renal bone disease
Presentation of ADVANCED chronic renal failure
Pruritus Nausea/Vomiting Dysopnoea Pericarditis Neuropathy Coma
Nature of ureteric diseases
Infection - ureteritis
Iatrogenic/Trauma - inadvertently cut or tied during hysterectomy or colon resection
Neoplasia - TCC of ureteror bladder, prostate cancer obstructing VUJ, gnancy,
Hereditary - PUJ obstruction
Obstruction - intra-luminal (stone, blood clot)
- intra-mural (scar tissue, TCC)
- extra-luminal (pelvic mass, lymph nodes)
Presentation of ureteric diseases
Pain (eg. renal colic)
Pyrexia
Haematuria
Palpable mass (ie. hydronephrosis) Renal failure (only if bilateral obstruction or single functioning kidney)
Nature of bladder diseases
Infection - Cystitis
Inflammation - Colonic diverticulitis 》colo-vesical fistula
Iatrogenic/Trauma - bladder rupture
Neoplasia - TCC or squamous cell carcinoma of bladder
Idiopathic - overactive bladder syndrome
Presentation of bladder diseases
Pain (supra-pubic )
Pyrexia
Haematuria
Lower urinary tract symptoms
- storage
- voiding
- incontinence
Recurrent UTIs
Chronic urinary retention (due to bladder underactivity)
Urinary leak from vagina (i.e. vesico-vaginal fistula)
Examples of storage and voiding symptoms related to bladder diseases
Storage - Frequency
Nocturia
Urgency
Urge/Incontinence
Voiding - Poor flow
Intermittency
Terminal DribblingWhat part of the brain controls Micturition
Pons
What controls the Micturition reflex
S2-4
Nature of bladder OUTFLOW diseases and examples
Infection/Inflammation - prostatitis
Iatrogenic/Trauma - urethral injury from catheterisation or pelvic fracture
Neoplasia - prostate cancer
Idiopathic - chronic pelvic pain syndrome
Obstruction - benign prostatic enlargement
(BPE) causing obstruction
- urethral stricture
- meatal stenosis
- phimosis
Presentation of bladder OUTFLOW diseases
Pain (suprapubic or perineal)
Pyrexia
Haematuria
Lower urinary tract symptoms
- voiding - overflow incontinence (high-pressure chronic urinary retention) - stress urinary incontinence
Recurrent UTIs
Acute/Chronic urinary retention
Examples of voiding symptoms related to bladder outflow diseases
Voiding -Hesitancy
Intermittency
Poor flow
Terminal dribbling,
Incomplete bladder emptyingDefinition ofacute urinary retention
Painful inability to void with a palpable and percussible bladder
Main risk factor for acute urinary retention
BPO
Treatment of acute urinary retention
Catheterisation
Definition of chronic urinary retention
Painless, palpable and percussible bladder after voiding
Main aetiological factor of chronic urinary retention
Underactive detrusor muscle
Treatment for chronic urinary retention
Catheterisation
Clean Intermittent Self-Catheterisation (CISC) when appropriate
Definition of recurrent UTI
> 3 / year
> 2 / 6 months
Definition of relapsed UTI
A UTI by the same organism within 2 weeks of preceding UTI
