Renal Disorders 2 Flashcards
Renal sensory innervation
- not completely understood
- kidney capsule and lower portions of nephrons seem to cause pain with stretching or puncture
Both visceral and sensory fibers enter the SC in close proximity and converge on some of the same neurons. What occurs and why is this important?
- get concurrent stimulation
- visceral pain can be felt as though it is skin pain
- usually felt throughout T10-L1 dermatomes
Where else is renal pain felt aside from dermatomes?
- posterior subcostal region
- costovertebral region
Where is ureteral pain felt?
- groin
- genitals
Flank pain wrapping around to lower abdominal quadrant may be felt from
- kidneys
- ureters
upper urinary tract: referral pain options
Variety of options depending on underlying pathology
- diaphragm
- shoulder
- iliopsoas
- TrPs in detrusor muscle
upper urinary tract: typical pain presentation
- mm spasm with rebound tenderness
- gen’l diffuse pain
- aching and dull
- can be severe, boring type of pain
- not usually relieved by positional change
Urethra is innervated by
Pudendal nerve (both sensory and motor fibers)
Pain from lower urinary tract is felt where?
- above the pubis
- low in the abdomen
Lower urinary tract pain: characterized as
- urinary urgency
- dysuria
Lower urinary tract: sensory receptors are present in
- mucosa of bladder
- muscular bladder walls
Who gets UTI’s?
- very common, all ages
- esp young women
UTI: urethra
Urethritis
UTI: bladder
Cystitis
Clinical manifestations of UTI
- ipsilateral lumbar/shoulder pain
- may also just see gen’l lumbar pain
UTI: screen should include
Questions about urination patterns and quality of urine
What may be seen with UTIs in addition to the lumbar/shoulder pain issues?
Constitutional sx:
- fever/chills
- malaise
- anorexia
- mental status changes
Many hospital admissions find UTI as a base cause*
Pyelonephritis
- frequently a sequelae of UTI
- usually unilateral lumbar pain and at costovertebral angle (murphy’s sign)
- chronic infection may cause scarring and eventually lead to ESRD
Risk factors for UTI
- immobility/inactivity
- urinary catheterization
- atonic bladder (SCI)
- spermicide in condoms or diaphragms
- presence/hx of obstructions
- constipation
- DM
- partners of viagra users
Why would partners of viagra users potentially be at risk for UTI?
Increased frequency of intercourse
Most common s/s of UTI
- urinary frequency, urgency, incontinence
- nocturia
- pain
- fever/chills
- costovertebral tenderness
Costovertebral tenderness with UTI = this sign
Murphy’s sign
Why do we get costovertebral tenderness with UTI?
Location of the kidneys
Cystitis =
Inflammation with infection of the bladder
Interstitial cystitis
Inflammation of the bladder without infection
Aka painful bladder syndrome
S/s of interstitial cystitis
- recurring pelvic pain
- pressure
- discomfort in bladder and pelvis
Other associated dx’s with interstitial cystitis
- allergies
- IBS
- fibromyalgia
Urethritis
Inflammation and infection of the urethra
Any client presenting with sx associated with infection/inflammation should
Be referred to physician for follow up b/c of the possibility of upward spread and resultant kidney damage
