Presentation of diseases of kidneys and urinary tract Flashcards
(65 cards)
1
Q
What are the parts of the upper urinary tract?
A
kidneys - parenchyma and pelvi-calyceal system
ureter = pelvi-ureteric junction, ureter and vesico-ureteric junction
2
Q
What are the parts of the lower urinary tract?
A
bladder
bladder outflow tract - bladder neck, prostate, internal and external urethral sphincter, urethra, urethral meatus
3
Q
List some renal diseases
A
trauma glomerulonephritis pyelonephritis iatrogenic - PCNL neoplasia - renal tumour renal calculi polycystic kidney disease nephrotic syndrome atherosclerosis
4
Q
How do renal diseases present? symptoms
A
pain pyrexia haematuria proteinuria pyuria mass on palpation renal failure genetic testing?
5
Q
What mg/day is proteinuria?
A
> 150
6
Q
3 types of haematuria
A
frank
microscopic
dipstick
7
Q
Microscopic haematuria is more than how many RBC per high power field?
A
3
8
Q
Oliguria
A
urine output <0.5ml/kg/hour
9
Q
Anuria
A
absolute or <100ml/24 hours
10
Q
Polyuria
A
urine output >3l/24 hours
11
Q
Nocturia
A
waking at night >1 time
12
Q
Nocturnal polyuria
A
nocturnal urine output >1/3 of 24 hour output
13
Q
How is AKI defined?
A
in stages
14
Q
Name the stages of AKI
A
Risk injury failure loss end stage kidney disease
15
Q
How can chronic renal failure present in terms of failure of normal kidney function
A
oedema, congestive heart failure electrolyte imbalanced blood pressure - hypertension erythropoietin, vitamin D bone pain tiredness, anaemia
16
Q
What are the symptoms relating to advanced renal disease?
A
pruritus dyspnoea nausea/vomiting pericarditis neuropathy coma
17
Q
Nature of ureteric disease
A
clots, stones, tumours BPE ureteritis PUJ obstruction, VUJ reflux hysterectomy TCC para-aortic lymphadenopathy
18
Q
Examples of intraluminal ureteric diseases
A
clot, stone
19
Q
Intramural ureteric diseases
A
TCC, scar tissue
20
Q
Extra luminal ureteric diseases
A
pelvic mass, lymph nodes
21
Q
How do ureteric diseases present?
A
palpable mass pyrexia pain - renal colic renal failure - bilateral haematuria
22
Q
List bladder diseases
A
TCC of bladder or SCC UTI, cystitis urinary retention bladder rupture neurogenic bladder dysfunction
23
Q
How do bladder diseases present?
A
pain - subrapubic pyrexia haematuria recurrent UTI pneumaturia chronic urinary retention urinary leak LUTS
24
Q
What are the 3 categories of LUTS?
A
storage
voiding
incontinence
25
Storage LUTS
frequency, nocturia, urgency, urge incontinence
26
Voiding LUTS
poor flow, intermittent, dribbling - underactive bladder
27
Incontinence LUTS
stress, urge, mixed
28
Is there a higher risk of bladder or renal cancer in a patient with frank haematuria?
bladder
29
List some causes of LUTS
bladder pathology eg OAB, UTI, TCC
bladder outflow obstruction (BOO)
pelvic floor dysfunction
neurological causes
30
Supra pontine lesions causing LUTS
stroke, alzheimers, parkinsons
31
infra pontine supra sacral lesions causing LUTS
spinal cord injury, disc prolapse, spina bifida
32
Infra-sacral LUTS causes
cauda equine syndrome, MS, diabetes
33
Where is the micturition centre found?
pons
34
what sacral segments are involved in the micturition reflex?
S2-4
35
2 phases of micturition
filling and voiding
36
List some bladder outflow tract diseases
```
urethritis/prostatitis
BPH, prostate cancer
primary bladder neck pbstruction
pelvic flow damage
urethral injury
```
37
How does bladder outflow tract diseases present?
```
pain
pyrexia
haematuria
LUTS
recurrent UTI
acute or chronic urinary retention
```
38
Define acute urinary retention
Painful inability to void with a palpable and percussible bladder
39
Residual volumes of acute urinary retention
500ml --> > 1l
40
Main risk factor for acute urinary retention
BPO
41
Other causes of acute urinary retention
alcohol excess
UTI
post operative
urethral stricture
42
Immediate treatment of acute urinary retention
catheterisation
43
Complications of catheterisation in acute urinary retention
```
post decompression haematuria
UTI
pathological diuresis
renal failure
electrolyte abnormalities
```
44
If acute urinary retention is due to BPE what should be started?
alpha blocker
| arrange TURP
45
Define chronic urinary retention
painless, palpable and percussible bladder after voiding
46
Residual volumes for chronic urinary retention
400ml --> >2l
47
Main cause of chronic urinary retention
detrusor muscle inactivity
48
Primary causes of detrusor muscle inactivity
primary bladder failure
49
Secondary causes of detrusor muscle inactivity
BPO, longstanding BOO
50
How can chronic urinary retention present?
LUTS
complications eg UTI, bladder stones, overflow incontinence and obstructive renal failure
incidental
51
Treatment for chronic urinary retention
IV fluids
catheter
CISC
TURP
52
Complications of catheter in chronic urinary retention
```
UTI
post decompression haematuria
pathological diuresis
electrolyte abnormalities
persistent renal dysfunctions
```
53
Features of pathological diuresis
urine output >200ml/hr
postural hypotension
weight loss
electrolyte abnormalities
54
2 types of diuresis in high pressure chronic urinary retention
physiological <200ml/hr
| pathological >200ml/hr
55
Define UTI
Infection affecting the urinary tract (bladder, kidneys, prostate, testis and epididymis)
56
What does a diagnosis of UTI allow?
microbiological findings
| symptoms/signs
57
Microbiological diagnosis for UTI
bacterial count 10 to the power of 4 from MSSU specimen with no more than 2 species of micro-organisms
58
Symptoms/signs of UTI
at least 1 of fever, dysuria, pain, frequency and urgency
59
Uncomplicated and complicated UTI
uncomplicated - young, sexually active females
60
Factors to consider in UTI
age
gender
sexually active
co-morbidities eg diabetes, immunosuppression
Catheter
abnormal renal tract eg BOO, VU reflux, tumour
61
Type of organisms causing UTI
E.coli, staph aureus, pseudomonas, Klebsiella, proteus
62
Complications of UTI
```
sepsis
AKI
scarring of kidneys
SCC of bladder
acute urinary retention
bladder/renal stones
frank haematuria
```
63
investigations of UTI
```
urinary dipstick - MSSU/CSU
cystoscopy
residual bladder scan
US kidney
CT KUB
renogram
```
64
Treatment of UTI
antibiotics
| treat cause and complications
65
Emergencies related to UTI
```
Sepsis
renal colic
haematuria
acute urinary retention
iatrogenic injury
chronic high pressure urinary retention
hypercalcaemia
```
