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Second Year > Renal Pathology > Flashcards

Renal Pathology Flashcards

1
Q

What is diabetes insipidious?

A

A condition in which large volumes of dilute urine are produced, and the patient feels very thirsty. Fluid restriction has no impact on urine output.

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2
Q

What are the main types of DI?

A

Central - hypothalamic areas cannot synthesize enough ADH, e.g. due to tumour, meningitis, previous surgery.

Peripheral - collecting duct has become insensitive to ADH (usually secondary to hypercalcaemia/hypokalaemia).

Can also arise due to genetic defect in V (ADH) receptor or the gene for the aquaporins.

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3
Q

What are the symptoms of diabetes insipidous?

A

Polyuria (>10L/day), polydipsia.

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4
Q

How do you treat DI?

A

In peripheral DI, thirst mechanism essential for survival therefore cannot give ADH, but treat underlying cause.

Central DI - give recombinant vasopressin.

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5
Q

What is a UTI?

A

An infection affecting the urinary tract (including the bladder, prostate, testis, epididymis).

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6
Q

In which gender are UTIs most common?

A

Women (esp. if sexually activate).

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7
Q

What are the two types of UTIs? When should you investigate a UTI further?

A

Uncomplicated, i.e. in sexual active women
Complication, i.e. everyone else, complicated UTIs must always be investigate (cystoscopy, flow studies, USS kidneys, residual bladder scan, IVU/CT-KUB, MAG-3 venogram, DMSA scan).

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8
Q

How do you investigate UTIs?

A

MSSU 10^5 pretty much know its UTI, (10^4/3 maybe UTI if symptomatic, if less than 10^3 usually no infection) - be aware of some bacteria that may be harmful and only present in low numbers. Do sensitivities to select appropriate antibiotic.

If on the ward, can do urinalysis testing for blood, leucocytes, protein and nitrates (produced by certain bacteria).

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9
Q

In which groups of people may it be difficult to collect a MSSU?

A

Elderly and children.

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10
Q

What does diagnosis of UTIs require?

A

Positive MSSU and symptoms.

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11
Q

What symptoms are associated with UTIs?

A

Fever (>38), lion/flank pain/tenderness, suprapubic pain/tenderness, urinary frequency, urinary urgency, dysuria, smelly/cloudy urine.

In children - diarrhoea (systemic response to illness), excessive crying, fever, nausea, vomiting, anorexia.

In adults - flank pain, chills and fever, strangury (desperate to urinate, but only dribbles out (cystitis), confusion in very old people.

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12
Q

What is it considered when the patient has no symptoms but has a positive MSSU?

A

Asymptomatic bacteriuria.

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13
Q

What bacteria cause UTIs?

A

Most commonly gut flora, e.g. E. coli…………………………..

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14
Q

What (other than bacteria) can cause a UTI?

A

Viral, fungal - but rare.

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15
Q

What is the route of infection in UTIs?

A

Always ascending (coming up from urethra).

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16
Q

Is an upper UTI or lower UTI more serious?

A

Upper.

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17
Q

What are the risk factors for UTIs?

A

Age, sexual activity, female (short urethra), com orbs (immunosuppression, steroids, renal failure, meds, malnutrition, diabetes), abnormal renal tract (stones, renal outflow obstruction, BOO, duplex ureter, horseshoe kidney, VU reflux, renal scarring, bladder tumour, stasis of urine, e.g. poor bladder emptying), FB (catheter, stent, stones), sexually active and poor voiding habits, oestrogen deficiency in post-menopausal women, fistula between bowel and bladder, bad voiding habits.

18
Q

Why are post-menopausal women at higher risk of UTIs? What can we give them to help them?

A

As they have a dry, atrophic perineurium, which leads to repeated cystitis and pyelonephritis.

19
Q

What do you call inflammation of the urethra?

A

Urethritis

20
Q

What do you call inflammation of the bladder?

A

Cystitis

21
Q

What do you can inflammation of the ureter?

A

Ureteritis

22
Q

What do you call inflammation of the kidneys?

A

Acute/chronic pyelonephritis

23
Q

What do you call inflammation of the prostate?

A

Prostatitis

24
Q

What do you call inflammation of the epididymia/testis?

A

Epidiymo-orchitis

25
Q

What are the two main predisposing factors to UTIs?

A

Obstruction (either congenital, e.g. vesicoureteric reflux, or acquired, e.g. benign prostate hyperplasia)

Loss of feeling of full bladder (e.g. spinal cord/brain injury)

26
Q

Why in normal health do we not get UTIs? And why do they sometimes occur?

A

As bacteria constantly moves up the urinary tract from the urethra, it is normally flushed out with urination. Slowed urine flow increases opportunity for sediments to form, leading to stone formation and more obstruction (leading to more infections, more stones…) (viscous cycle).

27
Q

What can occur if there is a blockage at the level of the urethra?

A

Leads to upper urethral and bladder dilatation, if unresolved can lead to bilateral hydroureter (water expansion of ureter) and then bilateral hydronephrosis –> chronic renal failure.

28
Q

What occurs in vesicoureteric reflux?

A

Decreased angulation of ureters as they enter bladder. Ureters not closed off properly when bladder fills, leading to reflux of urine –> hydroureter –> hydronephrosis etc. etc.

Damage is caused by reflux and infection.

29
Q

How can you investigate suspected vesicoureteric reflux?

A

Micturating cystogram (radionuclide 99Tc techniques), USS and biochemistry.

30
Q

How do you treat vesicoureteric reflux?

A

Surgery.

31
Q

What should you especially consider in males as a cause for recurrent UTIs?

A

Benign prostatic hyperplasia.

32
Q

What should you especially consider in females as a cause for recurrent UTIs?

A

If they have had children, consider uterine collapse.

33
Q

What should you consider in both sexes as causes of recurrent UTIs?

A

Renal calculi and tumours.

34
Q

Why are females at an increased risk of developing UTIs after sexual activity?

A

As it tends to move lower urethral flora up the tract. Females have a shorter urethra and no prostatic secretions and the urethral orifice is very close to the rectum.

35
Q

How can you prevent contracting UTIs after sexual activity?

A

Voiding after sex.

36
Q

Why are pregnant mothers at risk of UTIs?

A

Pressure on ureters and bladder.

37
Q

Why can catheterisation and other urological procedures put patients at an increased risk of UTIs?

A

As they move lower urethral flora up the tract. ENSURE that you clean around the urethral end.

38
Q

Why are diabetics at increased risk of UTIs?

A

Glucose in urine, and poor function of WBC.

39
Q

Why can pain from pyelonephritis not be considered as renal colic?

A

Colic refers to pain caused by the contraction of a hollow tube against obstruction and as the kidney is not hollow this is incorrect.

40
Q

What are the clinical features of acute pyelonephritis?

A

Pyrexia, poor localisation, lion tenderness (at renal angle), signs of dehydration, turbid urine.

Second Year (9 decks)

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