Urinary Pathologies

Question 1

What are the two types of UTI

Answer 1

Lower UTI - •urethritis, cystitis

Upper UTI - •= pyelonephritis

Question 2

Define UTI?

Answer 2

•Presence of more than 100,000 organisms per ml (105/ml) in a Mid-Stream Urine (MSU)specimen.

Question 3

What is the incidence for UTI?

Answer 3

Woman

pregnancy

Question 4

What is the organism responsible fr UTI?

Answer 4

E.Coli

Question 5

What are the risks for UTI?

Answer 5

Sexual intercorse

pregnancy

changes in the balance of the commensal organism

neonates

diabetes melileus

immunosuppressors

bladder instrumentation

lower urinary tract obstruction

Question 6

What are the clinical features of Lower UTI?

Answer 6

Urethritis

• dysuria
• Pain during urination

Cystitis

• pain during voiding
• The sensation of a full bladder

Foul smell urine

Hematuria

Fever

In elder: fatigue confusion

Question 7

WHat is an upper UTI?

Answer 7

•An infection can ascend and cause an acute pyelonephritis if the vesico-ureteric valves are incompetent and/or the bacteria can climb

Question 8

What is the pathophysiology of upper UTI?

Answer 8

•Spread of the infection further into the kidney an occur via two routes:

• •Directly through the lumen of the collecting tubules
• •Passing from the submucosa of the inflamed calyces into the interstitial tissue
• Organism proliferation incites an acute inflammatory reaction
• Abscess formation is possible and associated with renal damage

Question 9

Clinical features of Upper UTI?

Answer 9

• Sudden onset of unilateral or bilateral loin pain +/- radiations occurs to the iliac fossa and groin
• Tenderness/guarding are usually present in the renal angle and lumbar region
• Fever, rigors, nausea, vomiting can occur
• Symptoms of the initial cystitis:urinary frequency, dysuria, cloudy, offensive–smelling urine

Question 10

What is the management for UTI?

Answer 10

Urine test

Antibiotic therapy

PTE education

Address risk factors

Question 11

What is Nephrolithiasis?

Answer 11

Kidney stones

masses of minerals that cause urinary obstruction

Question 12

What are the types of renal calculi?

Answer 12

• •75-85% of calculi are composed of calcium oxalate and phosphate
• 5-10% are uric acid stones
• 5% are composed of struvite
• 1% are cystinestones

Question 13

What are the risk factors for renal calculi?

Answer 13

• Hot weather
• increase sweating
• decrease fluid intake
• Diseases with increase stone forming minerals
• Increased dietary intake of stone forming minerals
• correlation with chronic disease (HBP, obesity, diabetes,)

Question 14

What is the pathophys for kidney stones?

Answer 14

1. deposit of calcium phosphate (rnadal’s plaques)
2. plaques move into urinary lumen acting as nuclei for growth
3. aggregation of mineral leads to stone

Question 15

Clinical features of kidney stones?

Answer 15

dull flank pain

pain may radiate to the groin

pain exacerbated by urination

hematuria or stony fragments in urine

renal distention

asymptomatic

Question 16

What are the complications of renal calculi?

Answer 16

Ureteric impaction: renal colic

• pallor
• sweating
• vomiting
• crying agony

Neoplasia: •Large stones can Irritate the renal epithelium causing metaplasia, and eventually squamous cell carcinoma

Question 17

What is the ureteric referred pain pattern?

Answer 17

Question 18

What is the management of kidney stones?

Answer 18

Pain management

reduce the concentration of stone-forming substances

removal of stone

• ureteroscopy
• lithotripsy - laser

Question 19

What is chronic kidney disease?

Answer 19

The decline in kidney function

69-80 mild

<15 = kidney failure

Question 20

Aetiology of kidney failure?

Answer 20

• Systemic disease: diabetes HBP
• renal disease: kidney stones/ chronic pyelonephritis

Question 21

Pathophys of kidney disease?

Answer 21

Intact nephron hypothesis

• •Surviving nephrons compensate for damaged nephrons until the advanced stages of CKD
• •These nephrons undergo expansion and are capable of hyperfiltration

Trade off hypothesis

• •The continued loss of functioning nephrons and adaptive hyperfiltration likely results in further nephron injury and ultimately end-stage disease

Pathological processes of CKD

• •Progressive glomerular hypertension, hyperfiltration and hypertrophy
• •Glomerulosclerosis
• •Tubulointersitial inflammation and fibrosis

Question 22

Clinical features of kidney failure?

Answer 22

MUSCULOSKELETALCHANGES

• •Bone pain,
• increased # risk,
• m. weakness,
• myalgia,
• arthralgia

NEUROLOGICAL CHANGES

• •Peripheral neuropathies (esp. sensory in lower limb)
• •Cognitive or behavioural effects
• Neuromuscular irritation: muscle cramps, twitching

Question 23

MAnagement for kidney failure?

Answer 23

DIetary management

medication

KIDNEY FAILURE

• dialysis
• renal transplant

Question 24

What is AKI?

Answer 24

• Sudden decline in kidney function occurring over hours to days
• Results in reduced fluid & electrolyte regulation, waste elimination and acid-base balance

Question 25

What are the classifications of AKI?

Answer 25

* prerenal: impaired renal blood flow * intrarenal: nephron damage (infection) - least likely for osteos * postrenal: urinary tract obstruction

Question 26

What is Bladder cancer?

Answer 26

Primary cancer that starts in the bladder. * Transitional cell carcinoma

Question 27

Risk factors for bladder cancer?

Answer 27

* smoking * chemicals * family Hx

Question 28

What are the clinical features for bladder cancer?

Answer 28

Hematuria Urinary symptoms pain abdominal mass systemic features hepatomegaly

Question 29

What is the most common type of kidney cancer?

Answer 29

renal cell carcinoma

Question 30

Risk factors for renal cancer?

Answer 30

* male * smoking * chronic disease * chemicals * Family Hx

Question 31

Clinical features of kidney cancer?

Answer 31

* haematuria * flank pain * abdominal mass * systemic features * metastatic disease