Urological Emergencies

Urinary System

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  • Filters blood and reabsorbs to maintain homeostasis

Anatomy of the kidney

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Kidney Stones

Hard mineral and salt deposits that form in the kidneys when urine becomes too concentrated

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Renal colic - type of pain with kidneys

Risk Factors for Kidney Stones

  • Peak age 40-50

  • More common in men (23:1)

  • Ethnicity - more common in white poeple

  • Diet (excessive sodium and animal protein)

  • Chronic Dehydration

  • Obesity

  • Family History

  • Previous Kidney Stones

Signs and Symptoms of Renal Colic

  • Sudden onset severe unilateral abdominal pain, originating in loin or flank and radiating to groin

  • Pain lasts minutes to hours and occurs in spasms (with intervals of no pain or dull ache)

  • Often accompanied by nausea, vomiting and haematuria, and is usually described as the most severe pain experienced by the person

  • Also potential: dysuria, urinary frequency and straining

Treatment and Management of Renal Colic

A&E if:

  • Signs of systemic infections e.g. fever or sepsis

  • Increased risk of AKI - acute kidney injury

  • The person is dehydrated and cannot tolerate oral fluids due to nausea and/or vomiting

  • The diagnosis is uncertain

For all other people with suspected renal or ureteric colic:

  • Arrange urgent (within 24 hours of presentation )imaging t

Blocked Ureter

A blockage anywhere along the ureter from any cause

Causes of Uretal Obstruction

  • Kidney stones

  • Thrombus

  • Carcinom

  • Uretral Stenosis (narrowing)

Signs ans Symptoms of Uretral Obstruction

  • Abdominal and flank pain

  • Reduction in urine output

  • Difficulty urinating

  • Blood in urine

  • Urinary tract infections

Treatment and Management

  • Pain relief

  • Conveyance to A&E/SDEC for further assessment and treatment

Acute Kidney Injury (AKI)

Sudden reduction in kidney function

Ranges from minor loss of function to complete kidney failure

Causes of AKI

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Signs and Symptoms of AKI

  • No specific signs and symptoms

  • Nausea and vomiting, diarrhoea, or suspected dehydration

  • Reduced output or changes to urine colour

  • Confusion, fatigue or drowsiness

  • Risk factors for AKI

Risk Factors for AKI

  • Over 65

  • CKD or other kidney problems

  • Dehydration

  • Uretral blockage

  • Severe infection

  • Certain medications e.g. NSAIDS

Treatment and Management of AKI

  • Pain relief if required

  • All will require further assessment, but pathway is dependent on severoty risk (eg. CKD), and viable pathways (GP > SDEC > A&E)

  • Diagnosis with serum creatinine test

Haematuria

Urine that is visibly discoloured by blood or blood clot

It may be present as urine that is red to brown or as frank blood

As little as 1ml of blood can impart colour to 1l of urine

Causes of Haematuria

Common:

  • Benign prostatic hyperplasia

  • Urinary tract infection

  • Acute pyelonephritis (kidney infection)

  • Bladder cancer

Less common:

  • Renal trauma

  • Bladder trauma

  • Urethral trauma

  • Sickle cell anaemia

Signs and Symptoms of Haematuria

  • Visible blood in urine

Treatment and Management of Haematuria

  • This will be dependent on the history (probable cause)

  • Reassurance of patient

  • Pain relief if required

  • Refferal for further assessment unless other concerning symptoms