The Urinary System and the Male Genital Tract Flashcards
Urinary tract infections
Very common disorder of the urinary tract
Risk factors include: Females>males Sexual intercourse Pregnancy Diabetes Urinary tract obstructions e.g. stones or catheters
Bacterial causes of UTIs
E.coli is the most common causative organism (>70% of community UTIs).
Other organisms include: Staphylococcus, Proteus and Klebsiella.
Cystitis
frequency
dysuria
urgency
haematuria and super pubic pain
dysuria
painful or difficult urination
pyelonephritis
high fever
rigors
vomiting
loin pain and tenderness
Prostatitis
flu-like symptoms
few urinary symptoms
swollen tender prostate on PR
Management of UTIs
Drink plenty of fluids.
Urinate often (double voiding).
Antibiotics (trimethoprim usually first line treatment in uncomplicated UTIs).
Imaging – US in non-resolving UTIs, children, men and pyelonephritis.
Severe cases may require hospital admission specially pyelonephritis and in the elderly
Function of Kidneys
Maintinance of water, electrolyte and acid-base homeostasis.
Excretion of many toxic metabolic waste products (urea and creatinine).
Hormonal function
Renin – help control blood pressure
Erythropoietin- stimulates production of RBCs in the bone marrow and helps in the production of vitamin D.
The functional unit is the nephron (consisting of a glomerulus and a renal tubule).
Filtration of most small molecules from the blood in the glomerulus.
Selective reabsorption in the renal tubule of most of the water and some molecules.
Maintenance of the acid-base balance.
Acute renal failure
A significant deterioration in renal function occurring over hours or days
There is a low urine volume (
Causes of Acute renal failure
Pre-renal
Hypoperfusion, sepsis
Renal
ATN damage to tubules due to ischaemia or nephrotoxins
Post-renal
Renal tract obstruction (eg stones, tumours)
Management of acute renal failure
Find and treat the cause
Treat exacerbating factors ( hypovolaemia, sepsis.. etc).
Stop nephrotoxic drugs ( NSAIDs, ACE-I, gentamycin and Vancomycin)
May need renal replacement therapy (haemofiltration/dialysis)
Chronic renal failure
Classified into 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 by stage 4
common causes of chronic renal failure
Glomerulonephritis Diabetes Renovascular disease Hypertension Polycystic disease
management of chronic renal failure
Managed under nephrology team. Treat reversible causes. Avoid exacerbating factors, avoid nephrotoxic drugs.
May progress to renal replacement therapy
Glomerulonephritis
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 deposition of immune complexes in one part of the nephron
Kidney stones
Crystal aggregates that form in the collecting ducts of the kidneys and can deposit anywhere in the renal tract.
Life time incidence 15%
Peak age 20-40 years.
Male: female = 3:1
Risk factors for kidney stones
Dehydration
Dietary factors ( increase chocolates, tea and rhubarb)
Drugs ( loop diuretics, antacids, corticosteroids, theophylline and aspirin)
Renal tract abnormalities
Recurrent UTIs
Metabolic abnormalities (hyperparathyroidism, hyperthyroidism and cancer)
symptoms kidney stones
Patient may be asymptomatic (found accidently on x-ray or blood on dipstick ).
Pain. Kidney stones causes loin pain. Ureteric stones case renal colic (from loin to groin). Bladder and urethral stones cause pain on micturition with interrupted flow. Patients often can’t lie still from the pain.
management of kidney stones
Imaging options: KUB-xray (80% of stones are visible). CT scan (99% of stones visible).
Prompt pain relief
Stones 5mm or causing obstruction may need intervention
renal cancer
Renal cell carcinoma
85% of all renal cancers.
Usually presents between the ages of 50 and 70 years.
2:1 male predominance .
Smoking an important risk factor along with obesity, hypertension, exposure to asbestos and certain hereditary conditions.
renal cancer presentation
50% incidental findings on abdominal imaging.
Haematuria.
Loin pain.
Abdominal mass.
Para neoplastic syndromes: e.g. polycythaemia, hypercalcaemia and hypertension.
treatment of renal cancer
Radical nephrectomy +/- chemotherapy
Transitional Cell Carcinoma presentation
Classically – painless haematuria
Frequency, urgency and dysuria can occur.
Transitional Cell Carcinoma tests
Urine for cytology
Cystoscopy and biopsy
