Presentations of Diseases of the Kidney and Urinary Tract

Question 1

What makes up the lower urinary tract?

Answer 1

-Bladder
-Bladder outflow tract; bladder neck, prostate in men, external urethral sphincter, pelvic floor, urethra

Question 1

What makes up the upper urinary tract?

Answer 1

-Kidneys
-Ureters

Question 2

What us a typical presentation of renal disease?

Answer 2

Pain
Pyrexia (fever)
Haematuria
Proteinuria
Pyuria
Mass on palpation
Renal failure

Question 3

What is the definition of proetinuria?

Answer 3

Urinary protein excretion >150mg/day

Question 4

Oliguria?

Answer 4

Urine output <05.ml/kg/hour

Question 5

Absolute anuria?

Answer 5

No urine output

Question 6

Relative anuria?

Answer 6

<100ml/day

Question 7

Polyuria?

Answer 7

Urine output > 3L/day

Question 8

Nocturia?

Answer 8

Waking up at night to urinate more than once

Question 9

Nocturnal polyuria?

Answer 9

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

Question 10

Pyuria?

Answer 10

Pus cells in the urine

Question 11

What physiological process causes pus cells to be released?

Answer 11

Inflammation

e.g. infection -> inflammation -> pus or trauma -> inflammation -> pus

Question 12

What are the three types of haematuria?

Answer 12

Visible
Microscopic
Dipstick

Question 13

What is the definition of microscopic haematuria?

Answer 13

3 or more red blood cells per high power field

Question 14

RECAP
Name the six main functions of the kidneys :)

Answer 14

Body fluid homeostasis
Acid-base homeostasis
Electrolyte homeostasis
Excretory functions
Regulation of vascular tone
Endocrine functions

Question 15

When can the ureters be damaged?

Answer 15

During surgery, especially bowel surgery or gynae procedures, as surgeons may accidentally cut them

Question 16

Which valve prevents the reflux of urine?

Answer 16

Vesico-ureteric junction

Question 17

What are the three types of obstruction ureter disease?

Answer 17

Intra-luminal
Intra-mural
Extra-luminal

Question 18

Give an example of an intra-luminal obstruction in terms of ureteric disease.

Answer 18

Stone, blood clot

Question 19

Give an example of an intra-mural obstruction in terms of ureteric disease.

Answer 19

Scar tissue or tumour

Question 20

Give an example of an extra-luminal obstruction in terms of ureteric disease.

Answer 20

Pelvic mass or lymph nodes

Question 21

Give an example of hereditary ureteric disease.

Answer 21

VUJ reflux

Question 22

What are the two types of bladder cancer?

Answer 22

TCC (urothelial carcinoma/transitional cells carcinoma)
Squamous cell carcinoma of the bladder

TCC more common

Question 23

How do bladder diseases presenet?

Answer 23

Pain
Pyrexia
Haematuria
Recurrent UTI’s
Lower urinary tract symptoms
Chronic urinary retention

Question 24

What is the risk of bladder cancer in a patient presenting with visible haematuria?

Answer 24

25-30%

Question 25

What is the risk of renal cancer in a patient presenting with visible haematuria?

Answer 25

0.5-1%

Question 26

Lower urinary tract symptoms are not just specific to the bladder. What else could they be suggestive of?

Answer 26

Pelvic floor dysfunction Neurological causes Systemic disorders e.g. renal or cardiac failure

Question 27

Which part of the brain has the micturition centres?

Answer 27

Pons

Question 28

What are the two phases of micturition?

Answer 28

Storage/filling phase Voiding phase

Question 29

What is acute urinary retention?

Answer 29

Painful inability to void with a palpable and percussible bladder

Question 30

What is the main risk factor of acute urinary retention?

Answer 30

Benign Prostatic Obstruction

Question 31

What is the treatment of acute urinary retention?

Answer 31

Catheterisation

Question 32

Is acute urinary retention painful?

Answer 32

Yes

Question 33

Define chronic urinary retention?

Answer 33

Painless, palpable and percussible bladder after voiding

Question 34

What is the main cause of chronic urinary retention?

Answer 34

Detrusor muscle underactivity

Question 35

What does the diagnosis of a UTI require?

Answer 35

Microbiological evidence- MSSU Symptoms of signs e.g. fever, pain, tenderness

Question 36

Who usually gets uncomplicated UTI's?

Answer 36

Young sexually active females

Question 37

Hydronephrosis?

Answer 37

Swelling of the kidneys due to obstruction

Question 38

Which type of bacteria can cause UTI's due to catheters, stents or stones?

Answer 38

Pseudomonas aerugisnosa