Presentation of diseases of the kidneys and ureters Flashcards
What is a surgical sieve?
The surgical sieve is a thought process in medicine. It is a typical example of how to organise a structured examination answer for medical students and physicians when they are challenged with a question. It is also a way of constructing answers to questions from patients and their relatives in a logical manner e.g. mnemonics
How can renal disease present?
- Pain
- Pyrexia (fever)
- Haematuria
- Proteinuria
- Pyuria - pus in urine
- Mass on palpation
- Renal failure
What is the definition of proteinuria?
a. Presence of protein in urine b. Presence of albumin in urine c. Urinary protein excretion >1mg/day d. Urinary protein excretion >150mg/day e. Urinary protein excretion >15g/day
d. Urinary protein excretion >150mg/day
How many types of haematuria are there?
a. One b. Two c. Three d. Four e. Five
b. Two – microscopic and gross
c. Three – microscopic, gross and dipstick
The definition of microscopic haematuria is:
a. ≥1 red blood cells per high power field b. ≥2 red blood cells per high power field c. ≥3 red blood cells per high power field d. ≥4 red blood cells per high power field e. ≥5 red blood cells per high power field
between 3 and 5 is acceptable (this lecture said c)
Define oliguria
• Oliguria: Urine output <0.5ml/kg/hour
Define anuria (absolute and relative)
Anuria:
Absolute anuria - No urine output
Relative anuria - <100ml/24 hours
Describe polyuria
• Polyuria: Urine output >3L/24 hours
Describe nocturia
• Nocturia: Waking up at night ≥1 occasion to micturate
Describe nocturnal polyuria
• Nocturnal polyuria: Nocturnal urine output >1/3 of total urine output in 24 hours
Describe the RIFLE staging of acute kidney injury severity
o Risk - Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours
o Injury - Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours
o 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
o Loss - Persistent ARF or complete loss of kidney function >4 weeks
o End-stage kidney disease - complete loss of kidney function >3 months
How can chronic renal failure present?
- 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)
How does advanced chronic renal failure present?
- 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)
How does ureteric disease present?
- Pain (eg. renal colic from stones)
- Pyrexia
- Haematuria
- Palpable mass (ie. hydronephrosis)
- Renal failure (only if bilateral obstruction or single functioning kidney)
How can bladder diseases present?
• 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) - gas in urine
1What is the risk of bladder cancer in a patient who presents with frank haematuria?
a. 10-15% b. 15-20% c. 20-25% d. 25-30% e. 30-35%
C. 25-30%
What is the risk of renal cancer in a patient who presents with frank haematuria?
a. 0-0.5% b. 0.5-1.0% c. 5-10% d. 10-20% e. 20-25%
b. 0.5-1.0%
Why is the bladder an unreliable witness?
Lower urinary tract symptoms (LUTS) (i.e. voiding LUTS, storage LUTS, incontinence, polyuria, etc.) can have multitude of causes all at different levels and not just the bladder e.g. systemic causes, spinal lesions
What can cause supra-pontine lesions leading to LUTs?
stroke, Alzheimer’s, Parkinson’s
What can cause infra-pontine supra-sacral lesions leading to LUTs?
spinal cord injury, disc prolapse, spina bifida