W05: Clinical (UTI, Glomerular Disease, Renal and urinary diseases, Urinary Img.) Flashcards
(30 cards)
UTI Presentation
- DYSURIA
- FREQUENCY
- SMELLY URINE
+ systemic, failure to thrive
+ incont.
- infection always ASCENDS = more serious
- cystitis (bladder), prostatitis; pyelonephritis, orchitis
Investigations of UTI
Dx: MSU
- e.coli common
- viral rare
*MICROBIAL EVIDENCE OF 10^4 with no more than 2 species
+ SYMPTOMS: systemic, loin pain, frequency, urgency, dysuria
- bladder scan, cystoscopy, USS kidneys
Management of UTI
> Abx therapy
Renal sterility
Bacteriostatic qualities apart from the terminal urethra (skin and gut flora)
thus MSU
MSU
slight growth regardless but 10^5 = probably infection
considerations of +/- symptoms
*E. coli
UTI progression & RF
with ascension =
* urethritis, cystitis, ureteritis, acute pyelonephritis > chronic
RF: stasis, spinal cord/brain injury, pushing of bact promoting ascension, infection predisp e.g. DM
- obstruction = proximal dilatation and slowed urine flow + infection, calculi formation = vicious cycle
- ACUTE SEPSIS
- CHRONIC renal dmg = HT = renal failure
- CHRONIC HYDRONEPHROSIS (calculi) = HT = renal failure
Significance of paediatric obstruction
VESICOURETERIC REFLUX: decreased angulation = urine reflux = hydroureter
Common causes of adult obstruction
Men
* benign prostatic hyperplasia
Women
* uterine prolapse
Both
- tumours
- calculi
Common glomerular diseases
primarily dysfunction affecting podocyte, and mesangial cells
1) GLOMERULONEPHRITIS
2) MEMBRANEOUS GLOMERULONEPHRITIS
3) DIABETIC NEPHROPATHY
4) CRESCENTIC GLOMERULONEPHRITIS
GLOMERULONEPHRITIS
1) GLOMERULONEPHRITIS: inflamm or non-inflamm
* ig deposition (often mesangial cell + IgA infiltrate)
resulting in matrix expansion = self limiting v chronic sclerosing
* non-immune pathology: DM glomerular disease
- haematuria, heavy/increasing proteinuria, acute renal failure
MEMBRANEOUS GLOMERULONEPHRITIS
2) MEMBRANEOUS GLOMERULONEPHRITIS:
albuminuria, IgG deposition between basal lamina and podocyte, C3 recruitment punches holes = nephrotic syndrome
?underlying malignancy
DIABETIC NEPHROPATHY
3) DIABETIC NEPHROPATHY: glycated molecules deposition = thickened leaky basement + mesangial expansion COMPRESSES CAPILLARIES (no Ig)
* kimmelsteil-wilson lesion = nodule formation from mesangial matrix
> diabetic control
CRESCENTIC GLOMERULONEPHRITIS
4) CRESCENTIC GLOMERULONEPHRITIS: fibrous deposits, key CRESCENT MACROPHAGE influx around glomerular tuft
- WEGENER’S / granulomatosis with polyangitis = vascular inflamm
- ANCA (ab test) which target neutrophils = tissue dmg
- microscopic polyarteritis
- anti-glomerular basement membrane disease
> Cyclophosphamide (Wegener’s) + steroids
Describe the common clinical presentations of diseases of the kidney and urinary tract
- pain, pyrexia, haematuria, proteinuria (>150mg/day), pyuria, mass on palpation, renal failure
- haematuria (visible, microscopic - ≥3rbcs, dipstick+)
- oliguria <0.5ml/kg/hour; anuria; polyuria >3L/24hr; Nocturia
- LUTS: lower tract syndrome STORAGE or VOIDING, INCONTINENCE
d/t bladder path., obstruction, pelvic floor, neurological
-recurrent UTIs
Be able to recognise symptoms and signs of important diseases of the kidney and urinary tract
AKI:
R isk - 1.25x ⇧creatinine or 25%⇩GFR
I njury
F ailure - 3x creatinine, 75%⇩GFR, acute serum creatinine, anuria
L oss - persiistant or complete loss of kidney funct. >4w
E nd-stage - >mos
- fluid overload = oedema, congestive cardiac failure, HT
- anaemia
- bone pain
- adv: pruritus, n/v, dyspnoea, coma (untreated)
Recognise that some conditions are associated with important complications and sequelae if left untreated
a
Recognise some common clinical emergencies related to urinary tract diseases
Acute retention
Rupture
Sepsis
URETERIC DISEASES:
infectious origin; trauma (hysterectomy/colon resection); neoplasia; hereditary; obstruction
*pain, pyrexia, haematuria, palpable mass (hydronephrosis)
*
Significance of unexplained visible haematuria
- 25-30% bladder cancer risk
Neurological causes of LUTS
- supra-pontine lesion (stroke, AD, PD)
- infra-pontine supra-sacral lesions (spinal injury, disc prolapse)
- infra-sacral (MS, DM, cauda equina compression)
Outflow tract diseases
INFECTIOUS/INFLAMM
IATROGENIC/TRAUMA
NEOPLASIA
IDIOPATHIC
OBSTRUCTION
Acute urinary retention
painful inability to void with a palpable and percussible bladder
- RF: Benign Prostatic Obstruction (BPO)
- independent of BPO e.g. trauma/sx, urethral stricture, UTI
> catheter
tx of underlying trigger
Chronic urinary retention
painless, palpable and percussible bladder after voiding
- able to void with residual of up to >2L
- DETRUSOR INACTIVITY (1º)
- 2º to long-standing BPO
- LUTS or complications
- severe: overflow incontinence
*DIURESIS: physiological, pathological (hypovol. risk)
> catheterisation
> prostate resection (if apt)
Describe the role of common radiological and radioisotope tests used in the investigation of renal and urinary tract disorders.
*indications for imaging: colic or stone disease haematuria suspected mass UTI HT
- GOLD STANDARD CT*
- ct angio
- visualise stones
- stage tumours
