Presentation of Diseases of the Kidneys and Urinary Tract Flashcards
What is in the upper UT?
Kidneys - parenchyma to the pelvi-calcyceal system
Ureters - Pelvi-ureteric junction to the vesico-ureteric junction
What is in the lower UT?
Bladder to the bladder outflow tract all the way to foreskin in males
What is the surgical sieve for renal diseases?
Infection Inflammation Iatrogenic Neoplasia Trauma Vascular Hereditary
Define proteinuria.
> 150mg/day of protein in urine
What is pyuria?
Pus in the urine
Any infection or inflammatory disorder could cause it
What is oliguira?
Urine output less than 0.5 ml/kg/hr
What is absolute anuria?
No urine output
What is relative anuria?
<100mls urine in 24 hours
What is polyuria?
Urine output of >3L in 24 hours
What is nocturia?
Waking up more than once in a night to pee
Nocturnal polyuria?
Peeing a third of total urine output in 24 hours at night time
What is AKI?
Acute Kidney Injury
An abrupt loss of kidney function that develops within 7 days
Staging for AKI?
RIFLE which is a progressive criteria which stages the severity of the AKI
Describe RIFLE
R - risk = 1.5x baseline creatinine or loss of 25% of GRF or UO is less than 0.5 mL/kg/hr for 6 hours
I - injury = Serum creatinine increase by 2x or GFR decrease by 50% or UO is less than 0.5 mL/kg/hr for 12 hours
F - failure = Serum creatinine 3x baseline or GFR loss of 75% or anuria for 12 hours
L - loss = persistent AKI or complete loss of kidney function
E - End stage renal disese
What is infection of ureters called?
Ureteritis
What types of neoplasia can you get of ureters?
Transitional cell carcinoma of ureter or bladder
Prostate cancer
Pelvic malignancy
Name some hereditary urertic diseases.
PUJ obstruction
VUJ reflux
Name the types of ureteric obstruction.
Intra-luminal - Stones or blood clots
Intra-mural - Scar tissue or TCC (Transitional Cell Carcinoma)
Extra-luminal - Pelvic mass or lymph nodes
Types of pain in urinary disease?
Renal colic - in obstructions
Suprapubic pain - bladder or urethral disorders
Perineal pain - Bladder outflow tract disorders
What is pneumaturia?
Gas or air in the urine
Most often due to a colo-vesical fistula from colonic diverticulosis
Acute vs Chronic urinary retention?
Acute is a painful inability to void with palpable/percussible bladder
Chronic is painless inability to void - and the bladder is still palpable/percussible after voiding
C5ause of acute UR?
Benign Prostatic Obstruction
Treatment for acute UR?
Catheterisation and treat cause
Whats the main cause of Chronic Urinary Retention?
Detrusor muscle inactivity caused by:
- 1y bladder failure
- 2y to an longstanding bladder outflow obstruction
Chronic UR treatment?
Catheterisation and IV fluids
Long term catheter/clean intermittent self cath or treat underlying cause - transurethral resection of prostate
Complications of urinary retention?
Voiding - LUTS UTIs Post-decompressive Haematuria Electrolyte distubances or persistant renal dysfunction (chronic) Pathological Diuresis
What is pathological diuresis?
UO of over 200ml per hour
Postural hypotension
Weight loss
Electrolyte abnormalities
Criteria for a UTI diagnosis?
Microbio evidence
and at least 1 of: Fever, loin/flank pain, suprapubic pain, urinary frequency or urgency or dysuria
UTI types?
Complicated (due to a co-morbidity) and uncomplicated
What is paraphimosis?
Retracted foreskin that cannot be returned to normal position –> gangrene and amputation
