describe vesicoureteral reflux (VUR). how can this cause AKI?
- urine refluxing from bladder back up ureters
- if this then reduces kidney function, this is post-renal AKI
where is the obstruction in an upper obstructive uropathy?
ureters
presentation of upper obstructive uropathy?
- loin-to-groin / flank pain
- reduced / no UO
- systemic symptoms like vomiting
- impaired renal function on UEs
presentation of lower obstructive uropathy?
- micturition symptoms
- urinary retention
- impaired renal function on bloods
what kind of micturition symptoms might be experienced in a lower obstructive uropathy?
- poor flow
- difficulty initiating
- terminal dribbling
causes of an upper obstructive uropathy?
- kidney stones
- tumours (pressing on ureters)
- ureteric strictures
- retroperitoneal fibrosis
- bladder Ca
- ureterocoele (usually congenital)
causes of a lower obstructive uropathy?
- BPH
- prostate cancer
- urethral strictures
- neurogenic bladder
causes of a neurogenic bladder?
- MS
- DM
- stroke
- parkinson’s disease
- brain / SC injury
- spina bifida
presentation of neurogenic bladder?
- urge incontinence
- increased bladder pressure
- lower obstructive uropathy
management of obstructive uropathy?
- nephrostomy
- urethral catheter
- suprapubic catheter
complications of treating an obstructive uropathy?
- catheter-associated UTI
- post-catheter diuresis (fluid and electrolyte loss, seen on UEs)
complications of obstructive uropathy?
- post-renal AKI
- CKD
- infection (ascending, bacterial)
- hydronephrosis
- overflow incontinence of urine
describe the pathophysiology of hydronephrosis?
obstruction to urine outflow causes backflow up to the kidneys
what is the cause of idiopathic hydronephrosis?
- narrowing at the PUJ
- may be congenital
features of hydronephrosis?
- vague renal angle pain
- mass felt in kidney area
investigations for hydronephrosis?
all imaging:
- USS
- CT
- IV urogram (X-ray)
treatment of hydronephrosis?
- treat underlying cause
- percutaneous nephrostomy
- antegrade ureteric stent
indications for a urinary catheter?
- urinary retention
- neurogenic bladder
- surgery
- output monitoring in septic pt
- bladder irrigation
- to deliver medications
demographic typically affected by BPH?
men over 50
presentation of BPH?
all LUTS:
- hesitancy
- weak flow
- urgency
- frequency
- intermittency
- straining
- terminal dribbling
- incomplete emptying
- nocturia
which examinations are needed in suspected BPH?
- DRE
- abdo exam (check for palpable bladder)
investigations for BPH?
- urinary frequency volume chart
- urine dipstick
- prostate-specific antigen (PSA)
common causes of a raised PSA?
- prostate Ca
- BPH
- prostatitis
- UTIs
- cycling
- recent ejaculation
- prostate stimulation
findings on DRE in prostate Ca?
- prostate feels firm / hard
- asymmetrical
- craggy / irregular surface
- loss of central sulcus
