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Urinary System > Lecture 9: Presentations of Diseases of the Kidneys and Urinary Tract > Flashcards

Lecture 9: Presentations of Diseases of the Kidneys and Urinary Tract Flashcards

1
Q

which structures compose the upper urinary tract?

A

Kidneys:
- parenchyma
- pelvi-calyceal system

Ureters:
- pelvi-ureteric junction
- ureter
- vesico-ureteric junction

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2
Q

which structures compose the lower urinary tract?

A
  • bladder
  • IUS
  • prostate (men)
  • EUS
  • urethra
  • urinary meatus
  • foreskin (men)
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3
Q

aetiology of renal diseases

A
  • infection: pyelonephritis
  • inflammation: glomerulonephritis, tubulointerstitial nephritis
  • iatrogenic: nephrotoxicity, PCNL
  • neoplasia: renal tumours, collecting system tumours
  • trauma: blunt trauma
  • vascular: atherosclerosis, hypertension, diabetes
  • hereditary: polycystic kidney disease, nephrotic syndrome
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4
Q

clinical presentation of renal disease

A
  • pain
  • pyrexia
  • haematuria
  • proteinuria
  • pyuria (pus in urine)
  • mass on palpation
  • renal failure
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5
Q

what is considered proteinuria?

A

urinary protein excretion > 150mg/day

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6
Q

in clinical practise, how many types of haematuria are there?

A

three

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7
Q

what is considered microscopic haematuria?

A

> /= 3 red blood cells per high power field

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8
Q

what is considered oliguria?

A

urine output < 0.5ml/kg/hr

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9
Q

what is considered anuria? absolute and relative

A
  • absolute anuria: no urine output
  • relative anuria: < 100ml/24 hours
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10
Q

what is considered polyuria?

A

urine output > 3L/24 hours

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11
Q

what is considered nocturia?

A

waking up at night >/= 1 occasion to micturate

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12
Q

what is considered nocturnal polyuria?

A

nocturnal urine output >1/3 total urine output in 24 hours

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13
Q

which factors should be excluded when investigating polyuria and polydipsia?

A
  • chronic renal failure
  • hypokalaemia
  • hyperglycaemia
  • hypercalcaemia
  • thyrotoxicosis
  • diuretics
  • diet
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14
Q

presentation of chronic renal failure

A
  • asymptomatic (found on blood and urine testing)
  • tiredness
  • anaemia
  • oedema
  • high blood pressure
  • bone pain due to renal bone disease

in advanced renal failure:
- pruritus
- nausea/vomiting
- dyspnoea
- pericarditis
- neuropathy
- coma (untreated)

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15
Q

presentation of ureteric disease

A
  • pain (e.g. renal colic)
  • pyrexia
  • haematuria
  • palpable mass (i.e. hydronephrosis)
  • renal failure (only if bilateral obstruction or single functioning kidney)
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16
Q

presentation of bladder diseases

A
  • pain (suprapubic)
  • pyrexia
  • haematuria
  • recurrent UTIs
  • chronic urinary retention
  • urinary leak from vagina (i.e. vesico-vaginal fistula)
  • pneumaturia (i.e. colo-vesical fistula)

Lower urinary tract symptoms:
- storage i.e. frequency, nocturia, urgency, urge incontinence
- voiding i.e. poor flow, intermittency, terminal dribbling - due to underactive bladder
- incontinence i.e. stress, urge, mixed, overflow, neurogenic, dribbling etc.

17
Q

what is the risk of bladder cancer in patients with macroscopic haematuria?

A

25-30%

18
Q

what is the risk of renal cancer in a patient who presents with macroscopic haematuria?

A

0.5-1%

19
Q

list the possible causes of lower urinary tract symptoms (LUCTS) i.e. voiding LUTS, storage LUTS, incontinence polyuria etc.

A
  • bladder pathology: OAB, UTI, interstitial cystitis, bladder cancer
  • bladder outflow obstruction
  • pelvic floor dysfunction
  • neurological causes: supra-pontine lesions (e.g. stroke, alzheimer;s, parkinson’s), infra-pontine supra-sacral lesions (e.g. spinal cord injury, disc prolapse, spina bifida), infra-sacral lesions (e.g. MS, diabetes, cauda equina compression, surgery to tetroperitoneum)
  • systemic disorders: chronic renal failure, cardiac failure, diabetes mellitus, diabetes insipidus)
20
Q

list the areas of the CNS involved in controlling micturition

A

1) cortical centre (bladder sensation and conscious inhibition of micturition)
2) pons (micturition centre)
3) sacral segments (S2-S4) (micturition reflex) causing:
- relaxation of IUS
- relaxation of EUS
- contraction of detrusor muscle

21
Q

presentation of bladder outflow tract diseases

A
  • pain (suprapubic or perineal)
  • pyrexia
  • haematuria
  • LUTS
  • recurrent UTIs
  • acute urinary retention
  • chronic urinary retention
22
Q

define acute urinary retention

A

painful inability to void urine with palpable and percussible bladder

23
Q

aetiology of acute urinary retention

A
  • main risk factor: benign prostatic obstruction (BPO)
  • UTI
  • urethral stricute
  • alcohol excess
  • post-op causes
  • acute surgical or medical problems
24
Q

what is the immediate treatment for acute urinary retention?

A

catheterisation

25
Q

define chronic urinary retention

A
  • painless, palpable and percussible bladder after voiding
  • patiebts often able to void but with residuals ranging from 400ml to >2 litres depending on stage of condition.
26
Q

what is the main aetiological factor in chronic urinary retention?

A

detrusor muscle underactivity which can be primary (i.e. primary bladder failure) or secondary (i.e. due to longstanding bladder outflow obstruction, such as BPO or urethral stricture)

27
Q

chronic urinary retention presentation

A
  • LUTS
  • complication e.g. UTI, bladder stones, overflow incontinence, post-renal or obstructive renal failure
  • asymptomatic, incidental finding
28
Q

in high-pressure chronic urinary retention, which two types of diuresis may occur?

A
  • physiological (usually < 200ml/hr)
  • pathological (usually > 200ml/hr)
29
Q

treatment of chronic urinary retention

A
  • immediate: catheterisation
  • subsequent: long-term urethral or suprapubic catheter, CISC or TURP if due to benign prostatic obstruction (BPO)
30
Q

what does a diagnosis of a UTI require?

A
  • microbiological evidence: bacteral count of 10^4 cfu/ml from MSSU specimen with no more than two species of micro-organisms.
  • symptoms/signs, at least one of the following: fever > 38, loin/flank pain or tenderness, suprapubic pain or tenderness, urinary frequency, urinary urgency, dysuria
31
Q

what are the two types of UTIs?

A
  • uncomplicated UTIs (young sexually active females only with clear relation to sexual activity)
  • complicated UTIs (everyone else, always need to be investigates)
32
Q

complications of UTIs

A
  • infective: sepsis (esp. pyelonephritis), perinephric abscess
  • renal failure (scarring)
  • bladder malignancy (squamous cell carcinoma)
  • acute urinary retention
  • frank haematuria
  • bladder or renal stones
33
Q

UTI investigations

A
  • MSSU/CSU
  • lower tract: flow studies, residual bladder scan, cytoscopy
  • upper tract: USS kidneys, IVU/CT-KUB, MAG-3 renogram, DMSA scan
34
Q

UTI treatment

A
  • appropriate antibiotic therapy (type? duration? route?)
  • treat complications and cause
35
Q

list emergencies related to urinary tract diseases

A
  • acute renal failure
  • sepsis
  • renal colic
  • severe haematuria causing haemorrhagic shock
  • metastatic disease
  • acute urinary retention
  • chronic high-pressure urinary retention
  • iatrogenic injury/trauma to upper or lower urinaru tract, penis and testis
  • testicular torsion
  • paraphimosis
  • priapism
36
Q

list the organisms commonly associated with UTIs

A
  • E.coli
  • Klebsiella species
  • proteus species
  • pseudomonas aeruginosa

Urinary System (21 decks)

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