Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

Makindo Medical Notes "One small step for man, one large step for Makindo"
Download all this content in the Apps now Android App and Apple iPhone/Pad App

MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Renal and Urology Emergencies

About

Anaesthetics and Critical Care

Obstetrics Gynaecology

Oncology

Ophthalmology

Oral Medicine and Dentistry

Statistics and Research

Stroke

Surgery

Toxicology

Trauma and Orthopaedics

Twitter

Urology

Renal and Urological Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Acute Kidney Injury (AKI)	Oliguria or anuria, fatigue, and confusion. Edema, hypertension, and signs of fluid overload. History of recent illness, medication use (e.g., NSAIDs, ACE inhibitors), or dehydration.	Elevated serum creatinine and BUN levels. Urinalysis showing casts, proteinuria, or haematuria. Renal ultrasound to assess for obstruction or hydronephrosis.	Identify and treat the underlying cause (e.g., volume resuscitation for dehydration, stopping nephrotoxic drugs). Manage fluid and electrolyte imbalances (e.g., hyperkalemia, acidosis). Dialysis may be necessary for severe cases or complications (e.g., uraemia, refractory hyperkalemia). Monitor renal function and urine output closely.
Hyperkalemia	Muscle weakness, fatigue, and palpitations. Peaked T waves, widened QRS complexes, and possible arrhythmias on ECG. Associated with renal failure, acidosis, or use of potassium-sparing diuretics.	Serum potassium level >5.5 mEq/L. ECG to assess for cardiac effects of hyperkalemia. Serum creatinine and BUN to evaluate renal function.	IV calcium gluconate to stabilize cardiac membranes. Insulin and glucose, beta-agonists (e.g., albuterol), or sodium bicarbonate to shift potassium intracellularly. Kayexalate (sodium polystyrene sulfonate) or patiromer for potassium removal. Dialysis may be required in severe cases or if refractory to other treatments.
Acute Urinary Retention	Severe lower abdominal pain and inability to void. Distended bladder palpable on physical examination. Associated with benign prostatic hyperplasia (BPH), urethral stricture, or medications (e.g., anticholinergics).	Bladder ultrasound showing significant post-void residual volume. Urinalysis to rule out infection or haematuria. Serum creatinine to assess renal function if prolonged obstruction.	Immediate catheterization to decompress the bladder. Treat underlying cause (e.g., alpha-blockers for BPH, surgery for stricture). Pain management and monitor for post-obstructive diuresis. Referral to urology for further evaluation and management.
Testicular Torsion	Sudden onset of severe scrotal pain, often with nausea and vomiting. Swollen, tender testicle with high-riding position and absent cremasteric reflex. Common in adolescent males; a urological emergency.	Doppler ultrasound of the scrotum showing reduced or absent blood flow to the affected testicle. Urinalysis to rule out infection if clinically indicated.	Immediate surgical detorsion and fixation (orchiopexy) to salvage the testicle. Manual detorsion may be attempted if surgery is delayed, but definitive surgical treatment is required. Monitor for complications such as testicular atrophy or infertility.
Renal Colic	Severe, intermittent flank pain radiating to the groin. Hematuria, nausea, vomiting, and restlessness. Associated with kidney stones (nephrolithiasis).	Non-contrast CT scan of the abdomen and pelvis is the gold standard for diagnosing kidney stones. Urinalysis showing haematuria, possible crystals, or signs of infection. Blood tests to assess renal function and serum electrolytes.	IV fluids and pain management with NSAIDs or opioids. Alpha-blockers (e.g., tamsulosin) to facilitate stone passage. Extracorporeal shock wave lithotripsy (ESWL) or surgical intervention for larger stones or if complicated. Monitor for complications such as infection or obstruction.
Priapism	Painful, prolonged erection lasting more than 4 hours. Associated with sickle cell disease, medications (e.g., phosphodiesterase inhibitors, antipsychotics), or spinal cord injury. May lead to ischaemic damage to the penile tissue if not treated promptly.	Cavernosal blood gas analysis to differentiate between ischaemic (low-flow) and non-ischaemic (high-flow) priapism. Doppler ultrasound of the penis may be used to assess blood flow. Complete blood count and reticulocyte count if associated with sickle cell disease.	Immediate aspiration of blood from the corpora cavernosa, followed by irrigation with saline or alpha-agonist (e.g., phenylephrine) injection. Analgesia and possible sedation for comfort during the procedure. For non-ischaemic priapism, observation or surgical intervention may be required. Treat underlying cause and consider urology consultation for recurrent cases.
Acute Pyelonephritis	Fever, chills, and flank pain. Dysuria, frequency, and urgency associated with urinary tract infection. Costovertebral angle tenderness on physical examination.	Urinalysis showing pyuria, bacteriuria, and possibly haematuria. Urine culture to identify the causative organism and antibiotic sensitivity. Blood cultures if systemic infection is suspected (e.g., sepsis).	Empiric IV antibiotics (e.g., ceftriaxone, ciprofloxacin) followed by oral antibiotics based on culture results. IV fluids for hydration and to maintain renal perfusion. Hospitalization for severe cases, immunocompromised patients, or those unable to tolerate oral antibiotics. Follow-up imaging (e.g., ultrasound) if obstruction or abscess is suspected.
Bladder Rupture	Suprapubic pain and difficulty urinating following trauma (e.g., pelvic fracture). Hematuria and possible signs of peritonitis if intraperitoneal rupture. Possible shock if associated with significant blood loss.	Retrograde cystography (CT or conventional) showing contrast extravasation from the bladder. Urinalysis showing gross haematuria. Abdominal or pelvic CT scan to assess associated injuries.	Surgical repair for intraperitoneal ruptures. Catheterization and conservative management for small, extraperitoneal ruptures. Monitor for complications such as infection or persistent leakage. Manage associated injuries and provide supportive care.
Postobstructive Diuresis	Polyuria following relief of urinary tract obstruction (e.g., catheterization for urinary retention). Dehydration, hypotension, and electrolyte imbalances. May occur after prolonged or severe obstruction.	Monitor urine output closely. Serum electrolytes to assess for imbalances (e.g., hypokalemia, hyponatremia). Renal function tests (serum creatinine, BUN) to monitor for improvement post-obstruction.	IV fluid replacement to match urine output and prevent dehydration. Monitor and correct electrolyte imbalances as needed. Gradual tapering of fluids as urine output stabilizes. Close monitoring until diuresis subsides and electrolyte levels normalize.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

Edit