Kidney, bladder & renal replacement therapy

Question 1

Calculi - calcium
– oxalate and/or
phosphate

Answer 1

75%
• Hypercalcaemia
– eg sarcoid, Renal tubular
acidosis, hyperPTHism

Question 2

Calculi - Uric acid

Answer 2

20+%

• Gout

Question 3

Calculi - infection - proteus species

Answer 3

• Obstruction

– eg vesico-ureteric reflux

Question 4

Calculi - cystine

Answer 4

• Genetic

* Dehydration

Question 5

Urinary tract neoplasms

Answer 5

• Bladder – urothelial (transitional cell) carcinoma

* Renal – 4/5 are clear cell carcinoma (ccRCC)

Question 6

(Wilms’ Tumour)

Answer 6

Renal nephroblastoma

• Children(usually<3y)
• WT1 tumour suppressor gene
• Histology resembles immature or embryonal blastema
• Younger patients have better prognosis
• Surgery, radio, chemo leads to 90% survival

Question 7

Renal cell carcinoma

Answer 7

• Originates in ducts esp PCT
• Commonest type is “clear cell”
• Also -papillary, chromophobe
• Mostly sporadic
• Smoking and obesity
• Genetics
– vonHippel-LindauSyndrome – autosomaldominantRCC
– hereditarypapillary

Question 8

RCC

Answer 8

• Incidence increasing
• Smoking
• Obesity
• Chronic cystic disease
• Grows along renal vein to ivc
• Metastasises to lung – “cannonball lesions”
• 50% five year survival – but very stage dependant

Question 9

risk factors for rcc

Answer 9

• Men > women
• Haematuria most common
• Mass
• Pain
• Metastases
• Paraneoplastic syndromes eg pyrexia, hormones (eg EPO)

Question 10

Bladder (urothelial) cancer

Answer 10

• Fieldchange
• Careful monitoring and follow up

Aetiology
• Smoking
• Industrial eg aniline dyes
Presentation
• Haematuria – even once is significant
• Dysuria
• Obstruction

Question 11

Causes of acute renal failure

Answer 11

• Pre-renal
– Shock, major trauma
• Renal
– Some glomerulo- nephritides, toxic eg drugs, malignant hypertension, vasculitis, analgesics
• Post-renal
– Obstruction

Question 12

effects of acute renal failure

Answer 12

Potassium high
• Creatinine high
• Maybe oliguria
• Hypertension
• (Lipids in nephrotic syndrome)

Question 13

causes of chronic renal failure

Answer 13

• Pre-renal
– Atherosclerosis
• Renal
– Glomerulonephritis, diabetes, hypertension, polycystic
• Post-renal
– Obstruction

Question 14

effects of chronic renal failure

Answer 14

• Potassiumhigh • Creatininehigh • Maybeoliguria • Hypertension
• Anaemia
• Smallkidneys

Question 15

Post-renal renal failure mechanism

Answer 15

• Bladder outflow obstruction 
– Prostate enlargement in men 
– Uterine prolapse in women
– Calculi
– Tumours
– Urethral strictures
– Neurological damage

Question 16

Post-renal renal failure causes

Answer 16

• Caused by obstruction
– Extrinsic-tumourse.g.cervicalcancer
– Intrinsic
• Within the wall - intrinsic tumour e.g.
transitional cell carcinoma
• In the lumen - calculi, blood clot etc
• Must be bilateral to cause renal failure (or unilateral if patient has only one kidney)

Question 17

symptoms of Post-renal renal failure

Answer 17

• Anaemia
• Immunosuppression
• Bone disease
• Neuropathy
• Neoplasia

Question 18

Renal replacement therapy

Answer 18

• Electrolytes
• Fluid
• Excretion
• Erythropoietin
• Diet&nutrition
• Anaemia
• Calcium/phosphate
• Bloodpressure
• Infection

Question 19

Peritoneal Dialysis

Answer 19

• Continuous ambulatory peritoneal dialysis requires a permanent catheter

Question 20

Transplantation

Answer 20

• Donor availability
– cadaveric, live related, liver unrelated
• Crossmatching
• Immunosuppression
– risk of infection eg BK virus
– risk of skin cancer eg HPV – risk of lymphoma

Question 21

complications of transplantation

Answer 21

• Acute cellular rejection
• Acute antibody
mediated rejection
• Acute vascular rejection
• Chronic allograft nephropathy (chronic rejection)