Presentations of Diseases of the Kidney and Urinary Tract Flashcards
What makes up the lower urinary tract?
-Bladder
-Bladder outflow tract; bladder neck, prostate in men, external urethral sphincter, pelvic floor, urethra
What makes up the upper urinary tract?
-Kidneys
-Ureters
What us a typical presentation of renal disease?
Pain
Pyrexia (fever)
Haematuria
Proteinuria
Pyuria
Mass on palpation
Renal failure
What is the definition of proetinuria?
Urinary protein excretion >150mg/day
Oliguria?
Urine output <05.ml/kg/hour
Absolute anuria?
No urine output
Relative anuria?
<100ml/day
Polyuria?
Urine output > 3L/day
Nocturia?
Waking up at night to urinate more than once
Nocturnal polyuria?
Nocturnal urine output > 1/3 of total urine output in 24hrs
Pyuria?
Pus cells in the urine
What physiological process causes pus cells to be released?
Inflammation
e.g. infection -> inflammation -> pus or trauma -> inflammation -> pus
What are the three types of haematuria?
Visible
Microscopic
Dipstick
What is the definition of microscopic haematuria?
3 or more red blood cells per high power field
RECAP
Name the six main functions of the kidneys :)
Body fluid homeostasis
Acid-base homeostasis
Electrolyte homeostasis
Excretory functions
Regulation of vascular tone
Endocrine functions
When can the ureters be damaged?
During surgery, especially bowel surgery or gynae procedures, as surgeons may accidentally cut them
Which valve prevents the reflux of urine?
Vesico-ureteric junction
What are the three types of obstruction ureter disease?
Intra-luminal
Intra-mural
Extra-luminal
Give an example of an intra-luminal obstruction in terms of ureteric disease.
Stone, blood clot
Give an example of an intra-mural obstruction in terms of ureteric disease.
Scar tissue or tumour
Give an example of an extra-luminal obstruction in terms of ureteric disease.
Pelvic mass or lymph nodes
Give an example of hereditary ureteric disease.
VUJ reflux
What are the two types of bladder cancer?
TCC (urothelial carcinoma/transitional cells carcinoma)
Squamous cell carcinoma of the bladder
TCC more common
How do bladder diseases presenet?
Pain
Pyrexia
Haematuria
Recurrent UTI’s
Lower urinary tract symptoms
Chronic urinary retention
What is the risk of bladder cancer in a patient presenting with visible haematuria?
25-30%
What is the risk of renal cancer in a patient presenting with visible haematuria?
0.5-1%
Lower urinary tract symptoms are not just specific to the bladder. What else could they be suggestive of?
Pelvic floor dysfunction
Neurological causes
Systemic disorders e.g. renal or cardiac failure
Which part of the brain has the micturition centres?
Pons
What are the two phases of micturition?
Storage/filling phase
Voiding phase
What is acute urinary retention?
Painful inability to void with a palpable and percussible bladder
What is the main risk factor of acute urinary retention?
Benign Prostatic Obstruction
What is the treatment of acute urinary retention?
Catheterisation
Is acute urinary retention painful?
Yes
Define chronic urinary retention?
Painless, palpable and percussible bladder after voiding
What is the main cause of chronic urinary retention?
Detrusor muscle underactivity
What does the diagnosis of a UTI require?
Microbiological evidence- MSSU
Symptoms of signs e.g. fever, pain, tenderness
Who usually gets uncomplicated UTI’s?
Young sexually active females
Hydronephrosis?
Swelling of the kidneys due to obstruction
Which type of bacteria can cause UTI’s due to catheters, stents or stones?
Pseudomonas aerugisnosa
