diseases of the urinary tract 1 Flashcards
what are the main functions of the kidney
eliminate metabolic waste, regulate fluid and electrolyte balance, acid base balance, production of some hormones (renin and EPO)
how to patients with renal disease present
acute renal failure- rapid rise in urea and creatinine
chronic renal failure- gradual declining function.
3 components of nephritic syndrome
oedema, proteinuria and haematuria.
3 conditions of nephrotic syndrome
oedema, proteinuria and hypoalbuimanemia.
what defines proteinuria
> 3g per 24 h
what 2 structures form the renal cortex
medulla is dark, cortex is light.
in what structure in the glomerulus found
Bowman’s capsule.
what structures are involved in filtration of the kidney
podocytes, foot processes, endothelial cells and basement membrane which allows filtration.
function of renal tubules
collects what you need and filters what you don’t need
how can the immune system damage the glomeruli
circulating immune complexes deposit in glomeruli
circulating antigen deposit in the glomeruli which complement antibodies of the basement membrane.
this causes damage via Complement activation, Neutrophil activation, Reactive oxygen species, Clotting factors.
what are non-immunological factors which cause damage to the glomeruli.
injury to endothelial vessels.
altered basement membrane due to hyperglycaemia in diabetes.
abnormal basememnt membrane or podocytes- inherited condition
deposition of abnormal proteins in the kidney e.g. amyloid.
how does schema cause tubular damage
hypotension- shock/ septic patients.
glomerular damage
damage to vessels within the kidney.
what toxic material can cause tubular damage
Direct toxins- X ray, heavy metal.
Hypersensitivity reactions e.g. to drugs
Deposition of crystals in tubules- gout uric acid crystals
Deposition of abnormal proteins in the tubules
define thrombotic microangioapthy (vascular damage) and what causes it to happen
thrombi in capillaries and small arterioles due to endothelial damage
causes of endothelial damage
bacteria, toxins, drugs, abnormal complement and clotting pathways.
define vasculitis
acute or chronic inflammation of the blood vessels.
what 3 factors cause renal damage
damage to tubules
damage to the glomerulus
damage to the blood vessels.
nephrotic syndrome damages which structure within the kidney
glomerulus.
what are the main complications of nephrotic syndrome
infections, thrombosis, pitting oedema.
diagnosis of nephrotic syndromes
renal biposy
what is the most common cause of nephrotic syndrome in adults
membranous nephropathy
what is the most common cause of nephrotic syndrome in children
minimal change disease.
other symptoms of nephrotic syndrome except the triad
hypertension and hyperlipidaemia.
other symptoms of nephritic syndrome except the triad
Hypertension
Acute renal failure
what is the most common cause of nephritic syndrome in adults and children
post infective glomerulonephritis.
after what infection does post infective glomerulonephritis occur
Streptococcal throat infection.
how is acute renal failure diagnosed
anuria/oliguria + raised creatinine and urea
treatment for acute renal failure
short term dialysis.
what are the pre-renal causes of acute renal failure
dehydration, hypotension
what are the post renal causes of acute renal failure
tumours of the urinary tract, tumours of the pelvis, bladder stones, prostatic enlargement.
what are the renal causes of acute renal failure in adults
vasculitis, acute interstitial nephritis (tubular damage with inflammation)
what are the renal causes of acute renal failure in children
Henoch- Schmlein purpura
haemolytic uraemic syndrome
acute interstitial nephritis.
what is Henoch-Schonlein purport and what age group is it common in
children
Specific type of IgA nephropathy
define haemolyctic uraemic syndrome and what age group does is commonly affect
children
acute nephritis, haemolysis and thrombocytopenia,
what are the complication of acute renal failure
cardiac failure, arrthymias (electrolyte imbalance), GI bleeding, Jaundice, Infections
what are the 5 stages of chronic renal failure
stage 1- kidney damage with normal of increased GFR stage 2- mild reduction in GFR stage 3-moderate reduction in GFR stage 4-severe reduction in GFR stage 5-kidney failure.
what are the common causes of chronic renal failure in adults
diabetes, glomerulernephriris, reflux nephropathy
what are the common causes of chronic renal failure in children
Developmental abnormalities/malformations
Reflux nephropathy
Glomerulonephritis
why might bops not be helpful in diagnosis of chronic renal failure
Kidney shows severe scarring with loss of glomeruli and tubules
Similar changes are seen in end-stage renal disease due to any cause
what the the effects of chronic renal failure
reduced excretion of water and electrolytes- oedema and hypertension.
reduced excretion of toxic metabolites
reduced production of EPO- anaemina
renal bone disease
most common diagnosis of elderly patient with acute renal failure
Acute interstitial nephritis due to drug reactions.
myeloma- tumour of plasma cells which for immunoglobulins and circulate in the kidney
most likely diagnose of male with haematuria and rash
Henoch-Schonlein purpura
most likely diagnosis of Teenager/young adult with haematuria
Post-infective glomerulonephritis
IgA nephropathy.
most likely diagnosis of Adult with acute renal failure, fever and myalgia
vasculitis.
most likely diagnosis of Young woman with haematuria and facial rash
Lupus
