Presentation of Diseases of the Kidneys and Urinary Tract

Question 1

What is in the upper UT?

Answer 1

Kidneys - parenchyma to the pelvi-calcyceal system

Ureters - Pelvi-ureteric junction to the vesico-ureteric junction

Question 2

What is in the lower UT?

Answer 2

Bladder to the bladder outflow tract all the way to foreskin in males

Question 3

What is the surgical sieve for renal diseases?

Answer 3

Infection
Inflammation
Iatrogenic
Neoplasia
Trauma
Vascular
Hereditary

Question 4

Define proteinuria.

Answer 4

> 150mg/day of protein in urine

Question 5

What is pyuria?

Answer 5

Pus in the urine

Any infection or inflammatory disorder could cause it

Question 6

What is oliguira?

Answer 6

Urine output less than 0.5 ml/kg/hr

Question 7

What is absolute anuria?

Answer 7

No urine output

Question 8

What is relative anuria?

Answer 8

<100mls urine in 24 hours

Question 9

What is polyuria?

Answer 9

Urine output of >3L in 24 hours

Question 10

What is nocturia?

Answer 10

Waking up more than once in a night to pee

Question 11

Nocturnal polyuria?

Answer 11

Peeing a third of total urine output in 24 hours at night time

Question 12

What is AKI?

Answer 12

Acute Kidney Injury

An abrupt loss of kidney function that develops within 7 days

Question 13

Staging for AKI?

Answer 13

RIFLE which is a progressive criteria which stages the severity of the AKI

Question 14

Describe RIFLE

Answer 14

R - risk = 1.5x baseline creatinine or loss of 25% of GRF or UO is less than 0.5 mL/kg/hr for 6 hours

I - injury = Serum creatinine increase by 2x or GFR decrease by 50% or UO is less than 0.5 mL/kg/hr for 12 hours

F - failure = Serum creatinine 3x baseline or GFR loss of 75% or anuria for 12 hours

L - loss = persistent AKI or complete loss of kidney function

E - End stage renal disese

Question 15

What is infection of ureters called?

Answer 15

Ureteritis

Question 16

What types of neoplasia can you get of ureters?

Answer 16

Transitional cell carcinoma of ureter or bladder
Prostate cancer
Pelvic malignancy

Question 17

Name some hereditary urertic diseases.

Answer 17

PUJ obstruction

VUJ reflux

Question 18

Name the types of ureteric obstruction.

Answer 18

Intra-luminal - Stones or blood clots

Intra-mural - Scar tissue or TCC (Transitional Cell Carcinoma)

Extra-luminal - Pelvic mass or lymph nodes

Question 19

Types of pain in urinary disease?

Answer 19

Renal colic - in obstructions

Suprapubic pain - bladder or urethral disorders

Perineal pain - Bladder outflow tract disorders

Question 20

What is pneumaturia?

Answer 20

Gas or air in the urine

Most often due to a colo-vesical fistula from colonic diverticulosis

Question 21

Acute vs Chronic urinary retention?

Answer 21

Acute is a painful inability to void with palpable/percussible bladder

Chronic is painless inability to void - and the bladder is still palpable/percussible after voiding

Question 22

C5ause of acute UR?

Answer 22

Benign Prostatic Obstruction

Question 23

Treatment for acute UR?

Answer 23

Catheterisation and treat cause

Question 24

Whats the main cause of Chronic Urinary Retention?

Answer 24

Detrusor muscle inactivity caused by:

1. 1y bladder failure
2. 2y to an longstanding bladder outflow obstruction

Question 25

Chronic UR treatment?

Answer 25

Catheterisation and IV fluids

Long term catheter/clean intermittent self cath or treat underlying cause - transurethral resection of prostate

Question 26

Complications of urinary retention?

Answer 26

Voiding - LUTS
UTIs
Post-decompressive Haematuria 
Electrolyte distubances or persistant renal dysfunction (chronic) 
Pathological Diuresis

Question 27

What is pathological diuresis?

Answer 27

UO of over 200ml per hour
Postural hypotension
Weight loss
Electrolyte abnormalities

Question 28

Criteria for a UTI diagnosis?

Answer 28

Microbio evidence

and at least 1 of: Fever, loin/flank pain, suprapubic pain, urinary frequency or urgency or dysuria

Question 29

UTI types?

Answer 29

Complicated (due to a co-morbidity) and uncomplicated

Question 30

What is paraphimosis?

Answer 30

Retracted foreskin that cannot be returned to normal position –> gangrene and amputation