Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

year 2 renal > Presentation of Diseases of the Kidneys and Urinary Tract 2020 pre-lecture version > Flashcards

Presentation of Diseases of the Kidneys and Urinary Tract 2020 pre-lecture version Flashcards

1
Q

what makes up the upper urinary tract?

A
  1. Kidneys
    - Parenchyma
    - Pelvi-calyceal system
  2. Ureters
    - Pelvi-ureteric junction
    - Ureter
    - Vesico-ureteric junction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what makes up the lower urinary tract?

A
  1. Bladder
  2. Bladder outflow tract
    - Bladder neck (intrinsic urethral sphincter)
    - Prostate
    - External urethral sphincter/pelvic floor
    - Urethra
    - Urethral meatus
    - Foreskin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

study this picture showing the anatomy of the kidney

Upper urinary tract disease: Kidney

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is in a surgical sieve?

A
  • Infection
  • Inflammation
  • Iatrogenic
  • Neoplasia
  • Trauma
  • Degenerative
  • Congenital
  • Genetic/Hereditary
  • Vascular
  • Endocrine
  • Failure
  • Idiopathic
  • Etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what may the nature of renal diseases be?

A
  • Infection
  • Inflammation
  • Iatrogenic
  • Neoplasia
  • Trauma
  • Vascular
  • Hereditary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

nature of renal diseases:

what is an exmaple of infection?

A

•pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

nature of renal diseases:

what is an exmaple of inflammation?

A

•glomerulonephritis, tubulointerstitial nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

nature of renal diseases:

what is an exmaple of iatrogenic?

A

nephrotoxicity, PCNL (surgery to remove stones form the kidney, drill big hole into the kidneys and can cause damage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

nature of renal diseases:

what is an exmaple of neoplasia?

A

renal tumours, collecting system tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

nature of renal diseases:

what is an exmaple of trauma?

A

blunt trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

nature of renal diseases:

what is an exmaple of vascular origin?

A

atherosclerosis, hypertension, diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

nature of renal diseases:

what is an exmaple of heriditary cause?

A

polycystic kidney disease, nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the presentation of renal diseases?

A
  • Pain
  • Pyrexia
  • Haematuria
  • Proteinuria
  • Pyuria
  • Mass on palpation
  • Renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. 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
A

Everyone secretes protein in urine so cant be A

Answer = D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. How many types of haematuria are there?
    a. One
    b. Two
    c. Three
    d. Four
    e. Five
A

Macroscopic – gross or frank haematuria

Microscopic – examined under microscope and can see the cells

Dipstick positive haematuria

Answer = C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. 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
A

Answer = C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Urine output: Definitions:

What is Oliguria?

A

Urine output <0.5ml/kg/hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Urine output: Definitions:

What is Anuria?

A

Absolute anuria - No urine output; Relative anuria - <100ml/24 hours

failure of the kidneys to produce urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Urine output: Definitions:

What is Polyuria?

A

Urine output >3L/24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Urine output: Definitions:

What is Nocturia?

A

Waking up at night ≥1 occasion to micturate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Urine output: Definitions:

What is Nocturnal polyuria?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Acute Kidney Injury (AKI) (ARF) - what is the definiton in terms of staging?

A
  1. Risk - Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours
  2. Injury - Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours
  3. 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
  4. Loss - Persistent ARF or complete loss of kidney function >4 weeks
  5. End-stage kidney disease - complete loss of kidney function >3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

presentation of chronic renal failure - what are the functionns of the kidneys?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

one function of the kidney is body fluid homeostasis, what is an example of this?

A

fluid overload (peripheral oedema, congestive cardiac failure, pulmonary oedema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

one function of the kidney is electrolyte homeostasis, name examples of this?

A

Na+

K+

Cl-

etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

one function of the kidney is acid-base homeostasis, name examples of this?

A

excrete H+

generate HCO3-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

one function of the kidney is regulation of vascular tone, what is an example of this?

A

regulation of blood pressure

28
Q

one function of the kidney is regulation of excretory functions, what is an example of this?

A

physiological waste (esp. urea)

drugs

29
Q

one function of the kidney is endocrine functions, what are examples of this?

A

erythropoeitin

vitamin D metab

renin

30
Q

what is the presentation of chronic renal failure?

A
  • 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)
31
Q

what are the different natures of ureteric diseases?

A

infection

iatrogenic/trauma

neoplasia

hereditary

obstruction

32
Q

the nature of ureteric disease may be infection, what is an example of this?

A

ureteritis

33
Q

the nature of ureteric disease may be iatrogenic/trauma, what is an example of this?

A

inadvertently cut or tied during hysterectomy or colon resection

34
Q

the nature of ureteric disease may be neoplasia, what are examples of this?

A

TCC of ureter, TCC of bladder obstructing VUJ, prostate cancer obstructing VUJ, pelvic malignancy, pelvic or para-aortic lymphadenopathy

35
Q

the nature of ureteric disease may be hereditary, what are examples of this?

A

PUJ obstruction, VUJ reflux

36
Q

the nature of ureteric disease may be obstruction, what are examples of this?

A

intra-luminal (stone, blood clot)

intra-mural (scar tissue, TCC)

extra-luminal (pelvic mass, lymph nodes)

37
Q

what is the presentation of ureteric diseases?

A
  • Pain (eg. renal colic)
  • Pyrexia
  • Haematuria
  • Palpable mass (ie. hydronephrosis)
  • Renal failure (only if bilateral obstruction or single functioning kidney)
38
Q

what is the nature of bladder disease?

A
  • Infection - cystitis
  • Inflammation - interstitial cystitis, colonic diverticulitis resulting in colo-vesical fistula
  • Iatrogenic/Trauma - bladder rupture, bladder injury from hysterectomy (resulting in vesico-vaginal fistula)
  • Neoplasia - TCC of bladder, squamous cell carcinoma of bladder
  • Idiopathic - overactive bladder syndrome
  • Degenerative - chronic urinary retention
  • Neurological - neurogenic bladder dysfunction
39
Q

what is the presentation of bladder diseases?

A
  • 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)
40
Q
  1. What 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%
A

D

41
Q
  1. 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%
A

C

42
Q

what is shown here?

A

Endoscopic view of superficial TCC of bladder

43
Q

Specimen of Bladder with solid TCC

A
44
Q

Lower urinary tract symptoms (LUTS) (i.e. voiding LUTS, storage LUTS, incontinence, polyuria, etc.) can have multitude of causes, what are they?

A
  • bladder pathology (OAB, UTI, interstitial cystitis, bladder cancer)
  • bladder outflow obstruction
  • pelvic floor dysfunction
  • neurological causes (i.e. neurogenic bladder dysfunction):
    i. supra-pontine lesions (e.g. stroke, Alzheimer’s, Parkinson’s)
    ii. infra-pontine supra-sacral lesions (e.g. spinal cord injury, disc prolapse, spina bifida)
    iii. infra-sacral (e.g. multiple sclerosis, diabetes, cauda equina compression, surgery to retroperitoneum)
  • systemic disorders (e.g. chronic renal failure, cardiac failure, diabetes mellitus, diabetes insipidus)
45
Q

what is the control of micturation done by?

A

1) Cortical centre (bladder sensation and conscious inhibition of micturition)
2) Pons (micturition centre) - main centre controlling voiding
3) Sacral segments (S2-S4) (micturition reflex):
- relaxation of internal urethral sphincter (autonomic - sympathetic)
- relaxation of external urethral sphincter (somatic)
- contraction of detrusor muscle (autonomic – parasympathetic)

46
Q

What are the phases of the micturition cycle?

A

1) Storage (or filling) phase
2) Voiding phase

47
Q

What are the different natures of bladder outflow tract diseases?

A
  • Infection/Inflammation - prostatitis, balanitis
  • Iatrogenic/Trauma - pelvic floor damage after traumatic vaginal delivery or hysterectomy, urethral injury from catheterisation or pelvic fracture
  • Neoplasia - prostate cancer, penile cancer
  • Idiopathic - chronic pelvic pain syndrome
  • Obstruction:
  • primary bladder neck obstruction
  • benign prostatic enlargement (BPE) causing obstruction
  • urethral stricture
  • meatal stenosis
  • phimosis
48
Q

what are the presentations of bladder outflow tract diseases?

A
  • Pain (suprapubic or perineal)
  • Pyrexia
  • Haematuria
  • Lower urinary tract symptoms (LUTS)
  • voiding LUTS (i.e. hesitancy, intermittency, poor flow, terminal dribbling, incomplete bladder emptying) due to Bladder Outflow Obstruction (BOO)
  • overflow incontinence (high-pressure chronic urinary retention)
  • stress urinary incontinence
  • Recurrent UTIs
  • Acute urinary retention
  • Chronic urinary retention
49
Q

what is acute urinary retention?

A

Defined as ‘painful inability to void with a palpable and percussible bladder’

Residuals vary from 500ml to 1 litre (but usually <1 litre)

50
Q

what is the main risk factor for acute urinary retention?

A

Main risk factor is Benign Prostatic Obstruction (BPO) but can also occur independently of BPO (eg. UTI, urethral stricture, alcohol excess, post-operative causes, acute surgical or medical problems)

•For those with BPO, usually triggered by an unrelated event (eg. constipation, alcohol excess, post-operative causes, urological procedure)

51
Q

what is the treatment for acute urinary retention?

A
  • Immediate treatment is catheterisation (either urethral or suprapubic)
  • Treat underlying trigger if present
52
Q

what is chronic urinary retention?

A
  • Defined as ‘painless, palpable and percussible bladder after voiding’
  • Patients often able to void but with residuals ranging from 400ml to >2 litres depending on stage of condition (i.e. wide spectrum)
53
Q

what causes chronic urinary retention and how does it present?

A
  • Main aetiological factor is detrusor underactivity which can be primary (i.e. primary bladder failure) or secondary (i.e. due to longstanding BOO, such as BPO or urethral stricture)
  • Presents as LUTS or complications (e.g. UTI, bladder stones, overflow incontinence, post-renal or obstructive renal failure) or incidental finding
  • Overflow incontinence and renal failure occur at severe end of spectrum, when bladder capacity is reached and bladder pressure is in excess of 25cm water (i.e. chronic high-pressure urinary retention)
54
Q

What is the treatment of chronic urinary retention?

A
  • Asymptomatic patients with low residuals do not necessarily need treatment
  • Patients with symptoms or complications need treatment (but no role for medical therapy!)
  • Immediate treatment is catheterisation (either urethral or suprapubic initially, followed by CISC if appropriate)
55
Q

what are complications of chronic urinary retention?

A

UTI, post-decompression haematuria, pathological diuresis, electrolyte abnormalities (hyponatraemia, hyperkalaemia, metabolic acidosis), persistent renal dysfunction due to acute tubular necrosis

56
Q

If high-pressure chronic urinary retention, two types of diuresis may occur, what are they?

A

Physiological (usually <200ml/hour)

Pathological (usually >200ml/hour)

57
Q

what is a UTI?

A

Defined as infection affecting urinary tract (including kidneys, bladder, prostate, testis and epididymis)

58
Q

how do you diagnose a UTI?

A

• A diagnosis requires microbiological evidence AND symptoms/signs:

i. Microbiological evidence: Bacterial count of 104 cfu/ml from MSSU specimen with no more than two species of micro-organisms
ii. Symptoms/signs: At least one of the following: Fever >38ºC; loin/flank pain or tenderness; suprapubic pain or tenderness; urinary frequency; urinary urgency; dysuria

59
Q

what are the 2 types of UTIs?

A

i. Uncomplicated UTIs (young sexually active females only with clear relation to sexual activity)
ii. Complicated UTIs (everyone else!)

• Complicated UTIs always need to be investigated

60
Q

What are some factors to consider in differentiating between complicated vs uncomplicated UTI?

A
  • Age
  • Sexual activity (females)
  • Gender
  • Co-morbidities (e.g. immunosuppression, renal failure, medications)
  • Abnormal renal tract (e.g. stones, renal outflow obstruction, BOO, horseshoe kidney, VU reflux, renal scarring, bladder tumour)
  • Foreign body (e.g. catheter, ureteric stent)
  • Type of organisms (E. coli, Staph. saprophyticus, Klebsiella, Proteus, Pseudomonas, Staph aureus)
61
Q

what does the presentation of UTIs depend on?

A

• Presentation depends on organ affected

  • bladder (cystitis); prostate (prostatitis); kidney (pyelonephritis); testis (orchitis)
62
Q

whata re complications of UTI?

A
  • infective: sepsis (esp. pyelonephritis), perinephric abscess
  • renal failure (scarring)
  • bladder malignancy (squamous cell carcinoma)
  • acute urinary retention
  • frank haematuria
  • bladder or renal stones
63
Q

what are the investigations for UTI?

A
  • MSSU/CSU
  • lower tract: flow studies, residual bladder scan, cystoscopy
  • upper tract: USS kidneys, IVU/CT-KUB, MAG-3 renogram, DMSA scan
64
Q

what is the treatment of UTI?

A
  • Appropriate antibiotic therapy (type? duration? route?)
  • Treat complications and cause
65
Q

what are some emergencies related to UTI?

A
  • Acute renal failure
  • Sepsis due to UTI +/- upper or lower urinary tract obstruction
  • Renal colic
  • Severe haematuria causing haemorrhagic shock
  • Metastatic disease causing metabolic derangements (eg. hypercalcaemia from bony metastases), spinal cord compression from vertebral metastases, etc.
  • Acute urinary retention
  • Chronic high-pressure urinary retention
  • Iatrogenic injury/Trauma to upper or lower urinary tracts, penis and testis
  • Testicular torsion
  • Paraphimosis - Foreskin comes back and cant go forward again and causes ischemia
  • Priapism - erection over 4 hours after sexual activity
66
Q
  1. The following are essential features of acute urinary retention except:
    a. painful
    b. palpable bladder
    c. inability to urinate
    d. bladder volume >800ml
    e. percussible bladder
A

D

67
Q
  1. The following organisms are commonly associated with urinary tract infections except:
    a. E. coli
    b. Klebsiella species
    c. Proteus species
    d. Chlamydia trachomatis
    e. Pseudomonas aeruginosa
A

top 3 are coliforms

Chlamydia is a sexual transited disease

E is an opportunistic organism

D is the correct answer

year 2 renal (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions