U (-Z)

Question 1

What are urinary tract abnormalities (UTA)?

Answer 1

Congenital structural abnormality of kidneys, bladder or urethra.

Question 2

What may cause urinary tract abnormalities?

Answer 2

Known as CAKUT, associated with chromosomal abnormalities and PAX2 mutations.

Question 3

What are the renal causes of UTA?

Answer 3

Multicystic dysplastic kidneys
Medullary sponge kidney
Nephronophitosis
Unilateral renal agenesus
Ectopic or horseshoe kidney

Question 4

Define: 
Multicystic dysplastic kidneys
Medullary sponge kidney
Nephronophitosis
Unilateral renal agenesus
Ectopic or horseshoe kidney

Answer 4

· Multicystic dysplastic kidneys: MCDK, renal medullary and hepatic cysts. Early ureteric obstruction.

· Medullary sponge kidney: cystic dilation of the collecting ducts, multiple calculi

· Nephronophitosis: multiple cyst formation at corticomedullary junction with progressive glomerular sclerosis.

· Unilateral renal agenesus: absence of a kidney

· Ectopic or horseshoe kidney: Fusion of lower poles leading to symmetrical or asymmetrical horseshoe.

Question 5

What are the Non-renal causes of UTA?

Answer 5

PUJ obstruction
VUR
Non obstructed non refluxin primary megaureter
Bladder outlet obstruction
Uterterocele
Hypospadias or epispadias

Question 6

Define:
PUJ obstruction
VUR
Non obstructed non refluxin primary megaureter
Bladder outlet obstruction
Uterterocele
Hypospadias or epispadias

Answer 6

· PUJ obstruction: stenosis or stresia of proximal ureter.

· VUR: with associated hydronephrosis, graded 1-4.

· Non obstructed non refluxin primary megaureter: aperistaltic megaureter

· Bladder outlet obstruction: posterior urethral vale malformation, congenital lesion with variable obstruction.

· Uterterocele: Intrabladder hernia ot cystic ballooning at the lower end of ureter.

· Hypospadias or epispadias: abnormal ectopic urethral opening. Ventral is hypo, dorsal is epispadias.

Related to other congenital malformations (cardiac etc)

Question 7

What is the epidemiology of UTA?

Answer 7

3/1k.

Question 8

What are the history and exam findings of UTA?

Answer 8

Antenata: common oligohydramnios, decreased fetal urine output. Pulmonary hypoplasia in severe cases. Antenatal diagnosis of hydronephrosis.

Postnata: intra abdominal masses, UTI, pain, hematuria, calculi, renal failure, HTN, hepatosplenomegaly, liver fibrosis, voiding dysfunction.

Question 9

What investigations do you do for UTA?

Answer 9

USS: non invasive, visualize kidney.

IVUG: Visualise majority of anomalis including VUN/PUV that are not seen in USS.

Nuclear imaging: DMSA and MAG3 for assessment of kidney function and perfusion. Overestimate function in obstructed system.

Question 10

What management do you do for UTA?

Answer 10

General: antenatal scanning and counselling.

Medical: symptom control: BP, Ca, PO4 binders, vitamin D, antibiotics for infections, dialysis if renal failure.

Surgical: treat the cause: eg nephrectomy in MCDK/non funcitoning kidneys, hypospadias correction, pyeloplasty in PUJ obstruciton, PUV or ureterocele puncturing, nephrostomy placement in severe obstruction, suprapubic catheter.

Question 11

What are the complications and prognosis of UTA?

Answer 11

HTN, renal osteodystrophy, URI and calculi.

Most renal anomalies lead to end stage renal failure sooner or later. Pgx good with non renal abnormalities if well managed.

Question 12

What is the definition of urinary tract infection?

Answer 12

Characterised by >1x10^5 colony forming units per mm of urine. May affect bladder (cystitis) or kidney (pyelonephritis) or prostate (prostatitis).

Question 13

What is the aetiology of urinary tract infection?

Answer 13

Usually transurethral ascent of colonic organisms. Most common are E.coli, then Proteus mirabilis, Klebsiella and Enterococci

Question 14

What is the epidemiology of urinary tract infection?

Answer 14

30% of women will have one at some point. More common in pregnant women. Young males with UTIs should be investigated as it is uncommon.

Question 15

What would you find in the history of urinary tract infection?

Answer 15

May be clinically asymptomatic

Cystitis: frequency, urgency, dysuria, haematuria, suprapubic pain, smelly urine

Pyelonephritis (acute): fever, loin pain

Prostatitis: fever, lower back pain, irritative (urgency, frequency) and obstructive (hesitancy, dribbling, poor flow) LUTS.

Elderly: malaise, nocturia, incontinence, confusion.

Question 16

What would you find in the exam of urinary tract infection?

Answer 16

May be asymptomatic.

Cystitis: fever, suprapubic or loin tenderness, bladder distension

Pyelonephritis: fever, loin tenderness

Prostatitis: fever, tender painful prostate.

Question 17

What would you find in the investigations of urinary tract infection?

Answer 17

Mid stream urine investigation for:

· Dipstick test: haematuria, nitrites, proteinuria, leucocytes.

· MCS: >10^5 colonies/ml indicates bacteriuria.

· If there is sterile pyuria (pus cells but no organism) consider malignancy or unresolved UTI.

Imaging in children and young men to exclude predisposing factors.

Question 18

What is the management of urinary tract infection?

Answer 18

Cystitis: if symptomatic, consider microbiological policies (cotrimetazole, trimetopham, amoxicillin win women)

Pyelonepritis: IV gentamicin, cefuroxime or ciproflaxin

Catheterised patients: remove catheter, obtain culture. Donot treat unless symptomatic

Prophylaxis: drinking lots of water and cramberry juice. Frequent UTIs may go on 6m-12m abios.

Surgical: if complicated with stones.

Question 19

What are the complications of urinary tract infection?

Answer 19

Renal papillary necrosis (with underlying renal disease ie. DM or stones)

Renal/paranephric abscess (seen on renal USS)

Pyonephrosis (pus in palvicalyceal system)

Gram negative septicaemia

Question 20

What is the prognosis of urinary tract infection?

Answer 20

Mostly resolve with treatment. Among pregnant women 20% go to acute pyelonephritis if not treated. High relapse rate.