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RAD415 PT2 > renal pathology > Flashcards

renal pathology Flashcards

1
Q

what is renal (ureteric) colic

A
  • pain caused by kidney stones/crystals
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2
Q

what is the cause of renal colic / most potent stimulus

A
  • forms due to over saturation solutes in urine
  • most potent acute stimulus is dehydration
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3
Q

what causes the colicky pain from kidney stones

A
  • peristaltic movements pushing crystal through the ureter and urethra
  • pain with each contraction
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4
Q

what is haematuria

A
  • blood in urine
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5
Q

why would there be haematuria as a result of renal colic

A
  • trauma to the ureters and urethra due to kidney stone passing
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6
Q

what test is done to identify haematuria

A

urine dipstick

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7
Q

what is the NICE recommend imaging for renal colic

A

non-contrast low dose CT abdome

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8
Q

why is no contrast needed for abdominal CT of kidney stones

A
  • stones are already highly radiopaque, applying contrast will make it hard to see the stones within the ureter or urethra
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9
Q

what 5 things can kidney stones be composed of

A
  • calcium oxalate (most common)
  • struvite (triple phosphate)
  • pure calcium phosphate
  • uric acid (most radiolucent)
  • cystine
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10
Q

what are 2 treatments for renal colic

A
  • analgesia (pain relief)
  • alpha blockers
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11
Q

how can alpha blockers relieve renal colic

A
  • relax smooth muscles in ureters
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12
Q

if stones less than 5mm, it can be left to pass on own with no treatment. But if stones greater than 5mm, what can be done

A
  • shockwave lithotripsy
  • ureteroscopy
  • percutaneous nephrolithotomy
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13
Q

what is shockwave lithotripsy

A

using ultrasound waves to break up stones

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14
Q

what is ureteroscopy

A

keyhole surgery where surgeon passes a small lighted tube (ureteroscope), through the urethra and bladder and into the ureter to the point where the stone is located. If the stone is small, it may be snared with a basket device and removed whole from the ureter.

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15
Q

what is percutaneous nephrolithotomy

A

going through the skin to invasively break the stone

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16
Q

what are general methods of secondary prevention of kidney stones/ renal colic

A
  • avoid dehydration
  • avoid high oxalate foods
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17
Q

what is acute kidney injury

A
  • sudden episode of kidney failure or damage
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18
Q

what are the 3 types/causes of acute kidney injury

A

intrinsic
pre-renal
post-renal

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19
Q

what is intrinsic kidney injury

A

anything that directly damages the kidney tissue

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20
Q

whats pre-renal kidney injury

A

anything that means reduced renal blood flow

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21
Q

whats post-renal kidney injury

A

anything that blocks urine outflow

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22
Q

what are the 3 symptoms of acute kidney injury

A
  • increase in serum creatinine of more than 26 micromol/l over 48 hours
  • 50% increase in baseline serum creatinine over 1 week
  • fall in urine output to less than 0.5ml/kg per hour
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23
Q

what is contrast nephropathy

A
  • sudden decline in kidney function after administration of contrast agent
  • a rise in serum creatinine of at least 0.5 mg/dL or a 25% increase from baseline within 48 to 72 hours after contrast exposure.
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24
Q

if contrast is still needed despite risk of contrast nephropathy, what must be done

A
  • patient should be optimally hydrated
  • positive study of administration of sodium bicarbonate during contrast giving, but where it is more effective that simple hydration with water is unsure
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25
Q

how do you treat acute kidney injury

A
  • treat underlying cause
  • temporary dialysis only when severe
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26
Q

what is chronic kidney disease CKD

A

kidney damage or loss of function lasting 3 months or more

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27
Q

what are the 4 main categories/causes of chronic kidney disease

A
  • diabetes type 2 (largest cause)
  • hypertension
  • autoimmune disease
  • genetic disease/cancer e.g PKD
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28
Q

What is PKD

A

polycystic kidney disease

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29
Q

what are the 5 stages of progression of chronic kidney disease

A
  1. normal
  2. increase risk (e.g T2DM)
  3. kidney damage (e.g albuminuria)
  4. reduced kidney function (e.g low GFR)
  5. kidney failure
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30
Q

which stages of kidney disease progression begins to classify as chronic kidney disease

A

3rd and 4th stage
- kidney damage
- reduced kidney function

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31
Q

how does albuminuria signify kidney damage

A
  • Albumin is supposed to be filtered into blood, so if it ends up in the urine, then kidney is damagesd as it got through the glomerular filtration
  • measured by albumin creatinine ratio (ACR), precise, non-invasive and cheap
32
Q

be aware that chronic kidney disease is progressive, it is not sudden onset

A
33
Q

eGFR is used as marker of renal function, what is this and how does it work

A

eGFR (estimated glomerular filtration rate) is a measure of how well your kidneys are working.

  • our eGFR is an estimated number based on a blood test and your age, sex, and body type.
34
Q

what eGFR value is considered as kidney failure

A

eGFR below 15mls/min

35
Q

what treatment is used for chronic kidney disease

A
  • treat underlying cause e.g if due to hypertension, treat that
  • avoid insults (e.g nephrotoxic medication)
36
Q

what is the main cause of mortality in patients with CKD

A

cardiovascular disease

37
Q

what is renal replacement therapy RRT

A

replaces the normal blood-filtering function of the kidneys

38
Q

when may RRT begin to be needed

A

those whose disease progresses to kidney fialure

39
Q

what is the main form of RRT

A

dialysis

  • some patients though may need transplant
40
Q

what are the 2 renal replacement modalities

A
  • haemodialysis
  • peritoneal dialysis
41
Q

how is haemodialysis done

A
  • blood taken out body and moved next to semipermeable membrane similar to glomerulus
  • other side of membrane is dialysate solution resembling ionic composition of patients physiological plasma
  • a tube is attached to a needle in your arm. Blood passes along the tube and into an external machine that filters it, before it’s passed back into the arm along another tube
42
Q

how is peritoneal dialysis done

A
  • prescribed ionic solutions (diasylate) infused into peritoneal cavity and allowed to equilibrate with blood
  • allows body to remove soluble waste and excess and bring blood to more physiological state
43
Q

neither peritoneal or harm-dialysis replaces hormonal function of kidney so they still need to get replaced e.g vitamin D

A
44
Q

what system does haemodialysis use to allow filtration of blood and be replaced dialysate

A
  • countercurrent flow
  • of patient blood and diasylate through semipermeable membrane
45
Q

haemofiltration uses ultrafiltration (pressure to filter out fluid) which is then replaced with diasylate, limited to ppl with acute renal failure

A
46
Q

what are 2 surgical solutions for long term vascular access for haemodialysis (allowing movement of large volume of fluid)

A
  • fistula (between vein and artery)
  • arteriovenous graft (graft connecting vein and artery)
47
Q

what is a non-surgical solution for long term vascular access for haemodialysis

A
  • tunnelled cathere
  • a catheter (thin tube) that is placed under the skin in a vein, allowing long-term access to the vein.
48
Q

be aware that tunnelled catheters can become blocked

A
49
Q

what are risks associated with peritoneal dialysis

A

infection
reduced mobility

50
Q

patients need to have matching blood groups and HLA for kidney transplant

A
51
Q

what is HLA

A

Human leukocyte antigen (HLA) typing is used to match patients and donors for bone marrow or cord blood transplants.

52
Q

kidney donation from heart beating donor has better outcome

A
53
Q

what is the commonly associated scar seen with kidney transplants

A
  • rutherford morisons ‘ hockey stick ‘ scar in right or left lower quadrant
54
Q

patients with kidney transplants need life long immunosuppression, hence there at risk of hospital acquired infection

A
55
Q

what are 4 complications with kidney transplant

A
  • acute/chronic rejection
  • arterial/venous thrombosis
  • urine leaks
  • lymph collections
56
Q

what is renal cell carcinoma

A

a disease in which malignant (cancer) cells form in tubules of the kidney.

57
Q

renal cell carcinoma is often asymptomatic and picked up incidentally, what is a potential sign of this

A
  • haematuria
58
Q

paraneoplastic effects may occur due to renal cell carcinoma, what is this

A

paraneoplastic syndromes, the malignant cells do not directly cause symptoms related to metastasis; rather, they generate autoantibodies, cytokines, hormones, or peptides that affect multiple organ systems

59
Q

what is the main treatment for renal carcinoma

A

surgery
- nephrectomy
- partial nephrectomy
((partial)/removal of kidney)

60
Q

what are the main symptoms of UTI

A
  • dysuria (pain during urination)
  • urinalry frequency/urgency
  • cloudy/blood in pee
61
Q

what are some upper urinary symptoms of UTI

A
  • kidney pain (costovertebral angle tenderness)
  • fever/chills
62
Q

which bacteria is a largest cause of UTI

A

E.coli (95% of cause)

63
Q

which bacteria is the cause of UTI from sexual interactions

A

staphylococcus saprophyticus

64
Q

how would you diagnose a UTI

A
  • basis of history
  • urine dipstick
65
Q

what things show positive on urine dipstick for UTI

A
  • leucocytes (immune system fighting inflammation)
  • nitrites (bacteria)
  • potentially some blood
66
Q

note that bacteria in urina doesnt directly mean UTI.

A
67
Q

what type of bacteria do elderly people usually have in urine and it is not relating to UTI, it is completely normal

A

asymptomatic bacteriuria

68
Q

what can be done with urine to further investigate UTI

A

urine culture, tested with antibiotic patches

  • checks for resistant bacteria
  • confirms bacteria suspicion
69
Q

what is the difference between treatment for upper and lower UTI

A

lower = oral antibiotics

upper = IV antibiotics and hospital admission

70
Q

scans for UTI are only done if tis severe or high risk patient

A
71
Q

what is acute pyelonephritis

A

Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys

  • pus related
72
Q

what are radiographic signs of pyelonephritis on CT

A
  • uneven enhancement/thickening of renal parenchyma
  • enlarged kidneys
  • emphysematous kidney (severe infection)
73
Q

what radioisotope is used to enhance kidney on CT to check for pyelonephritis

A

DMSA (dimercapto succinic acid) is a short-lived radioisotope that goes directly to the kidneys once inside the body and only stays radioactive for a few hours

74
Q

what is hydronephrosis

A

one or both kidneys become stretched and swollen as the result of a build-up of urine inside them.

  • water in kidney
75
Q

what causes hydronephrosis

A

Hydronephrosis is usually caused by a blockage in the urinary tract or something disrupting the normal workings of the urinary tract.

76
Q
A

RAD415 PT2 (14 decks)

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