Renal & Genitourinary Flashcards
Sites of ureteric constriction (sites where urinary stones can lodge)
- Pelvicureteric junction
- Pelvic Brim
- Vesicoureteric junction
Anatomy of kidney
Structure of nephron
Pathophisiology of kidney stones (nephrolithiasis)
Within tubule of nephrons crystal like structures can form. These crystal like structures are precipitance of electrolytes that have acculumated. Urine supersaturation with stone forming salts -> crystal formation
If crystal is small it will pass in urine.
If crystal remains in kidney it becomes a stone
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Clinical presentation of kidney stones
Triad: fever, vomiting, flank pain
Risk Factors for developing kidney stones
What do the risk factors in developing kidney stones increase/decrease ?
Increase urinary solutes (Calcium, uric acid, oxalate and sodium)
Decrease stone inhibitors (citrate and magnesium)
=this causes urine supersaturation leading to urinary crystal formation
What factors contribute to urine supersaturation and therefore urinary crystal formation
Increase urinary solutes (calcium, uric acid, oxalate and sodium)
Decrease stone inhibitors (citrate and magnesium)
Dcerease urinary volume
Increase/decrease urinary pH
Stone pathology
Investigations for kidney/urinary stone formation
Acute management of kidney stones
Management of kidney stones
Percutaneous nephrostomy (symptomatic relief)
Ureteric stent insertion
Percutaneous nephrolithotomy
Endoscopic treatment/open surgery
Extracorporeal shock wave lithotripsy
What is acute kidney injury
sudden deterioration in kidney function
What is kidney fucntion measured in?
Glomelular Filtration Rate
What is GFR?
Flow rate of filtered fluid through the kidney
How is GFR measured?
Difficult to measure directly, estimated using creatinine clearance
Cockcroft-Gault formula:
Causes of Acute Kidney Injury
Signs and symptoms of acute kidney injury
Diagnosis of acute kidney injury
Definition:
1. Increase in serum creatinine of 26micromol/l in 48h
2. Increase in serum creatinine of 1.5x of baseline
3. Urine production below 0.5mol/kg/h
List some nephrotoxic medication (DAMN)
D:iuretics
A: CEi/ARB/antibiotics
M: etformin
N: SAIDs
Tretment for AKI
Indications for acute dialysis
What is chronic kidney disease
Progressive, irreversible condition characterised by reduced kidney function or kidney damage (Any cause), lasting for >=3 months
Classification of chronic kidney disease
Based on GFR
Symptoms and complication of chronic kidney disease
Aetiology of CKD
Most common causes:
1.Type 2 diabetes mellitus (30-50%)
Type 1 diabetes mellitus (4%)
- Hypertension
Pathophysiology of CKD
Epidemiology + Risk Factors for CKD
Diagnosis of CKD
Treatment for CKD
+Renal Replacement therapy:
Usually later stages but not based on GFR alone
Extracorporeal: haemodialysis/haemofiltration, peritoneal dialysis, renal replacement
What is a urinary tract infection
Bacterial infection of the urinary tract
Causative agents:
1. E-coli (80%)
2. Enterobacteriae
3. Proteus mirabilis
4. Klebsiella pneumoniae
Why are women at a greater risk of getting a UTI
Urethra is shorter than males
Lower Urinary Tract Infection
- Cystitis (bladder)
- Prostatitis (prostate)
- Urethritis (urethra)
- Epidydmo-Orchitis
Upper Urinary Tract Infection
Pyelonephritis (kidney)
Pathogenesis of UTI
- Contamination
- Colonisation in urethra/bladder
- Inflammatory response
- Neutrophil infiltration
- Bacteria multiply: Immune system evasion (virulence)
- Ascension to the kidney
- Colonisation of kidney
- Bacteremia
Risk Factors for UTI
Signs and symptoms of UTI
Classification of UTI
Investigations + Diagnosis for UTI
Treatment for UTI
Prevention of UTI
What is nephritic syndrome?
Collection of signs and symptoms as a result of glomerulonephritis
Nephritic syndrome vs nephrotic syndrome
Anatomy of Glomerulus
Pathophysiology of nephritic syndrome
Cause -> Inflammation: cell proliferation, complement, leukocyte recruitment, protease/free radials -> injury
Signs and symptoms of nephritic syndrome
Characteristics of nephritic syndrome:
1. Proteinuria
2. Haematuria: Acanthocyte
3. RBC casts: suggestive of GN
4. Sterile pyuria
5. RAAS activation -> Hypertension
6. Decrease GFR -> Oliguria
Causes of nephritic syndrome
- Rapidly progressive glomerulonephritis (RPGN) aka “crescentic GN”
a. Anti glomerular basement membrane (Goodpasture’s)
b. Immune complex mediated
-IgA neuropathy (Berger disease)
-Post Streptococcal Glomerulonephritis
-Diffuse proliferative glomerulonephritis
Anti glomerular basement membrane (Goodpasture’s)
IgA neuropathy (Berger disease)
Post Streptococcal Glomerulonephritis
Diagnosis of nephritic syndrome
Treatment for nephritic syndrome
SLE neuropathy (Lupus nephritis)
caused by lupus and can present as nephrotic and nephritic syndrome
occurs due to immune complexes in the nephron. It is a type III hypersensitivity.
inflammation can be detected by biopsy
Treatment is the same as lupus:
-corticosteroids
-mycophenolate
-cyclophosphamide
Pathophisiology of nephrotic syndrome
Injury to structures -> Excessive protein loss -> Hypoalbuminemia
Signs and symptoms of nephrotic syndrome
Causes of nephrotic syndrome
1.Minimal change disease
2.Focal segmental glomerulosclerosis
3.Membranous nephropathy
Can be primary (idiopathic) or secondary
Minimal change disease
95% cases in children
abnormalities seen on electron microscopy
mostly primary
secondary causes include: hodgkin’s lymphoma & NSAIDs
Focal segmental glomerulosclerosis
Primary possible
More commonly secondary: HIV, obesity, reflux nephropathy, drugs: lithium, biphosphanates
Genetic: Nephrin (slit diaphragm), laminin 2 (GBM)
Membranous nephropathy (membranoproliferative glomerulonephritis)
Thickening of basement membrane
Spike and dome pattern of immune deposits in the suepithelial space
70% primary, 1/3 secondary
Secondary causes: malignancy, hepatitis, syphilis, lupus, drugs (penicillamine, NSAIDs)
Epedimiology/Risk Factors of nephrotic syndrome
Diagnosis of nephrotic syndrome
Treatment for nephrotic syndrome
What is benign prostatic hyperplasia (BPH)
non-cancerous growth of the prostate gland
common in men over 50
not premalignant
characterised by nodular prostatic hyperplasia
Anatomy of the prostate
Anatomy of prostate gland
Symptoms of BPH