Diseases of the urinary tract 1 (Kidneys and Urinary Tract Pathology)

Question 1

What is the function of the Kidney?

Answer 1

• eliminate waste products
• regulate fluid-electrolyte balance.
• acid-base balance
• produce hormones e.g. Renin and Erythropoietin

Question 2

What hormones does the kidney produce?

Answer 2

Renin (fluid balance)

Erythropoietin (RBC production)

Question 3

How many people develop acute / chronic renal disease in the UK per year?

Answer 3

26,000 = acute RD
5,500 = Chronic RD

Question 4

How do patients with acute renal disease present

Answer 4

1) Acute renal failure:
- rapid rise in CREATININE and UREA.
- generally unwell

Question 5

How do patients with nephrotic syndrome present?

Answer 5

Nephrotic Syndrome:

• Oedema
• Proteinuria (mostly albumin)
• Hypoalbuminaemia

Question 6

How do patients with acute nephritis (nephritic syndrome) present?

Answer 6

Acute Nephritis / Nephritic syndrome :

1) Oedema
2) Proteinuria
3) Haematuria
4) Renal Failure

Question 7

How can immulogical processes cause damage to the glomerular basement membrane?

Answer 7

1) Circulating immune complexes and antigens deposit in glomerulus.
2) Antibodies bind to basement membrane / glomerulus.
3) COMPLEMENT activation, NEUTROPHIL activation, CLOTTING factors then DAMAGE Glomerulus.

Question 8

What non-immunological processes can cause damage to the glomerulus?

Answer 8

1) Injury to endothelium of vessel.
2) Hyperglucaemia in diabetes can damage basement membrane
3) Genetics can give rise to abnormalities
4) Deposition of abnormal proteins

Question 9

What are the Ischaemic mechanisms of tubular damage?

Answer 9

ISCHAEMIC:

1) Hypotension,
2) Damage to vessels within kidney
3) Glomerular damage

Can all REDUCE BLOOD supply to tubules causing damage.

Question 10

What are the toxic mechanisms of tubular damage?

Answer 10

1) direct toxins
2) Hypersensitivity reactions (e.g. to drugs)
3) deposition of crystals in tubules
4) Deposition of abnormal proteins in the tubules.

Can all cause direct tubular damage

Question 11

What is the effect of thrombotic microangiopathy on the vasculature of the kidney?

Answer 11

1) Thrombi in capillaries and small arterioles
2) occur due to endothelial damage

cause vascular damage

e.g. Haemolytic uraemic syndrome

Question 12

How does vasculitis cause vascular damage in the kidneys?

Answer 12

• Inflammation of the blood vessel walls,
• obliteration of lumen by inflammation.

e.g. Wegener’s granulomatosis

Question 13

What are the key features of Nephrotic Syndrome?

Answer 13

• Always due to damaged glomerulus.

- Oedema + Proteinuria (>3g in 24hrs) + Hypoalbuminaemia

Question 14

What are the common causes of acute nephritis?

Answer 14

• IgA Nephropathy
• Vasculitis
• Lupus
• Haemolytic-uraemic syndrome (children)

Question 15

What is Haemolytic Uraemic Syndrome?

Answer 15

1) ACUTE NEPHRITIS +
2) HAEMOLYSIS (rupture of RBCs) +
3) THROMBOCYTOPAENIA (decrease platelets)

Question 16

What are the causes of Acute Renal Failure?

Answer 16

Pre-Renal : Reduced blood flow to the kidney caused by:

• dehyrdration
• hypotension

Renal : Damage to kidney caused by:

• Vasculitis
• Nephritis

Post Renal: Obstructed urinary tact caused by:

• tumour
• stones
• prostatic enlargement

Question 17

What are the consequences of renal failure?

Answer 17

• cardiac failure (fluid overload)
• Arrythmias (electrolyte imbalance)
• Jaundice (hepatic venous congestion)

Question 18

What are the characteristics of chronic renal failure?

Answer 18

-Permanently reduced GFR due to the reduced number of nephrons.

Question 19

What are the common causes of chronic renal failure?

Answer 19

• Diabetes
• Glomerulonephritis
• Reflux nephropathy (reflux of urine causing infection and scarring of kidney)

Question 20

What are the effects / consequences of Chronic renal failure?

Answer 20

1) Reduced excretion of water and electrolytes leads to OEDEMA and HYPERTENSION.
2) Reduced excretion of toxins
3) Reduced production of erythropoietin leads to ANAEMIA.
4) RENAL BONE disease.

Question 21

What is isolated haematuria?

Answer 21

Haematuria (with or without proteinuria) with Normal renal function.

Question 22

What are the causes of isolated haematuria?

Answer 22

• IgA Nephropathy
• thin basement membrane (genetic)
• hereditary nephropathy.

Question 23

What is Isolated proteinuria?

Answer 23

Proteinuria (less than nephrotic range, so less than 3g in 24hrs)
No renal failure, haematuria or oedema.

Question 24

What is Pyelonephritis?

Answer 24

Pyelonephritis is infection of the kidney caused by haematogenous spread of infection or via the ureter.

Question 25

What are the features of acute pyelonephritis?

Answer 25

Acute pyelonephritis:

• usually spreads from urinary tract.
• usually diabetics
• can from abscesses
• more common in women

Question 26

What are the features of chronic pyelonephritis?

Answer 26

• associated with relfux of urine into kidney leading to infection and scarring.
• chronic renal failure can occur

Question 27

Describe the causes and features of renal artery stenosis?

Answer 27

Atheroma causes ischaemia of kidney.

Causing reduced renal function.

Question 28

Describe the association between vasculitis and the kidney.

Answer 28

1) Vasculitis is inflammation of blood vessels.
2) it can cause obliteration of the glomerular vessel lumens thereby destroying the glomerulus.
3) can cause hypoxia of the tubules.
4) can cause rashes and muscle pain

Question 29

Describe the association between hypertension and the kidney

Answer 29

1) Hypertension damages renal vessels and causes thickening of the vessel wall and reduction of the lumen.
2) leads to HYPOXIA and LOSS of TUBULES&raquo_space;»loss of renal function.
3) Reduced blood flow in the kidney activates RAAS&raquo_space;> increased hypertension.

Question 30

Describe the association between diabetes and the kidney

Answer 30

1) Hyperglycaemia damages the basement membrane of glomerulus.
2) BM becomes thicker and nodules form.
3) reduced renal function

Question 31

describe the association between myeloma and the kidney

Answer 31

1) Myeloma is tumour of plasma cells producing immunoglobulins.
2) excess immunoGs deposit in the tubules.
3) tubules get damaged & inflammed.
4) fibrosis of kidney
5) loss of tubules&raquo_space;>loss of renal function.

Question 32

What causes injury to the endothelium of vessels?

Answer 32

1) Vasculitis
2) Hypertension
3) Clotting
4) diabetes
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