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Urology > Lecture 14 Presentation of Diseases of the Kidneys and Urinary Tract > Flashcards

Lecture 14 Presentation of Diseases of the Kidneys and Urinary Tract Flashcards

1
Q

What does the upper urinary tract consist of

A

Kidneys

Ureter

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2
Q

Name the junctions of the ureter

A

Pelvi-ureteric

Vesico-ureteric

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3
Q

What does the lower urinary tract consist of

A

Bladder

Bladder outflow tract

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4
Q

What makes up the bladder outflow tract

A 
Bladder neck
Prostate
External urethral sphincter/pelvic floor
Urethra
Urethral meatus
Foreskin
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5
Q

Presentation of Renal Diseases

A
  • Pain
  • Pyrexia
  • Haematuria
  • Proteinuria
  • Pyuria
  • Mass on palpation
  • Renal failure
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6
Q

In terms of mg/day what is the definition of proteinuria

A

Urinary protein excretion >150mg/day

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7
Q

How many types of haematuria are there

A

Three- macroscopic, microscopic and dipstick positive (Hb)

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8
Q

In terms of RBCs/high power field define microscopic haematuria

A

> 3 RBC per high power field

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9
Q

Define oliguria

A

Urine output <0.5ml/kg/hour

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10
Q

Define Anuria

A

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

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11
Q

Define Polyuria

A

Urine output >3L/24 hours

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12
Q

Define Nocturia

A

Waking up at night ≥1 occasion to micturate

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13
Q

Define Nocturnal Polyuria

A

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

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14
Q

What serum creatinine levels, GFR and UO would suggest a risk of AKI?

A

Increase in serum creatinine level (1.5x) or decrease in GFR by 25%, or UO <0.5 mL/kg/h for 6 hours

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15
Q

What serum creatinine levels, GFR and UO would suggest AKI?

A

Increase in serum creatinine level (2.0x) or decrease in GFR by 50%, or UO <0.5 mL/kg/h for 12 hours

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16
Q

What serum creatinine levels, GFR and UO would suggest AK Failure

A

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

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17
Q

What serum creatinine levels, GFR and UO would suggest AK loss of function

A

Persistent ARF or complete loss of kidney function >4 weeks

18
Q

What serum creatinine levels, GFR and UO would suggest End Stage Kidney Disease

A

complete loss of kidney function >3 months

19
Q

Name the presentation of chronic renal failure

A 
Can be asymptomatic
Tiredness
Anaemia
Oedema
High BP
Bone pain
Pruritus
Nausea
Dyspnoea 
Pericarditis
Neuropathy
Coma
20
Q

Presentation of Ureteric Diseases

A 
Pain(colic)
Pyrexia
Haematuria
Palpable mass (hydronephrosis)
Renal failure
21
Q

Presentation of bladder disease

A

Pain
Pyrexia
Haematuria
– Storage- frequency, nocturia, urgency, urge incontinence
– Voiding- poor flow, intermittency, terminal dribbling
– Incontinence- stress, urge, mixed, overflow, neurogenic, dribbling

22
Q

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

A

25-30%

23
Q

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

A

0.5-1.0%

24
Q

Presentation of bladder outflow tract

A

• Pain (suprapubic or perineal)
• Pyrexia
• Haematuria
• Lower urinary tract symptoms (LUTS)
– Voiding- hesitancy, intermittency, poor flow, terminal dribbling, incomplete bladder emptying due to bladder outflow obstruction
– Overflow incontinence- characterized by the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate
– Stress urinary incontinence- occurs when an activity such as coughing, sneezing, or exercising causes a small amount of urine to leak from the urethra, which is the tube urine passes through
• Recurrent UTIs
• Acute urinary retention
• Chronic urinary retention

25
Q

What are the symptoms of acute urinary retention

A
  • Painful
  • Inability to void
  • Palpable and percussable bladder
  • Residuals vary from 500ml to >1 litre
26
Q

Complications of acute urinary retention

A 
UTI
Post-decompression haematuria
Pathological diuresis
Renal failure
Electrolyte abnormalities
27
Q

Symptoms of Chronic Urinary retention

A
  • Painless
  • Palpable and percussable bladder
  • Ability to void
  • Residuals ranging from 400ml to >2 litres
28
Q

Causes of chronic r retention

A

detrusor underactivity
– Primary- primary bladder failure
– Secondary- longstanding bladder obstruction of outflow (BPO or urethral stricture)

29
Q

Immediate treatment for urinary retention

A

Catheterisation

30
Q

Complications of chronic urinary retention

A

UTI, post-decompression haematuria, pathological diuresis, electrolyte abnormalities (hyponatraemia, hyperkalaemia, metabolic acidosis), persistent renal dysfunction due to acute tubular necrosis

31
Q

What is more dangerous chronic or acute urinary retention and why

A

Chronic is more dangerous because Increased pressure over a long period of time and bladder reaches capacity and urine is unable to enter –>renal failure

32
Q

What are the 2 types of diuresis that make occur in high-pressure chronic urinary retention

A

Physiological (usually <200ml/hour)

• - Pathological (usually >200ml/hour)

33
Q

What is physiological diuresis?

A

Self-limiting
Response to solute and water overload
Stops after return to euvolemic state

34
Q

What is pathological diuresis

A

Inappropriate diuresis of water beyond euvolemic state due to insensitivity of collecting tubule to ADH
Self-limiting

35
Q

How are UTIs diagnosed

A

MSSU specimen >10^5 cfu

36
Q

What are the 2 types of UTIs

A

Uncomplicated- sexually active females

Complicated UTIs- everyone else (always needs to be investigated

37
Q

Factors that need to be considered in differentiating between complicated and uncomplicated UTIs

A 
Age
Sexual activity
Gender
Co-morbidities (imunosupression, RF)
Foreign body (catheter, ureteric tent)
38
Q

Name 3 types of organic that cause UTIs

A 
E.coli
Staph. Saprophyticus
Klebsiella
Proteus
Pseudomonas 
Staph aureus
39
Q

What are the 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
40
Q

Treatment for UTIs

A

Antibiotics

41
Q
  1. The following are essential features of acute urinary retention except:
    a. painful
    b. palpable bladder
    c. inability to urinate
    d. bladder volume >800ml
    e. percussible bladder
A

d. bladder volume >800ml

42
Q
  1. The following organisms are commonly associated with urinary tract infections except:
    a. E. coli
    b. Klebsiella species
    c. Proteus species
    d. Chlamydia trachomatis
    e. Pseudomonas aeruginosa- immunocompromised, long term foreign body (catheter etc.)
A

d. Chlamydia trachomatis

Urology (26 decks)

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