Diseases of urinary tract 1 Flashcards by Rob Mackenzie

What are the functions of kidney>

Eliminating metabolic waste products

Regulate fluid and electrolyte balance

Influence acid based balance

Hormone production - renin (fluid balance) and EPO (haemopoiesis)

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What are the clinical presentations of acute renal failure?

Generally unwell

- Raised creatinine and urea

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What are the clinical presentations of chronic renal failure?

Progressive decline in renal function

Raised creatinine and urea

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What are the clinical features of nephrotic syndrome?

Oedema
Proteinuria (>3g per day)
Hypoalbuminaemia

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What are the clinical features of nephritic syndrome?

Oedema

Proteinuria (not as much as nephrotic syndrome)
Haematuria
Acute renal failure

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How are patients diagnosed?

Radiology - abnormalities, kidney sie, structural abnormalities

Blood - urea/creatinine; urine - protein/electrolytes

Biopsy
Cystoscopy - obstruction/haematuria

Renal physician - clinical exam/history

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What components of the glomerulus can be damaged?

Vessel

Basement membrane

Podocytes

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How are the mechanisms of glomerular disease divided?

Immune and non immune mediated

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How doe the immunological mechanisms of glomerular damage occur?

Circulating immune complexes/antibodies/antigens - deposit into glomerulus (BM) - activating of coagulation cascade, neutrophil activation, ROS species, clotting factors -> inflammatory/immune response -> damage to glomerulus

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What are the non-immunological mechanisms by which glomerular damage occurs?

Direct damage e.g. hypotension, toxins, gout

Altered basement membrane - hyperglycaemia

Inherited disorders - alters basement membrane/podocytes

Deposited abnormal proteins e.g. amyloid

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“Any damage to glomerulus will likely cause damage tubule.” Why?

Reduced blood supply to tubule - ischaemia

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What re the two main means by which the kidney tubule can be damaged?

Ischaemia

Toxic

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Give some examples of cause of ischaemia to the kidney tubule?

Hypotension e.g. toxic shock

Damage to the vessel

Glomerular damage

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Give some examples of toxic causes of damage to kidney tubule?

Direct toxins e.g. lead, mercury, X-ray contrasts - damage tubules DIRECTLY

Hypersensitivity reactions e.g. drugs

Deposition of crystals/abnormal protein in tubules e.g. gout

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Renal function correlates well with…

Damage to renal tubule! (not glomeruli)

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What are main means by which the kidney vasculature is damaged?

Diabetes
Hypertension
Atheroma e.g. renal stenosis
Vasculitis
Thrombotic micro-angiopathy

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What damage is always seen with nephrotic syndrome?

Glomerular damage

What are the criteria for nephrotic syndrome? What are the complications?

Proteinuria (>3g in 24 hrs)
Oedema
Hypoalbuminaemia

Complications - infections and thrombosis

What are the main causes of nephrotic syndrome?

Membranous nephropathy (most common) - idiopathic (damage to Basement membrane)

Focal segmental glomerulosclerosis (FSGS) - usually idiopathic but can be due to genetic (podocyte abnormalities), HIV, heroine use, hypertension etc

Minimal change disease - MOST common in children - no change in light microscopy

Diabetes
Lupus nephritis
Amyloid

What are the clinical presentations of nephritic syndrome?

Haematuria
Oedema
Proteinuria (not as much as nephrotic syndrome)
Hypertension
Acute renal failure

What are the main causes of Acute nephritis?

Post-infective glomerulonephritis - post strep throat infection

IgA nephropathy - common, IgA deposits, haematuria in teenager/young adults

Vasculitis - fever, unwell, rash myalgia, arthralgia

Lupus

What are the main causes of acute nephritis in children?

Post infective glomerulonephritis (most common0)

IgA Nephropathy

Henoch-Schonlein purpura - type of IgA nephropathy - typically young boys with haematuria, rash, abode pain, arthralgia

Haemolytic uraemic syndrome - E coli 0157 - acute nephritis + haemolysis + thrombocytopenia

What are the 3 cardinal signs of haemolytic uraemic syndrome?

Acute nephritis

Thrombocytopenia

Haemolysis

What are the diagnostic features of acute renal failure?

Oliguria (reduced urination) and anuria (no urination)

Raised creatinine and urea levels

What are the three main causes of acute renal failure?

Pre-renal failure - reduced blood flow e.g. dehydration, hypotension (septic shock, blood loss) Renal: kidney damage Post-renal failure - obstruction tumour (pelvic/ureter), bladder stone, enlarged prostate

What types of acute renal failure is biopsies useful?

Renal: damage to kidney (not pre/post renal!)

What will all acute renal failures show on biopsies?

ATN - Acute tubular necrosis

What are the main causes of acute renal failure in adults and children?

Adult - vasculitis - acute interstitial nephritis (tubular damage inflammation - drugs) Children - Henloch-Scholein purpura - Haemolytic uraemic syndrome (E coli 0157) - Acute interstitial nephritis - drugs?

What are the complications of acute renal failure?

-Cardiac failure (fluid overload) - Arrythmias (electrolyte imbalance) - Jaundice - GI bleeding - Infection - lung, urinary tract

What is the treatment for acute renal failure?

- Course of dialysis might be required | - Treat underlying course!

What is chronic renal failure defined as?

Progressive, permanent reduction in GFR - related to reduced number of nephrons

What are the 5 stages of chronic renal failure?

Stage 1 Kidney damage with normal GFR (>90 mL/min) Stage 2 - mild reduction in GFR (60-89 mL/min) Stage 3 - Moderate reduction - 30-59 mL/min) Stage 4 Severe reduction - 15 - 29 mL/min) Stage 5 - Kidney failure (GFR

What are the main causes of chronic renal failure in adults and children?

Adults - DIABETES - Glomerulonephritis - reflux nephropathy - chronic reflux up ureter - repeated infection) Children - Developmental abnormalities - Glomerulonephritis - Reflux nephropathy

If chronic failure is established, are renal biopsies helpful?

No - severe scarring (loss of glomeruli/tubules - doesn't show cause!)

What are the effects of chronic renal failure?

Reduced H2O and electrolytes excretion - hypotension and oedema Reduced toxic metabolite excretion Reduced EPO production - anaemia Renal bone disease

What is the likely cause of an elderly patient with acute renal failure?

Acute interstitial nephritis (new drug reaction?) Myeloma - Ig's deposit in kidney

What is the likely cause of a young male with haematuria and rash?

Henloch Schonlein purpura

What is the likely cause of a young male with haematuria?

Post infective glomerulonephritis IgA Nephropathy

Whats the main cause of an adult with acute renal failure, fever and myalgia?

Vasculitis

Whats the main cause of an female adult with haematuria and facial rash?

Lupus

Whats the main cause of an adult with nephrotic syndrome?

Membranous nephropathy

Whats the main cause of an child with nephrotic syndrome?

Minimum change syndrome