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*Urinary System > Presentation of Kidney + Urinary Tract Disease > Flashcards

Presentation of Kidney + Urinary Tract Disease Flashcards

1
Q

What are the 2 components of the upper urinary tract?

A
  • Kidneys (parenchyma, pelvi-calyceal system) - Ureters (pelvi-ureteric junction, ureter, vesico-ureteric junction)
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2
Q

What are the 2 components of the lower urinary tract?

A
  • Bladder - Bladder outflow tract (bladder neck, prostate, external urethral sphincter/pelvic floor, urethra, urethral meatus, foreskin)
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3
Q

Give the various natures of renal diseases using a surgical sieve

A

IVINTHI Infection Vascular Inflammation Neoplasia Trauma Hereditary Iatrogenic

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4
Q

Give examples for each of the 7 natures of renal diseases

A

IVINTHI Infection - pyelonephritis Vascular - atherosclerosis Inflammation - glomerulonephritis, tubulointerstitial nephritis Neoplasia - renal tumours, collecting system tumours Trauma - blunt trauma Hereditary - polycystic kidney disease, nephrotic syndrome Iatrogenic - nephrotoxicity, PCNL

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5
Q

Name the various presentations of renal disease using a surgical sieve

A

4P Her Majesty Royal Pain Pyrexia Pyuria Proteinuria Haematuria Mass on palpation Renal failure

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6
Q

How many mg/day is considered proteinuria?

A

>150mg

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7
Q

Definition of microscopic haematuria is how many RBCs over a high power field?

A

5 or more

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8
Q

What is oliguria defined as?

A

Urine output <0.5ml/kg/hr

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9
Q

What is absolute anuria and relative anuria?

A

Absolute anuria - no urine output Relative anuria - <100ml/24 hrs

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10
Q

What is polyuria defined as?

A

>3L/24 hrs

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11
Q

What is nocturia defined as?

A

Waking up at night on 1 or more occasion to micturate

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12
Q

What is nocturnal polyuria defined as?

A

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

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13
Q

What is the stagng criteria for Acute Kidney Injury (AKI)

A

RIFLE

(Risk Injury Failure Loss End)

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14
Q

Give the meaning for each of the RIFLE stages of AKI (ridiculous lol no way will they expect us to remember it all)

A

Risk - increase in serum creatinine (1.5x)/decrease in GFR by 25% or UO<0.5ml/kg/h for 6 hrs

Injury - increase in serum creatinine level (2.0x) or decrease in GFR by 50% or UO <0.5ml/kg/h for 12 hrs

Failure - increase in serum creatinine level (3.0x), or decrease in GFR by 75%, or serum creatinine level >355umol/L with acute increase of >44umol/L; or UO <0.3ml/kg/h for 24 hrs, or anuria for 12 hrs

Loss - persistent ARF or complete loss of kidney function >4 months

End-stage kidney disease - complete loss of kidney function > 3 months

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15
Q

Give the 6 key functions of the kidneys (3 homeostasis, 2 functions, 1 regulation)

A

Body fluid homeostasis - fluid overload (PerO, CHF, PulO)

Electrolyte homeostasis (Na+, K+, Cl- etc)

Acid-base homeostasis (excrete H+, generate HCO3-)

Regulation of vascular tone (BP)

Excretory functions (waste (esp urea), drugs)

Endocrine functions (EPO, vit D metab, renin)

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16
Q

Try to name the presentations of chronic renal failure (think of functions)

A

Asymptomatic (found on blood/urine testing)

Tiredness

Anaemia

Oedema

High BP

Bone pain

In advanced renal failure - pruritus, nausea/vomiting, dyspnoea, pericarditis, neuropathy, coma

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17
Q

Give the 5 types of nature of ureteric disease and examples of each

A
  • Infection - ureteritis
  • Iatrogenic/trauma - cut/tied during hysterectomy or colon resection
  • Neoplasia - TCC of ureter, TCC of bladder osbtructing VUJ, prostate cancer obstructing VUJ, pelvic malignancy, pelvic or para-aortic lymphadenopathy
  • Hereditary - PUJ obstruction, VUJ reflux
  • Obstruction - intra-luminal (stone, blood clot), intra-mural (scar tissue, TCC), extra-luminal (pelvic mass, lymph nods)
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18
Q

What are the 5 presentations of ureteric disease?

A

Pain (e.g. renal colic)

Pyrexia

Haematuria

Palpable mass (e.g. hydronephrosis)

Renal failure (only if bilateal obstruction or single functioning kidney)

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19
Q

Give the 7 types of nature of ureteric disease and examples of each

A
  • Infection - cystitis
  • Inflammation - interstitial cystitis, colonic diverticultisis = colo-vesical fistula
  • Iatrogenic/trauma - bladder rupture, bladder injury from hysterectomy (= vesico-vaginal fistula)
  • Neoplasia - TCC of bladder, SCC of bladder
  • Idiopathic - overactive bladder syndrome
  • Denegerative - chronic urinary retention
  • Neurological - neurogenic bladder dysfunction
20
Q

What are the 8 presentations of bladder disease?

A

Pain

Pyrexia

Haematuria

Lower urinary tract symptoms (storage; voiding; incontinence)

Recurrent UTIs

Chronic urinary retention (due to bladder underactivity)

Urinary leak from vagina (i.e. vesico-vaginal fistula)

Pneumaturia (i.e. colo-vesical fistula)

21
Q

What are the types of haematuria?

A

Microscopic

Gross (frank/macroscopic)

22
Q

What are 5 general causes of LUTS?

A
  • Bladder pathology (OAB, UTI, interstiital cystitis, bladder cancer)
  • Bladder outflow obstruction
  • Pelvic floor dysfunction
  • Neurological causes (i.e. neurogenic bladder dysfunction)
  • Systemic disorders (e.g. chronic renal failure, cardiac failure, diabetes mellitus, diabetes insipidus)
23
Q

What are the 3 further neurological causes for LUTS

A

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)

24
Q

What aspects of micturition is the cortical centre responsible for?

A

Bladder sensation and conscious inhibition of micturition

25
Q

What is the pons called in terms of micturition?

A

Micturition centre

26
Q

What are the sacral segments (S2-S4) responsible for in terms of micturition?

A

Micturition reflex

27
Q

What are the 2 stages of the micturition cycle?

A

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

28
Q

GIve the 5 types of nature of bladder outflow tract disease and examples of each

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 or penile cancer

Idiopathic - chronic pelvic pain syndrome

Obstruction - primary bladder neck obstruction, benign prostatic enlargement (BPE) causing obstruction, urethral structure, meatal stenosis, phimosis

29
Q

Give the 7 presentations of bladder outflow tract diseases

A

Pain (suprapubic or perineal)

Pyrexia

Heamaturia

LUTS (voiding; overflow incontinence, stess urinary incontinence)

Recurrent UTI

Acute urinary retention

Chronic urinary retention

30
Q

What is acute urinary retention defined as?

A

‘painful inability to void with a palpable and percussable bladder’

31
Q

Residuals in acute urinary retention vary from what?

A

500ml to 1L

32
Q

Main risk factor for AUR and what is it triggered by?

A

Benign Prostatic Obstruction (BPO) but can also occur independently (e.g. UTI, urethral stricture, alcohol excess, post-op, acute surgical or medical problems)

BPO usually triggered by unrelated event (e.g. constipation, alcohol excess, post-op causes, urological procedure)

33
Q

Treatment for acute urianry retention?

A

Immediate catheterisation

Treat underlying trigger

34
Q

What is chronic urinary retention defined as?

A

‘painless, palpable and percussable bladder after voiding’

35
Q

Are patients with chronic urinary retention able to void?

A

Yes, patients often able to void but with residuals ranging from 400ml to >2L depending on stage of condition

36
Q

Main aetilogical factor for CUR?

A

Detrusor underactivity - can be primary (i.e. primary bladder failure) or secondary (i.e. due to longstanding BOO, e.g. BPO or urethral stricture)

37
Q

What does CUR present as?

A

LUTS or complications (e.g. UTI, bladder stones, overflow incontinence, post-renal or obstructive renal failure) or incidental finding

38
Q

When do overflow incontinence and renal failure occur in CUR?

A

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)

39
Q

Treatment for CUR?

A

Asymptomatic patients with low residuals do not necessarily need treatment

Patients with symptoms/complications need treatment

Immediate treatment is catheterisation (either urethral or suprapubic initially, followed by CISC if appropriate)

40
Q

Complications from CUR?

A

UTI

post-decompression haematuria

pathological diuresis

electrolyte abnormalities

persistent renal dysfunction due to acute tubular necrosis

41
Q

If high-pressure CUR, 2 types of diuresis may occur, what are they?

A
  • Physiological (usually <200ml/hr)
  • Pathological (usually >200ml/hr)
42
Q

What r the 2 things required for a diagnosis of UTI?

A
  1. Microbiological evidence (bacterial count 104 cfu/ml from MSSU)
  2. Symptoms/signs (at least one of fever, loin/flank pain/tenderness, suprapubic pain/tenderness, urinary frequency, urinary urgency, dysuria)
43
Q

2 types of UTI?

A

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

44
Q

Complications of UTI?

A
  • Infective - sepsis, perinephric abscess
  • Renal failure
  • Bladder malignancy
  • Acute urianry retention
  • Frank haematuria
  • Bladder/renal stones
45
Q

Investigations for UTI?

A
  • MSSU/CSU
  • Lower tract - flow studies, residual blader scan, cytoscopy
  • Upper tract - USS kidneys, IVU/CT-KUB, MAG-3 renogram, DMSA scan
46
Q

Treatment for UTI?

A

Appropriate abx

Treat complications

47
Q

Emergencies related to UTI? (loads!!)

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 of the penis, once retracted, cannot return to its original location
  • Priapism - painful and persistent erection of the penis

*Urinary System (26 decks)

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