Conditions of the Kidney

Question 1

Four congenital malformations of the kidney

Answer 1

• Agenesis
• Hypoplasia
• Ectopic kidney
• Horseshoe kidney

Question 2

What are the two types of agenesis of the kidney?

Answer 2

Absence of one or both kidneys.

Bilateral

• Potter’s syndrome
• Incompatible with life

Unilateral

• Asymptomatic
• Other kidney undergoes compensatory hypertrophy

Question 3

What is hypoplasia of the kidneys?

Answer 3

Small but normally developed kidneys.

Usually unilateral.

Question 4

What are ectopic kidneys?

Answer 4

Kidney not located in the usual position

E.g. In pelvis due to failure of ascension during embryogenesis

Question 5

What are horshoe kidneys?

Answer 5

Fusion of the upper or lower (most common) poles of the two kidneys.

Question 6

What is this?

Complications?

Answer 6

Simple renal cyst.

Mostly asymptomatic, but can rupture, causing:

• Haematuria
• Pain
• Abdominal mass

Question 7

What is this?

Answer 7

Cystic renal dysplasia

• Irregular cysts of varying sizes.

Question 8

What are the two types of polycystic kidney disease, and which is more common?

Answer 8

Autosomal dominant PKD and autosomal recessive PKD

Autosomal dominant is far more common.

Question 9

What are the differences in presentation between autosomal dominant PKD and autosomal recessive PKD?

Answer 9

ADPKD = multiple, large cysts of the kidney that result in massive enlargement. Kidneys can be up to 4kgs.

Presents in adulthood

ARPKD = much smaller cysts that fill up the kidney.

Presents in childhood

Question 10

Presentations of PKD?

Answer 10

• FLank pain due to abdo mass
• Haematuria
• Hypertension
• Pain from haemorrhage into cyst

Question 11

What other congenital anomaly is associated with mortality in ADPKD?

Answer 11

Intracranial berry aneurysms.

Question 12

WHat is obstructive uropathy?

What are four consequences of this

Answer 12

Obstructive uropathy is an obstruction in the urinary tract at any levels from renal pelvis to urethra.

Can be instrinsic or extrinsic.

Consequences:

• Kidney enlargement
• Dilation of renal pelvis
• Hydronephrososi
• Hypertrophy of bladder wall

Question 13

What is hydronephrosis?

Answer 13

Water build up inside the kidney due to improper drainage.

• Distension and dilatation of renal pelvis
• Atrophy of kidney

Question 14

4 types of urolithiasis stones?

Answer 14

1. Calcium oxalate
2. Uric acid
3. Struvite
4. Calcium phosphate

Question 15

What is the most common type of kidney stone, and what are the aetiologies that lead to its development?

Answer 15

Calcium oxalate stone:

• Dehydration
• Hypercalciuria (renal tubules don’t reabsorb Ca effectively)
• Hyperoxaluric (increased oxalate - genetic or diet - spinach, chocolate, beers)

Question 16

What are the aetiologies for uric acid stone development

Answer 16

• Dehydration
• Acidic urine
• Hyperuricaemia (diet rich in shellfish and red meat)
• Increased cell turnover (e.g. chemo, leukaemia that results in lots of uric acid release)

Question 17

What are the aetiologies for struvite stones?

Answer 17

Magnesium ammonium phosphate stones.

Occur after infection with urea-splitting bacteria:

• Proteus, Klebsiella

Urea converted to ammonia, forms magnesium ammonium phosphate.

Question 18

Complications of urolithiasis?

Answer 18

• Silent
• Ulceration and bleeding (haematuria)
• Infection risk
• Renal colic pain