renal conditions Flashcards
Renal colic: Presentation
Acute severe flank pain
pain radiating to groin
nausea
vomiting
dysuria
haematuria
urgent and frequent urination
Renal Colic: Pathophysiology
Plaques form in the nephron, these plaques are formed of calcium phosphate and apatite. These plaques erode and form a surface which calcium oxalate can nucleate on and from crystals. These are the stones which can cause obstruction as well as stretching of the nephron. this stretching puts pressure on nerves which causes pain.
Renal Colic: Differentials
Abdominal aortic aneurysm
Appendicitis
Pancreatitis
Ovarian cyst
Ectopic pregnancy
Renal Colic: risk factors
Drug/alcohol misuse
Renal disease
Dehydration
Diabetes
Atherosclerosis
Hypertension
Diet high in salt
Family Hx
Gender male
Renal Colic: treatment and management
- referral to urological clinic within 24 hours
- analgesia for pain (non steroidal anti-inflammatory and morphine)
- watchful waiting if asymptomatic and stone is 5-10mm
-pts admitted if no improvement with 1hr analgesia and antiemetics, severe dehydration and vomiting, older than 60, risk of kidney failure.
Acute Urinary retention: Presentation
Oliguria
Decreased stream force
fever
flank pain
tachypnoea
tachycardia
hypertension
Acute urinary retention: Pathophysiology
obstructive uropathy is obstruction of urinary flow at any point in the urinary tract. this can be unilateral or bilateral. Blockage or dysfunction prevents urine flow and causes fluid back up in kidneys. this increases pressure which decreases glomerular flow rate, renal blood flow and increases the activity of the renin/angiotensin system. Atrophy and apoptosis of renal tissue occurs and functions decrease including water and sodium reabsorption and potassium and urea excretion.
unilateral causes for AUR
ureteral blockage
renal colic
kidney disease or injury
retroperitoneal disorder
Bilateral causes for AUR
Urethral blockage
Bladder dysfunction
pelvic trauma
prostate inflammation (BPH)
AUR: risk factors
BPH
constipation
renal colic
spinal/nervous illness
Parkinson’s
pregnancy
AUR: Treatment and management
alpha blockers to reduce inflammation and relax tissues in prostate and bladder neck.
Always suspect sepsis especially with UTI.
urology referral
Antibiotics if infection present
analgesia if renal colic is a cause
urgency depends on distress and presence of infection
catheter in hospital
acute kidney injury: Pathophysiology
sudden interruption of renal function due to prerenal, intrarenal or postrenal causes. Prerenal is a lack of perfusion to the kidneys due to hypovolemia, obstruction, heart failure. Intrarenal is damage to the filtering systems normally due to necrosis. Postrenal is bilateral obstruction causing the back up of fluid into the ureters and kidneys.
lack of kidney function means urine is not produced properly and water and sodium are not reabsorbed into the bloodstream efficiently.
AKI: signs and symptoms
oliguria - however many patients are not.
hypotension
lethargy or coma
flat neck veins
dry mucus membranes
heart failure symptoms
AKI: risk factors
age
kidney disease
diabetes mellitus
sepsis
dehydration
haemorrhage
trauma
pancreatitis
renal colic
AKI: differentials
AUR
chronic kidney disease presentation
drug side effects
AKI: treatment and management
priority is treating hypovolemia and correcting electrolyte imbalances
IV fluid bolus of 500ml over 15 minutes
CONSIDER sepsis as a cause
treat hyperkalaemia and acidosis
transfer for treatment of cause
Haematuria: pathophysiology
may result from structural alterations, anticoagulatory drugs, immune/inflammatory causes or trauma.
can be microscopic or macroscopic.
Common symptoms alongside haematuria
fever
abdominal/flank/back pain
oedema
urinary symptoms
causes of haematuria
STI
benign prostate hyperplasia
lower UTI
renal colic
trauma
cancer
pyelonephritis
pyelonephritis
Kidney infection caused by bacteria travelling from the bladder to one or both kidneys
