9.3: Lecture: Urological disorders (part 1of2) Flashcards
5 consequences of kidney failure
Filtration failure
Hypertension, water retention
Metabolic acidosis
Anaemia
Vit. D deficiency and secondary hyperparathyroidism
What does anaemia arise from
Lack of erythropoietin production
What happens if there is filtration faliure of the kidneys
Unwell with accumulation of waste substances
Haematuria and proteinuria, low serum protein including albumin in the blood
What is inflammation of the bladder called?
Cystisis
2main non-infective causes of inflammatory urinary disorders + examples
Metabolic - diabetic nephropathy
Immunological - nephrotic syndrome, nephritic syndrome
2 causes of obstructive urinary disorders
Stones
Benign prostatic hypertrophy
4 neoplasticism urinary disorders
Kidney
Bladder
Prostate
Testicular
Cancer
2 developmental or genetic urinary disorders
Polycystic kidneys
Horseshoe kidney
Potential mechanisms by which immune system damage to kidney may occur
Antibodies or inflammatory cells (neutrophils, monocytes, macrophages, T cells)
3 clinical presentations of immunological disorders
Nephritic syndrome
Proteinuria
Nephrotic syndrome
What is glomerulonephritis
Inflammation of microscopic filtering of the kidney
5 steps in diagnosing immunological causes of inflammatory urological disorders
History and physical exam
Urine test
Blood test: immunology test included
Imaging: start w ultrasound
Kidney biopsy
What is horseshoe kidney
When 2 kidneys fuse together at the bottom
When does horseshoe kidney occur?
As a babies kidneys move into place as it grows in the womb
How is horseshoe kidney identified
Abdomen or pelvis imagining
3 consequences of horseshoe kidney
Increased risk of obstruction, stones and infection
Method for testing for raised concentration of waste substances in blood
Measure serum concentrations of urea and creatinine (blood test)
Reasoning behind why there is raised concentrations of waste substances in blood with kidney failure
Reduction in golmerular filtration rate results in accumulation of waste substances in blood
Reading behind why there is blood cells in urine in kidney failure
Damaged glomeruli (leaking from cells into urine) or bleeding due to structural problems (tumours, polycystic kidneys)
How would you tests for blood cell presence in someone with kidney damage
Urine dipstick
Urine microscopy
Why is constant high blood pressure not a consequence of kidney disease
Often high due to salt and water retention
Some patients experience hypotension - if they have dehydration (due to vomiting) or low vascular volume (unable to produce concentrated urine, loosing too much Na+ in urine)
Why is an abnormal hormone profile a consequence of kidney disease
Reduction of synthesis in erythropoietin or secondary hyperparathyroidism
(Anaemia - reduced haem conc.
history of late stage chronic kidney disease, despite sufficient B12, folate and iron )
(Increased PTH as secondary response to Vit D. Deficiency - measured In peripheral blood in presence of low or normal serum calcium)
2 possible locations for an infection
Bladder - cystitis
Kidney - pyelonephritis
3 potential pathogens of kidney disease?
Bacteria (most common)
Virus (immunocompromised patients)
Fungal (immunocompromised patients)
4 step diagnosis of UTIs
History
Physical examina
Urine dipstick
Urine microscopy, culture and sensitivity
5 symptoms of UTIs
Fever
Suprapubic pain
Frequency of passing urine
Dysuria (painful urination)
Haematuria
UTI treatment
Antibiotics- depend on illness severity, and most commonly found bacteria e.g. trimethopimsulfamethoxazole, ciprofloxacin, penicillin,
(If urine culture available- modified with sensitivity)
Pain support
Supportive e.g hydration
3 UTI complications
Pyelonephritis
Uprosepsis
Septic shock
5 risk factors for UTIs
Young biological females
Sexual intercourse
Post menopausal
Diabetes mellitus, impaired bladder emptying / urinary stasis
Pathophysiology of UTIs
Inflection in bladder or kidney
Bacterial infection most common and the viral and fungal infections are most likely with immunocompromised patients
Pathophysiology of Nephritic syndrome
Inflammation of glomerulus that causes sudden onset appearance of RBCs, variable proteinuria, WBC in urine
6 symptoms of nephritic syndrome
Haematuria
Proteinuria
Hypertension
Reduced urine output
Increased urea and creative
Sore throat
4 steps in diagnosing nephritic syndrome
Urine dipstick: blood and protein
Blood test: serum urea and creative, reduced eGFR
Urine: raised urine protein:creating ratio
Kidney biopsy: IgA nephropathy
Treatment of nephritic syndrome
Supportive- angiotensin receptor inhibitor (irbesartan) or ACEI (remipril) reduce Na+ intake
Immunotherapy - renal replacement therapy - late stage kidney disease (transplant or dialysis)
Influence of nephritic syndrome on kidney failure
30% of patients with nephritic syndrome progress to kidney failure
What disease is the most common glomerulonephritis world wide
IgA nephropathy (lot of IgA in kidney)
Pathophysiology of diabetic nephropathy
Glycosuria - basement membrane thickens, hyaline arteriosclerosis, afferent dilation, increased pressure in glomerulus, increased glomerular filtration rate, thickens basement membrane , glomerulus expands, filtration slits widen and increase permeability
High pressure - supportive structural matrix - kimmelstiel-wilson nodules
Symptoms of diabetic nephropathy
Worsening blood pressure control Polyuria
Swelling of feet,hand,eyes
Microalbuminuria
Proteinuria
Association with diabetic retinopathy and neuropathy
Diagnosis of diabetic nephropathy
Positive result of 2/3 tests
(30-300mg albumin per g of creating in 6month period)
8 Treatments of diabetic nephropathy
Optimised diabetic control - metformin
Optimised hypertension treatment
Reduce proteinuria using ARB or ACEI
Stop smoking
SGLT2 inhibitor
Pancreas or kidney transplant
Dialysis
3 risk factors of diabetic nephropathy
Hypertension
Poor diabetic control
Smoking
Pathophysiology of nephrotic syndrome
Hypoalbumin results when liver fails to synthesis loss of albumin through urine - leads to low down capillary on optic pressure leading to unopposed capillary hydrostatic pressure and subsequent oedema formation
5 symptoms of nephrotic syndrome
Peripheral oedema
Severe proteinuria
Low serum albumin
Variable microscopic Haematuria
Associated with hyperlipidaemia (give statins for this)
4 diagnosis of Nephrotic syndrome
Urine dipstick: high protien
Blood tests: very low albumin conc.
High urine protein to creating ratio
Kidney biopsy: minimal change glomerulopathy
3 Treatments of nephrotic syndrome
Immunotherapy- corticosteroid, cyclophosphamide, tacrolimus, antibody therapy targeting B cell pathway
Diuretics- to reduce peripheral oedema
Prevention of thrombosis - anticoagulation
Pathophysiology of stones
Form when urine contains more Crystal-forming substances (e.g Ca2+, oxalate and uric acid than urine can dilute)
Urine can also lack substances preventing crystals from sticking together - ideal env. For stone formation
2 symptoms of stones
Pain - abdomen and back
Blood in urine
3 methods of diagnosing stones
Urine dipstick : blood and evidence of UTI
Blood test: kidney function reduced (possibly)
Imagining- Plain X ray
Ultrasound (best imagining method- easier to see but cannot identify very small stones) and CT scan
4 treatments for stones
Supportive - pain control and hydration
Shockwave lithotripsy
Uteroscopy
Precutaneous nephrolithotomy
5 types of urological cancers
Benign prostatic hypertrophy
Renal cell carcinoma
Transitional cell carcinoma
Prostatic cancer
Testicular cancer
3 symptoms of urological cancers
Asymptomatic
Haematuria
Pain
Diagnosing urological cancers
Ultrasound, CT scan, MRI
Urine cytology
Prostatic specific antigen
Histological diagnosis : any evidence of metastasis
Treatments of urological cancers
Release obstruction of urinary tract - nephrostomy, bladder catheter, surgery
Chemotherapy
Radiotherapy
Hormonal therapy for hormone sensitive cancer
Surgery
Pathophysiology of Polycystic Kidney Disease
Neonatal - autosomal recessive
Adult onset: autosomal dominant
Numerous cysts grow in kidneys, filled with fluid, grow and enlarge kidney damaged
9 Symptoms of Polycystic kidney disease
Back pain
Bleeding into renal cysts
Infection of renal cysts
Asymptomatic (sometimes)
Loss of kidney function
High blood pressure
Increased size of abdomen due to enlarged kidneys
Headaches
Haematuria (sometimes)
5 methods of diagnosing Polycystic kidney disease
Ultrasound
CT scan
MRI
Genetic screening
Urine test- blood and protein
4 Treatments of Polycystic kidney disease
Tolvaptan (Vasopressin 2 antagonist) to slow down cyst formation
Treat hypertension / infection
Pain control
Renal replacement therapy - transplant, dialysis
