Kidney disorders Flashcards
What is obstructive uropathy
blockage of urinary flow which can affect one or both kidneys depending on the degree of blockage.
how long does it take for obstructive uropathy to become prevalent
it can develop slowly over days weeks or even months
what are the two different types of obstruction
upper and lower
what are the lower obstruction
ureter or below e.g. Benign prostatic hyperplasia (prostate gland enlargement)
what are the upper obstruction
obstruction above ureter e.g. kidney stones
obstruction to the kidneys can result in what
a condition known as hydronephrosis which can lead to renal failure
what is hydronephrosis
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.
what are the most common causes of obstructive uropathy in children
structural abnormalities
what are the most common causes of obstructive uropathy in young adults
stone in the kidney, ureter or elsewhere in the urinary tract
what are the most common causes of obstructive uropathy in adults
benign prostatic hyperplasia (enlarged prostate)
prostate cancer
retroperitoneal or pelvic tumours
calculi
what is calculi
kidney stone
what are some other possible causes of obstructive uropathy
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
what are the symptoms of obstructive uropathy if the patient has a distended kidney (swollen)
renal colic can develop (stone)
what are the symptoms of obstructive uropathy if the patient has a BPH
hesistancy frequency nocturia terminal dribbling bladder discomfort (voiding, storage)
what is nocturia
condition in which you wake up during the night because you have to urinate.
what are the symptoms of obstructive uropathy if the patient has developed a urinary tract infection
pus or blood in urine
fever
discomfort in the area of the bladder of kidneys
what tests can we carry out to diagnose obstructive uropathy
imaging testing
endoscopy
blood and urine tests
how can ultrasound on the bladder be used to diagnose obstructive uropathy
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
how can ultrasound on the kidney be used to diagnose obstructive uropathy
tell us if hydronephrosis is present
how can CT scan be used to diagnose obstructive uropathy
pick up renal stones
how can endoscopy be used to diagnose obstructive uropathy
a camera can be used to examine the urethra, prostate, bladder, ureters or kidneys to identify sites of obstruction
what is endoscopy
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.
how can blood tests be used to diagnose obstructive uropathy
blood may reveal high urea or creatine levels
how can urine tests be used to diagnose obstructive uropathy
may reveal high WBCs
what is the aim of treatment for obstructive uropathy
to relieve the cause of the obstruction
how do we treat BPH or prostate cancer
medications or surgery
how do we treat hydronephrosis
nephrostomy tube or ureteral stent
renal calculi stones
removal
in what ages are kidney stones (calculi) common
20 - 40
in what gender are kidney stones common
male
where do calculi begin to form
kidney but may enlarge in the ureter or bladded
what are the 4 types of renal calculi
calcium oxalate
uric acid stone (urate)
cystine stone
infection stones
what is the most common kidney stone
calcium oxalate
what is oxalate
waste product of food that sticks to calcium
what are the causes of calcium oxalate stones
dehydration
high protein diet
high oxalate diet
medical conditions
what are urate stones caused
result of hyperuricaemia and or when urine is too acidic
what are cystine genetic disorder
causes cysteine to leak from kidneys to urine
infection stones also known as
struvite stones
what are infection stones made up of
made up of minerals such as magnesium and ammonium and phosphate
what are the causes infection stones
urinary tract infection
What are some overall causes of calculi
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
what are some symptoms of renal calculi
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
what are the ways in which we can diagnose renal calculi
symptoms
urinalysis
x ray
intravenous urogram
Ct scan
how can urinalysis be used to diagnose renal calculi
will pick up on the presence of blood or pus in the urine
how can xray be used to diagnose renal calculi
not super accurate however will pick up on calcium stones
how can intavenous urogram be used to diagnose renal calculi
the dye will be able to determine the degree of blockage and the location.
why is intravenous urogram not preffered to diagnose renal calculi
is risky due to the dye’s potential to worsen kidney failure or cause an allergic reaction thus is not preferred
how can Ct scane be used to diagnose renal calculi
can locate the stone and indicate the degree to which the stone is blocking the urinary tract.
out of all the methods to diagnose renal calculi which is preferred
Ct Scan
How do we manage the symptoms of renal calculi
paracetamol is a safe option
NSAIDs or opioids but be careful of both due to potentially reduced renal function
anti emetics
what are the two types of stone removal
non invasive
invasive
describe non invasive management
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
what are three forms of invasive management
Ureteroscope
Percutaneous nephrolithotomy
Open surgery
what is ureteroscope and how is it used to break kidney stones
small viewing telescope inserted into the urethra and through the bladder to remove small stones in the lower part of the ureter
what is percutaneous nephrolithotomy and how is it used to break kidney stones
Small into the back and a probe is inserted through the nephroscope to break the stone into smaller pieces
how often is open surgery used
rare and only used if theres a very large stone or abnormal anatomy
What is a UTI
Urinary tract infection which is an infection of any part of your urinary system
what are the different types of UTIs
acute and chronic pyelonephritis cystitis urethritis epididymitis prostatitis
What bacteria is the most common cause of a UTI in community
Escherichia Coli is responsible for 80-90% of infections in the community
what are the symptoms of a UTI
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
does asymptomatic UTI need to be treated
only needs to be treated in pregnant woman as it can lead to developmental delay, cerebral palsy or foetal death
what are some complication of UTI’s
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
what is acute pyenlonephritis
sudden and severe infection which can result in the kidneys swelling causing permanent damage.
how can we treat acute pyenlonephritis
antibiotics e.g. co - amoxiclav but may differ depending on local resistance pattern
what are the risk factors of acute pyenlonephritis
chronic kidney stones
older adults
immunocompromised patients
vesicoureteral reflux
BPH
diabetes
pregnancy
catherter use
utrinary tract surgery
nerve or spinal cord damage
what are the complications of chronic pyelonephritis
progressive renal scarring hydronephrosis CKD secondary hypertension pyonephrosis focal segmental glomerulosclerosis
what is polycystic kidney disease
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
what are the symptoms of PKD (polycystic kidney disease)
pain or tenderness in abdomen and or back
hameaturia
frequent urination
UTI + kidneys stone
fatigue
joint pain
skin that bruises easily
pale skin colour
How do we treat PKD
Tolvaptan, slows the progression of cyst development and helps protect renal function which significantly delays the need for dialysis or kidney transplant.
what is the problem with TOLVAPTAN
prescriber needs specialist training prior to prescribing.
what is an auto immune disease
immune system creates antibodies or immunoglobulins that attack the body itself
what is systemic lupus erythematosus
a type of autoimmune disease that can affect the kidneys causing lupus nephritis
what is goodpasture syndrom
an autoimmune disease that can target the lungs and kidneys
what is glomerulonephritis
inflammation of the glomeruli which caused by autoimmune or non autoimmune disease which can lead to kidney failure
what is nephrotic syndrome
result of glomerulonephritis, damage of the glomeruli causes proteins to leave blood and be passed into tubules with the filtrate and enter the urine
how do we treat nephrotic syndrome
diet modification
blood pressure control
immunosuppressants for the glomerulonephritis
