BLOCK 9: Renal Flashcards
Describe the virulence factors that may assist a micro-organism establishing a urinary infection. (2 marks)
(8 factors)
- Migration - flagella and pili
- Adherence - bacterial adhesin interact with receptors on surface of uroepithelial cells
- Invasion
- Gaining nutrients from host cells by releasing toxins and proteases
- Colonisation - tissue damaging toxins (eg. urease)
- Formation of biofilms - extracellular DNA, exopolysaccharides, pili, flagella, and other adhesive fibres create a scaffold to form a multicellular bacterial community that is protected from immune response (eg. in bacteria that cause catheter associated UTIs)
- Morphological plasticity - microorganisms adopt morphological changes, such as filamentation, to circumvent host immune systems
- Iron scavenging - uropathogens produce siderophores (aerobactin) for iron scavenging
List host factors which create susceptibility to UTIs. (2 marks)
(10 factors)
- Female gender
- Sexual intercourse
- Pregnancy
- Vesicoutereral reflux
- Structural renal disease
- Urinary tract obstruction/stasis - eg. BPH, calculi, neurogenic bladder.
- Immunocompromised - eg. diabetes, alcoholism, extremes of age.
- IDC/ Instrumentation/Stent
- Urinary/fecal incontinence
- Dehydration
Pregnant females - UTIs predispose to premature labour, miscarriage, and IUGR (intrauterine growth retardation)
List some of the complications of UTIs. (3 marks)
- Sepsis, septic shock, urosepsis
- Confusion, delirium
- AKI
- CKD
- Renal calculi (struvite stones)
- Papillary necrosis
- Hydronephrosis/pyonephrosis
- Perinephric abscess
- Scarring of the kidneys/ chronic pyelonephritis/ relux nephropathy
Describe key strategies for a successful adjustment to chronic illness. (4 marks)
= A. Escherichia coli
A 38 year old male presents with vague flank pain and describes the passage of blood clots in his urine and oliguria. Physical examination reveals bilateral flank and abdominal masses. Laboratory studies show elevated serum urea and creatinine. Urinalysis reveals haematuria, proteinuria. A CT scan discloses bilaterally, massively enlarged kidneys. The patient subsequently develops end-stage kidney disease and receives a renal transplant. The explanted kidneys are shown.
What is the most likely diagnosis?
- A. Autosomal dominant polycystic kidney disease
- B. Autosomal recessive polycystic kidney disease
- C. Hydronephrosis
- D. Medullary sponge kidney
- E. Multicystic renal dysplasia
= B. Nephrotic Syndrome
= A. Acute nephritic syndrome
= D. Red blood cell casts
= A. Amyloid nephropathy
