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Therapeutics > Kidney disorders > Flashcards

Kidney disorders Flashcards

1
Q

What is obstructive uropathy

A

blockage of urinary flow which can affect one or both kidneys depending on the degree of blockage.

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2
Q

how long does it take for obstructive uropathy to become prevalent

A

it can develop slowly over days weeks or even months

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3
Q

what are the two different types of obstruction

A

upper and lower

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4
Q

what are the lower obstruction

A

ureter or below e.g. Benign prostatic hyperplasia (prostate gland enlargement)

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5
Q

what are the upper obstruction

A

obstruction above ureter e.g. kidney stones

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6
Q

obstruction to the kidneys can result in what

A

a condition known as hydronephrosis which can lead to renal failure

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7
Q

what is hydronephrosis

A

swelling of the kidney and appear distended, which can lead to an infection to develop in the kidneys as the bacteria aren’t being flushed out. If both kidneys are obstructed.

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8
Q

what are the most common causes of obstructive uropathy in children

A

structural abnormalities

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9
Q

what are the most common causes of obstructive uropathy in young adults

A

stone in the kidney, ureter or elsewhere in the urinary tract

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10
Q

what are the most common causes of obstructive uropathy in adults

A

benign prostatic hyperplasia (enlarged prostate)

prostate cancer

retroperitoneal or pelvic tumours

calculi

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11
Q

what is calculi

A

kidney stone

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12
Q

what are some other possible causes of obstructive uropathy

A

polyps in the ureter

tumour in or near the ureter

disorders of the muscles or nerves in the bladder or ureter

formation of scar tissue in or around ureter

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13
Q

what are the symptoms of obstructive uropathy if the patient has a distended kidney (swollen)

A

renal colic can develop (stone)

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14
Q

what are the symptoms of obstructive uropathy if the patient has a BPH

A 
hesistancy
frequency
nocturia
terminal dribbling 
bladder discomfort (voiding, storage)
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15
Q

what is nocturia

A

condition in which you wake up during the night because you have to urinate.

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16
Q

what are the symptoms of obstructive uropathy if the patient has developed a urinary tract infection

A

pus or blood in urine

fever

discomfort in the area of the bladder of kidneys

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17
Q

what tests can we carry out to diagnose obstructive uropathy

A

imaging testing

endoscopy

blood and urine tests

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18
Q

how can ultrasound on the bladder be used to diagnose obstructive uropathy

A

Ultrasound of the bladder will tell us the volume of urine retained in the bladder.

If patient is in severe retention then a catheter will be inserted

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19
Q

how can ultrasound on the kidney be used to diagnose obstructive uropathy

A

tell us if hydronephrosis is present

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20
Q

how can CT scan be used to diagnose obstructive uropathy

A

pick up renal stones

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21
Q

how can endoscopy be used to diagnose obstructive uropathy

A

a camera can be used to examine the urethra, prostate, bladder, ureters or kidneys to identify sites of obstruction

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22
Q

what is endoscopy

A

A long, thin tube with a small camera inside, called an endoscope, is passed into your body through a natural opening such as your mouth.

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23
Q

how can blood tests be used to diagnose obstructive uropathy

A

blood may reveal high urea or creatine levels

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24
Q

how can urine tests be used to diagnose obstructive uropathy

A

may reveal high WBCs

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25
Q

what is the aim of treatment for obstructive uropathy

A

to relieve the cause of the obstruction

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26
Q

how do we treat BPH or prostate cancer

A

medications or surgery

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27
Q

how do we treat hydronephrosis

A

nephrostomy tube or ureteral stent

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28
Q

renal calculi stones

A

removal

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29
Q

in what ages are kidney stones (calculi) common

A

20 - 40

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30
Q

in what gender are kidney stones common

A

male

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31
Q

where do calculi begin to form

A

kidney but may enlarge in the ureter or bladded

32
Q

what are the 4 types of renal calculi

A

calcium oxalate

uric acid stone (urate)

cystine stone

infection stones

33
Q

what is the most common kidney stone

A

calcium oxalate

34
Q

what is oxalate

A

waste product of food that sticks to calcium

35
Q

what are the causes of calcium oxalate stones

A

dehydration
high protein diet
high oxalate diet
medical conditions

36
Q

what are urate stones caused

A

result of hyperuricaemia and or when urine is too acidic

37
Q

what are cystine genetic disorder

A

causes cysteine to leak from kidneys to urine

38
Q

infection stones also known as

A

struvite stones

39
Q

what are infection stones made up of

A

made up of minerals such as magnesium and ammonium and phosphate

40
Q

what are the causes infection stones

A

urinary tract infection

41
Q

What are some overall causes of calculi

A

may form if the urine is too saturated with salts or if the urine lacks the normal inhibitors for stone formation

hyperparathyroidism

dehydration

renal tubular acidosis

diet high in animal source protein or vitamin C

family history of stone formation

bariatric surgery

rarely drugs

42
Q

what are some symptoms of renal calculi

A

bladder stones may cause lower abdomen pain

ureter or renal pelvis stones may cause back pain or renal colic

nausea and vomiting

sweating

blood or a stone piece in the urine

infection signs

43
Q

what are the ways in which we can diagnose renal calculi

A

symptoms

urinalysis

x ray

intravenous urogram

Ct scan

44
Q

how can urinalysis be used to diagnose renal calculi

A

will pick up on the presence of blood or pus in the urine

45
Q

how can xray be used to diagnose renal calculi

A

not super accurate however will pick up on calcium stones

46
Q

how can intavenous urogram be used to diagnose renal calculi

A

the dye will be able to determine the degree of blockage and the location.

47
Q

why is intravenous urogram not preffered to diagnose renal calculi

A

is risky due to the dye’s potential to worsen kidney failure or cause an allergic reaction thus is not preferred

48
Q

how can Ct scane be used to diagnose renal calculi

A

can locate the stone and indicate the degree to which the stone is blocking the urinary tract.

49
Q

out of all the methods to diagnose renal calculi which is preferred

A

Ct Scan

50
Q

How do we manage the symptoms of renal calculi

A

paracetamol is a safe option

NSAIDs or opioids but be careful of both due to potentially reduced renal function

anti emetics

51
Q

what are the two types of stone removal

A

non invasive

invasive

52
Q

describe non invasive management

A

increase fluid intake to encourage the smaller stones to be flush out

take alpha adrenergic blockers to relax the smooth muscle of the ureter and allow stones to pass

penicillamine can be used to dissolve cystine stones

Extracorporeal shock wave lithotripsy (ESWL) use of sound waves to shatter kidney stones so that they can be flushed out

53
Q

what are three forms of invasive management

A

Ureteroscope

Percutaneous nephrolithotomy

Open surgery

54
Q

what is ureteroscope and how is it used to break kidney stones

A

small viewing telescope inserted into the urethra and through the bladder to remove small stones in the lower part of the ureter

55
Q

what is percutaneous nephrolithotomy and how is it used to break kidney stones

A

Small into the back and a probe is inserted through the nephroscope to break the stone into smaller pieces

56
Q

how often is open surgery used

A

rare and only used if theres a very large stone or abnormal anatomy

57
Q

What is a UTI

A

Urinary tract infection which is an infection of any part of your urinary system

58
Q

what are the different types of UTIs

A 
acute and chronic pyelonephritis
cystitis
urethritis
epididymitis
prostatitis
59
Q

What bacteria is the most common cause of a UTI in community

A

Escherichia Coli is responsible for 80-90% of infections in the community

60
Q

what are the symptoms of a UTI

A

Increase in urinary frequency, urgency and or strangury

Dysuria

offensive smelling & cloudy urine

Haematuria and or pus in the urine

Constant lower abdominal ache

Nausea, tiredness and cold sweats

Urge incontinence

61
Q

does asymptomatic UTI need to be treated

A

only needs to be treated in pregnant woman as it can lead to developmental delay, cerebral palsy or foetal death

62
Q

what are some complication of UTI’s

A

Ascending infection can lead to pyelonephritis

Renal failure, especially in the elderly

sepsis

can lead to permanent damage to the kidneys

can lead to infection stones

63
Q

what is acute pyenlonephritis

A

sudden and severe infection which can result in the kidneys swelling causing permanent damage.

64
Q

how can we treat acute pyenlonephritis

A

antibiotics e.g. co - amoxiclav but may differ depending on local resistance pattern

65
Q

what are the risk factors of acute pyenlonephritis

A

chronic kidney stones

older adults

immunocompromised patients

vesicoureteral reflux

BPH

diabetes

pregnancy

catherter use

utrinary tract surgery

nerve or spinal cord damage

66
Q

what are the complications of chronic pyelonephritis

A 
progressive renal scarring 
hydronephrosis
CKD
secondary hypertension
pyonephrosis
focal segmental glomerulosclerosis
67
Q

what is polycystic kidney disease

A

mainly an inherited kidney disorder which is the fourth leading cause of kidney failure it can be acquired in patients who already have kidney fialure or are on dialysis.

Causes filled cysts to form in the kidneys and may impair kidney function and eventually cause kidney failure

68
Q

what are the symptoms of PKD (polycystic kidney disease)

A

pain or tenderness in abdomen and or back

hameaturia

frequent urination

UTI + kidneys stone

fatigue

joint pain

skin that bruises easily

pale skin colour

69
Q

How do we treat PKD

A

Tolvaptan, slows the progression of cyst development and helps protect renal function which significantly delays the need for dialysis or kidney transplant.

70
Q

what is the problem with TOLVAPTAN

A

prescriber needs specialist training prior to prescribing.

71
Q

what is an auto immune disease

A

immune system creates antibodies or immunoglobulins that attack the body itself

72
Q

what is systemic lupus erythematosus

A

a type of autoimmune disease that can affect the kidneys causing lupus nephritis

73
Q

what is goodpasture syndrom

A

an autoimmune disease that can target the lungs and kidneys

74
Q

what is glomerulonephritis

A

inflammation of the glomeruli which caused by autoimmune or non autoimmune disease which can lead to kidney failure

75
Q

what is nephrotic syndrome

A

result of glomerulonephritis, damage of the glomeruli causes proteins to leave blood and be passed into tubules with the filtrate and enter the urine

76
Q

how do we treat nephrotic syndrome

A

diet modification

blood pressure control

immunosuppressants for the glomerulonephritis

Therapeutics (50 decks)

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