Urinary Tract Infection (Kidneys etc)

Question 1

What is the definition of proteinuria?

Answer 1

Urinary protein excretion >150mg/day

Question 2

What are the three types of haematuria?

Answer 2

Visible
Microscopic
Dip stick positive

Question 3

What is the definition of microscopic haematuria?

Answer 3

≥3 red blood cells per high power field

Question 4

What is the definition of oliguria?

Answer 4

Urine output <0.5ml/kg/hour

Question 5

What is the definition of polyuria?

Answer 5

Urine output >3L/24 hours

Question 6

What are the two types of anuria?

Answer 6

Absolute anuria - No urine output

Relative anuria - <100ml/24 hours

Question 7

What is the definition of nocturia?

Answer 7

Waking up at night ≥1 occasion to micturate

Question 8

What is the definition of nocturnal polyuria?

Answer 8

> 1/3 of total urine output in 24 hours

Question 9

What is the presentation of chronic kidney disease?

Answer 9

Asymptomatic (found on blood and urine testing)
Tiredness
Anaemia 
Oedema
High blood pressure
Bone pain due to renal bone disease
Pruritus (in advanced renal failure)
Nausea/vomiting (in advanced renal failure)
Dyspnoea (in advanced renal failure)
Pericarditis (in advanced renal failure)
Neuropathy (in advanced renal failure)
Coma (untreated advanced renal failure)

Question 10

What are some causes of ureteric disease?

Answer 10

Infection - ureteritis
Iatrogenic/Trauma - inadvertently cut or tied during hysterectomy or colon resection
Neoplasia - TCC of ureter, TCC of bladder obstructing VUJ, prostate cancer obstructing VUJ, pelvic malignancy, pelvic or para-aortic lymphadenopathy
Hereditary - PUJ obstruction, VUJ reflux
Obstruction - intra-luminal (stone, blood clot)
- intra-mural (scar tissue, TCC)
- extra-luminal (pelvic mass, lymph nodes)

Question 11

What is the presentation of ureteric disease?

Answer 11

Pain (eg. renal colic)
Pyrexia
Haematuria
Palpable mass (ie. hydronephrosis)
Renal failure (only if bilateral obstruction or single functioning kidney)

Question 12

What are some causes of bladder disease?

Answer 12

Infection - cystitis
Inflammation - interstitial cystitis, colonic diverticulitis resulting in colo-vesical fistula
Iatrogenic/Trauma - bladder rupture, bladder injury from hysterectomy (resulting in vesico-vaginal fistula)
Neoplasia - TCC of bladder, squamous cell carcinoma of bladder
Idiopathic - overactive bladder syndrome
Degenerative - chronic urinary retention
Neurological - neurogenic bladder dysfunction

Question 13

What is the presentation of bladder disease?

Answer 13

Pain (suprapubic)
Pyrexia
Haematuria
Lower urinary tract symptoms (LUTS)
- storage LUTS (i.e. frequency, nocturia, urgency, urge incontinence)
- voiding LUTS (i.e. poor flow, intermittency, terminal dribbling) – due to underactive bladder
- incontinence (stress, urge, mixed, overflow, neurogenic, dribbling, etc.)
Recurrent UTIs
Chronic urinary retention (due to bladder underactivity)
Urinary leak from vagina (i.e. vesico-vaginal fistula)
Pneumaturia (i.e. colo-vesical fistula)

Question 14

What are the three controls of microurition?

Answer 14

Cortical centre (bladder sensation and conscious inhibition of micturition)

Pons (micturition centre)

Sacral segments (S2-S4) (micturition reflex):

- relaxation of internal urethral sphincter (autonomic - sympathetic)
- relaxation of external urethral sphincter (somatic)
- contraction of detrusor muscle (autonomic – parasympathetic)

Question 15

What are some causes of bladder outflow diseases?

Answer 15

Infection/Inflammation - prostatitis, balanitis
Iatrogenic/Trauma - pelvic floor damage after traumatic vaginal delivery or hysterectomy, urethral injury from catheterisation or pelvic fracture
Neoplasia - prostate cancer, penile cancer
Idiopathic - chronic pelvic pain syndrome
Obstruction - primary bladder neck obstruction
- benign prostatic enlargement (BPE) causing obstruction
- urethral stricture
- meatal stenosis
- phimosis

Question 16

What is the presentation of bladder outflow diseases?

Answer 16

Pain (suprapubic or perineal)
Pyrexia
Haematuria
Lower urinary tract symptoms (LUTS)
	- voiding LUTS (i.e. hesitancy, intermittency, poor flow, terminal dribbling, incomplete bladder emptying) due to Bladder Outflow Obstruction (BOO)
	- overflow incontinence (high-pressure chronic urinary retention)
	- stress urinary incontinence
Recurrent UTIs
Acute urinary retention
Chronic urinary retention

Question 17

What is the definition of acute urinary retention?

Answer 17

Painful inability to void with a palpable and percussible bladder
Residuals vary from 500ml to >1 litre depending on time lag in seeking medical attention
Main risk factor is Benign Prostatic Obstruction (BPO)

Question 18

What are some complications of acute urinary retention?

Answer 18

UTI, post-decompression haematuria, pathological diuresis, renal failure, electrolyte abnormalities

Question 19

What is the definition of chronic urinary retention?

Answer 19

Painless, palpable and percussible bladder after voiding

Patients often able to void but with residuals ranging from 400ml to >2 litres depending on stage of condition

Question 20

Name six organisms associated with UTI

Answer 20

E. coli 
Staph. saprophyticus 
Klebsiella 
Proteus 
Pseudomonas
Staph aureus

Question 21

What are predisposing factors for getting UTI?

Answer 21

Female sex (short urethra)
Sexual intercourse and poor voiding habits
Congenital abnormalities e.g. duplex kidney
Stasis of urine e.g. due to poor bladder emptying
Foreign bodies eg catheters, stones
Oestrogen deficiency in postmenopausal women
Fistula between bladder & bowel

Question 22

What is strangury?

Answer 22

A condition caused by blockage or irritation at the base of the bladder, resulting in severe pain and a strong desire to urinate

Question 23

What symptoms are found in children with UTI?

Answer 23

Diarrhoea	
Excessive crying
Fever
Nausea and vomiting
Not eating

Question 24

What is the treatment for UTI?

Answer 24

Fluids
Antibiotics
-Amoxicillin 
-Cephalosporin
-Trimethoprim
Severe infections
-Intravenous antibiotics