Presentation of diseases of Kidneys and Urinary Tract & Urinary Retention

Question 1

What structures consist of the upper urinary tract?

Answer 1

Kidneys and ureters

Question 2

What is responsible for preventing back flow of urine from the bladder into the ureters?

Answer 2

Vesico-ureteric junction

Question 3

What drugs can cause nephrotoxicity?

Answer 3

NSAIDS

Antibiotics i.e. gentamicin

Question 4

What are the presentations/symptoms of renal diseases?

Answer 4

Pain
Pyrexia
Haematuria
Proteinuria
Pyuria 
Mass on palpation
Renal failure

Question 5

What cells are present in pyuria?

Answer 5

Leukocytes (pus cells)

Question 6

Name 2 inflammatory renal diseases.

Answer 6

Glomerulonephritis

Tubulointerstitial nephritis

Question 7

What is the definition of proteinuria?

Answer 7

Urinary protein excretion > 150mg/day

Question 8

What are the types of haematuria?

Answer 8

3 types
Macorscopic - visible
Microscopic - only dipstick visible & non-visible

Question 9

What is the definition of microscopic haematuria?

Answer 9

Greater than or equal to 3 RBC per high power field

Question 10

What is the definition of oliguria?

Answer 10

Urine output < 0.5ml/kg/hour

Question 11

What si the name for no urine output?

Answer 11

Absolute anuria

Question 12

What is relative anuria?

Answer 12

Decreased urine output < 100ml/24hrs

Question 13

What is the definition of polyuria?

Answer 13

Urine output > 3l/24 hrs

Question 14

What is the definition of nocturia?

Answer 14

Wakening up through the nigh > 1 time

Question 15

What is nocturnal polyuria?

Answer 15

Wakening up through the night with urine output > 1/3 total urine output i.e. > 600mls

Question 16

How would you investigate if someone is presenting with nocturia or nocturnal polyuria?

Answer 16

Frequency volume chart (bladder chart)

Question 17

What staging is used to assess the extent of acute kidney injury?

Answer 17

RIFLE
Risk
Injury
Failure
Loss
End-stage kidney disease

Question 18

What is defined as end stage kidney disease?

Answer 18

Complete loss of kidney function > 3months

Question 19

What si the levels of creatinine, urine output and GFR in the risk, injury and failure stages of acute kidney injury?

Answer 19

Risk - increased serum creatinine (1.5x) or decreased GFR by 25% or urine output < 0.5ml/kg/h for 6 hrs
Injury - creatinine (2x) or GFR by 50% or UO < 0.5ml/kg/h for 12 hours
Failure - creatinine (3x) or GFR by 75% or UO < 0.3ml/kg/h for 24 hours

Question 20

What are the functions of the kdiney?

Answer 20

Body fluid homeostasis
Electrolyte homeostasis
Endocrine function i.e. erythropoetin, vitamin D synthesis, renin
Extretory function of physiological waste and drugs
Regulation of vascular tone - BP
Acid base homeostasis (excretion of H and generation of HC03)

Question 21

What is the presentation/symptoms of chronic renal failure?

Answer 21

Asymptomatic 
Tiredness
Anaemia
Oedema
High aBP
Bone pain due to renal bone disease

Question 22

What are the presentations/symptoms of advanced chronic renal failure?

Answer 22

Pruritis 
Nausea/vomiting
Dyspnoea
Pericarditis
Neuropathy
Coma

Question 23

What is the presentation of ureteric diseases?

Answer 23

Pain
Pyrexia
Haematuria
Palpable mass
Renal failure

Question 24

What ureteric disease will present with a palpable mass?

Answer 24

Hydronephrosis

Question 25

What are the different ureteric diseases?

Answer 25

Infection - ureteritis Iatrogenic - inadvertedly cut or ties duringcolon resection or hysterectomy Neoplasia - TCC of bladder or ureter, prostate cancer obstructing VUJ, pelvic malignancy, pelvic or para-aortic lymphadenopathy Hereditary - PUJ obstruction, VUJ reflux Obstruction - stone, blood clot, scar tissue, TCC, pelvic mass

Question 26

What are the types of obstruction that can lead to ureteric diseases?

Answer 26

Intra luminal i.e. blood clot, stone Extra luminal i.e. pelvic mass, lymphadenopathy Intra mural i.e. scar tissue, TCC

Question 27

What are the presentations of bladder diseases?

Answer 27

``` Pain (suprapubic) Pyrexia Haematuria LUT symptoms; - freuqency, urgency, dribbling, incontinence, urge, poor flow, intermittendency ``` Recurrent UTI’s Chronic urinary retention Urinary leak form vagina (fistula) Pneumaturia

Question 28

What is the term for gas in the urine and what could it be a sign of?

Answer 28

Pneumaturia | Colo-vesico fistula caused by diverticular disease, crohns, colonic or bowel cancer

Question 29

What is the presentation of bladder outflow tract diseases?

Answer 29

``` Pain Pyrexia Haematuria LUT symptoms; - hesistancy, intermittency, poor flow, terminal dribbling, incomplete emptying - over flow incontinence - stress urinary incontinence Recurrent UTI’s Acute or chronic urinary retention ```

Question 30

Why may over flow incontinence occur as a result of a bladder outflow tract disease?

Answer 30

High pressure chronic urinary retention

Question 31

Where is the micturition center located?

Answer 31

Pons

Question 32

What is responisble for our conscious inhibition of micturition?

Answer 32

Cortical center | Sympathetic via hypogastric nerve T10-L2

Question 33

What nerve supply is responsible for voiding phase of micturition?

Answer 33

Sacral segments S2-S4

Question 34

what is acute urinary retention?

Answer 34

painful inability to void with a palpable and percussible bladder

Question 35

what is chronic urinary retention?

Answer 35

painless, palpable and percussible bladder after voiding | high residual volume after voiding

Question 36

what is responsible for the high residual volume after voiding in chronic urinary retention?

Answer 36

weakness of the detrusor muscle

Question 37

what is the presentation of chronic urinary retention?

Answer 37

presents as lower urinary tract symptoms i.e. frequency, urgency, dribbling, nocturia etc can present with complications; - UTI - bladder stones - overflow incontinence - post renal or obstructive renal failure

Question 38

what is the immediate treatment for chronic urinary retention?

Answer 38

catheterisation

Question 39

what are the treatments for chronic urinary retention if it is caused by benign prostate enlargement?

Answer 39

clean intermittent self catheterisation | transurethral resection of the prostate

Question 40

what is the treatment for chronic urinary retention if it caused by something other than prostate enlargement?

Answer 40

urethral or suprapubic catheter

Question 41

what are the complications of chronic urinary retention?

Answer 41

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

Question 42

what are the causes of acute urinary retention?

Answer 42

``` benign prostate enlargement UTI urethral stricture alcohol excess post operative causes acute surgical or medical problems ```

Question 43

what is the treatment for acute urinary retention?

Answer 43

catheterisation | treat underlying trigger