31 - Diseases of the urinary tract

Question 1

Functions of kidney

Answer 1

Eliminating metabolic waste products
Regulating fluid and electrolyte balance
Influencing acid-base balance
Production of some hormones - renin, EPO

Question 2

Acute renal failure - clinical presentation

Answer 2

Rapid rise in creatinine and urea

Generally unwell

Question 3

Nephrotic syndrome - clinical presentation

Answer 3

Oedema
Proteinuria
Hypoalbuminaemia
Proteinuria >3g per 24hr (mostly albumin)

Question 4

Acute nephritis - clinical presentation

Answer 4

Oedema
Proteinuria
Haematuria
Renal failure

Question 5

Chronic renal failure - clinical presentation

Answer 5

Slowly declining renal function

Question 6

Mechanisms of glomerular damage - two categories

Answer 6

Immunological

Non-immunological

Question 7

Mechanisms of glomerular damage - immunological

Answer 7

Deposition of circulating immune complexes in glomerulus
Deposition of circulating antigens in glomerulus
Antibodies to basement membrane

Question 8

Mechanisms of glomerular damage - why immunological damages glomerulus

Answer 8

Complement activation
Neutrophil activation
Reactive oxygen species
Clotting factors

Question 9

Mechanisms of glomerular damage - non-immunological

Answer 9

Injury to endothelium
Altered basement membrane due to hyperglycaemia
Abnormal basement membrane or podocytes
Deposition of abnormal proteins in the kidney

Question 10

Mechanisms of tubular damage - two types

Answer 10

Ischaemic

Toxic

Question 11

Mechanisms of tubular damage - ischaemic

Answer 11

Hypotension
Damage to vessels within kidney
Glomerular damage

Reduces blood supply

Question 12

Mechanisms of tubular damage - toxic

Answer 12

Direct toxins
Hypersensitivity
Deposition of crystals in tubules
Deposition of abnormal proteins

Question 13

Mechanisms of vascular damage

Answer 13

Thrombotic microangiopathy (e.g. haemolytic uraemic syndrome)
Vasculitis (e.g. Wegener’s granulomatosis)
Hypertension
Diabetes
Atheroma e.g. renal artery stenosis

Question 14

Immunological e.gs

Answer 14

Membranous
Anti-GBM disease
IgA nephropathy
Lupus nephritis
Post-infective

Question 15

Direct toxicity e.g.s

Answer 15

Gentamicin

Question 16

Nephrotic syndrome - why, clinical presentation, complications

Answer 16

Always due to glomerular damage
CP - oedema, proteinuria (>3g in 24hr), +/- hypertension, +/- hyperlipidaemia

Complications - infection, thrombosis

Question 17

Nephrotic syndrome - causes

Answer 17

Membranous nephropathy (most common, idiopathic, M>F)
Focal segmental glomerulosclerosis (FSGS, idiopathic, genetic, heroin use, HIV, M>F)
Minimal change disease

Diabetes, lupus nephritis, amyloid

Question 18

Nephrotic syndrome - child causes

Answer 18

Minimal change disease

Focal segmental glomerulosclerosis

Question 19

Acute nephritis - clinical presentation

Answer 19

Oedema
Haematuria
Proteinuria
Hypertension
Acute renal failure

Question 20

Acute nephritis - common causes

Answer 20

Post-infective glomerulonephritis (weeks after Strep throat)
IgA nephropathy (most common primary disease)
Vasculitis
Lupus

Question 21

Acute nephritis - causes for children

Answer 21

Post-infective glomerulonephritis
IgA nephropathy
Henoch-Schonlein purpura
Haemolytic-uraemic syndrome

Question 22

Henoch-Schonlein purpura

Answer 22

Specific type of IgA nephropathy
M>F
Typically young boys with arthralgia, abdo pain, rash, haematuria, acute renal failure

Question 23

Haemolytic-uraemic syndrome

Answer 23

Typically children with E.Coli enteritis

Acute nephritis + haemolysis + thrombocytopoenia

Question 24

Acute renal failure - diagnosis

Answer 24

Anuria/oliguria + raised creatinine and urea

Question 25

Acute renal failure - causes

Answer 25

Pre-renal: reduced blood flow = most common. E.g. severe dehydration, hypotension, bleeding, septic shock, LV failure Renal Post-renal: obstructed urinary tract e.g. tumours of urinary tract, tumours in pelvis, bladder stones, prostatic enlargement

Question 26

Acute renal failure - causes

Answer 26

All biopsies show acute tubular necrosis Adult - vasculitis, acute interstitial nephritis Children - henoch-schonlein purpura, haemolytic uraemic syndrome, acute interstitial nephritis

Question 27

Acute renal failure - complications

Answer 27

``` Cardiac failure Arrythmias GI bleeding Jaundice Infection ```

Question 28

Acute renal failure - treatment

Answer 28

Short term dialysis if needed | Treat underlying cause

Question 29

Chronic renal failure - what is it

Answer 29

Stages of permanently reduced GFR

Question 30

Chronic renal failure - causes

Answer 30

Diabetes (commonest) Glomerulonephritis Reflux nephropathy

Question 31

Chronic renal failure - causes for children

Answer 31

Developmental abnormalities Reflux nephropathy Glomerulonephritis

Question 32

Chronic renal failure - effects

Answer 32

Reduced excretion of water and electrolytes = oedema, hypertension Reduced excretion of toxic metabolites Reduced production of EPO Renal bone disease

Question 33

Clinical scenario: elderly patient w/ acute renal failure

Answer 33

Drug rxn | Myeloma

Question 34

Clinical scenario: young male with haematuria + rash

Answer 34

Henoch-Schonlein purpura

Question 35

Clinical scenario: teenager/young adult with haematuria

Answer 35

Post-infective glomerulonephritis | IgA nephropathy

Question 36

Clinical scenario: adult w/ acute renal failure, fever and myalgia

Answer 36

Vasculitis

Question 37

Clinical scenario: young woman with haematuria and facial rash

Answer 37

Lupus

Question 38

Clinical scenario: adult w/ nephrotic syndrome

Answer 38

Membranous nephropathy

Question 39

Clinical scenario: child w/ nephrotic syndrome

Answer 39

Minimal change disease

Question 40

SLIDES 32 ONWARDS ARE IN LECTURE

Answer 40

BUT SHE DID NOT PRESENT THEM