31 - Diseases of the urinary tract Flashcards
Functions of kidney
Eliminating metabolic waste products
Regulating fluid and electrolyte balance
Influencing acid-base balance
Production of some hormones - renin, EPO
Acute renal failure - clinical presentation
Rapid rise in creatinine and urea
Generally unwell
Nephrotic syndrome - clinical presentation
Oedema
Proteinuria
Hypoalbuminaemia
Proteinuria >3g per 24hr (mostly albumin)
Acute nephritis - clinical presentation
Oedema
Proteinuria
Haematuria
Renal failure
Chronic renal failure - clinical presentation
Slowly declining renal function
Mechanisms of glomerular damage - two categories
Immunological
Non-immunological
Mechanisms of glomerular damage - immunological
Deposition of circulating immune complexes in glomerulus
Deposition of circulating antigens in glomerulus
Antibodies to basement membrane
Mechanisms of glomerular damage - why immunological damages glomerulus
Complement activation
Neutrophil activation
Reactive oxygen species
Clotting factors
Mechanisms of glomerular damage - non-immunological
Injury to endothelium
Altered basement membrane due to hyperglycaemia
Abnormal basement membrane or podocytes
Deposition of abnormal proteins in the kidney
Mechanisms of tubular damage - two types
Ischaemic
Toxic
Mechanisms of tubular damage - ischaemic
Hypotension
Damage to vessels within kidney
Glomerular damage
Reduces blood supply
Mechanisms of tubular damage - toxic
Direct toxins
Hypersensitivity
Deposition of crystals in tubules
Deposition of abnormal proteins
Mechanisms of vascular damage
Thrombotic microangiopathy (e.g. haemolytic uraemic syndrome)
Vasculitis (e.g. Wegener’s granulomatosis)
Hypertension
Diabetes
Atheroma e.g. renal artery stenosis
Immunological e.gs
Membranous Anti-GBM disease IgA nephropathy Lupus nephritis Post-infective
Direct toxicity e.g.s
Gentamicin
Nephrotic syndrome - why, clinical presentation, complications
Always due to glomerular damage
CP - oedema, proteinuria (>3g in 24hr), +/- hypertension, +/- hyperlipidaemia
Complications - infection, thrombosis
Nephrotic syndrome - causes
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
Nephrotic syndrome - child causes
Minimal change disease
Focal segmental glomerulosclerosis
Acute nephritis - clinical presentation
Oedema Haematuria Proteinuria Hypertension Acute renal failure
Acute nephritis - common causes
Post-infective glomerulonephritis (weeks after Strep throat)
IgA nephropathy (most common primary disease)
Vasculitis
Lupus
Acute nephritis - causes for children
Post-infective glomerulonephritis
IgA nephropathy
Henoch-Schonlein purpura
Haemolytic-uraemic syndrome
Henoch-Schonlein purpura
Specific type of IgA nephropathy
M>F
Typically young boys with arthralgia, abdo pain, rash, haematuria, acute renal failure
Haemolytic-uraemic syndrome
Typically children with E.Coli enteritis
Acute nephritis + haemolysis + thrombocytopoenia
Acute renal failure - diagnosis
Anuria/oliguria + raised creatinine and urea
Acute renal failure - causes
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
Acute renal failure - causes
All biopsies show acute tubular necrosis
Adult - vasculitis, acute interstitial nephritis
Children - henoch-schonlein purpura, haemolytic uraemic syndrome, acute interstitial nephritis
Acute renal failure - complications
Cardiac failure Arrythmias GI bleeding Jaundice Infection
Acute renal failure - treatment
Short term dialysis if needed
Treat underlying cause
Chronic renal failure - what is it
Stages of permanently reduced GFR
Chronic renal failure - causes
Diabetes (commonest)
Glomerulonephritis
Reflux nephropathy
Chronic renal failure - causes for children
Developmental abnormalities
Reflux nephropathy
Glomerulonephritis
Chronic renal failure - effects
Reduced excretion of water and electrolytes = oedema, hypertension
Reduced excretion of toxic metabolites
Reduced production of EPO
Renal bone disease
Clinical scenario: elderly patient w/ acute renal failure
Drug rxn
Myeloma
Clinical scenario: young male with haematuria + rash
Henoch-Schonlein purpura
Clinical scenario: teenager/young adult with haematuria
Post-infective glomerulonephritis
IgA nephropathy
Clinical scenario: adult w/ acute renal failure, fever and myalgia
Vasculitis
Clinical scenario: young woman with haematuria and facial rash
Lupus
Clinical scenario: adult w/ nephrotic syndrome
Membranous nephropathy
Clinical scenario: child w/ nephrotic syndrome
Minimal change disease
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