Kidney Flashcards
(23 cards)
What is the most common organism causing UTIs
E. Coli.
What are the causes of sterile pyuria?
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.
Give examples of antibiotics for a UTI
Nitrofurantoin
Pivmecillinam
Trimethoprim
Fosfomycin
What is the treatment for pyelonephritis?
Cefuroxime, ciprofloxacin
If over 65 use piperacillin-tazobactam
Use for 7-14 days.
If have asymptomatic bacteriuria, do…
Treat only specific groups, the pregnant, infants and prior to urological procedures.
The elderly and catheterised do not require antibiotics.
What are the proximal tubular cells?
They have long microvilli and lots of mitochondria. Reabsorb two thirds of filtered water, sodium, glucose, and proteins.
Vulnerable to Ischaemic change.
What is the juxtaglomerular apparatus?
Glomerulus and distal tubulus, the principal source of renin
What is the clinical presentation of nephrotic syndrome?
Increased permeability to macromolecules. Oedema, proteinuria and hypoalbuminaemia.
Proteinuria >3g per 24hours (mostly albumin)
What is the presentation of acute nephritis?
Reduced GFR, glomerular inflammation and necrosis, visible haematuria, oliguria, uraemic and proteinuria.
Fluid retention and hypertension.
Give examples of immunological glomerular diseases.
No imm specify for glomerular, deposits along the basement membrane.
Eg, lupus nephritis, IgA nephropathy, membranous nephropathy.
What is Anti-GBM disease
Antibodies directly against normal components of BM.
Goodpastures syndrome and post infective glomerolunephritis
What is the most common nephrotic syndrome?
Membranous nephropathy. (Immune deposits on the podocyte side of BM, usually adults 30-60, usually male) 20-30% progress to renal failure
What is minimal change disease?
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.
What is post infective glomerulonephritis (nephritic syndrome)
Typically occurs a few weeks after strep throat infection or viral infection. Glomerular inflammation from deposits of immune complexes eg, IgG
Most recover completely.
What is the most common primary glomerular disease worldwide?
IgA neuropathy, usually teenagers and young adults with haematuria.
20-50% progress to renal failure over 20 years.
How does myeloma affect the kidney?
Tumour of plasma cells produces immunoglobulins. These deposit in kidney tubules and they become damaged. Kidney becomes fibrosed and inflamed. Declining irreversible kidney function.
How does vasculitis affect the kidney?
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.
How does diabetes damage the kidney?
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.
What are the first 3 stages of reduced GFR?
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)
What are the worst 2 stages of GFR?
Stage 4: Severe reduction in GFR (15-29 mL/min)
Stage 5: Kidney failure (GFR
What is Von Hippel-Lindau syndrome?
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.
Syndromes associated with renal cell carcinoma
Cushings (ACTH)
hypercalcaemia (parathyroid related hormone)
Polycythaemia (erythropoietin)
What is a significant bacteriuria count?
10^5 cfu/ml
10^4 to 10^5 is probable infection.
