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Clinical Pathology > Diseases of urinary tract 1 > Flashcards

Diseases of urinary tract 1 Flashcards

1
Q

What are the functions of kidney>

A

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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2
Q

What are the clinical presentations of acute renal failure?

A
  • Generally unwell

- Raised creatinine and urea

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3
Q

What are the clinical presentations of chronic renal failure?

A

Progressive decline in renal function

Raised creatinine and urea

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4
Q

What are the clinical features of nephrotic syndrome?

A

Oedema
Proteinuria (>3g per day)
Hypoalbuminaemia

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5
Q

What are the clinical features of nephritic syndrome?

A

Oedema

  • Proteinuria (not as much as nephrotic syndrome)
  • Haematuria
  • Acute renal failure
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6
Q

How are patients diagnosed?

A

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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7
Q

What components of the glomerulus can be damaged?

A

Vessel

Basement membrane

Podocytes

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8
Q

How are the mechanisms of glomerular disease divided?

A

Immune and non immune mediated

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9
Q

How doe the immunological mechanisms of glomerular damage occur?

A

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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10
Q

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

A

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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11
Q

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

A

Reduced blood supply to tubule - ischaemia

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12
Q

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

A

Ischaemia

Toxic

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13
Q

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

A

Hypotension e.g. toxic shock

Damage to the vessel

Glomerular damage

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14
Q

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

A

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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15
Q

Renal function correlates well with…

A

Damage to renal tubule! (not glomeruli)

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16
Q

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

A
  • Diabetes
  • Hypertension
  • Atheroma e.g. renal stenosis
  • Vasculitis
  • Thrombotic micro-angiopathy
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17
Q

What damage is always seen with nephrotic syndrome?

A

Glomerular damage

18
Q

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

A

Proteinuria (>3g in 24 hrs)
Oedema
Hypoalbuminaemia

Complications - infections and thrombosis

19
Q

What are the main causes of nephrotic syndrome?

A

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

20
Q

What are the clinical presentations of nephritic syndrome?

A
  • Haematuria
  • Oedema
  • Proteinuria (not as much as nephrotic syndrome)
  • Hypertension
  • Acute renal failure
21
Q

What are the main causes of Acute nephritis?

A

Post-infective glomerulonephritis - post strep throat infection

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

Vasculitis - fever, unwell, rash myalgia, arthralgia

Lupus

22
Q

What are the main causes of acute nephritis in children?

A

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

23
Q

What are the 3 cardinal signs of haemolytic uraemic syndrome?

A

Acute nephritis

+

Thrombocytopenia

+

Haemolysis

24
Q

What are the diagnostic features of acute renal failure?

A

Oliguria (reduced urination) and anuria (no urination)

Raised creatinine and urea levels

25
Q

What are the three main causes of acute renal failure?

A

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

26
Q

What types of acute renal failure is biopsies useful?

A

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

27
Q

What will all acute renal failures show on biopsies?

A

ATN - Acute tubular necrosis

28
Q

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

A

Adult

  • vasculitis
  • acute interstitial nephritis (tubular damage inflammation - drugs)

Children

  • Henloch-Scholein purpura
  • Haemolytic uraemic syndrome (E coli 0157)
  • Acute interstitial nephritis - drugs?
29
Q

What are the complications of acute renal failure?

A

-Cardiac failure
(fluid overload)

  • Arrythmias (electrolyte imbalance)
  • Jaundice
  • GI bleeding
  • Infection - lung, urinary tract
30
Q

What is the treatment for acute renal failure?

A
  • Course of dialysis might be required

- Treat underlying course!

31
Q

What is chronic renal failure defined as?

A

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

32
Q

What are the 5 stages of chronic renal failure?

A

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

33
Q

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

A

Adults

  • DIABETES
  • Glomerulonephritis
  • reflux nephropathy - chronic reflux up ureter - repeated infection)

Children

  • Developmental abnormalities
  • Glomerulonephritis
  • Reflux nephropathy
34
Q

If chronic failure is established, are renal biopsies helpful?

A

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

35
Q

What are the effects of chronic renal failure?

A

Reduced H2O and electrolytes excretion - hypotension and oedema

Reduced toxic metabolite excretion

Reduced EPO production - anaemia

Renal bone disease

36
Q

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

A

Acute interstitial nephritis (new drug reaction?)

Myeloma - Ig’s deposit in kidney

37
Q

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

A

Henloch Schonlein purpura

38
Q

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

A

Post infective glomerulonephritis

IgA Nephropathy

39
Q

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

A

Vasculitis

40
Q

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

A

Lupus

41
Q

Whats the main cause of an adult with nephrotic syndrome?

A

Membranous nephropathy

42
Q

Whats the main cause of an child with nephrotic syndrome?

A

Minimum change syndrome

Clinical Pathology (50 decks)

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