Post Renal Disease Flashcards
How common is post renal disease in comparison to pre and renal disease?
- least common
- accounts for only 5% of kidney disease
What is post renal disease?
- obstruction of urine flow from the kidneys
Where are the 3 locations post renal disease can occur?
1 - ureters
2 - bladder
3 - urethra
Post renal disease is an obstruction that can occur in the ureterm bladder or urethra. The obstruction can occur intraluminal or intramural, what does that mean?
- intraluminal = within the lumen
- intramural = within the walls
What are some of the most common causes of post-renal disease?
- kidney stones
- tumours both intrinsic and extrinsic
- fibrosis
Is post renal disease more common in men or women?
- twice as common in men
Is post renal disease reoccurance common?
- yes
- up to 50% re-occurance after 5 years
Kidney stone formation begins with oversaturation, what does this mean?
- solutes (waste products, electrolytes, etc.) in urine become too concentrated
- can occur in dehydrated states
In kidney stone formation the urine becomes oversaturated, what happens next?
- concentrated solutes precipitate forming small crystals
- the crystal then grows and larger crystals come together forming larger crystals called a stone
How can post-renal obstruction be diagnosed non-invasively?
- imaging techniques of Kidney Urinary Bladder (KUB)
- CT scan (non contrast)
- intravenous Urography/CT Urography
Urinary bladder carcinoma is a common cause of post-renal disease. Is it more common in men or women?
- men
Urinary bladder carcinoma is a common cause of post-renal disease. 90% of bladder carcinoma are urothelial and 10% are non-urothelial in their origin. What does urothelial mean?
- urothelial means transitional cells are affected
- non-urothelial means squamous cell, adenocarcimona and small cell are affected
Urinary bladder carcinoma is a common cause of post-renal disease. 90% of bladder carcinoma are urothelial and 10% are non-urothelial in their origin. Although rare, in Egypt non-urothelial bladder cancer is more common due to a parasitic infection of bladder called what?
- schistosomiasis (sch-stow-sir-mia-uh-sis)
- schistos’ that means ‘split’ and ‘soma’ that means ‘body
Bladder cancer can be a common cause of post-renal disease. What are the 2 most common risk factors for bladder cancer?
1 - smoking
2 - occupational exposure to naphthylamine (formerly used in dyes to make paint and in rubber industry)
Bladder cancer can be a common cause of post-renal disease. What do patients commonly present with?
- painless haematuria (blood in urine)
- can present with painful micturition (dysuria), urgency, hydronephrosis (swollen kidneys)
Bladder cancer can be a common cause of post-renal disease. What is the prognosis for bladder cancer?
- depends upon the tumour grade and stage (TNM staging)
- can have good prognosis though
- has a high rate of recurrence
Prostate cancer is a common cause of post-renal disease. What is the most common prostate cancer that causes a post renal obstruction?
- benign prostatic hyperplasia
Prostate cancer is a common cause of post-renal disease. The most common prostate cancer that causes a post renal obstruction is benign prostatic hyperplasia. How common is this?
- ubiquitous in older men
- 60% at age 60; 80% at age 80
- not all develop obstuction though
Prostate cancer is a common cause of post-renal disease. The most common prostate cancer that causes a post renal obstruction is benign prostatic hyperplasia which is ubiquitous with ageing. What can patients commonly present with?
- lower urinary tract symptoms:
- urgency, incontinence, hesitancy, poor urinary stream, nocturia, incomplete bladder emptying
- in severe cases can lead to bladder outflow obstruction
How is prostate carcinoma diagnosed?
- elevated serum prostate specific antigen (protein released by prostate)
- digital rectal examination: induration, aysmmetry, nodule
- prostate biopsy
Does prostate cancer have a good prognosis?
- yes
- 98% 5 year survival
How many stages of chronic kidney disease are there?
- 5
In chronic kidney disease staging there are 5 stages, what is used to determine the stages?
- eGFR
In chronic kidney disease staging there are 5 stages, eGFR is used to determine the different stages. What is the eGFR for stage 1 chronic kidney disease?
- eGFR >90 ml/min/1.732
In chronic kidney disease staging there are 5 stages, eGFR is used to determine the different stages. What is the eGFR for stage 5 chronic kidney disease?
- eGFR <15ml/min/1.732
- patient placed on dialysis
What is the most common cause of chronic kidney disease?
- diabetes
What is the second common cause of chronic kidney disease?
- hypertension
Diabetic Glomerulosclerosis is the most common cause of chronic kidney disease. Can it occur in both type 1 and 2 diabetes?
- yes
Diabetic Glomerulosclerosis is the most common cause of chronic kidney disease. Does it occur straight away in type 1 and 2 diabetes?
- no
- generally have diabetes for 10 years
In the H&E stain below there is the common signs of Kimmelsteil Wilson lesions. Although biopsy in this group of patients with chronic kidney disease is rare, what condition does this patient have?
- diabetes
Hypertension is the second leading cause of chronic kidney disease. Is it more common in white or black patients?
- black patients
Hypertension is the second leading cause of chronic kidney disease. What can be found in the urine in some of these patients?
- haematuria with variable proteinuria
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited condition that causes chronic kidney disease, what is ADPKD?
- mutation causes small fluid-filled sacs called cysts to develop in the kidneys
- impairs kidney function
What is autosomal dominance?
- affecting non sex chromosomes
- dominant meansd only a single gene can cause the disease
What are some of the clinical features of autosomal dominant polycystic kidney disease (ADPKD) an inherited condition that causes chronic kidney disease?
- asymptomatic with normal renal function until 3-4th decade of life
- presents with renal insufficiency, haematuria and hypertension
- abdominal mass and flank pain
- can cause end stage renal failure usually in the 7th decade of life
Chronic kidney disease is a terminal illness that requires life sustaining treatment such as dialysis. Are all patients able to have dialysis?
- no
- not suitable for older (>70 years) frail patients, palative more common
In patients with stage 5 chronic kidney disease, is the damage reversible?
- no
- unable to maintain fluid, electrolyte and acid/base homeostasis and excrete metabolic waste products from the body
Dialysis is used in some patients with stage 5 chronic kidney disease, what is the purpose of dialysis?
- water volume homeostasis
- electrolytes (Sodium/Potassium)
- acid/Base balance
- removal of nitrogenous and other metabolic waste products
What is the final treatment option for patients with stage 5 chronic kidney disease?
- transplant
Dialysis is a extracorporeal therapy, what does extracorporeal mean?
- treatment from outside of the body
Peritoneal dialysis and hemodialysis are both options for patients. Which is more common?
- hemodialysis
- safer
Does a living or deceased kidney donor provide a better prognosis for the receiptitant?
- living donor
- BUT deceased is more common
The most common organs transplanted are the liver, kidneys, heart, lungs and the skin. These transplanted organs are all able to mount immune responses, but what is the order of producing the largest immune response and rejection?
- skin (most immunogenic)
- lungs
- heart
- kidney
- liver (least immunogenic)
When patients recieve a transplant, is the transplanted organ placed in the same place as the old kidney?
- no
- located in the iliac fossa
When patients recieve a transplant, the transplanted organ is placed in the iliac fossa, becoming extraperitoneal. When does the new kidney recieve its blood supply from?
- common iliac artery and vein
