Genitourinary Disorders Lecture 2024 PDF

Genitourinary Disorders PARA2003 Objectives Review of Kidney function Aetiology of renal disease Consequences of renal disease Implications for paramedic practice Discuss the most common male genital disorders This material has been reproduced and communicated to yo...

Genitourinary Disorders PARA2003 Objectives Review of Kidney function Aetiology of renal disease Consequences of renal disease Implications for paramedic practice Discuss the most common male genital disorders This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Learning LO3: Demonstrate an understanding of the pathophysiology, diagnosis and pre-hospital Outcomes management of patients with genitourinary and renal related conditions. This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Key Idea #1 Water follows Sodium (Na+) This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Key Idea #2 Renal System = Wall Street physiology Buy = Reabsorption Sell = Secretion This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Key Idea #3 Kidneys = blood pressure This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Key Idea #4 UTI = can be complicated This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Key Idea #5 What’s the Potassium? – K+ This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  The Renal System This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Structure of the Kidney This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Nephron Approx. 1 million functional units per kidney Comprised of: Renal corpuscle Glomerulus Glomerular capsule (Bowman’s Capsule) Proximal convoluted tubule (PCT) Loop of Henle (LOH) Distal convoluted tubule (DCT) Collecting ducts (CD) This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Renal blood flow Renal artery ↓ Afferent arteriole ↓ Glomerulus ↓ Efferent artery ↓ Peritubular capillaries (Vasa recta) ↓ Venous drainage – renal vein This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. 1.Filtration 2.Reabsorption 3.Secretion 4.Excretion This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Renal Filtration This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Filtration Glomerulus Fenestrated capillaries Hydrostatic pressure controlled by afferent & efferent arterioles Water, electrolytes & wastes leak out Protein & cells remain This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Glomerular filtration rate (GFR) 90-120ml/min (150-180 L/day) Only about 1% of this is excreted as urine Regulated by: Renal autoregulation of blood pressure Sympathetic control Hormonal control (renin- angiotensin-aldosterone) Medications/drugs This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Renal reabsorption & Renal secretion This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Tubular reabsorption & secretion Reabsorption of H2O & solutes Differ along the tubule Fine tuned in the DCT & CD Secretion of excess H2O, ions & wastes also variable along tubule Also fine tuned in DCT & CD This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Transport mechanisms Diffusion Osmosis Active transport Na+/K+, Na+/H+ etc Facilitated transport Leakage through cell junctions This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Renal excretion This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Fluid balance (Water H2O) dehydration vs. fluid overload BP (and thus renal perfusion) regulates GFR Osmosis drives H2O reabsorption in Prox. CT & LOH – Transport of Na+ into extracellular fluid in the medulla – increases osmotic pressure and thus diffusion – water follows sodium Hormone systems involved in fluid balance: Aldosterone – reabsorbs Na+ → H2O follows ADH - inserts aquaporins through cell membrane H2O - osmosis Atrial natriuretic hormone This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Antidiuretic hormone ADH secreted in response to ↑ osmolarity (blood) or ↓ BP Increases permeability (aquaporins) of CD H2O moves out of CD High osmolarity of renal medulla aids this movement Inhibited by ETOH This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Further Reading: https://teachmephysiology.com/urinary-system/regulation/the-renin-angiotensin-aldosterone-system/ This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Atrial natriuretic peptide Opposes RAAS system Too much blood volume Impedes renin secretion Na+ lost – H2O follows This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Blood volume / fluid and electrolyte balance This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this Martini 25-5 communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Fluid balances Not purely a renal problem But renal is a major contributor Fluid loss through bowel, skin and respiration This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Severe dehydration – forced or acute injury Effects on Kidneys? Kidney failure Kidney stone Low blood pressure Increased blood osmolarity This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Dehydration Aetiology Inadequate intake Excessive loss GI Elderly – blunted thirst Gastroenteritis GI obstruction response Febrile illness Burns Dementia Heat stroke Cystic fibrosis Stroke Endocrine Incapacitation Diabetic ketoacidosis Diabetes insipidus Outdoor worker Thyrotoxicosis Addison’s disease Recreational activity Diuretics Alcohol, Caffeine This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Hydration Status Assessment (HSA) Exam History Tongue & Membranes Thirst Skin turgor Fluid input (oral / IV) Cap Refil – peripheral Fluid output – urine vs central Sweat, Vomiting, Diarrhoea Peripheral Oedema ?Known diuretics Pulmonary Oedema (eg. Caffeine, ETOH, JVP Medications) Investigations Pulse, BP – Postural BP Urine / serum specific gravity https://geekymedics.com/hydration-status-assessment-osce-guide/ This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Dehydration - History, Exam & Investigations Thirst Dry tongue & membranes ↓ Fluid intake ↓ Urine Output Increased skin turgor ? ↑ Sweat, Vomiting, Diarrhoea Tachycardia, Postural BP Drop Concentrated urine https://geekymedics.com/hydration-status- assessment-osce-guide/ This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Hypotension, tachycardia, confused, uncoordinated, collapse This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Dehydration Management Paramedic management Assess severity Consider underlying pathologies E.g. hyperglycaemia Mindful of the vulnerabilities Elderly & very young Cardiac Comorbidities Oral fluid replacement IV access – IV fluid 1: to restore perfusion 2: to rehydrate (slowly) – be weary of electrolyte disturbance This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Over hydration - Oedema Causes Idiopathic (unknown) Polydipsia Iatrogenic Diseases Renal failure Liver failure Hypoproteinuria Cardiac failure Lymphoedema Oedema of renal failure http://www.cmej.org.za/index.php/cmej/article/viewFile/2353/2191/12517 This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Pathophysiology of Oedema ↑ hydrostatic pressure Hypervolaemia Venous congestion ↓ osmotic pressure Haemodilution / hypervolaemia ↓ plasma proteins Abnormal distribution across fluid compartments → peripheral oedema & pulmonary oedema This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Oedema Management Main Causes: heart failure or renal failure Paramedic management Assess severity A good history here will allow you to differentiate the cause Assess breath sounds Peripheral oedema JVP Manage pulmonary oedema O2, GTN, CPAP Restrict fluids Diuretics(?) Lasix/frusemide This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Electrolyte balances Fine balance between reabsorption and secretion Allows loss of wastes – urea, uric acid, creatine, NH4+ & drug metabolites Allows retention of important electrolytes – Na+, K+ Ca2+ Mg2+ & Cl- Normal Values (Kumar & Clark’s Clinical Medicine, 9th Ed) This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Imbalance? Na+ Ca+ K+ HCO3 This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Electrolyte imbalances – Na+ Hypernatraemia (rare) Hyponatraemia (less rare) CNS impairment Psychogenic polydipsia ADH insufficiency ‘Salt wasting’ kidney disease DKA Aldosterone insufficiency Diabetes insipidus Diuretic use Dehydration Consequences Cellular dehydration Consequences Stimulates thirst Oedema Rarely symptomatic Nausea & vomiting May cause CNS effects Fever Headache, confusion, restlessness, Confusion myoclonic jerks This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Electrolyte imbalances – K+ Hyperkalaemia Acidosis (DKA) Treatment: ↓ aldosterone - Calcium Gluconate (cardiac protector) K+ sparing diuretics (spironolactone) - Salbutamol – suspected hyperkalaemia with ECG changes Meds: ACE inhibitors, ARBs, NSAIDs, B blockers - Insulin + Glucose Vigorous exercise Signs - Sodium Bicarbonate (only in acidosis – buffer H+) ECG changes (peaked T, sine wave pattern, VT/VF, - Resonium (get rid of K+ through GI) bradycardia – asystole) - Dialysis Kussmaul’s resps (if acidosis – blow off CO2) Muscle weakness, lethargy, confusion – (action potential implications) Nausea / vomiting !!!!! This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Electrolyte imbalances – K+ Hypokalaemia (common) Diuretics – thiazides (flozins) Excessive aldosterone (Conns syndrome) Excessive IV fluids (Other rarer causes) Signs Muscle weakness, fatigue Headaches Arrhythmias - Ectopic beats Serious with digoxin toxicity This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Normal K+ Range 3.5 – 5 mmol/L This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Acid/Base Review 1. Water exists in equilibrium as H2O H+ + OH- 2. pH = -ve log H+  Solutions with many free H+ have low pH & display acidic properties and v/v 3. Introduction of a molecule that alters the H+ or OH- Concentration will change pH Hear it from someone else: https://www.youtube.com/watch?v=Xeuyc55LqiY This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Acid/base balance Buffering in the kidneys Secretion/Reabsorption of H+ and HCO3- (and NH4+) Generally active transport associated with Na+/K+ & H+ pumps This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Role of the kidneys in acid-base balance CO2 + H2O H2CO3 H+ + HCO3- Carbonic Acid Bicarbonate (buffer) 1. Kidneys directly excrete H+ through Na+ / H+ transporters 2. Kidneys synthesise and reabsorb HCO3- Further Reading: https://teachmephysiology.com/urinary-system/ion-balance/urinary-acid-base/ This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Renal disorders Pre-renal disorders Intra-renal disorders Post-renal disorders Acute Kidney Injury Chronic Kidney disease & dialysis Genital disorders This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. What can go wrong – pre- renal Problems with the perfusion Hypotension Hypovolaemia / Volume depletion Cardiac Failure (C/R Syndromes) Septic shock Renal stenosis Atherosclerosis AAA GFR ↓ → Acute renal failure Kidneys become ischaemic This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. What can go wrong – intra-renal Problems within the kidney / nephron Interstitial disease Vascular disease Tubular necrosis Often 2nd ischaemia Glomerulonephritis Nephrotic & nephritic disease Many causes Inflammation Infection Toxins DM - Chronic hyperglycaemia Genetic disease (Polycystic kidney disease, Alport Syndrome) Autoimmune disorder This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this Idiopathic communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Glomerulonephritis Damage to: Leads to: Glomerulus Renal insufficiency Becomes leaky Proteinuria (Nephrotic syndrome) Tubule Haematuria (Nephritic syndrome) Blockage HTN & Oedema Ischaemic Long term Immune mediated changes chronic kidney disease ↓ Loss of function This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Rhabdomyolysis - AKI Break-down of muscles – release of products – Associated hypovolaemia creatine kinase, myoglobin, K+ & others low GFR Due to: Ischaemia & necrosis of tubules Crush injuries Acute renal failure (rare – extreme exercise, some drugs & toxins) Toxins – envenomation Characteristic red-brown urine Prolonged muscle use – severe dehydration Myoglobinuria or hemoglobinuria Leads to Tubular obstruction Direct epithelial injury Filytering network breakdown Ischaemia through vasoconstriction This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. What can go wrong – post renal Problems with the plumbing UTI’s Renal stone Ureteric obstructions Prostatism Congestion within tissues of the kidneys - hydronephrosis Impairs function This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Urinary Tract Infection (UTI) Lower urinary tract infections Cystitis (“traditional” UTI) Urethritis (often sexually- transmitted) Lab Findings Positive Urine Culture Upper urinary tract Most common pathogens for cystitis, Infections prostatitis, pyelonephritis: GUT flora & STIs Pyelonephritis Escherichia coli This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. UTI Sign & Symptoms Dysuria Frequency, urgency Voiding of small urine volumes Haematuria Suprapubic / lower abdominal pain (cystitis) Nausea/Vomiting (pyelonephritis) Flank pain (pyelonephritis) Urine that looks cloudy or smells foul Fever/sepsis Altered mentation in the aged Management Antibiotics Fluids This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. UTI management Recognition May be secondary reason for attendance Look for signs of sepsis – qSOFA HAT Unexplained confusion This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Kidney Stones Hard mineral/salt deposits formed in ducts Can obstruct collecting ducts / ureters Risk factors Family history (45%) Diet High in protein, Na and sugar low in fibre and fluids Weight Stress Dehydration Digestive Diseases & surgery Other medical conditions Renal tubular acidosis, cystinurea, Hyperparathyroidism, Some medications – Thiazide diuretics This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Symptoms Symptoms Severe pain – Loin to groin Haematuria General weakness Fever Nausea Paramedic Management Analgesia – large doses Antiemetic Transport This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Gout Elevated uric acid levels Normally cleared by kidneys Crystals uric acid form in joints (often big toe) →inflammatory arthritis / attacks Thiazide diuretics Foods high in purine – wine, red meat, seafoods Note: CKD is only one cause of gout Really painful Anti-inflammatory treatments - corticosteroids This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Acute Renal Failure (ARF) Rapid decrease in kidney function Loss of fluid balance, retention of metabolic waste (↑urea & creatinine → diagnostic tools) and loss of acid-base homeostasis Significant mortality rate Potentially reversible Can complicate almost all critical illness Risk factors Advanced age Pre-existing renal disease Diabetes mellitus/ vascular disease Underlying cardiac or liver disease This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. S&S with ARF and Uraemia Symptoms Fluid overload Mental status changes Shortness of breath Seizures (ꜛꜛꜛurea and electrolytes) Peripheral oedema Anaemia Pulmonary oedema Fatigue Elevated right atrial pressure Anorexia Nausea and vomiting Pruritus (Urea) This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Hospital Management of ARF Treat underlying cause Blood pressure Infections Cease nephrotoxic medications Remove nephrostomy tubes/ureteral stents if obstruction Manage fluid & electrolytes Hydration Diuresis (Lasix) Electrolyte correction Dialysis Renal transplant This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Symptoms of chronic kidney disease (CKD) Asymptomatic until 90% loss of function Peripheral / Pulmonary Oedema Electrolyte imbalance Uraemia Accumulation of toxic wastes within the blood Measured via Creatinine & Urea Metallic taste in mouth (urea) Insomnia, fatigue & depression GI disturbances Nausea & vomiting Constipation or diarrhoea This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Risk factors for chronic kidney disease Elevated Risk In: DM HTN Vast array of underlying causes Hx of atherosclerotic disease – e.g. heart disease Congenital or stroke Vascular Familial history Primary + Secondary Glomerular Disease Obesity Tubular / Interstitial Disease Smoking Urinary Tract Disease Increasing age Are of Aboriginal or Torres Strait Islander origin? Kidney Health Australia - Risk Factors (10th leading cause of death for First Nations https://kidney.org.au/your-kidneys/prevent/risk-factors people. First Nations females accounted for 58% https://www.indigenoushpf.gov.au/report-overview/overview/summary-report/4-tier-1-%E2%80%93- health-status-and-outcomes/kidney- of deaths due to kidney disease among First disease#:~:text=Kidney%20diseases%20were%20the%2010th,Nations%20people%20decreased%20by%203 6%25. Nations people) Previous acute kidney disease This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Signs of kidney disease or Chronic Kidney Disease (CKD) ↓ GFR Proteinuria (albuminaemia) Haematuria ↑ Creatinine ↑ Urea ↑ Potassium This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Chronic Kidney Disease Symptoms Polyuria/oliguria/anuria Hypertension Pulmonary oedema, dyspnoea Electrolyte imbalances Anaemia (due to erythropoietin deficiency) Weakness, fatigue Nausea, vomiting, appetite loss This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Community Management of CKD Fluid and Electrolyte Balance Avoid dehydration or excess hydration IV glucose and insulin (ꜛK+) Diet (Possibly) restrict sodium, phosphate, calcium Supplement diet with multivitamin, Vit D Iron supplements, blood, erythropoietin Reduce protein breakdown (adequate carbohydrates & fats) Correct acidosis Control complications of: hypertension nervous system involvement Dialysis - After all other methods have failed Kidney transplantation This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Renal Replacement Therapy / Dialysis Peritoneal Dialysis Achieved either via Haemodialysis transplant, haemodialysis or peritoneal dialysis Replicate function of kidneys Solute exchange across semi- permeable membrane Nowhere near as effective as a kidney (= GRF 10- 12mL/min/m2) This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Renal Replacement Therapy / Dialysis This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Arteriovenous (AV) fistula Haemodialysis requires blood flow of 250-450mL / min Anastomosis of an artery with a vein DO NOT Take BP on fistula arm DO NOT cannulate fistula arm Need to protect and preserve its integrity This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Paramedic Management Pre-renal prevention Minimise and manage Shock Manage presenting symptoms Intra & post-renal failure Recognition and management of cause Judicious fluid management if dehydrated Analgesia/medications with caution Transport This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Renal failure Impaired renal excretion of drugs/ metabolites Prolongs half life and drugs Narrows therapeutic drug index Increased risk for adverse drug reactions This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Male urinary disorders (a quick overview) This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Prostatic hypertrophy Benign Cancer Unclear aetiology Asymptomatic or similar to Related to androgens and benign testicular hormones Metastases – may have complications associated Usually affects 50+ age group with this Causes urethral restriction Age is major risk factor PSA measurement/screen This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Prostatitis Inflammation of the prostate E. coli is the most common Microorganisms are carried to the prostate from the urethra Sign &Symptoms Perineal discomfort Burning, urgency, frequency Pain after ejaculation Dysuria Fever and chills Rectal or low back pain Paramedic Management Symptom relief and referral This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Testicular Pain Torsion Hydrocele Trauma Epididymitis / Orchitis Paramedic care: Analgesia (maybe antiemetic) This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Epididymitis / Orchitis Inflammation of epididymis or teste Often secondary to UTI or STI Red swollen, shiny scrotum Scrotal and pelvic pain This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Testicular Torsion Most common acute scrotal disorder Twisting of spermatic cord Usually 8-18 years Often assessed with U/S Acute surgical emergency Surgery required within 3 hours (80% salvage) This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  Paramedic management Major conditions Testicular/penis trauma Testicular torsion Epididymitis/orchiditis Look for urethral bleeding – serious sign Analgesia Anti-emetics Transport This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Genitalia injury or mutilation Can occur for cultural, medical or non-medical reasons reasons in Australia to both males and females May include circumcision, removal of clitoris, stitching and/or cauterising the labia (closes the opening to vagina), piercings May be confronting Pain management, manage bleeding and transport This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.  References  Levey, A and Inker, L. (2024). Definition and staging of chronic kidney disease in adults. Online: https://www.uptodate.com/contents/definition-and-staging-of-chronic-kidney-disease-in-adults  https://www.aihw.gov.au/reports/chronic-kidney-disease/chronic-kidney-disease-indigenous- australians/summary  Murdeshwar HN, Anjum F. Hemodialysis. [Updated 2023 Apr 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563296/  Simon LV, Hashmi MF, Farrell MW. Hyperkalemia. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470284/  Martini, Nath, Bartholomew. Fundamentals of Anatomy and Physiology, 11th ed. Chapters 26 and 27.  Robbins, Stanley L. (Stanley Leonard) et al., eds. 2005. Robbins and Cotran Pathologic Basis of Disease / [Edited by] Vinay Kumar, Abul K. Abbas, Nelson Fausto ; with Illustrations by James A. Perkins. 7th ed. Philadelphia: Elsevier Saunders. This material has been reproduced and communicated to you by or on behalf of Flinders University in Accordance with section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act.