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BRS 9: Urology and Renal Medicine > 9.3: Lecture: Urological disorders (part 1of2) > Flashcards

9.3: Lecture: Urological disorders (part 1of2) Flashcards

1
Q

5 consequences of kidney failure

A

Filtration failure
Hypertension, water retention
Metabolic acidosis
Anaemia
Vit. D deficiency and secondary hyperparathyroidism

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2
Q

What does anaemia arise from

A

Lack of erythropoietin production

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3
Q

What happens if there is filtration faliure of the kidneys

A

Unwell with accumulation of waste substances
Haematuria and proteinuria, low serum protein including albumin in the blood

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4
Q

What is inflammation of the bladder called?

A

Cystisis

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5
Q

2main non-infective causes of inflammatory urinary disorders + examples

A

Metabolic - diabetic nephropathy
Immunological - nephrotic syndrome, nephritic syndrome

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6
Q

2 causes of obstructive urinary disorders

A

Stones
Benign prostatic hypertrophy

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7
Q

4 neoplasticism urinary disorders

A

Kidney
Bladder
Prostate
Testicular

Cancer

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8
Q

2 developmental or genetic urinary disorders

A

Polycystic kidneys
Horseshoe kidney

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9
Q

Potential mechanisms by which immune system damage to kidney may occur

A

Antibodies or inflammatory cells (neutrophils, monocytes, macrophages, T cells)

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10
Q

3 clinical presentations of immunological disorders

A

Nephritic syndrome
Proteinuria
Nephrotic syndrome

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11
Q

What is glomerulonephritis

A

Inflammation of microscopic filtering of the kidney

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12
Q

5 steps in diagnosing immunological causes of inflammatory urological disorders

A

History and physical exam
Urine test
Blood test: immunology test included
Imaging: start w ultrasound
Kidney biopsy

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13
Q

What is horseshoe kidney

A

When 2 kidneys fuse together at the bottom

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14
Q

When does horseshoe kidney occur?

A

As a babies kidneys move into place as it grows in the womb

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15
Q

How is horseshoe kidney identified

A

Abdomen or pelvis imagining

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16
Q

3 consequences of horseshoe kidney

A

Increased risk of obstruction, stones and infection

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17
Q

Method for testing for raised concentration of waste substances in blood

A

Measure serum concentrations of urea and creatinine (blood test)

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18
Q

Reasoning behind why there is raised concentrations of waste substances in blood with kidney failure

A

Reduction in golmerular filtration rate results in accumulation of waste substances in blood

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19
Q

Reading behind why there is blood cells in urine in kidney failure

A

Damaged glomeruli (leaking from cells into urine) or bleeding due to structural problems (tumours, polycystic kidneys)

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20
Q

How would you tests for blood cell presence in someone with kidney damage

A

Urine dipstick
Urine microscopy

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21
Q

Why is constant high blood pressure not a consequence of kidney disease

A

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)

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22
Q

Why is an abnormal hormone profile a consequence of kidney disease

A

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)

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23
Q

2 possible locations for an infection

A

Bladder - cystitis
Kidney - pyelonephritis

24
Q

3 potential pathogens of kidney disease?

A

Bacteria (most common)
Virus (immunocompromised patients)
Fungal (immunocompromised patients)

25
Q

4 step diagnosis of UTIs

A

History
Physical examina
Urine dipstick
Urine microscopy, culture and sensitivity

26
Q

5 symptoms of UTIs

A

Fever
Suprapubic pain
Frequency of passing urine
Dysuria (painful urination)
Haematuria

27
Q

UTI treatment

A

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

28
Q

3 UTI complications

A

Pyelonephritis
Uprosepsis
Septic shock

29
Q

5 risk factors for UTIs

A

Young biological females
Sexual intercourse
Post menopausal
Diabetes mellitus, impaired bladder emptying / urinary stasis

30
Q

Pathophysiology of UTIs

A

Inflection in bladder or kidney

Bacterial infection most common and the viral and fungal infections are most likely with immunocompromised patients

31
Q

Pathophysiology of Nephritic syndrome

A

Inflammation of glomerulus that causes sudden onset appearance of RBCs, variable proteinuria, WBC in urine

32
Q

6 symptoms of nephritic syndrome

A

Haematuria
Proteinuria
Hypertension
Reduced urine output
Increased urea and creative
Sore throat

33
Q

4 steps in diagnosing nephritic syndrome

A

Urine dipstick: blood and protein
Blood test: serum urea and creative, reduced eGFR
Urine: raised urine protein:creating ratio
Kidney biopsy: IgA nephropathy

34
Q

Treatment of nephritic syndrome

A

Supportive- angiotensin receptor inhibitor (irbesartan) or ACEI (remipril) reduce Na+ intake

Immunotherapy - renal replacement therapy - late stage kidney disease (transplant or dialysis)

35
Q

Influence of nephritic syndrome on kidney failure

A

30% of patients with nephritic syndrome progress to kidney failure

36
Q

What disease is the most common glomerulonephritis world wide

A

IgA nephropathy (lot of IgA in kidney)

37
Q

Pathophysiology of diabetic nephropathy

A

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

38
Q

Symptoms of diabetic nephropathy

A

Worsening blood pressure control Polyuria
Swelling of feet,hand,eyes
Microalbuminuria
Proteinuria
Association with diabetic retinopathy and neuropathy

39
Q

Diagnosis of diabetic nephropathy

A

Positive result of 2/3 tests
(30-300mg albumin per g of creating in 6month period)

40
Q

8 Treatments of diabetic nephropathy

A

Optimised diabetic control - metformin
Optimised hypertension treatment
Reduce proteinuria using ARB or ACEI
Stop smoking
SGLT2 inhibitor
Pancreas or kidney transplant
Dialysis

41
Q

3 risk factors of diabetic nephropathy

A

Hypertension
Poor diabetic control
Smoking

42
Q

Pathophysiology of nephrotic syndrome

A

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

43
Q

5 symptoms of nephrotic syndrome

A

Peripheral oedema
Severe proteinuria
Low serum albumin
Variable microscopic Haematuria
Associated with hyperlipidaemia (give statins for this)

44
Q

4 diagnosis of Nephrotic syndrome

A

Urine dipstick: high protien
Blood tests: very low albumin conc.
High urine protein to creating ratio
Kidney biopsy: minimal change glomerulopathy

45
Q

3 Treatments of nephrotic syndrome

A

Immunotherapy- corticosteroid, cyclophosphamide, tacrolimus, antibody therapy targeting B cell pathway

Diuretics- to reduce peripheral oedema

Prevention of thrombosis - anticoagulation

46
Q

Pathophysiology of stones

A

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

47
Q

2 symptoms of stones

A

Pain - abdomen and back
Blood in urine

48
Q

3 methods of diagnosing stones

A

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

49
Q

4 treatments for stones

A

Supportive - pain control and hydration
Shockwave lithotripsy
Uteroscopy
Precutaneous nephrolithotomy

50
Q

5 types of urological cancers

A

Benign prostatic hypertrophy
Renal cell carcinoma
Transitional cell carcinoma
Prostatic cancer
Testicular cancer

51
Q

3 symptoms of urological cancers

A

Asymptomatic
Haematuria
Pain

52
Q

Diagnosing urological cancers

A

Ultrasound, CT scan, MRI
Urine cytology
Prostatic specific antigen
Histological diagnosis : any evidence of metastasis

53
Q

Treatments of urological cancers

A

Release obstruction of urinary tract - nephrostomy, bladder catheter, surgery
Chemotherapy
Radiotherapy
Hormonal therapy for hormone sensitive cancer
Surgery

54
Q

Pathophysiology of Polycystic Kidney Disease

A

Neonatal - autosomal recessive
Adult onset: autosomal dominant

Numerous cysts grow in kidneys, filled with fluid, grow and enlarge kidney damaged

55
Q

9 Symptoms of Polycystic kidney disease

A

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)

56
Q

5 methods of diagnosing Polycystic kidney disease

A

Ultrasound
CT scan
MRI
Genetic screening
Urine test- blood and protein

57
Q

4 Treatments of Polycystic kidney disease

A

Tolvaptan (Vasopressin 2 antagonist) to slow down cyst formation

Treat hypertension / infection

Pain control

Renal replacement therapy - transplant, dialysis

BRS 9: Urology and Renal Medicine (2 decks)

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