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A2 ME3031 URINARY > W05: Clinical (UTI, Glomerular Disease, Renal and urinary diseases, Urinary Img.) > Flashcards

W05: Clinical (UTI, Glomerular Disease, Renal and urinary diseases, Urinary Img.) Flashcards

1
Q

UTI Presentation

A
  • DYSURIA
  • FREQUENCY
  • SMELLY URINE

+ systemic, failure to thrive
+ incont.

  • infection always ASCENDS = more serious
  • cystitis (bladder), prostatitis; pyelonephritis, orchitis
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2
Q

Investigations of UTI

A

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
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3
Q

Management of UTI

A

> Abx therapy

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4
Q

Renal sterility

A

Bacteriostatic qualities apart from the terminal urethra (skin and gut flora)

thus MSU

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5
Q

MSU

A

slight growth regardless but 10^5 = probably infection

considerations of +/- symptoms

*E. coli

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6
Q

UTI progression & RF

A

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
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7
Q

Significance of paediatric obstruction

A

VESICOURETERIC REFLUX: decreased angulation = urine reflux = hydroureter

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8
Q

Common causes of adult obstruction

A

Men
* benign prostatic hyperplasia

Women
* uterine prolapse

Both

  • tumours
  • calculi
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9
Q

Common glomerular diseases

A

primarily dysfunction affecting podocyte, and mesangial cells

1) GLOMERULONEPHRITIS
2) MEMBRANEOUS GLOMERULONEPHRITIS
3) DIABETIC NEPHROPATHY
4) CRESCENTIC GLOMERULONEPHRITIS

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10
Q

GLOMERULONEPHRITIS

A

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
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11
Q

MEMBRANEOUS GLOMERULONEPHRITIS

A

2) MEMBRANEOUS GLOMERULONEPHRITIS:
albuminuria, IgG deposition between basal lamina and podocyte, C3 recruitment punches holes = nephrotic syndrome

?underlying malignancy

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12
Q

DIABETIC NEPHROPATHY

A

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

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13
Q

CRESCENTIC GLOMERULONEPHRITIS

A

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

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14
Q

Describe the common clinical presentations of diseases of the kidney and urinary tract

A
  • 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

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15
Q

Be able to recognise symptoms and signs of important diseases of the kidney and urinary tract

A

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)
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16
Q

Recognise that some conditions are associated with important complications and sequelae if left untreated

A

a

17
Q

Recognise some common clinical emergencies related to urinary tract diseases

A

Acute retention

Rupture

Sepsis

18
Q

URETERIC DISEASES:

A

infectious origin; trauma (hysterectomy/colon resection); neoplasia; hereditary; obstruction

*pain, pyrexia, haematuria, palpable mass (hydronephrosis)
*

19
Q

Significance of unexplained visible haematuria

A
  • 25-30% bladder cancer risk
20
Q

Neurological causes of LUTS

A
  1. supra-pontine lesion (stroke, AD, PD)
  2. infra-pontine supra-sacral lesions (spinal injury, disc prolapse)
  3. infra-sacral (MS, DM, cauda equina compression)
21
Q

Outflow tract diseases

A

INFECTIOUS/INFLAMM

IATROGENIC/TRAUMA

NEOPLASIA

IDIOPATHIC

OBSTRUCTION

22
Q

Acute urinary retention

A

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

23
Q

Chronic urinary retention

A

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)

24
Q

Describe the role of common radiological and radioisotope tests used in the investigation of renal and urinary tract disorders.

A 
*indications for imaging:
colic or stone disease
haematuria
suspected mass
UTI
HT
  • GOLD STANDARD CT*
  • ct angio
  • visualise stones
  • stage tumours
25
Q

Points of narrowing @ ureters

A

PUJ

Pelvic brim

VU junction - angular

26
Q

ureterocele

A

visualised via USS, swelling at bottom of ureters producing obstruction. birth defect.

27
Q

MRI significance

A

cannot detect calcification and stones but can visualise urothelium

= angiolipoma
= transitional cell tumour
= cysts

28
Q

significance of isotope scans

A

DMSA - renal scarring

MAG3 - renal funct and drainage

bone scan - mets

29
Q

significance of PET

A

limited use due to high uptake of urine

30
Q

interventional radiology

A

stenting of vasculature

A2 ME3031 URINARY (14 decks)

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