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Genitourinary 2 Flashcards

1
Q

What causes glomerulonephritis?

A

IgA nephropathy
Goodpasture’s disease
Post strep glomerulonephritis
Henoch Schoenlein purpura

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2
Q

What is IgA nephropathy?

A

Deposition of IgA into the mesangium of the kidney - results in inflammation and damage

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3
Q

How does IgA nephropathy present?

A

Asymptomatically with microscopic haematuria

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4
Q

How is IgA nephropathy treated?

A

Same as nephritic syndrome

Fish oil and steroids if persistent proteinuria after 3-6 months

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5
Q

How is IgA nephropathy diagnosed?

A

Biopsy

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6
Q

What is the most common cause of nephritic syndrome in high income countries?

A

IgA nephropathy

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7
Q

What causes Goodpasture’s disease?

A

Autoantibodies to type IV collagen in glomerular and alveolar membrane

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8
Q

How does Goodpasture’s disease present?

A

SOB and oliguria due to respiratory and renal damage

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9
Q

How is Goodpasture’s disease diagnosed?

A

Anti-GBM antibodies in bloods and biopsy

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10
Q

How is Goodpasture’s disease managed?

A

Plasma exchange, steroids and cyclophosphamide for immune suppression

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11
Q

What is Goodpasture’s disease a cause of?

A

Rapidly progressing glomerulonephritis leading to renal failure in days/weeks

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12
Q

What is post streptococcal glomerulonephritis?

A

Nephritic syndrome following infection 3-6 weeks prior

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13
Q

What causes post streptococcal glomerulonephritis?

A

Deposition of strep antigens in the glomeruli leading to inflammation and damage

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14
Q

How does post streptococcal glomerulonephritis present?

A

Haematuria - can present with acute nephritis

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15
Q

How is post strep glomerulonephritis diagnosed?

A

Evidence of strep infection

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16
Q

How is post strep glomerulonephritis treated?

A

Antibiotics to clear strep and supportive care

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17
Q

What is Henoch Schoenlein purpura?

A

Small vessel vasculitis that affects the kidney and joints due to IgA deposition

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18
Q

How does Henoch Schoenlein purpura present?

A

Purpuric rash on legs, nephritic symptoms and joint pain due to IgA deposition

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19
Q

How is Henoch Schoenlein purpura diagnosed?

A

Clinically, confimed with renal biopsy

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20
Q

How is Henoch Schoenlein purpura managed?

A

Corticosteroids and ACEi/ARB

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21
Q

What is nephrotic syndrome?

A

Issue with filtration barrier
Podocytes being implicated
Results in leaking of protein into urine

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22
Q

How does nephrotic syndrome present?

A

Proteinuria
Hypalbuminaemia
Oedema
Frothy urine

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23
Q

What causes nephrotic syndrome?

A

Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy

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24
Q

What are the secondary causes of nephrotic syndrome?

A

DDANI

Diabetes, drugs, autoimmune, neoplasia

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25
How is nephrotic syndrome investigated?
Urinalysis Urine protein:creatinine ratio Blood tests Renal biopsy
26
How is nephrotic syndrome managed?
``` Fluid and salt restriction Loop diuretics - furosemide to manage oedema Treat cause ACEi/ARB to reduce protein loss Manage complications ```
27
What are the complications of nephrotic syndrome?
Hyperlipidaemia - loss of albumin increases cholesterol formation (manage with statins) VTE due to increased clotting factors - give heparin
28
How is minimal change disease diagnosed?
Biopsy
29
How does minimal change disease present?
Nephrotic presentation
30
How is minimal change disease treated?
High dose steroids - prednisolone
31
What is the most common cause of nephrotic syndrome on renal biopsy?
Focal segmental glomerulosclerosis
32
What causes focal segmental glomerulosclerosis?
Idiopathic
33
How is focal segmental glomerulosclerosis diagnosed?
Presence of scarring of glomeruli i.e. focal sclerosis
34
How is focal segmental glomerulosclerosis managed?
Steroids for idiopathic disease | All patients should receive ACEi/ARB for BP control
35
How is membranous nephropathy diagnosed?
Renal biopsy = thickened glomerular basement membrane | Anti-phospholipase A2 receptor antibody 70-80% of patients
36
How is membranous nephropathy managed?
ACEi/ARB in all | High risk of progression = prednisolone and cyclophosphamide
37
What are the key clinical features of nephritic syndrome?
``` Proteinuria ++ HTN Haematuria visible/non-visible Oedema + GFR ↓↓ Rash? N+V? Abdo pain? ```
38
What is the most common GU tract malignancy?
Bladder cancer - M>F
39
What is the epidemiology of bladder cancer?
3% of all cancer deaths and 10th most common cancer
40
What makes up the majority of bladder cancers?
90% are urothelial carcinoma and spreads to iliac and para-aortic nodes, liver and lungs
41
What causes bladder cancer?
``` Smoking - 2-4x risk, accounts for half of male cases of bladder cancer >55 Pelvic radiation Exposure to occupational carcinogens Bladder stones - chronic inflammation ```
42
How does bladder cancer present?
Painless haematuria | UTI symptoms without bacteriuria
43
How is bladder cancer investigated?
Urinalysis - sterile pyuria Cytoscopy and biopsy - diagnostic CT urogram - allows staging
44
How is bladder cancer managed?
T1: transurethral resection or local diathermy T2-3: radical cystectomy T4: palliative chemo and radio
45
What are the majority of renal cancers found to be?
90% of cancers are found to be arising from the proximal tubular epithelium and are classes of carcinomas
46
What is the epidemiology of renal cancer?
Mean age of diagnosis is 55 with M:F = 2:1
47
How is renal cancer picked up?
50% are picked up incidentally with 30% having mets on diagnosis
48
Where can renal cancer spread to?
Bone, liver and lungs
49
What are the risk factors for renal cancer?
Haemodialysis Smoking HTN
50
How does renal cancer present?
Haematuria Flank pain Palpable abdominal mass
51
How is renal cancer investigated?
``` Bloods - polycythaemia from EPO secretion Raised BP - renin secretion US CT/MRI CXR - shows cannon ball mets ```
52
What score is used to predict survival from renal cancer?
Mayo prognostic risk score
53
How is renal cancer treated?
Stage 1: partial or radical nephrectomy Stage 2: radical nephrectomy Stage 3: radical nephrectomy and adrenalectomy Stage 4: systemic treatment
54
What is a UTI?
Presence of microorganisms in the urinary tract and produces clinical features
55
What do UTIs affect?
Lower tract causing cystitis (bladder), urethritis and prostatitis, and upper causing pyelonephritis
56
What can untreated urolithiasis lead to?
UTI
57
What causes a UTI?
KEEPS ``` Klebsiella E. Coli - most common causing 50% of cases Enterococci Proteus Staphylococcus coagulase -ve ```
58
How does a UTI present?
Voiding symptoms - FUNDS Frequency Urgency Nocturia Dysuria
59
What is pyelonephritis?
Infection and inflammation of kidney, most often due to ascending UTI
60
How does pyelonephritis present?
Loin pain, fever and pyuria Costovertebral joint pain and tenderness Septic shock in advanced disease
61
How is pyelonephritis investigated?
Urinalysis Midstream urine and culture - gold standard Bloods Renal US
62
How is pyelonephritis treated?
Antibiotics - cefalexin for 7-10 days Trimethoprim or amoxicillin if sensitive Paracetamol for analgesia
63
What is cystitis?
Infection of the urinary bladder and is most common in young sexually active women
64
What are the risk factors of cystitis?
History of UTI Diabetes Frequent sexual intercourse Pregnancy
65
How does cystitis present?
``` Dysuria - discomfort pain, burning on urination Frequency Urgency Cloudy smell urine Suprapubic tenderness/discomfort ```
66
How is cystitis investigated?
Urine dipstick - if positive for nitrites or WBCs and RBCs then UTI likely (unreliable in women over 65 so don't bother) Urine culture and sensitivity - gold standard
67
How is cystitis managed?
3 days of trimethoprim (avoid if pregnant) or nitrofurantoin (avoid at term pregnancy)
68
What are the secondary causes of focal segmental glomerulosclerosis?
HIV, heroin or lithium
69
How does minimal change disease present on microscopy?
Normal appearance upon microscopy but there is abnormal function

Phase 2a (25 decks)

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