Urogenital Pathology - Urinary System

Question 1

Murphy’s Percussion

Answer 1

Test for costo- vertebral tenderness, used to rule out involvement of the kidney and assess for pseudo renal pain. Positive if patient feels a sharp pain, RED FLAG!
Positive → Inflamed, infected kidney.

Question 2

Common Signs of Urinary Tract Problems

Answer 2

• Urinary frequency, urgency, incontinence
• Pain (shoulder, back, flank, pelvis, lower abdomen)
• Costovertebral tenderness
• Fever and chills
• Increase of sensitivity
• Dysuria: pain or discomfort during urination
• Hematuria: blood in the urine
• Pyuria: urinal test: increase presence of white cells
• Dyspareunia: pain during intercourse
• Nocturia: need to urinate during the night

Question 3

Urinary Tract Infection - Types

Answer 3

Pyelonephritis: affects kidneys
Cystitis: affects urinary bladder
Urethritis: Urethra
Upper UTIs: Kidneys or ureteral infection
Lower UTIs: Bladder or urethral infection

Question 4

Urinary Tract Infection - Etiology and Risk Factors

Answer 4

• Age
• Women greater than men
• Immobility/inactivity (impaired bladder emptying)
• Increased sexual activity
• Prostatic hyperplasia
• Malformations or urinary tract abnormalities
• Pregnancy
• Diabetes mellitus
menopause without hormone replacement therapy
Renal calculi

Question 5

Cystitis and Urethritis Clinical Manifestation

Answer 5

• Cystitis: inflammation with infection of the bladder
• Interstitial cystitis: inflammation without infection of the
bladder
• Urethritis: inflammation and infection of the urethra

Question 6

Cystitis and Urethritis Symptoms

Answer 6

Frequency, urgency, dysuria, nocturia
Fever, chills, and malaise may be present
May notice: - Cloudy, bloody, or foul-smelling urine and a burning or painful sensation during urination or intercourse.
- Pain in suprapubic, lower abdominal, groin, or flank areas, depending on location of infection.

Question 7

Upper Urinary Tract Infection - Most Common

Answer 7

• Acute pyelonephritis: infectious process involving the kidneys.
• Chronic pyelonephritis: inflammatory disease involving the kidney parenchyma and renal pelvis.
• Acute and chronic glomerulonephritis: inflammation of the glomeruli of both kidneys.

Question 8

Pyelonephritis - Clinical Manifestation Acute vs. Chronic

Answer 8

Acute pyelonephritis is usually abrupt:
Fever, chills, malaise, headache, and flank pain.
May have a positive murphy sign and bladder irritation.
Chronic pyelonephritis: vary depending upon the cause, may have no symptoms. Diagnosis by laboratory detection of kidney function changes.

Question 9

Renal Cancer - Risk Factors

Answer 9

3-4% of cancers. 90% renal cancers are renal cell carcinoma.
Tobacco smoking, moderate to heavy drinking (alcohol),obesity, hypertension, barbecued meat, occupational exposure to substances such as dust…

Question 10

Renal Cancer - Clinical Manifestation

Answer 10

• Flank pain
• Hematuria (blood in urine) 50% of cases
• Palpable abdominal mass
  Generally silent, especially in beginning.
  May develop malaise, anemia and unexplained weight loss (RED FLAG!).
  Can influence hormones: PTH, gonadotropins, renin, glucagon and insulin.

Question 11

Renal Cystic Disease - Definition

Answer 11

Renal cyst: cavity filled with fluid or renal tubular elements making up a semisolid material. Can lead to degeneration of renal tissue and obstruction of tubular flow.

Question 12

Renal Cystic Disease - Classifications

Answer 12

• Polycystic kidney disease (PKD): requires dialysis and renal transplantation.
• Cystic diseases of the renal medulla
• Acquired cystic disease: secondary to dialysis, diabetes or glomerulonephritis
• Single cyst: Most common and usually do not produce symptoms or compromise renal function
• Cystic renal dysplasia
• Miscellaneous renal cystic disorders.

Question 13

Polycystic Kidney Disease - Clinical Manifestation/Symptoms

Answer 13

Hereditary, cysts often asymptomatic.
Signs and Symptoms:
- Hematuria, fever, and hypertension
- Abdominal or flank pain (most common symptom)
- Significantly enlarged kidneys, palpable abdominally

Question 14

Renal Calculi - Definition

Answer 14

Urinary stone disease or nephrolithiasis.
Formed inside the kidney, travels down urinary tract and released with urine. Extremely painful. Can’t locate the pain exactly because it is moving with the stone. Can get stuck.

Question 15

Renal Calculi - Obstruction

Answer 15

Urinary obstruction typically occurs on three sites:

• the ureteropelvic junction
• where the ureter crosses over the iliac vessels
• at the ureterovesical junction

Question 16

Renal Calculi - Clinical Manifestation

Answer 16

Severe pain, unable to find comfortable position, moving pain. Positive murphy sign.
Hematuria in more than 90%.
Symptoms consistent with a UTI such as urinary urgency and frequency and dysuria.
Nausea and vomiting may also be manifest.

Question 17

Chronic Kidney Disease - Definition and Cause

Answer 17

Alteration of kidney function or structure for a duration of 3 months.
Can be caused by:
- Diabetes (44%)
- Hypertension (27%)
- Glomerulonephritis (8%)
- Cystic kidney disease and other urologic diseases (5%)
- Excessive aspirin or acetaminophen use (Rest)
End stage renal disease: final stage of CKD, need dialysis or kidney transplant.

Question 18

Chronic Kidney Disease - Systemic Manifestation

Answer 18

Can cause multiple symptoms from many different systems:
Urinary: decreased urinary output, abnormal urinary constituents, abnormal blood serum level.
Cardiopulmonary: hypertension, congestive heart failure, pulmonary edema, dyspnea.
GI tract: bleeding, nausea, vomiting, anorexia.
Central and peripheral nervous system, endocrine, skeletal…

Question 19

Chronic Kidney Disease - Prevention

Answer 19

Improving glycemic control, preventing hypertension, preventing coronary artery disease, increasing physical activity, and reduce or stop smoking.

Question 20

Renal Pain - Location and Description

Answer 20

Posterior subcostal and costovertebral region, usually unilateral. Radiates forward, around flank, down to the groin. May have ipsilateral shoulder pain.
Dull, aching, boring, constant pain.
Acute: severe, intense. Chronic: vague, poorly localized.

Question 21

Renal Pain - Associated Signs and Symptoms

Answer 21

Positive murphy sing.
Fever, chills.
Increased urinary frequency, blood in urine.
Hypersensitivity in T9, T10.
Abdominal pain and muscle spasm, nausea and vomiting (severely acute).
Ipsilateral testicular pain
UNRELIEVED BY A CHANGE IN POSITION.

Question 22

Pseudo-Renal Pain - History

Answer 22

Not a kidney problem, but pain very similar.
Trauma, straining, lifting, accident or other mechanical injury to thoracic spine.
Associated signs and symptoms are none. Murphy’s sign negative, no change in bowel or bladder activity.

Question 23

Pseudo-Renal Pain - Pain Pattern

Answer 23

• Back and/or flank pain occur at the same level as the
kidney
• Affected by change in position!
• Lying on the involved side increases pain
• Prolonged sitting increases pain
• Symptoms are reproduced with movements of the
spine
• Costovertebral angle tenderness present on palpation

Question 24

Ureter Pain - Location and Description

Answer 24

Costovertebral angle. More in hip area compared to renal pain. Unilateral or bilateral.
Radiates to lower abdomen, upper thigh, testis, or
labium on the same side.
Excruciating severe pain (stones are passing or get stuck)
Constant pain until treated or stone is passed.

Question 25

Ureter Pain - Associated Signs and Symptoms

Answer 25

Painful rectal cramps.
Nausea, abdominal distension, vomiting.
Hypersensitivity T10-L1, tenderness over kidney or ureter.
UNRELIEVED BY A CHANGE IN POSITION.

Question 26

Bladder/Urethra Pain - Description and Associated Signs and Symptoms

Answer 26

Suprapubic or low abdomen, low back, pelvis
Sharp, localized, moderate-to-severe pain.
Intermittent; may be relieved by emptying the bladder.
Great urinary urgency
Tenesmus (cramping rectal pain)
Dysuria
Hot or burning sensation during urination!