The Urinary System

Question 1

What are urinary tract infections? (UTIs)

Answer 1

• Risk factors - female, sex, pregnancy, diabetes, urinary tract obstructions (stones/catherters). - Caused by bacteruria - bacteria in the urine, may be asymptomatic or symptomatic - In urethra - urethritis - in bladder - cystitis (increased frequency, pain.) - in prostate - prostatitis (flu-like symptoms) - in kidney - pyelonephritis (fever, vomiting, pain) - E-coli most common cause (70%), other organisms include staphylococcus, proteus and klebsiella.

Question 2

What disorders affect the kidneys?

Answer 2

• Acute renal failure. - Chronic renal failure. - Glomerulonephritis. - Stones. - Renal Cancer.

Question 3

What is acute renal failure?

Answer 3

• A significant deterioration in renal function occurring over hours or days. - Low urine volume. - Rising plasma urea and creatinine levels. - Can be pre-renal (80%), renal and post-renal. - Causes - 1) pre-renal - hypoperfusion sepsis 2) renal - ATN damage to tubules due to ischaemia or nephrotoxins. 3) post-renal - renal tract obstruction.

Question 4

What is chronic renal failure?

Answer 4

• 5 stages depending on the glomerular filtration rate (GFR). - GFR is the volume of fluid filtered from the glomerular capillaries into the Bowman’s capsule per unit time. - Symptoms usually occur at stage 4. - Causes - glomerulonephritis, diabetes, hypertension, renovascular disease, polycystic disease.

Question 5

What is glomerulonephritis?

Answer 5

• A group of disorders where there is damage to the glomerular filtration apparatus. This may cause a leak of protein or blood into the urine. - Usually there is a disposition of immune complexes in one part of the nephron.

Question 6

What are kidney stones?

Answer 6

• Crystal aggregates that form in the collecting ducts of the kidneys and can deposit anywhere in the renal tract. - Risk factors - dehydration, diet, drugs,renal tract abnormalities,recurrent UTIs, metabolic abnormalities. - Painful - cause loin pain, uretic stones cause renal colic (from loin to groin) bladded and urethral stones cause pain on micturition with interrupted flow. - Treatment - pass spontaneously usually.

Question 7

What is renal cancer?

Answer 7

• Renal cell carcinoma - 85% of all renal cancers. - Presents between ages of 50-70 years. - Smoking, hypertension, asbestos exposure and hereditary conditions are risk factors. - Symptoms - haematuria, loin pain, abdominal mass, paraneoplastic syndrome. - Treatment - radical nephroextomy +/- chemo.

Question 8

What disorders affect the bladder?

Answer 8

• Cystitis - benign. - Transitional cell carcinoma - malignant.

Question 9

What I transitional cell carcinoma?

Answer 9

• Common malignant condition. - Classically - painless haematuria. - Frequency, urgency and dysuria can occur. - Tests - urine for cytology, cystoscopy and biopsy. - Treatment - small lesions can be managed with diathermy or cystoscopy, later stages are treated with radical cystectomy or palliative chemo/radiotherapy.