Presentation of Diseases of the Kidneys and Urinary Tract

Question 1

Where is the division of the upper and lower urinary tracts?

Answer 1

Anything above bladder is the upper urinary tract

Bladder and below is the lower urinary tract

Question 2

What is the definition of proteinuria?

Answer 2

Urinary protein excretion >150mg/day

Question 3

What are the three types of haematuria and what characterises each one?

Answer 3

Macroscopic- blood visible in urine
Microscopic- Intact blood cells visible on microscopy
Dipstick- blood cells present on urine dipstick analysis

Question 4

What is the threshold for microscopic haematuria?

Answer 4

3 or more intact red blood cells per high power field

Question 5

What is the definition of oliguria?

Answer 5

Urine output <0.5mg/kg/hr

Question 6

What are the two different kinds of anuria and how is each characterised?

Answer 6

Absolute anuria- no urine output

Relative anuria- <100ml urine produced in 24hrs

Question 7

What is the definition of polyuria?

Answer 7

Urine output >3L per 24 hours

Question 8

What is the definition of nocturia?

Answer 8

Waking up at night at least once to micturate

Question 9

What is the definition of nocturnal polyuria?

Answer 9

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

Question 10

How is acute kidney injury staged?

Answer 10

RIFLE
Risk- Increase in serum creatinine by 1.5x or decrease in GFR by 25% or urine output less than 0.5ml/kg/hr for 6 hours
Injury- Increase in serum creatinine by 2.0x or decrease in GFR by 50% or urine output less than 0.5ml/kg/hr for 12 hours
Failure- Increase in serum creatinine by 3.0x or decrease in GFR by 75% or urine output less than 0.5ml/kg/hr for 24 hours or anuria for 12 hours
Loss- Persistent ARF or complete kidney function loss >4 weeks
End-stage kidney disease- complete loss of kidney function >3 months

Question 11

How does chronic renal failure present?

Answer 11

Asymptomatic (found on blood/urine testing)
Tiredness
Anaemia
Oedema
High blood pressure
Bone pain

Question 12

What are the characteristics of advanced renal failure?

Answer 12

Pruritis
Nausea/vomiting
Dyspnoea
Pericarditis
Neuropathy
Coma (untreated advanced renal failure)

Question 13

How do ureteric diseases present?

Answer 13

Pain
Pyrexia
Haematuria
Palpable mass
Renal failure

Question 14

How do bladder diseases present?

Answer 14

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

Question 15

What is the risk of bladder cancer in someone who presents with haematuria?

Answer 15

25-30%

Question 16

What is the risk of kidney cancer in someone who presents with haematuria?

Answer 16

0.5-1%

Question 17

How do bladder outflow tract diseases present?

Answer 17

Pain (subpubic or perineal)
Pyrexia
Haematuria
Lower urinary tract symptoms
Recurrent UTIs
Acute urinary retention
Chronic urinary retention

Question 18

How is acute urinary retention defined?

Answer 18

The painful inability to void with a palpable and percussable bladder

Question 19

How is chronic urinary retention defined?

Answer 19

A painless, palpable and percussable bladder after voiding. Patients often able to void but have high residuals

Question 20

What differentiates complicated and uncomplicated UTIs?

Answer 20

Uncomplicated UTIs- young sexually active females with clear link to sexual activity
Complicated UTIs- everything else

Question 21

What bacterial species are often associated with UTIs?

Answer 21

E. coli
Klebsiella species
Proteus species
Pseudomonas aeruginosa (common with foreign bodies ie catheters)