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Kumar and Clark's > Kidney and Urinary Tract Disease > Flashcards

Kidney and Urinary Tract Disease Flashcards

1
Q

Around % of hospitalised pts are affected w/ AKI?

A

20%

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2
Q

What % of the general population meet the criteria for CKD?

A

10-15%

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3
Q

The kidneys are often involved in which type of systemic conditions?

A

Diabetes

HTN

Autoimmune disorders

Haematological malignancies

Infections (e.g. HIV, viral hepatitis)

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4
Q

What are the core skills and knowledge you need to address kindly and urinary tract diseases?

A

diagnosing the cause of AKI and managing its complications

CKD: its causes, complications and progression

principles of dialysis and transplantation

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5
Q

Are the kidney retroperitoneal or intraperitoneal organs?

A

Retro

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6
Q

At what level of the vertebral column do the kidneys lie?

A

T12 - L3

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7
Q

Which sided kidney is lower and why?

A

Right bc its pushed down by the liver

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8
Q

Each kidney is enclosed in a fibrous capsule, what are the 2 main parts that lie w/in?

A

an outer cortex and an inner medulla

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9
Q

There are about 1 million nephrons in each kidney; what are the components of each nephron? (6)

A

Glomerulus

Proximal Tubule

Loop of Henle

Distal tubule

Collecting duct

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10
Q

Which part of the kidney does the glomerulus lie w/in?

A

In the cortex

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11
Q

the collecting ducts merge in the medulla to form which ducts?

A

Bellini

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12
Q

Where do the Bellini ducts empty at?

into what?

A

papilla at the apex of the renal pyramid

calyx

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13
Q

The renal arteries branch off the……

A

Abdominal aorta

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14
Q

Afferent glomerular arterioles arise from…..

A

interlobular branch arteries

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15
Q

The glomerular capillary tuft has its arterial drainage into which vessels?

A

efferent glomerular arterioles

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16
Q

What does CKD describe?

A

Deteriorating kidney function of any underlying cause

Long standing > 3 months, w/ possible progressive impairment in renal function

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17
Q

In most cases there is no effective revisal of the underlying process of CKD.

What are the scenarios in which there exceptions to this? (4)

A

Relief of urinary obstruction

Immunosuppressive therapy for glomerulonephritis or systemic vasculitis

treatment of accelerated HTN

Correction of critical narrowing of renal arteries

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18
Q

What is the global prevalence of CKD?

Majority are at what stage?

A

11% - 15%

Stage 3

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19
Q

Classification of CKD are based of which 2 parameters?

A

eGFR (Prefix G) and albuminuria (prefix A)

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20
Q

eGFR + albuminuria correlate w/ what 2 inactions in CKD?

A

Progressive renal impairment

+

Cardiovascular risk

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21
Q

What is the most common cause of Glomeulornephritis in sub-Sharan Africa?

A

Malaria

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22
Q

Symptoms of uraemia are most commonly seen when serum urea concentrations exceed what amount?

A

> 40 mmol/L

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23
Q

List symptoms of uraemia/ uremic syndrome

A

Malaise, loss of energy

loss of appetite, weight loss

insomnia

nocturia + polyuria

pruritus

nausea + vomitting

‘Restless leg’ syndrome

bone pain

peripheral oedema

symptoms due to anaemia

amenorrhoea in women

erectile dysfunction in men

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24
Q

In more advanced uraemia, these symptoms become more severe and central nervous system symptoms are common including;

A

Bradyphernia (Mental slowing + clouding of consciousness)

Seizures + myoclonic twitching

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25
Q

What are broad groups of risk factors for renal disease? (6)

A

PMH

Medications

FHx

Recent ill health

Symptoms of UTIs

Symptoms of systemic inflammatory or malignant conditions

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26
Q

List 5 disease that commonly affect the kidneys

A

Diabetes

HTN

Systemic inflammatory diseases

Blood-borne viruses

Myeloma

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27
Q

List 2 nephrotoxic agents pts could be on

A

NSAIDs

Herbal remedies

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28
Q

What 2 things do you ask in the FHx section? (Kidney/UT disease)

A

Hx of renal disease

renal replacement therapy

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29
Q

What 2 acute conditions can cause renal hypo perfusion + pre-renal AKI?

A

Sepsis

Dehydration

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30
Q

What are some symptoms of systemic inflammatory or malignant conditions?

A

Fever

Malaise

Rashes

Eye inflammation

Hair thinning

Nasal discharge

Haemoptysis

etc.

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31
Q

What are the 4 ways in which porteinuria is quantified ?

A

1st line:

Urine dip

Then one of the following 3;

24hr urine protein collection (g/24 h)

Urine protein:creatinine ratio (uPCR mmol)

Urinary albumin:creatinine ration (uACR mg/mmol)

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32
Q

What are the 3 main groups causes for unexplained renal dysfunction

A

Pre-renal causes

Intrarenal causes

Post-renal causes

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33
Q

List pre-renal causes of renal dysfunction (3)

A

Intercurrent illness - systemic infection or sepsis

Vomiting, diarrhoea, dehydration

Concurrent uses of antihypertensives or diuretics - esp. ACEi + ARBs

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34
Q

List Intrarenal causes of renal dysfunction (4)

A

Hx of disease w/ associated renal manifestations
(ex. cast nephropathy in myeloma)

Nephrotoxic medications

Symptoms suggestive of systemic inflammatory disease

Presence of proteinuria

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35
Q

List post-renal causes of renal dysfunction (3)

A

Symptoms of urinary tract obstruction

Complete anuria

Hx of a condition liable to progress to causing urinary tract obstruction
(benign or malignant prostate disease, bladder or pelvis cancer)

Bladder distention or hydronephrosis on US

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36
Q

What is hydronephorsis?

What kind of renal dysfunction cause is it?

A

Hydronephrosis describes hydrostatic dilation of the renal pelvis and calyces as a result of obstruction to urine flow downstream.

Post-renal

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37
Q

In healthy people there should be virtually no urinary albumin (uACR <2.5 mg/mmol for men, <3.5 mg/mmol for women); even very low levels above this threshold (not detectable by dipstick testing) indicate increased what?

A

Cardiovascular risk

38
Q

High levels of proteinuria (uPCR >200 mg/mmol) generally indicate what kind of disease?

A

glomerular disease

39
Q

uPCR >350 mg/mmol indicates what is symptoms such as hypoalbuminuria and fluid overload exist?

A

Nephrotic syndrome

40
Q

What things may be seen in the observations chart of someone w/ renal dysfunction? (2)

What might these to findings suggest?

A

Hypoxia

HTN

Fluid overload

41
Q

What can be seen in the general features of a renal patient?

A

Short stature

Pallor (anemia)

Photosensitive pigmentation (ESRD)

Yellowish complexion

42
Q

What might short stature indicate on a renal patient?

A

Childhood renal disease

43
Q

What might you see in a fundoscopy of a renal pt?

A

Signs of diabetic or hypertensive eyes disease

44
Q

what does a dry mouth suggest in a renal pt?

A

Intravascular fluid depletion

45
Q

What would you asses in the neck of a renal pt?

A

Observe the JVP to asses the fluid status

46
Q

What may be palpated in the abdomen of someone w/ polycystic kidney disease?

A

Grossly enlarged kidneys

47
Q

What chest findings may be present O/E of a renal pt?

A

Basal crackles - suggesting fluid overload

Pericardial friction rub

48
Q

What can happen to the peripheral pulses of a renal pt?

Why may this happen?

A

Be reduced

due to atherosclerotic disease

49
Q

What can be seen in the hands of a renal pt?

A

Brown discolouration of the nails

50
Q

What could you see in the legs of a renal pt?

A

Peripheral oedema

Purpuric rash

51
Q

What can the presence of a purpuric rash suggest in a renal pt?

A

Underlying vasculitis w/ potential renal involvement

52
Q

What is a purpuric rash?

A

A purpuric rash (smaller petechiae 1-2 mm) is produced due to bleeding into the skin or mucosa from small vessels

53
Q

Efferent arterioles from the outer cortical glomeruli drain into which network w/in the renal cortex?

A

Peritubular capillary network and then into the renal vein

54
Q

Blood from the inner juxtamedullary glomeruli pass via what and returns via the cortex to the renal veins that drain into the inferior vena cava

A

Vasa recta

55
Q

The renal capsule and ureters are innervated by which nerve roots?

Where do you get renal pain?

A

T10-12 + L1

Over the corresponding dermatomes

56
Q

The Bowman’s capsule is lined w/ what kind of cells?

A

Parietal epithelial cells

57
Q

The glomerular tuft is held together and regulated by what kind of cells?

What is the function of these cells?

A

Mesangial cells

Its the filtration barrier, allowing filtrate from plasma to move into the urinary (Bowman’s) space

58
Q

The rate of glomerular filtration is influenced by changes in what?

A

Changes in the contractile tone in either the afferent or efferent arterioles

59
Q

Vasoconstriction will do what to the transglomerular capillary pressure and filtration?

A

Increase both

60
Q

Glomerular capillaries are w/ cells that are fenestrated?

A

Endothelial cells

61
Q

Which cells (sitting w/in the tuft) are able to contract and relax to control blood flow and the filtration surface area along the glomerular capillaries in response to a host of mediators?

A

Mesangial cells

62
Q

The loop of Henle lined with squamous cells is more permeable to what more than solute?

A

Water

63
Q

The loop of Henle lined with cuboidal epithelium is more permeable to what more than water?

A

Solute

64
Q

The distal tubule regulates which 2 things via the cuboidal epithelium?

A

Electrolytes and pH

65
Q

What do the interstitial fibroblast-like cells in the renal cortex produces in response to hypoxia?

A

Erythropoietin

66
Q

What 2 things are measured in CKD as surrogates of accumulating metabolites (uraemia toxins)?

A

Urea + creatinine concentrations

67
Q

Why might urine be bloody/’cola-coloured’?

A

Myoglobinuria

Haemoglobinuria

68
Q

Cloudy, offensive-smelling urine may denote what?

What investigation must be done to confirm this?

A

Infection

Urine culture

69
Q

In temperate climates healthy adults will pass how much urine per hour?

A

1 mL/Kg

800 - 2500 mL/24hrs

70
Q

List 2 conditions in which the kidneys lose concentration capacity?

A

CKD

Diabetes insipidus

71
Q

Why is there higher urine volume requirement in dysfunction kidneys?

This gives rise to which to symptoms?

A

Bc the kidney is unable to concentrate the solute into a smaller amount of urine volume (like in healthy conditions)

Nocturia and polyuria

72
Q

Why are high daily volumes seen with glycosuria or increased protein catabolism following surgery?

A

Bc the larger solute load requires higher excretion rates

73
Q

Measurement of the urinary pH (5.5 - 6.5) is only helpful in the investigation and treatment of which condition?

A

Renal tubular acidosis

74
Q

Red cell casts in the urine always what type of disease?

Why do they indicate this?

A

Glomerular disease

Bc dysmorphic red cells (from glomerular bleeding) pass through the distal tubular lumen and form into cylindrical bodies of the casts

75
Q

A dipstick that is strongly positive for haematuria with no red cells seen on microscopy might suggest what 2 things?

A

Haemoglobinuria

or

Myoglobinuria

76
Q

If haematuria is found on dipstick what investigation can be ordered to asses for red cells or casts

A

Midstream urine sample + urine microscopy

77
Q

When blood is seen at the start of voiding and then urine becomes clear where is the site of the bleed?

A

The urethra

78
Q

If blood is diffusely present thorough out the urine where is the site of the bleed

A

The blood is coming from the bladder or above it

79
Q

If blood is only present at the end of micturition suggests bleeding is coming from where?

A

The prostate or bladder base

80
Q

How is AKI defined?

A

Abrupt deterioration in renal function over hours or days

Usually reversible over days or weeks

81
Q

How can an AKI cause a medical emergency?

A

By causing a sudden life-threatening biochemical disturbances

82
Q

What are the 3 main anatomical regions for the cause of an AKI?

A

Pre-renal

Renal parenchymal disorders

Post-renal

83
Q

What is the primary mechanism behind the pre-renal cause of AKI?

A

Reduced kidney perfusion, leading to a falling GFR

84
Q

What is the primary mechanism behind the renal cause of AKI?

A

Injury glomerulus, tubule or vessels

85
Q

What is the primary mechanism behind the post-renal cause of AKI?

A

UTI

Functioning kidneys cannot excrete urine w/ back-pressure affecting function

86
Q

What are the key features of AKI?

A

Oligouria

and

Rising serum urea and creatinine

87
Q

List 3 causes of low serum urea other than altered renal function

A

Low protein intake

Liver failure

Sodium valproate treatment

88
Q

Name a cause of low serum creatinine other than altered renal function

A

Low muscle mass

89
Q

List 3 causes of high serum urea other than altered renal function

A

Corticosteroid treatment

Tetracycline treatment

GI bleed

90
Q

Name 4 causes of high serum creatinine other than altered renal function

A

High muscle mass

Red meat ingestion

Muscle damage (rhabdomyolysis)

Decreased tubular secretion (eg. therapy w/ cimetidine or trimethoprim)

91
Q

1 in _ adults and 1 in _ children worldwide experience AKI during a hospital episode of care

A

5

and

3

92
Q

How is oliguria defined?

A

urinary output less than 400 ml per day or less than 20 ml per hour

Kumar and Clark's (4 decks)

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