renal 5 Flashcards
what are the 5 consequences of urinary tract obstruction?
- Reduced glomerular filtration rate
- Reduced renal blood flow (after initial rise)
- Impaired renal concentrating ability
- Impaired distal tubular function
- Post-obstructive diuresis
what are the possible tubular dysfunctions that could occur?
- Nephrogenic diabetes insipidus
- Renal salt wasting
- Renal tubular acidosis
- Impaired potassium concentration
what happens to the Intraluminal pressure during acute urinary tract obstruction?
initially, it rises due to obstruction - increase in Peristalsis
after a few hours it decreases-due to Disorganised peristalsis dilation of tubules and ureter
what happens to the RBF during acute urinary tract obstruction?
initial rise due toVasodilation-Prostacyclin-ProstraglandinE2
after a few hours-decrease-due to Vasoconstriction-Angiotensin II
-Thromboxane A2
what happens to the GFR during acute urinary tract obstruction?
initial decrease due to Intratubular pressure
after a few hours- decrease due to-Continuing obstruction-vasoconstriction
how does one commonly differentiate between renal diseases?
Imaging of the urinary tract is frequently used to examine obstructions and differentiate between renal disease
what is the emergency treatment for any renal obstruction?
Narcotic analgesic for pain relief
Correction of fluid and electrolyte balances
Intravenous antibiotics
Relief obstruction
how would one determine pathogenesis of renal obstruction?
Stone analysis
fluid intake and dietary history
Family history genetic factors
Serum and urinary screening
how does one prevent further Prevent further calculi?
Increased fluid intake (2-3l/d)Modification of diet Specific treatment of metabolic abnormality
what size stone may pass through?
-Stones with diameters less than 1 cm may pass spontaneous
what is Lithotripsy?
(fragmentation of the stone i.e. ultrasonic)
stones lodged in proximal ureter are broken into fragments that are excreted in the urine
what is a Cystoscope?
passing catheter like instrument through cytoscope into ureter, which snares and removes stones lodged in distal ureter
how would you remove a stone in the renal pelvis/ kidney?
ESWL
open surgery
percutaneous nephrothlipotomy
how would you remove a stone in the upper ureter?
ESWL
ultrasonic destruction
leptosomic removal
open surgery
how would you remove a stone in the lower ureter?
ESWL
ultrasonic destruction
dornier basket obstruction
how would you remove a stone in the bladder?
cystopic destruction
open removal- if larger than hens egg
what are the 4 types of Glomerular diseases?
–Immunological injury
–Inherited abnormalities (Alport’s syndrome)
–Metabolic stress ( Diabetic mellitus)
–Deposition of extraneous materials(amyloid)
what are the 2 categories of glomerular diseases?
- Glomerulonephritis(the inflammation of the membrane tissue in the kidney that serves as a filter, separating wastes and extra fluid from the blood)
- Glomerulosclerosis(the scarring or hardening of the tiny blood vessels within the kidney)
what is Proteinuria?
large amounts of protein- symptoms of a glomular disease in the urine
what is Haematuria?
blood in the urine
what is Hypoproteinemia
low blood protein
what are symptoms of glomular diseases
proteinuria/ haematuria/ hypoproteinemia/ reduced GFR/ oedema
One or more of these symptoms can be the first sign of kidney disease.
what is Nephritic Syndrome?
injures podocytes- causes a change in artecture/ scarring and deposition of matrix or other elements
what is nephrotic syndrome?
- inflammation/reactive cell proliferation/ breaks in GBM/ crescent formation
what is Glomerulonephritis?
An inflammation of the glomeruli caused by antigen-antibody reaction within the glomeruli
what does an Interaction of antigen and antibody activate?
activates complement and liberates mediators that attract leukocytes
•Leukocytes release destructive lysosomal enzymes that cause injury to the glomeruli
•Antigen-antibody reaction take place
:1. Immune-complex glomerulonephritis
2. Antiglomerular basement membrane(anti-GBM) glomerulonephritis
what happens when antigen-antibody reacts with circulation?
forming small clumps called immune complexes
Deposit in the walls of the glomerular capillaries as the blood filters through the glomeruli
how does inflamation against the basement membrane occur?
inflammation caused by an autoantibody directed against the basement membranes of the glomerular capillaries
what are the 2 immune mechanisms of glomular disease?
1- antiglomular membrane antibodies
2-circulating antigen-antibody complex deposition
how would you treat the following in nephritic syndrome? Glommerular inflammation/Proteinuria/Fluid retention,oedema/Uraemia/Hypertension /Infection
glommerular inflamation- Steroids, cytotoxics
proteinuria- no protein supplement usually necessary
fluid retention-Na/water restriction Loop diuretic Dialysis
oedema-Protein restriction
hypertension-Hypotensivetherapy
infection-Antibiotics
nephrotic syndrome causes a decrease in the plasma oncotic pressure, what is this?
Oncotic pressure, or colloid osmotic pressure, is a form of osmotic pressure exerted by proteins in blood plasma that usually tends to pull water into the circulatory system
the oncotic pressure tends to pull fluid into the capillaries.
give an example of when plasma pressure would be used?
In conditions where plasma proteins are reduced, e.g. from being lost in the urine(proteinuria) or from malnutrition, the result of low oncotic pressure can be excess fluid build up in the tissues (oedema).
how would you treat proteinuria in nephrotic syndrome?
protein supplements are give > 100g/ day
how would you treat Low plasma oncotic pressure in nephrotic syndrome?
Albumin, mannitol infusion
how would you treat Hypokaelmia in nephrotic syndrome?
Spironolactone, amiloride
what is Pyelonephritis?
Pyelonephritis refers to infection of the kidney parenchyma (interstitial) cells and renal plevis
define acute pyelonephritis
infection of the upper urinary tract specially the renal parenchymaand renal pelvis
define chronic pyelonephritis
is a progressive process. There is scarring and deformation of renal calyces and pelvis
how is acute pyelonephritis characterized?
•Ascends from the UT to Kidney•Onset is rapid, characterized by•Fever•Chills•Pain in the flank•Nausea•Urinary frequency•Relapse or re-infection common•Affects the women more than men
MCQ NB- Why do women get more UTis than men?
- Shorter urethra, allowing quicker access to the bladder
- Urethral opening is nearer the anus
- Intercourse may result in UTIs in women
what is the main bacteria that causes UTIs?
E.coli
how does a UTI occur?
bacteria spreads either blood stream/Infection in the renal pelvis or interstitial cells of kidney
Renal medulla gets infiltrated by blood white cells
inflammation and oedema of the cells of interstitiumand renal tubules
Cells of Renal pappillae become necrotic (glomeruliare usually spared)
what happens if infection is contained?
healing occurs> scarring- arcetecture of renal tubules may be distorted
what are the drugs given for UTI?
Fluoroquinolones Nitrofurantoin Ampicillin/Amoxicillin Cephalosporins Amoxicillin + Clavulanic acid Trimethoprim
what happens in Chronic Pyelonephritis?
Destruction of renal tissue and fibrosis
•Irregularly shrunken small kidney
•Chronic inflammatory infiltrates
•Tubular atrophy with casts
what are the 3 possible induced drug disoders?
- Acute tubular necrosis(toxic) Gentamycin,mercury, contrast agents.
- Acute tubulointerstitial nephritis (allergic) –methicillin, thiazides.
- Analgesic nephropathy (Phenacetin) chronictubulointerstitial nephritis with papillarynecrosis.
what do the drugs interact with in the cell wall?
peptidoglycan gram -ve
