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Clincial pathology > Kidney > Flashcards

Kidney Flashcards

1
Q

What is the most common organism causing UTIs

A

E. Coli.

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2
Q

What are the causes of sterile pyuria?

A

Inhibition of bacterial growth eg. U prescribed antibiotics or specimen contaminated with antiseptic.

Hard to grow organisms (anaerobes) eg. mycobacterium tuberculosis, haemophilus spp, neisseria gonorrhoeae

Or urinary tract inflammation.

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3
Q

Give examples of antibiotics for a UTI

A

Nitrofurantoin
Pivmecillinam
Trimethoprim
Fosfomycin

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4
Q

What is the treatment for pyelonephritis?

A

Cefuroxime, ciprofloxacin

If over 65 use piperacillin-tazobactam
Use for 7-14 days.

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5
Q

If have asymptomatic bacteriuria, do…

A

Treat only specific groups, the pregnant, infants and prior to urological procedures.

The elderly and catheterised do not require antibiotics.

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6
Q

What are the proximal tubular cells?

A

They have long microvilli and lots of mitochondria. Reabsorb two thirds of filtered water, sodium, glucose, and proteins.

Vulnerable to Ischaemic change.

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7
Q

What is the juxtaglomerular apparatus?

A

Glomerulus and distal tubulus, the principal source of renin

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8
Q

What is the clinical presentation of nephrotic syndrome?

A

Increased permeability to macromolecules. Oedema, proteinuria and hypoalbuminaemia.
Proteinuria >3g per 24hours (mostly albumin)

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9
Q

What is the presentation of acute nephritis?

A

Reduced GFR, glomerular inflammation and necrosis, visible haematuria, oliguria, uraemic and proteinuria.

Fluid retention and hypertension.

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10
Q

Give examples of immunological glomerular diseases.

A

No imm specify for glomerular, deposits along the basement membrane.

Eg, lupus nephritis, IgA nephropathy, membranous nephropathy.

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11
Q

What is Anti-GBM disease

A

Antibodies directly against normal components of BM.

Goodpastures syndrome and post infective glomerolunephritis

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12
Q

What is the most common nephrotic syndrome?

A

Membranous nephropathy. (Immune deposits on the podocyte side of BM, usually adults 30-60, usually male) 20-30% progress to renal failure

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13
Q

What is minimal change disease?

A

T cell driven factors, idiopathic. Normal biopsy on light microscopy. Under electron microscope can see podocyte destruction.

Most common in children, majority of whom make full recovery.

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14
Q

What is post infective glomerulonephritis (nephritic syndrome)

A

Typically occurs a few weeks after strep throat infection or viral infection. Glomerular inflammation from deposits of immune complexes eg, IgG
Most recover completely.

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15
Q

What is the most common primary glomerular disease worldwide?

A

IgA neuropathy, usually teenagers and young adults with haematuria.
20-50% progress to renal failure over 20 years.

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16
Q

How does myeloma affect the kidney?

A

Tumour of plasma cells produces immunoglobulins. These deposit in kidney tubules and they become damaged. Kidney becomes fibrosed and inflamed. Declining irreversible kidney function.

17
Q

How does vasculitis affect the kidney?

A

Blood vessels inflamed. Can affect the glomerular vessels and lead to clotting with obliteration of capillary lumens. Inflammation of larger arterioles can lead to hypoxia of tubules.

18
Q

How does diabetes damage the kidney?

A

Hyperglycaemia is main cause of diabetic neuropathy by damaging the basement membrane. BM becomes thicker produces extra cellular matrix which forms nodules.

Also damages small vessels.

19
Q

What are the first 3 stages of reduced GFR?

A

Stage 1: Kidney damage with normal or increased GFR (>90ml/min)
Stage 2: Mild reduction in GFR (60-89 mL/min)
Stage 3: Moderate reduction (30-59 mL/min)

20
Q

What are the worst 2 stages of GFR?

A

Stage 4: Severe reduction in GFR (15-29 mL/min)

Stage 5: Kidney failure (GFR

21
Q

What is Von Hippel-Lindau syndrome?

A

The most common of cancer syndrome observed in Renal cell carcinoma.
Loss of gene function for breakdown of hypoxia inducible factor-1. Causes cell growth and increased cell survival, so tumours develop in kidneys, blood vessels and pancreas.

22
Q

Syndromes associated with renal cell carcinoma

A

Cushings (ACTH)
hypercalcaemia (parathyroid related hormone)
Polycythaemia (erythropoietin)

23
Q

What is a significant bacteriuria count?

A

10^5 cfu/ml

10^4 to 10^5 is probable infection.

Clincial pathology (5 decks)

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