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Phase 2a > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What is nephroliathiasis?

A

Calcium oxalate stones form in the collecting duct of the kidney , can be deposited anywhere from the renal pelvis to the urethra.

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2
Q

What are other types of kidney stones?

A

-calcium phosphate
-Uric acid
-struvite
-cysteine

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3
Q

What is the epidemiology of nephroliathisis?

A
  • very common
    more common in men
    -uncommon in children
    -20-40y
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4
Q

What are the risk factors of nephroliathisis?

A

-chronic dehydration
-UTI’s
-Primary kidney disease
-HyperPTH (hypercalcaemia/uria)
-History of previous stone

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5
Q

What is the pathology of nephroliathisis?

A

-Excess solute in collecting duct leading to supersaturated urine; favours crystallisation
-Stones cause regular outflow obstruction; Hydronephrosis
-Dilation and obstruction of renal pelvis = damage and infection risk

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6
Q

What is hydronephrosis?

A

a condition where one or both kidneys become stretched and swollen as the result of a build-up of urine inside them. - requires surgical decompression

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7
Q

What is the presentation of nephroliathisis?

A

Loin to groin pain, unilateral and colicky - peristaltic waves
-patient can’t lie still (Ddx- peritonitis; rigidity)
-haematuria + dysuria
-Fever - suggests infection(pyelonephritis)

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8
Q

What makes the nephroliathisis pain worse?

A

Diuretics and fluid

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9
Q

What is the investigation and diagnosis for nephroliathisis?

A

1st line - KUB XR (80% specific for renal stones - cheap and easy)
Gold Standard - NCCT KUB (99% specific for stones therefore diagnostic )
-Bloods;FBC, U+E - could suggest hydropnephrosis, Urine dipstick = UTI
-urinalysis- haematuria, preg test

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10
Q

Why would you not use contrast in a CT scan for nephroliathisis?

A

As the contact would need to be excreted by the kidneys - harmful

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11
Q

What are the 3 most commonest obstruction sites?

A
  1. PUJ - petro-ureteric junction
  2. Petric brim (ureters cross over iliac vessels)
  3. VUJ - Vesicoureteric junction obstruction
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12
Q

What is the treatment for nephroliathisis?

A

-Symptomatic –> hydrate, analgesia (NSAIDs-diclofenac)
-Abx if UTI present (Gentamycin for pyelonephritis)
-Stones normally pass if small enough <5mm
-Elective surgical Tx if too big (ESWL/PCNL) to pass

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13
Q

What is ESWL?

A

Extracorporeal shock wave lithotripsy - breaks stone with sound waves
smaller stones 6-10mm up to 20mm

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14
Q

What is PCNL?

A

Percutaneous nephrolithotomy - keyhole removal of larger stones - 20mm+

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15
Q

What is acute kidney injury?

A

Abrupt decline in kidney function (hrs-days), characterised by increase serum creatinine + urea and decreased urine output.

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16
Q

What is the classification of AKI?

A

Serum creatinine rise >26micromol/L in 48hr
OR
Rise in creatinine 1.5x baseline in 7 days
OR
Urine output <0.5ml/kg/hr for > consecutive 6hrs

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17
Q

What are the different stagings of AKI?

A

Used to be rifle : risk, injury, failure, loss of functioned stage renal failure

AKIN - 3 stages

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18
Q

What are the causes of AKI?

A

Pre-renal
Intra renal
Post renal

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19
Q

What are the pre-renal causes of AKI?

A

Hypoperfusion- Low blood volume (cariogenic shock, dehydration, bleeding) and low effective circulating volume (liver failure, congestive heart failure)
-renal artery blockage or stenosis
-NSAIDs +ACEi= low GFR

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20
Q

What are the intra-renal causes of AKI?

A

Kidney can’t filter the blood properly:
Nephron and parenchyma damage
-Tubular(mc) - acute tubular necrosis
-Interstitial - acute interstitial nephritis
-Glomerular - glomerulonephritis
-Toxins (sepsis)

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21
Q

How does glomerulonephritis cause renal AKI?

A

Barrier damage, protein leakage = low oncotic damage and therefore low GFR

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22
Q

How does tubular necrosis cause renal AKI?

A

Complex blood supply , tubule cells infarct, break away, low hydrostatic pressure and low GFR

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23
Q

What is the presentation of acute tubular necrosis?

A

muddy brown casts in urine -dead tubular cells

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24
Q

How does acute interstitial nephritis cause renal failure AKI?

A

infection, ischaemia, connective tissue diseases
-inflammation and immune cells = damage

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25
Q

What are the post renal causes of AKI?

A

Obstructive uropathy:
-stones (ureteral, bladder, urethra)
-BPH
-Drugs(CCBs, anticholinergic)
-occluded in dwelling catheter

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26
Q

What are the top 3 causes of AKI?

A

Sepsis
Cariogenic shock
major surgery

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27
Q

What are the risk factors of AKI?

A
  • increasing age
    -comorbidities (HTN,DM,CHF)
    -Hypovolemia
    -nephrotic drugs
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28
Q

What is the pathology of AKI?

A

The risk factors cause decreased blood filtration and urine output therefore there is an accumulation of (usually excreted) substances :
K+ hyperkalaemia (Arrhythmias)
Hyperuremia- pruritis+ uremic frost+ confusion
Fluid: oedema
H+ - acidosis

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29
Q

What is the presentation of AKI?

A

Due to substance accumulation:
uremia - encephalopathy, pericarditis, skin manifestations
Fluid overload - oedema
Oliguria + palpable bladder
H+ - acidosis
K+ - arrhythmias - hyperkalameia
Hameaturia + proteinuria

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30
Q

What is the ECG presentation of hyperkalaemia?

A

Tall tented T waves
P wave flattening
Wide QRS

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31
Q

What is the diagnosis of AKI?

A

Establish cause - pre,intra,post renal and diagnose with KDIGO classification
-Check K+,H+, urea, creatinine with U+E
FBC+CRP-check for infection
Renal biopsy will confirm intra renal cause
USS for post renal
ECG,Urine dipstick,CXR, ABG

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32
Q

What is the treatment for AKI?

A

-Treat complications:
Hperkalaemia - calcium glucanate
Met acidosis - sodium bicarbonate
Fluid overload - diuretics
-Treat underlying cause :
Last resort. -renal replacement therapy (Haemodialysis indicated in AFUK)

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33
Q

What is the treatment for hyperkalemia?

A

Iv calcium gluconate
Insulin + dextrose

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34
Q

Why is insulin and dextrose given for hyperkalaemia?

A

Insulin drives K+ into cells (+glucose) via Na+-K+ ATPase pump
Dextrose ensures patient doesn’t become hypoglycaemic

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35
Q

Why are NSAIDs CI in AKI?

A

NSAIDs known to cause AKI
- renal perfusion and decreases GFR - pre renal

Can cause glomerulonephritis + interstitial nephritis - renal

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36
Q

What is AFUK indications for haemodialysis?

A

Acidosis - pH<7.1
Fluid overload - oedema
Ureamia - symptomatic
K+ >6.5 / ECG change

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37
Q

what is Chronic kidney disease?

A

Reduction of eGFR <60ml/min/1.73m^2 for 3+ months

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38
Q

What are the clinically test readings to quantify CKD?

A

eGFR
ACR - albumin: creatinine - more sensitive measure of proteinuria

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39
Q

What are the classified stages 1-5?

A
  1. > 90 - normal and high
  2. 60-89 - mild reduction
  3. a- 45-59 - mild to mederate
    b- 30-44 - moderate to severe
  4. 15-29 - severe
  5. <15. -kidney failure
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40
Q

What are the 4 parameters for CKD classification ?

A

Creatinine
Age
Gender
Ethnicity

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41
Q

What is the ACR range?

A

<3 normal
3-30 moderately increased
>30 severely increased

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42
Q

What are the risk factors of CKD?

A

DM + HTN - mc
Glomerulonephritis
PKD
Nephrotoxic drugs - NSAIDs

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43
Q

What is the pathology of CKD?

A

1 million nephrons; in CKD many are damaged resulting in a lowered GFR therefore an increased burden on remaining nephrons
-compensatory RAAS to increase GFR but increase transglomerular pressure = shearing + loss of barrier membrane selective permeability –> proteinuria/ hameaturia

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44
Q

What causes mesangial scarring?

A

Angiotensin 2 regulates TGF-B and plasminogen activator -inhibitor 1 causing mesangial scarring

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45
Q

What is the presentation of CKD?

A

Early on - Asx
Sx due to substance accumulation + renal damage (diabetic neuropathy)
Complications:
-anaemia (low EPO)
-osteodystrophy (low vit d activation)
-Neuropathy and encephalopathy
-CVD
Hameaturia/proteinuria

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46
Q

What is the diagnosis of CKD?

A

FBC - anaemia of chronic disease
U+E
Urine dipstick - proteinuria
USS - bilateral renal atrophy
GFR function staging 1-5+ albumin: creatinine ratio

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47
Q

What is the treatment for CKD?

A

no cure so treat complications - anaemia - EPO+FE
Osteodystrophy - VIT D supplements
CVD - ACEi + statins
Oedema - diuretics
Stage 5 = RRT
if ESRF = renal transplant
Stop NSAIDs

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48
Q

What is the differences between AKI and CKD?

A

AKI = high serum creatinine and low urine output
- shorter Sx onset
-no anemia
-USS =normal

CKD = low eGFR
- 3months Sx
-Anaemia of CKD
-USS= bilateral renal atrophy

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49
Q

What is benign prostate hyperplasia ?

A

Non malignant prostate hyperplasia , normal with ageing.

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50
Q

What are the risk factors of BPH?

A

increasing age(Ethnicity. ;afrocaribbean = higher levels of testosterone

  • castration is protective
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51
Q

What is the pathology of BPH?

A

inner transitional zone of prostate proliferates and narrows urethra

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52
Q

What is the presentation of BPH?

A

LUTS:
Storage and voiding symptoms

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53
Q

what are the storage symptoms?

A

frequency, urgency, nocturia, incontinence

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54
Q

What are the voiding symptoms?

A

poor stream, dribbling, incomplete emptying, straining, dysuria

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55
Q

What is the diagnosis of BPH?

A

DRE (digital rectal exam) - smooth enlarged (prostate cancer = hard and irregular)
PSA test = rule out prostate cancer - unreliable as can be raised in both but usually more in cancer
Rule out UTI’s - urine dipstick
Stones

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56
Q

What is the treatment for BPH?

A

Lifestyle ; lower caffeine intake/ may need a catheter
Drugs :
1st line alpha blocker - Doxazosin+ Tamsulosin - relaxes bladder neck
2nd line - 5 ALPHA REDUCTASE INHIBITORS - FINASTERIDE - lower testosterone production therefore lower prostate size
Surgery: Transurethral resection of prostate

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57
Q

What is the mechanism for tamsulosin?

A

Blocker of alpha 1D and 1A adrenoreceptors - relaxes detrusor muscles of bladder prevent storage symptoms

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58
Q

What are the side effects of tamsulosin?

A

sexual dysfunction

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59
Q

What is doxazosin?

A

Alpha blocker - relaxes detrusor bladder neck but has side effects like postural hypotension due to increased vasodilation

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60
Q

What is the most common complication of BPH?

A

retrograde ejaculation

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61
Q

What is the most common renal cancer?

A

Renal cell carcinoma

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62
Q

What is the pathology of renal cell carcinoma?

A

malignant cancer of proximal convoluted tubule epithelium, can metastasise to bone, liver and lungs

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63
Q

What are the risk factors of renal cell carcinoma?

A

Smoking, haemodialysis, hereditary: von hippie Lindau syndrome

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64
Q

What is von hippel - Lindau syndrome?

A

-Autosomal dominance
-Loss of tumour suppressor gene
-Presentation- bilaterally:
renal and pancreas cysts
-cerebellum cancers

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65
Q

What is the presentation of a renal cell carcinoma?

A

Often asymptomatic; 25% metastasised cases at Px
Triad: Flank pain, haematuria, abdominal mass
May have left sided varicocele
Hypertension
Anaemia - low EPO

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66
Q

What is the diagnosis of renal cell carcinoma?

A

1st line - USS
Gold - CT chest/abdo/pelvis (more sensitive)
Staging - Robson staging 1-4

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67
Q

What is the treatment of renal cell carcinoma?

A

Nephrectomy (full/partial if bilateral)

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68
Q

What is Wilms tumour?

A

Renal mesenchymal stem cell tumour seen in children ,<3y/o, much rarer.
(Nephroblastoma)

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69
Q

What is the most common type of bladder cancer?

A

transitional cell carcinoma (TCC) of bladder

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70
Q

What are the risk factors of Bladder cancer?

A

-Occupational exposure to dyes/paints/rubber
(painter, hairdresser, mechanic working with tyres)
-smoking
-Chemo/radiotherapy
-Age (Px age = 73)

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71
Q

What is the most common subtype of bladder cancer?

A

Urothelial carcinoma

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72
Q

What patients are more likely to have squamous cell carcinoma bladder cancer than transitional?

A

If patient has schistosomiasis

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73
Q

Whats is the presentation of bladder cancer?

A

Painless haematuria

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74
Q

What is the diagnosis of bladder cancer?

A

Flexible cystoscopy and biopsy - gold standard

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75
Q

What is the treatment for bladder cancer?

A

Conservative - support
Medical - chemo/radio
Surgery - transurethral resection of bladder tumour or cystectomy

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76
Q

What is prostate cancer?

A

Adenocarcinoma - outer zone of peripheral prostate neoplastic, malignant proliferation

MC - male malignancy

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77
Q

What re the risk factors of prostate cancer?

A

Genetic - BRCA2 / HOXB13
Increasing age
Afrocaribbean ethnicity
FHx

78
Q

What is the presentation of prostate cancer?

A

LUTS like BPH but with systemic cancer SX
-weight loss
-fatigue
-night pain
Bone pain - typically metastasises to bone(scerlotic lesions), liver, lung ,brain

79
Q

What is the diagnosis for prostate cancer?

A

DRE + PSA
Transrectal USS + biopsy = diagnostic
Grading = Gleason score

80
Q

What is the treatment for prostate cancer?

A

Local –>prostatectomy
Metastatic –> Hormone therapy ( lower testosterone, slows cancer growth/ even death)
-Bilateral orchidectomy
Gnrh receptor agonist - Goserelin
Chemo/Radio

81
Q

What is the mechanism of GNRH agonist?

A

Agonises GnRH therefore increases LH and FSH but results in exogenous suppression of the HPG axis

82
Q

What is the most common cancer in young men 20-45?

A

Testicular cancer

83
Q

Where does testicular cancer arise from?

A

Germ cells -90%
Non germ cells -10%

84
Q

What are the germ cells?

A

Seminoma. -mc
Teratoma

85
Q

What are the non germ cells?

A

sertoli
leyding
sarcoma

86
Q

What are the risk factors for testicular cancer?

A

cryptorchidism - undescended testses
Infertility
FHx

87
Q

What is the presentation of testicular cancer?

A

painless lump in testicle which does not transluminate
May show lung metastasis signs - cough

88
Q

What is the diagnosis for testicular cancer?

A

Urgent (doppler) USS testes - 90% diagnostic
Tumour markers:
AFP - raised in teratoma
BhCG - raised in seminoma
LDH raised in tumours
CXR if lung signs

89
Q

what is the treatment for testicular cancer?

A

Urgent radical orchidectomy + offer sperm storage - always first line
Adjuvent chemo/radio

90
Q

What is obstructive uropathy?

A

Blockage of urine flow, can affect one or both kidneys depending on level of obstruction - Obstructive nephropathy

91
Q

What are the causes of obstructive uropthay?

A

BPH and stones - most common

92
Q

What is the pathology of obstructive neuropathy?

A

obstruction –> retention + increase in KUB pressure –> refluxing/ backlogged urine in renal pelvis (hydronephrosis) - dilated renal pelvis, which is more infection prone

93
Q

What is the presentation of obstructive neuropathy?

A

With obstruction - may be aSx if only 1 kidney affected

94
Q

What is the treatment for obstructive neuropathy?

A
  1. relieve kidney pressure –> catheterise urethra, urethral stent
  2. Tx BPH or stones + infection
95
Q

What is a urinary tract infection?

A

The inflammatory response of the urothelium to bacterial invasion usually associated with bacteria and pyuria. Pure growth of >10^5 organisms/ml of fresh mid stream urine

96
Q

What are the locations of the urinary tract infections ?

A

Upper- Kidney
Lower- bladder onward

97
Q

What are the upper UTIs?

A

Pyelonephritis

98
Q

What are the lower UTIs?

A

Cystitis, prostatitis, urethritis, epididymo-orchitis

99
Q

What organisms cause UTIs?

A

KEEPS:
Klebsiella
Enterobacter
E.coli - mc
Proteus
S.saprophyticus

100
Q

What causes 80% of UTIs?

A

UPEC- uropathogenic E.coli

101
Q

Why are females more effected by UTIs?

A

They have a shorter urethra therefore closer to anus and easier for bacteria to colonise

102
Q

What is the diagnosis for all UTIs?

A

Urine dipstick
- positive leukocytes
-positive nitrites
-+/- haematuria

Gold standard - midstream MC+s = confirm UTI and pathogen

103
Q

What is pyelonephritis?

A

Infection of renal parenchyma + upper ureter, ascending transurethral spread. Usually UPEC, can be other KEEPS

104
Q

What are the risk factors for pyelonephritis?

A

Urine stasis(stones), renal structural abnormality, catheters

105
Q

What is the presentation of pyelonephritis?

A

<35
Triad:
-loin pain
-fever
-pyuria. or N+V as pyuria seen on investigations

106
Q

What is the diagnosis of pyelonephritis?

A

1st - urine dipstic
Gold- mid stream - microscopic, culture and sensitivity

Ix for stones if suspected

107
Q

What is the treatment for pyelonephritis?

A

Analgesia -paracetamol
Abx - ciprofloxacin or co-amoxiclav

Cefalexin if Preg

108
Q

What is cystitis?

A

UPEC infection of bladder

109
Q

What are the risk factors of cystitis?

A

urine stasis, bladder lining damage, catheters

110
Q

What is the presentation of cystitis?

A

> 35
suprapubic tenderness and discomfort
increased frequency and urgency
visible haematuria

111
Q

What is the diagnosis of cystitis?

A

urine dip
mc+S

112
Q

What is the treatment for cystitis?

A

Abx; trimethoprim or nitrofurantoin

Amoxicillin if Preg

113
Q

What is urethritis?

A

Urethral inflammation +/- infection - mc = a sexually acquired condition

114
Q

What are the infective causes of urethritis?

A

Neisseria gonorrhoea - lc
chlamydia trachomatis - mc

115
Q

what are the non infective cause of urethritis?

A

Trauma

116
Q

What is Neisseria gonorrhoea?

A

Gram negative diplococcus

117
Q

what is chlamydia trachomatis?

A

obligate intracellular gram negative aerobe - bacillus

118
Q

What are the risk factors of urethritis?

A

MSM + unprotected sex

119
Q

What is the presentation of urethritis?

A

<35
Dysuria+/- urethra discharge (blood/pus), urethral pain

120
Q

What is the diagnosis of urethritis?

A

NAAT (nucleic acid amplification test ) –> detect STI (NG or CT)
Urine dip (positive if infectious UTI is indicated) + mc+s = will detect pathogen ID

121
Q

What is the treatment of urethritis?

A

NG–>IM ceftriaxone +azithromycin

CT–> azythromycin (or doxycycline)

122
Q

In what other reactive disease is urethritis seen?

A

Reactive arthritis
-cant see, can’t pee, can’t climb a tree

123
Q

What is epididymo - orchitis?

A

Inflammation of the epididymis, extending to the testes. Usually due to urethritis (STI) or cystitis (KEEPS) extension

124
Q

What is the presentation of epididymo-orchitis?

A

unilateral scrotal pain + swelling. -pain relieved when elevating testes and cremaster reflex intact

Ddx - rule out testicular torsion

125
Q

What is the diagnosis of epididymo-orchitis?

A

NAAT
Urine dip
MC+S

126
Q

What is the treatment for epidydmo- orchitis?

A

Depends on STI or UTI - Abx treatment for cystitis or standard STI treatments

127
Q

What is polycystic Kidney Disease?

A

cyst formation through renal parenchyma - bilateral enlargement and damage

128
Q

What is the aetiology of PKD?

A

Familial inherited :
- autosomal recessive and dominant

129
Q

What is the autosomal recessive cause of PKD?

A
  • less common
    -a disease of infancy or rebirth with increased mortality
    -many congenital abnormalities (e.g’s potters sequence - clubbed feet, flattened nose)
130
Q

What is the autosomal dominant cause of PKD?

A
  • most common
    -mutated PKD1(85%) or PKD2(15%)
    -more males
    -present at 20-30
131
Q

What is the pathology of PKD?

A

PKD 1+2 = code for polycystic (Ca ++ channels)
-In cilia of nephron, when filtrate passes, cilia move+ polycystic on cilia open –> Ca++ inhibits excessive growth

-PKD mutation=decrease in Ca++ influx therefore cilia excessive growth - cysts -many= polycysts

132
Q

What is the presentation of PKD?

A

Bilateral flank/back or abdo pain
+/- haematuria
Extrarenal cysts - particularly in circle of willis (berry aneurysm ;if ruptured = subarachnoid haemorrhage)

133
Q

What is the diagnosis of PKD?

A

Kidney USS - enlarged bilateral kidneys with multiple cysts
- also genetic testing +FHx of PKD

134
Q

What is the treatment of PKD?

A

Non curative, manage Sx (HTN - ACEi +ESRF- RRT or transplant )

135
Q

What is an epididymal cyst?

A

extratesticular cyst - above and behind testes that will transilluminate

136
Q

What is the diagnosis of epididymal cyst?

A

USS scrotum

137
Q

What’s a hydrocele?

A

Fluid collection in tunica vaginalis - cyst that testicle sits within that will transilluminate

138
Q

What is the diagnosis for hydrocele?

A

USS scrotum

139
Q

What is varicocele?

A

Distended pampiniform plexus due to increase in left renal vein pressure causing reflux

140
Q

What is the presentation of varicocele?

A

bag of worms on left hand side mostly - painless, maybe painful when larger therefore more severe

141
Q

What is the diagnosis for varicocele?

A

Clinical

142
Q

What is the complication of varicocele?

A

Infertility

143
Q

What is testicular torsion?

A

Spermatic cord twists on itself; occlusion of testicular artery - causes ischaemia -> gangrene of testis if not dealt with

144
Q

What are the risk factors of testicular torsion?

A

Bell clapper deformity - horizontal lie of testes

145
Q

What is the presentation of testicular torsion?

A

Severe unitesticular pain (hurts to walk), abdo pain, N+V -cremasteric reflex lost, no pain relief on elevating testes - prehns sign

146
Q

What is the cremasteric reflex?

A

stroke inner thigh; ipsilateral testicle should elevate

147
Q

What is the diagnosis of testicular torsion?

A

USS to check testicular blood flow - but first surgical exploration if there is a high risk

148
Q

What is the treatment for testicular torsion?

A

urgent surgery within 6hr (90-100% successful)
-surgical exploration always first line
-orchidectomy +bilateral fixation - testes to scrotal sac

149
Q

What are the types of incontinence in females?

A

-stress: (sphincter weakness - post pregnancy trauma) -pee leaks with intra-abdo pressure rise

-urge(detrusor muscle overactivity)
-spastic paralysis(neurological UMN lesion) - overactive reflexes + hypertonia of detrusor

150
Q

What is the treatment for incontinence?

A

surgery
anti-cholinergic drugs

151
Q

What is retention in males?

A

Inability to pass urine even when bladder full

152
Q

What are the causes of retention?

A

Obstruction - Stones,BPH, neurological flaccid paralysis (hypotonia of detrusor as LMN)

153
Q

What are storage symptoms?

A

Occur when bladder should be storing urine therefore need to pee:
Frequency, urgency, nocturia, incontinence

154
Q

What are the voiding symptoms?

A

Occur when bladder outlet’s obstructed - hard to pee:
Poor stream, hesitancy, incomplete emptying, dribbling

155
Q

What are the red flags LUTs?

A

Hamaturia , dysuria

156
Q

What is glomerulonephritis?

A

Glomerulonephritis refers to groups of parenchymal kidney diseases that all result in the inflammation of glomeruli and nephrons

157
Q

What are the classifications of glomerulonephritis?

A

Nephrotic and nephritic

158
Q

What is nephrotic syndrome?

A

Protein leaks due to the inflammation of podocytes.

159
Q

What are the characteristics of nephrotic syndrome?

A

-proteinuria (3.5g+/24hr)
-Hypoalbuminemia
-oedema due to 3rd spacing
-hyperlipidaemia
-hypogammaglobulinameia
-hypercoaguable blood (due to loss of antithrombin 3)

160
Q

What are the primary causes of nephrotic syndrome?

A

Minimal change disease - mc in children
Focal segmental glomerulosclerosis -mc in adults
Membranous nephropathy- adults, caucasian

161
Q

What is the secondary cause of nephrotic syndrome?

A

mc to diabetic (nephropathy)

162
Q

What is the presentation of nephrotic syndrome?

A

proteinuria, hypoalbuminemia, oedema, weight gain, hyperlipidemia

163
Q

What is minimal change disease?

A

Cytokines attack foot processes of podocytes–> protein leakage

164
Q

What is focal segmental gomerulosclerosis?

A

Scleosis forms in parts of the glomeruli

165
Q

What is membranous Nephropathy?

A

thickening of glomeruli capillary deposition in sub-epithelial surface- damaged glomerular –> protein leaks out

166
Q

What is the diagnosis for minimal change disease?

A

Take biopsy=
Light microscopy= NO CHANGE
Electron microscopy= podocyte effacement + fusion

167
Q

What is the diagnosis of focal segmental glomerulosclerosos?

A

Take biopsy=
Light microscopy= segmental sclerosis ; less than 50% glomeruli affected tho

168
Q

What is the diagnosis for membranous nephropathy?

A

Biopsy=
Light microscopy = thickened GBM
Electron microscopy= subpodocyte immune complex deposition, spike and dome appearance

169
Q

What is the treatment for nephrotic syndromes?

A

Corticosteroids for 12 weeks - prednisolone
- minimal change respond well to them
FSG +MN= not so well

170
Q

What is nephritic syndrome?

A

Glomerulonephritis pathologies that cause both haematuria and proteinuria. Increased permeability of glomeruli allows movement of RBCs in to filtrate

171
Q

What are the characteristics of nephritic syndrome?

A

-Haematuria (+ little proteinuria)
-oliguria
-HTN
-Oedema - due to fluid overload
-GBM breaks - inflammation- bowman’s crescents

172
Q

What are the causes of nephritic syndrome?

A

IgA nephropathy (Berger’s disease). -mc
Past strep glomerulonephritis
SLE
Goodpastures syndrome
Haemolytic uremic syndrome

173
Q

What is IgA nephropathy?

A

most common cause of nephropathy
-IgA deposits in mesangium of kidney and kidney is attacked by anti-glycan autoantibodies

174
Q

What is the presentation of IgA nephropathy?

A

visible haematuria
1-2 days after tonsillitis
Viral infection or gastroenteritis viral infection

175
Q

What is the diagnosis of IgA nephropathy?

A

Immunofluorescence microscopy shows IgA complex deposition

176
Q

What is the treatment for IgA neuropathy?

A

non curatvive - 30% progress to ESRF
BP control - ACEi

177
Q

What is the Ddx of IgA neuropathy?

A

henloch Schonlein purpura - small cell vasculitis
Dx - exact same result
Difference
IgA= only kidney deposition
HSP= systemic - kidney, liver

178
Q

What is the presentation of post strep glomerulonephritis?

A

Visible haematuria
2 weeks after pharyngitis from group A,B haemolytic strep - S.pyogenes

179
Q

What is the diagnosis of post strep GN?

A

light microscope - hyper cellular glomeruli
E microscope - sub endothelial immune complex deposition
Immunofluorescence shows starry sky appearance - IgG,IgM deposition along GBM

180
Q

What is the treatment for post strep GN?

A

Self limiting, sometimes may progress to rapidly progressing GN

181
Q

What is SLE?

A

Lupus nephritis secondary to SLE (ANA deposition in endothelium)

182
Q

What is the diagnosis for SLE?

A

ANA positive , anti double stranded DNA positive

183
Q

What is the treatment for SLE?

A

steroids + immunosuppressants

184
Q

What is good pastures?

A

pulmonary and alveolar haemorrhage and glomerulonephritis due to autoantibodies (anti-GBM)

185
Q

What is the treatment for good pastures?

A

steroids and plasma exchange

186
Q

What is haemolytic uremic syndrome?

A

a condition that can occur when the small blood vessels in your kidneys become damaged and inflamed

187
Q

What are the causes of HUS?

A

Shiga toxin - e.coli, shigella

188
Q

What is the presentation of HUS?

A

haemolytic anaemia
AKI therefore uraemia
Thrombocytopenia

189
Q

What is the treatment for HUS?

A

mostly self limiting
med emergency - supportive fluids +Abx

190
Q

What is rapidly progressing glomerulonephritis (RPGN?

A

subtype of GN that progresses to ESRF very fast

191
Q

What are the causes of PRGN?

A

wegeners granulomatosis (cANCA)
MPA(pANCA)
Good pastures

192
Q

What is the diagnosis of RPGN?

A

Inflammatory crescents in bowmans space

Phase 2a (9 decks)

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