Renal Disorders 2

Question 1

Renal sensory innervation

Answer 1

• not completely understood

- kidney capsule and lower portions of nephrons seem to cause pain with stretching or puncture

Question 2

Both visceral and sensory fibers enter the SC in close proximity and converge on some of the same neurons. What occurs and why is this important?

Answer 2

• get concurrent stimulation
• visceral pain can be felt as though it is skin pain
• usually felt throughout T10-L1 dermatomes

Question 3

Where else is renal pain felt aside from dermatomes?

Answer 3

• posterior subcostal region

- costovertebral region

Question 4

Where is ureteral pain felt?

Answer 4

• groin

- genitals

Question 5

Flank pain wrapping around to lower abdominal quadrant may be felt from

Answer 5

• kidneys

- ureters

Question 6

upper urinary tract: referral pain options

Answer 6

Variety of options depending on underlying pathology

• diaphragm
• shoulder
• iliopsoas
• TrPs in detrusor muscle

Question 7

upper urinary tract: typical pain presentation

Answer 7

• mm spasm with rebound tenderness
• gen’l diffuse pain
• aching and dull
• can be severe, boring type of pain
• not usually relieved by positional change

Question 8

Urethra is innervated by

Answer 8

Pudendal nerve (both sensory and motor fibers)

Question 9

Pain from lower urinary tract is felt where?

Answer 9

• above the pubis

- low in the abdomen

Question 10

Lower urinary tract pain: characterized as

Answer 10

• urinary urgency

- dysuria

Question 11

Lower urinary tract: sensory receptors are present in

Answer 11

• mucosa of bladder

- muscular bladder walls

Question 12

Who gets UTI’s?

Answer 12

• very common, all ages

- esp young women

Question 13

UTI: urethra

Answer 13

Urethritis

Question 14

UTI: bladder

Answer 14

Cystitis

Question 15

Clinical manifestations of UTI

Answer 15

• ipsilateral lumbar/shoulder pain

- may also just see gen’l lumbar pain

Question 16

UTI: screen should include

Answer 16

Questions about urination patterns and quality of urine

Question 17

What may be seen with UTIs in addition to the lumbar/shoulder pain issues?

Answer 17

Constitutional sx:

• fever/chills
• malaise
• anorexia
• mental status changes

Many hospital admissions find UTI as a base cause*

Question 18

Pyelonephritis

Answer 18

• frequently a sequelae of UTI
• usually unilateral lumbar pain and at costovertebral angle (murphy’s sign)
• chronic infection may cause scarring and eventually lead to ESRD

Question 19

Risk factors for UTI

Answer 19

• immobility/inactivity
• urinary catheterization
• atonic bladder (SCI)
• spermicide in condoms or diaphragms
• presence/hx of obstructions
• constipation
• DM
• partners of viagra users

Question 20

Why would partners of viagra users potentially be at risk for UTI?

Answer 20

Increased frequency of intercourse

Question 21

Most common s/s of UTI

Answer 21

• urinary frequency, urgency, incontinence
• nocturia
• pain
• fever/chills
• costovertebral tenderness

Question 22

Costovertebral tenderness with UTI = this sign

Answer 22

Murphy’s sign

Question 23

Why do we get costovertebral tenderness with UTI?

Answer 23

Location of the kidneys

Question 24

Cystitis =

Answer 24

Inflammation with infection of the bladder

Question 25

Interstitial cystitis

Answer 25

Inflammation of the bladder without infection

Aka painful bladder syndrome

Question 26

S/s of interstitial cystitis

Answer 26

• recurring pelvic pain
• pressure
• discomfort in bladder and pelvis

Question 27

Other associated dx’s with interstitial cystitis

Answer 27

• allergies
• IBS
• fibromyalgia

Question 28

Urethritis

Answer 28

Inflammation and infection of the urethra

Question 29

Any client presenting with sx associated with infection/inflammation should

Answer 29

Be referred to physician for follow up b/c of the possibility of upward spread and resultant kidney damage