Presentation of Diseases of the Kidney and Urinary Tract Flashcards Preview

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Flashcards in Presentation of Diseases of the Kidney and Urinary Tract Deck (59)
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1
Q

What are urinary tract disease classed as?

A

Upper or lower

2
Q

Upper urinary tract diseases include diseases of what?

A

Kidneys - parenchyma, pelvic-calyceal system

Ureters - pelvis-ureteric junction, ureter, vesico-ureteric junction

3
Q

Lower urinary tract diseases include diseases of what?

A

Bladder
Bladder outflow tract - bladder neck, prostate, external urethral sphincter/pelvic floor, urethra, urethral meatus, foreskin

4
Q

What are the dividing causes listed in the surgical sieve?

A
Infection 
Inflammation 
Iatrogenic 
Neoplasia 
Trauma 
Degenerative 
Congenital 
Genetic/hereditary 
Vascular 
Endocrine 
Failure 
Idiopathic
5
Q

What is oliguria?

A

Urine output < 0.5ml/kg/hour, usually indicative of renal dysfunction/failure

6
Q

What is anuria?

A

Absolute anuria - no urine output

Relative anuria - < 100ml/24 hours

7
Q

What is polyuria?

A

Urine output > 3l/24 hours

8
Q

What is nocturne?

A

Waking up at night on one or more occasion to micturate

9
Q

What is nocturnal polyuria?

A

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

10
Q

What are the different natures of renal diseases?

A

Infection e.g. pyelonephritis
Inflammation e.g. glomerulonephritis, tubulointerstitial nephritis
Iatrogenic e.g. nephrotoxicity
Neoplasia e.g. renal tumours, collecting system tumours
Trauma
Vascular e.g. atherosclerosis, hypertension
Hereditary e.g. polycystic kidney disease, nephrotic syndrome

11
Q

What are the main presentations of renal diseases?

A
Pain 
Pyrexia 
Haematuria 
Proteinuria 
Pyuria 
Mass on palpation 
Renal failure
12
Q

What are the components of the RIFLE staging criteria?

A
Risk 
Injury 
Failure 
Loss 
End-stage kidney disease
13
Q

According to the RIFLE staging criteria, what indicates risk of acute renal failure?

A

Increase in serum creatinine level (1.5x)
Decrease in GFR by 25%
UO < 0.5 ml/kg/hour for 6 hours

14
Q

According to the RIFLE staging criteria, what indicates acute renal injury?

A

Increase in serum creatinine level (2.0x)
Decrease in GFR by 50%
UO < 0.5 ml/kg/hour for 12 hours

15
Q

According to the RIFLE staging criteria, what indicates acute renal failure?

A

Increase in serum creatinine level (3.0x)
Decrease in GFR by 75%
UO < 0.3 ml/kg/hour for 24 hours, or anuria for 12 hours
Serum creatinine level > 355 umol/l with acute increase of > 44 umol/l

16
Q

According to the RIFLE staging criteria, what indicates acute renal failure?

A

Persistent acute renal failure or complete loss of kidney function > 4 weeks

17
Q

According to the RIFLE staging criteria, what indicates end-stage kidney disease?

A

Complete loss of kidney function > 3 months

18
Q

What is the presentation of chronic renal failure in terms of body fluid homeostasis?

A

Fluid overload
Peripheral oedema
Congestive cardiac failure
Pulmonary oedema

19
Q

What is the function of the kidneys in relation to regulation of vascular tone?

A

Regulation of blood pressure

20
Q

What is the excretory function of the kidneys?

A

Physiological waste excretion, especially urea

Excretion of drugs

21
Q

What are the endocrine functions of the kidneys?

A

Erythropoietin
Vitamin D metabolism
Renin

22
Q

What is the presentation of chronic renal failure?

A
Asymptomatic - may be found coincidentally 
Fatigue 
Anaemia 
Oedema 
Hypertension 
Bone pain due to renal bone disease
23
Q

What is the presentation of advanced renal failure?

A
Pruritis
Nausea/vomiting 
Dyspnoea 
Pericarditis 
Neuropathy 
Coma in untreated advanced renal failure
24
Q

What are the natures of ureteric diseases?

A

Infection e.g. ureteritis
Iatrogenic/trauma e.g. accidental damage in hysterectomy
Neoplasia e.g. urothelial carcinoma
Hereditary e.g. PUJ obstruction
Obstruction - intra-luminal (stone, clot), intra-mural (scar tissue), extra-luminal (pelvic mass)

25
Q

What is the presentation of ureteric diseases?

A
Pain 
Pyrexia 
Haematuria 
Palpable mass (hydronephrosis) 
Renal failure (if there is bilateral obstruction or a single functioning kidney)
26
Q

What are the natures of bladder diseases?

A

Infection e.g. cystitis
Inflammation e.g. interstitial cystitis
Iatrogenic/trauma e.g. bladder rupture, bladder injury from hysterectomy
Neoplasia e.g. transitional cell carcinoma
Idiopathic e.g. overactive bladder syndrome
Degenerative e.g. chronic urinary retention
Neurological e.g. neurogenic bladder dysfunction

27
Q

What is the presentation of bladder diseases?

A
Pain (suprapubic) 
Pyrexia 
Haematuria 
Lower urinary tract symptoms - storage LUTS e.g. frequency, or voiding LUTS e.g. poor flow 
Incontinence 
Recurrent UTIs
Chronic urinary retention 
Urinary leak from vagina i.e. vesico-vaginal fistula 
Pneumaturia i.e. coli-vesical fistula
28
Q

What are the lower urinary tract symptoms?

A

Storage

  • frequency
  • nocturia
  • urgency
  • urge incontinence

Voiding

  • poor flow
  • intermittency
  • terminal dribbling due to underachieve bladder
29
Q

What are the main causes of lower urinary tract symptoms?

A

Bladder pathology e.g. overactive bladder, UTI
Bladder outflow obstruction
Pelvic floor dysfunction
Neurological causes
Systemic disorders e.g. cardiac failure, CRF

30
Q

What are the neurological causes of lower urinary tract symptoms?

A

Supra-pontine lesions e.g. stroke, Alzheimer’s disease, Parkinson’s disease
Infra-pontine supra-sacral lesions e.g. spinal cord injury, disc prolapse
Intra-sacral e.g. MS, diabetes, cauda equina compression

31
Q

What are the components of micturition control?

A

Cortical centre - bladder sensation and conscious inhibition of micturition
Pons - micturition centre
Sacral segments S2-S4 - micturition reflex, relaxation of internal urethral sphincter
Micturition cycle - storage phase, voiding phase

32
Q

What are the natures of bladder outflow tract diseases?

A

Infection/inflammation e.g. prostatitis, balanitis
Iatrogenic/trauma e.g. pelvic floor damage after vaginal delivery, urethral injury from catheterisation
Neoplasia e.g. prostate/penile cancer
Idiopathic e.g. chronic pelvic pain syndrome
Obstruction e.g. benign prostatic enlargement, urethral stricture

33
Q

What is the presentation of bladder outflow tract diseases?

A
Pain - suprapubic or perineal 
Pyrexia 
Haematuria 
Lower urinary tract symptoms 
Recurrent UTIs
Acute urinary retention 
Chronic urinary retention
34
Q

What is required to make a diagnosis of urinary tract infection?

A

Microbiological evidence and symptoms/signs

Microbiological evidence - bacterial count of 10^4 cfu/ml from MSSU specimen with no more than two species of micro-organism

Symptoms/signs - at least one of:

  • fever > 38 degrees celsius
  • loin/flank pain or tenderness
  • suprapubic pain or tenderness
  • urinary frequency
  • urinary urgency
  • dysuria
35
Q

What are the two types of UTI?

A

Complicated and uncomplicated

36
Q

Who typically gets uncomplicated UTIs?

A

Young, sexually active females with a clear relation to sexual activity

37
Q

What factors should be considered when differentiating between complicated and uncomplicated UTI?

A

Age
Sexual activity in females
Gender
Co-morbidities e.g. immunosuppression, renal failure
Abnormal renal tract e.g. stones, renal outflow obstruction
Foreign body e.g. catheter, ureteric stent
Type of organisms e.g. common vs uncommon

38
Q

What is the specific name for a urinary tract infection involving the:

  • bladder
  • prostate
  • kidney
  • testis
A

Bladder - cystitis
Prostate - prostatitis
Kidney - pyelonephritis
Testis - orchitis

39
Q

What is a recurrent UTI?

A

Defined as > 3 UTIs per year or > 2 in 6 months

40
Q

What is a relapsing UTI?

A

Defined as UTI caused by the same organism within 2 weeks of the preceding UTI, usually indicative of inadequately treated UTI

41
Q

What are the potential complications of UTI?

A
Infective - sepsis, perinephric abscess
Renal failure - scarring 
Bladder malignancy 
Acute urinary retention 
Frank haematuria 
Bladder or renal stones
42
Q

What are the investigations that can be done for UTI?

A

MSSU/CSU
Lower tract - flow studies, residual bladder scan, cystoscopy
Upper tract - USS kidneys, IVU/CT KUB, MAG-3 renogram, DMSA scan

43
Q

What is the treatment of UTI?

A

Appropriate antibiotics

Treat any underlying cause and complications

44
Q

What is acute urinary retention?

A

Defined as a painful inability to void with a palpable and permissible bladder

45
Q

What is the variation in residuals in acute urinary retention?

A

From 500ml to > 1L, depending on time taken to seek medical attention

46
Q

What is the main risk factor of acute urinary retention?

A

Benign prostatic obstruction

It can also occur independently of this e.g. in UTIs, urethral stricture, alcohol excess, post-operatively, acute surgical/medical problems etc.

47
Q

How does acute urinary retention occur with benign prostatic obstruction?

A

Can occur spontaneously i.e. as a natural progression or can be triggered by an unrelated event e.g. constipation, alcohol excess

48
Q

What is the treatment of acute urinary retention?

A

Immediate treatment is catheterisation
If a trigger is present this should be treated
If due to BPE and no renal failure is present then alpha-blocker should be started immediately and catheter removed in 2 days (60% will void successfully at this point), if there is still a failure to void then re-catheterisation should be done and TURP organised

49
Q

What complications might develop if acute urinary retention is left untreated?

A
UTI 
Post-decompression haematuria 
Pathological diuresis 
Renal failure 
Electrolyte abnormalities
50
Q

What is chronic urinary retention?

A

Defined as painless, palpable and permissible bladder after voiding
Patients are often able to void but have residuals ranging from 400ml to > 2 litres, depending on the stage of their condition

51
Q

What is the main etiological factor in chronic urinary retention?

A

Detrusor muscle under activity, which can be primary or secondary

52
Q

How does chronic urinary retention present?

A

As lower urinary tract symptoms or as complications

53
Q

What complications occur at the severe end of the spectrum of chronic urinary retention?

A

Overflow incontinence

Renal failure

54
Q

What are the features of the severe end of the spectrum of chronic urinary retention?

A

Bladder capacity is reached and bladder pressure is in excess of 25cm water i.e. decompensated chronic urinary retention or acute-on-chronic urinary retention or chronic high-pressure urinary retention

55
Q

What is the treatment of chronic urinary retention?

A

Immediate treatment is catheterisation, either urethral or suprapubic initially, followed by CISC

Subsequent treatment is with either long-term urethral or suprapubic catheter, CISC or TURP if due to BPE

56
Q

What are the complications of chronic urinary retention?

A

UTI
Post-decompression haematuria
Pathological diuresis
Electrolyte abnormalities e.g. hyponatraemia, hyperkalaemia, metabolic acidosis
Persistent renal function due to acute tubular necrosis

57
Q

What are the features of pathological diuresis?

A

Urine output > 200ml/hour
Postural hypotension
Weight loss
electrolyte abnormalities

58
Q

What is the management of pathological diuresis?

A

Manage with IV fluids and close monitoring

59
Q

What are the common clinical emergencies related to urinary tract diseases?

A

Acute renal failure
Sepsis due to UTI +/- upper or lower urinary tract obstruction
Renal colic
Severe haematuria causing haemorrhagic shock
Metastatic diseases causing metabolic derangements
Acute urinary retention
Chronic high-pressure urinary retention
Iatrogenic injury/trauma to upper or lower urinary tracts, penis and testes
Testicular torsion
Paraphimosis
Priapism