Renal and Urologic

Question 1

What is the pain distribution for the upper urinary tract?

Answer 1

• T10-L1 dermatomes
• Renal- subostal and costovertebral
• Ureteral- groin and genital
• Lower abdominal quadrant
• Generalized- nausea, vomitting
• Hip OA- groin pain

Question 2

What is the pain distribution for lower urinary tract?

Answer 2

• Suprapubic-low abdomen
• Low back- UTI (common)

Question 3

What could you possibly find in the history of someone with a renal or urinary disorder?

Answer 3

1. HTN
2. Diabetes- Kidneys are first organs affected
3. Age- especially if male and over 45 y/o. Screen for prostate invlovement
4. Gender- Lower urinary most affected for women
5. Sexual Activity- UTI (STD’s)
6. Obstructive disorders- prostate enlargement
7. Common symptoms: alteriation in flow, nausea and vomitting, dysuria (burning pain)

Question 4

Signs and symptoms of Upper urinary tract

Answer 4

1. Flank and ipsilateral shoulder pain
2. fever and chills
3. Hyperesthesia of dermatomes
4. Hematuria,bacteriuria
5. Pyuria

Question 5

What is Murphy’s percussion test? Reason? How to treat?What is positive?

Answer 5

• Test for costovertebral tenderness
• Reason: Previous hx of kidney infection
• Treatment: We don’t treat. Requires immediate referral
• Positive= reproduction of back and/or flank pain

Question 6

Predictor for renal Colic:

Answer 6

• Urinalysis-hematuria
• Presence of renal tenderness
• <12 hours of pain
• Normal Appetite
• Gender- male 2x more likely

Question 7

Signs and Symptoms of lower urinary Tract:

Answer 7

1. Urinary frequency or urgency
2. Dysuria, Pyuria, Dyspareunia
3. Hematuria,bacteriuia
4. LBP, pelvic or lower ab pain

Question 8

What is the difference between Upper urinary obstructive disorders and lower urinary obstructive disorders?

Answer 8

• Upper urinary- pain is excruciating, spasmodic, and radiating with nausea and vomiting
• Lower urinary- more related to tumors, prostatic hypertrophy, nocturia, hesitancy

Question 9

What are some mechanical/neuromuscular disorders?

Answer 9

Incontinence, Infection, Endocrine disorders

Question 10

What are some meds that cause incontinence?

Answer 10

• Antichoinergic
• calcium channel blocker
• diuretics
• sedatives
• alpha-antagonists
• alpha-agonists

Question 11

Signs and symptoms of renal impairment:

Answer 11

• HTN
• decreased urinary output
• dependent edema
• unusual weakness
• dyspnea
• Headache
• Proteinuria

Question 12

What is the difference between acute and chronic renal failure?

Answer 12

• Acute-reversible
• Chronic- ends in End stage renal failure

Question 13

What are some other characteristics of Renal failure?

Answer 13

• Multiple systems involvement
• Signs and symptoms are the same as renal impairment but more severe
• Severe bilateral pitting edema

Question 14

Things to note in patients with ESRD:

Answer 14

• typically medically fragile
• areas in clinic must stay as sanitary as possible
• cannot take pain meds

Question 15

What results in an increase of creatine?

Answer 15

Renal impairment (increase normal in elderly)

Question 16

What causes abnormal BUN value?

Answer 16

• hepatic or renal disease; dehydration, infection, GI bleed, steroid use (increase BUN)
• secere hepatic damage (increase BUN)
• Malnutrition (decrease BUN)

Question 17

What causes an abnormal BUN/Creatine ratio?

Answer 17

• dehydration (increase)
• malnutrition (decrease)

Question 18

Types of imaging:

Answer 18

1. Ultrasound- looking for enlargement of kidneys (indicates blockage) or prostate
2. MRI-tumor
3. Cystoscopy-visualize lining of bladder