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urinary > Presentation of disease of the kidney and urinary tract > Flashcards

Presentation of disease of the kidney and urinary tract Flashcards

1
Q

What is the presentation of renal diseases?

A
  • Pain
  • Pyrexia
  • Haematuria
  • Proteinuria
  • Pyuria (pus in the urine)
  • Mass on palpation
  • Renal failure
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2
Q

What is the definition of proteinuria?

A

Urinary protein excretion >150mg/day

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3
Q

How many types of haematuria are there?

A

3

microscopic and frankhaemiaturia (visible haematuria) and dipstick haematuria

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4
Q

What is the definition of microscopic haematuria?

A

≥3 red blood cells per high power field

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5
Q

What is the definition of oliguria?

A

Urine output <0.5ml/kg/hour

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6
Q

What is the definition of anuria?

A

Absolute anuria - No urine output; Relative anuria - <100ml/24 hours

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7
Q

What is the definition of polyurea?

A

Urine output >3L/24 hours

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8
Q

What is the definition of nocturnal polyuria?

A

Nocturnal urine output >1/3 of total urine output in 24 hours

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9
Q

What are the staging criteria for acute renal failure/ acute kidney injury?

A
  • Risk: Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours
  • Injury: Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours
  • Failure: Increase in serum creatinine level (3.0x), or decrease in GFR by 75%, or serum creatinine level >355μmol/L with acute increase of >44μmol/L; or UO <0.3 mL/kg/h for 24 hours, or anuria for 12 hours
  • Loss : Persistent ARF or complete loss of kidney function >4 weeks
  • End-stage kidney disease: complete loss of kidney function >3 months
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10
Q

What is the 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
  • Pruritus (in advanced renal failure)
  • Nausea/vomiting (in advanced renal failure)
  • Dyspnoea (in advanced renal failure)
  • Pericarditis (in advanced renal failure)
  • Neuropathy (in advanced renal failure)
  • Coma (untreated advanced renal failure)
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11
Q

What is the presentation of ureteric diseases?

A
  • Pain (eg. renal colic)
  • Pyrexia
  • Haematuria
  • Palpable mass (ie. hydronephrosis)
  • Renal failure (only if bilateral obstruction or single functioning kidney)
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12
Q

What is the presentation of bladder diseases?

A
  • Pain (suprapubic)
  • Pyrexia
  • Haematuria
  • Lower urinary tract symptoms (LUTS)
  • storage LUTS (i.e. frequency, nocturia, urgency, urge incontinence)
  • voiding LUTS (i.e. poor flow, intermittency, terminal dribbling) – due to underactive bladder or obstruction
  • incontinence (stress, urge, mixed, overflow, neurogenic, dribbling, etc.)
  • Recurrent UTIs
  • Chronic urinary retention (due to bladder underactivity)
  • Urinary leak from vagina (i.e. vesico-vaginal fistula)
  • Pneumaturia (i.e. colovesical fistula)
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13
Q

What is the risk of bladder cancer in a patient who presents with frank haematuria?

A

25-30%

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14
Q

What is the risk of renal cancer in a patient who presents with frank haematuria?

A

0.5-1.0%

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15
Q

What is the presentation of bladder outflow tract disease?

A
  • Pain (suprapubic or perineal)
  • Pyrexia
  • Haematuria
  • Lower urinary tract symptoms (LUTS)
  • voiding LUTS (i.e. hesitancy, intermittency, poor flow, terminal dribbling, incomplete bladder emptying) due to Bladder Outflow Obstruction (BOO)
  • overflow incontinence (high-pressure chronic urinary retention)
  • stress urinary incontinence
  • Recurrent UTIs
  • Acute urinary retention
  • Chronic urinary retention
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16
Q

Describe urinary tract infections

A
  • Defined as infection affecting urinary tract (including kidneys, bladder, prostate, testis and epididymis)
  • A diagnosis requires microbiological evidence AND symptoms/signs:
    i. Microbiological evidence: Bacterial count of 104 cfu/ml from MSSU specimen with no more than two species of micro-organisms
    ii. Symptoms/signs: At least one of the following: Fever >38ºC; loin/flank pain or tenderness; suprapubic pain or tenderness; urinary frequency; urinary urgency; dysuria
  • Two types:
    i. Uncomplicated UTIs (young sexually active females only with clear relation to sexual activity)
    ii. Complicated UTIs (everyone else!)
  • Complicated UTIs always need to be investigated
17
Q

What are the complications of urinary tract infections?

A
  • infective: sepsis (esp. pyelonephritis), perinephric abscess
  • renal failure (scarring)
  • bladder malignancy (squamous cell carcinoma)
  • acute urinary retention
  • frank haematuria
  • bladder or renal stones
18
Q

What are the investigations of UTIs?

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

urinary (10 decks)

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