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Renal Pathology > Presentation of Kidney and Urinary Tract Diseases > Flashcards

Presentation of Kidney and Urinary Tract Diseases Flashcards

1
Q

Name for infection of renal system

A

Pyelonephritis

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2
Q

Name for inflammation of glomerulus

A

Glomerulonephritis

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3
Q

What hereditary syndromes can be found to do with renal diseases?

A

Polycystic kidney disease

Nephrotic syndrome

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4
Q

What is infection/inflammation of the ureter called?

A

Ureteritis

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5
Q

When can the ureter be cut accidentally?

A

Hysterectomy

Colon resection

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6
Q

Types of ureteric obstruction

A

Intra luminal (stone, blood clot)
Intra-mural (scar tissue, TCC)
Extra-luminal (pelvic mass, lymph nodes)

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7
Q

What is inflammation of the bladder called?

A

Cystitis

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8
Q

What is balanitis?

A

Skin irritation of head of penis

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9
Q

Presentation of renal diseases

A 
Pain 
Pyrexia
Haematuria
Proteinuria
Pyuria
Mass on palpation 
Renal failure
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10
Q

Definition of oliguira

A

The production of abnormally small amounts of urine (urine output <0.5ml/kg/hr)

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11
Q

Definition of anuria

A

Failure of the kidneys to produce urine

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12
Q

Types of anuria

A

Absaloute - no urine output

Relative - <100ml/24 hours

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13
Q

Definition of polyuria

A

Abnormally large production/passage of urine

Urine output > 3L/24 hours

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14
Q

Definition of nocturia

A

Waking up at night > 1 occasion to micturate

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15
Q

Definition of nocturnal polyuria

A

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

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16
Q

What should be done when a patient has polyuria and polydipsia?

A
  1. Exclude CRF, hypokalaemia, hyperglycaemia, hypercalcaemia and thyrotoxicosis
  2. Urine osmolarity
  3. If > 750mOsm/kg
    a. Check plasma osmolarity. If
    I) >300mOsm/kg, test for Diabetes insipidus - DDAVP - Check the urine osmolality. If no urine concentration; nephrogenic DI, if urine concentrates; cranial diabetes Inspidius
    I) > 300mOsm/kg, do a water deprivation test. If positive; think DI. If no increase or fluctuating urine osmolality; psychogenic polydipsia. If equivocal WDT, do a hypertonic saline infusion. If -ve (psychogenic polydipsia); but if +ve then cranial DI
    b) If urine osmolality > 750mOsm/kg; no abnormality in urine concentrating ability
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17
Q

What does AKI stand for?

A

Acute Kidney Injury

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18
Q

What is the definition of AKI done in terms of? Explain these

A 
Staging 
RIFLE 
R - Risk 
I - injury 
F - failure
L - Loss
E - end stage kidney disease
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19
Q

What counts as risk in staging of AKI?

A

Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO < 0.5mL/kg/h for 6 hours

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20
Q

What counts as injury in staging for AKI?

A

Increase in serum creatinine level (2.0x) or decrease in GFR by 50% or UO <0.5mL/kg/h for 12 hours

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21
Q

What counts as failure in staging for AKI?

A

Increase in serum creatinine (3x) or decrease in GFR by 75%, or serum creatinine level >355 umol/L with acute increase of > 44umol/L; or UO < 0.3mL/kg/h for 24 hours or anuria for 12 hours

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22
Q

What counts as loss in the staging for AKI?

A

Persistent ARF or complete loss of kidney function > 4 weeks

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23
Q

What counts as end stage kidney disease in the staging for AKI?

A

Complete loss of kidney function > 3 months

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24
Q

Functions of the kidney

A 
Erythropoietin production 
Vit D metabolism 
Renin 
Body fluid homeostasis 
Electrolyte homeostasis 
Acid base homeostasis
Regulation of vascular tone (i.e. BP)
Excretory functions
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25
Q

Presentation of chronic renal failure

A 
Asymptomatic
Tiredness
Anaemia
Peripheral oedema
High BP
Bone pain due to renal bone disease
Endocrine abnormalities (erythropoietin, vit D metabolism, renin) 
Congestive cardiac failure
Pulmonary oedema
Electrolyte abnormalities (Na, K, Cl)
Acid base homeostasis abnormalities 
Pruitis (in advanced renal failure)
Nausea vomiting (advanced)
Dyspnoea (advanced)
Pericarditis (advanced)
Neuropathy (advanced)
Coma (untreated advanced)
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26
Q

Presentation of ureteric diseases

A 
Pain 
Pyrexia
Haematuria
Palpable mass i.e. hydronephrosis
Renal failure (only if bilateral obstruction or single functioning kidney)
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27
Q

Presentation of bladder diseases

A 
Suprapubic pain 
Pyrexia
Haematuria
LUTS
Recurrent UTIs
Chronic urinary retention (due to bladder underactivity)
Urinary leak from vagina (i.e. vesico-vaginal fistula)
Pneumaturia (i.e. colo-vesical fistula)
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28
Q

What does LUTS stand for?

A

Lower urinary tract symptoms

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29
Q

What are the LUTS?

A 
Storage
- frequency 
- nocturia
- urgency 
- urge incontinence 
Voiding
- poor flow
- intermittency 
- terminal dribbling
Incontinence 
- stress
- urge
- mixed
- overflow
- neurogenic
- dribbling
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30
Q

Causes of LUTS

A 
OAB
UTI
Interstitial cystitis 
Bladder cancer
BOO
Pelvic floor dysfunction 
Neurological causes
Chronic renal failure
Cardiac failure
DM
DI
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31
Q

What does OAB stand for?

A

Over active bladder

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32
Q

What does UTI stand for?

A

Urinary tract infection

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33
Q

What neurological causes can cause LUTS?

A

Supra-pontine lesions (e.g. stroke, alzheimers, parkinsons)
Intra-pontine, suprasacral lesions (e.g. spinal cord injury, disc prolapse, spina bifida)
Infra-sacral (e.g. MS, DM, Cauda equina compression, surgery to retroperitoneum)

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34
Q

What does DM stand for?

A

Diabetes mellitus

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35
Q

What does DI stand for?

A

Diabetes inspidius

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36
Q

What controls micturition?

A
  1. Cortical centre (bladder sensation and conscious inhibition of micturition)
  2. Pons (micturition centre)
  3. Sacral segments (S2-S4) - micturition reflex
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37
Q

What is the micturition reflex?

A

Relaxation of internal urethral sphincter (autonomic - sympathetic)
Relaxation of external urethral sphincter (somatic)
Contraction of detrusor muscle (autonomic - parasympathetic)

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38
Q

What is the micturition cycle?

A
  1. Storage (or filling) phase

2. Voiding phase

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39
Q

What does BOO stand for?

A

Bladder outflow obstruction

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40
Q

Presentation of bladder outflow tract diseases

A 
Pain 
- suprapubic
- perineal 
Pyrexia
Haematuria
LUTS 
Overflow incontinence 
Recurrent UTIs
Acute urinary retention 
Chronic urinary retention
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41
Q

What LUTS are caused by BOO?

A 
Hesitancy 
Intermittency 
Poor flow
Terminal dribbling
Incomplete bladder emptying
42
Q

Definition of acute urinary retention

A

Painful inability to void with a palpable and percusable bladder

43
Q

Residuals in acute urinary retention

A

Vary from 500ml to 1 litre depending on time lag in seeking medical attention

44
Q

What is the main risk factor for acute urinary retention?

45
Q

Causes of acute urinary retention

A 
BPO
UTI
Urethral stricture
Alcohol excess 
Post op causes
Acute surgical or medical problems
46
Q

What does BPO stand for?

A

Benign prostatic obstruction

47
Q

Causes of BPO causing acute urinary retention

A 
Spontaneously (I.e. natural progression of BPO)
Triggers
- constipation 
- alcohol excess
- post op cases
- urological procedure
48
Q

Treatment of acute urinary retention

A

Immediate catheterisation (either urethral or suprapubic)
Treat underlying trigger if present
If due to BPE
- alpha blocker immediately then remove catheter in 2 days
- if fail to void; recatheterise and organise TURP (after 6 weeks)

49
Q

Complications of acute urinary retention

A 
UTI
Post decompression haematuria
Pathological diuresis
Renal failure
Electrolyte abnormalities
50
Q

What is diuresis?

A

Increased or excessive production of urine

51
Q

What does TURP stand for?

A

Transurethral resection of the prostate

52
Q

Definition of chronic urinary retention

A

Painless, palpable and percusable bladder after voiding

53
Q

Residuals in chronic urinary retention

A

Varies from 400ml to > 2 litres depending on the stage of condition (i.e. wide spectrum)

54
Q

Main cause of chronic urinary retention

A

Detrusor underactivity

55
Q

Types of detrusor underactivity

A

Primary i.e. primary bladder failure

Secondary i.e. due to longstanding BOO, such as BPO or urethral stricture

56
Q

Presentation of chronic urinary retention

A

LUTS
Complications
Incidental finding

57
Q

Complications of chronic urinary retention

A 
UTI
Bladder stones
Post decompression haematuria 
Pathological diuresis 
Electrolyte abnormalities 
Persistent renal dysfunction due to acute tubular necrosis 
Overflow incontinence 
Post renal or obstructive renal failure
58
Q

When does overflow incontinence and renal failure occur in chronic urinary retention?

A

At the severe end of the spectrum, when bladder capacity is reached and bladder pressure is in excess of 25cm water (i.e. chronic high pressure urinary retention)

59
Q

Who needs treatment in 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

60
Q

Treatment of chronic urinary retention

A

Immediate catheterisation
- either urethral or suprapubic initially
- then CISC if appropriate
IV fluids
Long term urethral or suprapubic catheter, CISC or TURP if due to BPE

61
Q

What electrolyte abnormalities as a complication would be seen in a patient with chronic urinary retention?

A

Hyponatraemia
Hyperkalaemia
Metabolic acidosis

62
Q

Features of pathological diuresis

A 
Urine output > 200ml/hr 
\+ 
Postural hypotension (systolic differential > 20mmHg between lying and standing)
\+ 
Weight loss
\+ 
Electrolyte abnormalities
63
Q

Treatment of pathological diuresis

A

IV fluids (total input = 90% of output) and monitor closely

64
Q

Which of acute or chronic retention does TURP have a more successful outcome in?

A

Acute retention

HOWEVER in low pressure chronic retention better outcomes

65
Q

If there is high pressure chronic urinary retention, what are the two types of diuresis that may occur?

A

Physiological (<200ml/hour usually)

Pathological (>200ml/hour usually)

66
Q

Definition of UTI

A

An infection affecting the urinary tract (including kidneys, bladder, prostate, testis and epididymis)

67
Q

What does a diagnosis of a UTI require?

A

Microbiological evidence
AND
Symptoms/signs

68
Q

What is the microbiological evidence required to diagnose a UTI?

A

Bacterial count of 10^4 cfu/ml from MSSU specimen with no more than two species of microorganisms

69
Q

What symptoms/signs are required to diagnose a UTI?

A

At least one of the following

  • fever > 38C
  • Loin/flank pain or tenderness
  • Suprapubic pain or tenderness
  • urinary frequency
  • urinary urgency
  • dysuria
70
Q

Types of UTI

A

Uncomplicated

Complicated

71
Q

What is an uncomplicated UTI? What is a complicated UTI?

A

Uncomplicated - Young sexually active females only with clear relation to sexual activity
Complicated - everyone else

72
Q

What type of UTI always needs to be investigated?

A

Complicated

73
Q

What factors should be considered in differentiating between complicated and uncomplicated UTIs?

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 organism

74
Q

What is inflammation of the bladder called?

75
Q

What is inflammation of the prostate called?

A

Prostatitis

76
Q

What is inflammation of the kidney called?

A

Pyelonephritis

77
Q

What is inflammation of the testis called?

78
Q

Complications of UTI

A

Infective; sepsis (especially pyelonephritis), perinephric abscess
Renal failure (scarring)
Bladder malignancy (squamous cell carcinoma)
Acute urinary retention
Frank haematuria
Bladder or renal stones

79
Q

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
80
Q

What is a CT KUB?

A

A CT scan of the kidneys, ureters and bladder

81
Q

Emergencies related to urinary tract diseases

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 (e.g. hypercalcaemia from bony mets), spinal cord compression from vertebral mets etc
Acute urinary retention
Chronic high pressure urinary retention
Iatrogenic injury/trauma to upper or lower urinary tracts, penis and testis
Testicular torsion
Paraphimosis
Priapism

82
Q

What is testicular torsion?

A

The spermatic cord rotates and becomes twisted

83
Q

What is paraphimosis?

A

The foreskin is pulled back behind the tip of the penis and becomes stuck there. The retracted foreskin and the penis become swollen and fluid build up

84
Q

What is priapism?

A

Persistent and painful erection of the penis

85
Q

Treatment of nephrogenic DI

A

Chlorothiazide

86
Q

What drug is a recognised cause of nephrogenic DI?

87
Q

What is a known cause of cranial DI?

A

Hereditary haemachromatosis

88
Q

Who is eGFR often inaccurate in?

A

People with extremes of muscle mass e.g. bodybuilders

89
Q

Inheritance of Alport syndrome

A 
X linked dominant (85%)
Autosomal recessive (10-15%)
90
Q

Pathology of Alport syndrome

A

Defect in the gene which codes for type IV collagen resulting in an abnormal GBM

91
Q

Who does Alport syndrome effect?

A

More severe disease in males
Females rarely develop renal failure
Presents in childhood usually

92
Q

Presentation of Alport syndrome

A 
Microscopic haematuria
Progressive renal failure
Bilateral sensorineural deafness
Lenticonus 
Retinitis pigmentosa
93
Q

Definition of lenticonus

A

Protrusion of the lens surface into the anterior chamber

94
Q

Diagnosis of Alport syndrome

A

Molecular genetic testing
Renal biopsy
- longitudinal splitting of lamina densa of the GBM resulting in a basket weave appearance

95
Q

When prescribing maintenance fluids, what is usually required?

A

25 - 30 ml/kg/day

96
Q

What is the recommended fluid challenge in a patient who is dehydrated who does not have clinical signs or documentation of HF?

A

500ml normal saline STAT

97
Q

What is the recommended fluid challenge in a patient who is dehydrated who has HF?

A

250ml normal saline STAT

98
Q

Symptoms of mild - moderate hypokalaemia

A

Asymptomatic

99
Q

Symptoms of severe hypokalaemia (< 2.5)

A

Weakness
Leg cramps
Palpitations secondary to cardiac arrhythmias
Ascending paralysis

100
Q

ECG changes seen in hypokalaemia

A

U waves
T wave flattening
ST segment changes

Renal Pathology (13 decks)

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