Presentation of urinary Disorders

Question 1

Divide the urinary tract into upper and lower

Answer 1

Upper Urinary Tract = Kidneys –> Vesicouretic junction

Lower Urinary Tract = Bladder –> Urethral meatus/foreskin

Question 2

Define proteinuria?

Answer 2

> 150mg/day or urinary protein

Question 3

Define pyuria?

Answer 3

Pus in the urine

Any infection or inflammatory disorder could cause it

Question 4

Define oliguria, anuria, polyuria, nocturia and nocturnal polyuria?

Answer 4

Oliguria <0.5ml/Kg/hr
Anuria = Absolure (no urine) or Relative (<100ml/24hrs)
Polyuria = >3L/24hrs
Nocturia = Waking >1 time a night to pee
Nocturnal polyuria = Nocturnal UO is >1/3rd of total ouput

Question 5

Define acute kidney injury (AKI)?

Answer 5

Aka Acute Kidney Failure (ARF)

An abrupt loss of kidney function that develops within 7 days

Question 6

How do we stage AKI?

Answer 6

RIFLE. A progressive set of criteria to monitor the severity of Kidney Injury

Question 7

What does the R in rifle mean?

Answer 7

RIFLE - AKI staging
R = Risk:

1) 1.5 serum creatinine
2) OR 25% loss of GFR
3) <0.5ml/Kg/hr UO for 6 hours

Question 8

What does the I in RIFLE mean?

Answer 8

I - Injury

1) 2x serum creatinine
2) Or 50% loss of GFR
3) <0.5ml/Kg/Hr UO for 12 hours

Question 9

What does the F in RIFLE mean?

Answer 9

Failure

1) 3x serum creatinine
2) Or 75% loss in GFR
3) Or UO <0.3ml/Kg/hr for 24 hours
4) Or Anuria for 12 hours

Question 10

What does the L in RIFLE mean?

Answer 10

Loss

1) Persistent AKI
2) Or complete loss of function >4 wks

Question 11

What does the E mean?

Answer 11

End Stage Disease

Completely loss of kidney function >3 months

Question 12

How does Chronic renal Failure present?

Answer 12

1) Fluid issues (Peripheral oedema, pulmonary oedema, dyspnoea & CHF)
2) Anaemia (produces erythropoeitin)
3) Hypertension (Renin)
4) Bone pain
5) Pruritis, N&V
6) Pericarditis
7) Neuropathy
8) tiredness
9) Coma
10) Electrolyte inbalances
11) Acid base inbalance

Question 13

Categories of Ureteric obstruction?

Answer 13

Intra-luminal - Stones or blood clots
Intra-mural - Scar tissue or TCC (Transitional Cell Carcinoma)
Extra-luminal - Pelvic mass or lymph nodes

Question 14

Disorders of what neurological regions can cause bladder dysfunction?

Answer 14

1) Cortical centres - Conscious micturition control
2) Pons - Micturition Centre
3) Sacral Segments S2-4 - Micturition reflex

Question 15

Types of pain in urinary diseae?

Answer 15

Renal colic - in obstructions
Suprapubic pain - bladder or urethral disorders
Perineal pain - Bladder outflow tract disorders

Question 16

What is pneumaturia?

Answer 16

Gas or air in the urine

Most often due to a colo-vesical fistula from colonic diverticulosis

Question 17

What are the groups of Lower Urinary Tract Symptoms?

Answer 17

Storage LUTS: (basically can’t hold urine in)
Frequency, nocturia, urgency, urge incontinence

Voiding LUTS: (Problems voiding bladder)
Poor Flow, intermittent, dribbling, hesitency, incomplete emptying, overflow incontinence
Most often down to Bladder Outflow Obstruction (BOO)

Question 18

Types of incontinence?

Answer 18

Stress
Urge
Mixed
Overflow (Urinary retention reaches such a high pressure that you become incontinent)
Neurogenic
Dribbling

Question 19

What are the main differences between acute and chronic urinary retention?

Answer 19

Acute is a painful inability to void with palpable/percussible bladder
Chronic is painless and the bladder is still palpable/percussible after voiding

Question 20

Whats the main cause of acute urinary retention?

Answer 20

Benign Prostatic Obstruction

Often with an underlying trigger such as excess alcohol, constipation or post-operatively

Question 21

Whats the treatment for acute urinary retention?

Answer 21

Catheterisation

Treat underlying trigger/cause

Question 22

Whats the main cause of Chronic Urinary Retention?

Answer 22

Mainly down to detrusor inactivity:

1) Primary bladder failure
2) Secondary to longstanding BOO (either Benign prostatic enlargement {BPE} or urethral stricture)

Question 23

How do you treat Chronic Urinary Retention?

Answer 23

Catheterise
IV fluids

Long Term Catheter
Or Clean Intermittent Self Catheterisation (CISC)
Or Transurethral Resection of Prostate (TURP) if down to Benign prostatic enlargement

Question 24

Complications/presentation of Urinary Retention?

Answer 24

Voiding LUTS
UTIs
Post-decompressive Haematuria
Electrolyte distubances or persistant renal dysfunction (chronic)
Pathological Diuresis

Question 25

What is pathological diuresis?

Answer 25

UO >200ml/hr
Postural Hypotension
Weight Loss
Electrolyte abnormalities

Its a possible complication of urinary retention

Question 26

What is required to diagnose a UTI?

Answer 26

Microbiological evidence = 10^4 cfu/ml bacterial account from a MSSU

+ atleast 1 of fever, loin/flank pain, suprapubic pain, urinary frequency, urinary urgency or dysuria

Question 27

Types of UTI?

Answer 27

complicated
- Due to some co-morbidy e.g. immunosuppression, an abnormal renal tract e.g. tumour or stone or a foreign body e.g. catheter

Uncomplicated
- Mainly sexually active young women

Question 28

List some major urinary emergencies?

Answer 28

1) Acute Kidney Injury
2) Sepsis from UTI
3) Renal Colic
4) Hemorrhagic shock from severe haematuria
5) Urinary Retention
6) Metastatic complications e.g. hypercalcaemia or spinal cord compression
7) Testicular Torsion
8) Paraphimosis
9) Priapism

Question 29

What is paraphimosis?

Answer 29

Retracted foreskin that cant be returned to normal position

can lead to gangrene -> amputation

Question 30

What is priapism?

Answer 30

A prolonged often painful erection