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Year 2 revision > Renal pathology > Flashcards

Renal pathology Flashcards

1
Q

What are renal calculi?

A

Stones that form within the renal tract. Most stones are made from calcium (radiopaque) but others are made from struvite and uric acid crystals (radiolucent).

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2
Q

Signs and symptoms of renal calculi

A
  • Asymptomatic
  • Pain (suprapubic and loin pain that can radiate to the genital region)
  • Dysuria
  • Urinary tract infection
  • Haematuria
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3
Q

Causes of renal calculi

A
  • Idiopathic
  • Hypercalcaemia
  • Hyperuricaemia
  • Hyperoxaluria
  • Recurrent UTI
  • Drugs eg loop diuretics
  • Hereditary conditions increase risk eg polycystic disease
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4
Q

Renal calculi investigations

A
  • 24 hour urine analysis: assess levels of calcium, uric acid, oxylate and citrate
  • CT kidney, ureter, bladder (KUB) for radiopaque stones
  • Ultrasound and IVU can also be utilised
  • Chemical analysis of stone composition
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5
Q

Complications of renal calculi

A
  • Recurrent UTI
  • Recurrent calculi
  • Obstruction
  • Trauma to ureter / uretric stricture
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6
Q

Conservative treatment of renal calculi

A

Prevent cause: low calcium diet

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7
Q

Medical treatment of renal calculi

A
  • Pain - anagesia and tamsulosin
  • Dehydration - IV and oral fluids
  • Nausea and vomiting - Antiemetics
  • ↑ calcium - low calcium diet and stop thiazide diuretics if possible
  • ↑ oxalate - low oxalate diet
  • ↑ uric acid - allopurinol
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8
Q

Radiology treatment for renal calculi

A
  • Nephrostomy insertion
  • Antegrade ureteric stent insertion
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9
Q

Surgical treatment for renal calculi

A
  • Antegrade or retrograde removal of large stones or staghorn calculus
  • Extracorporeal shock wave lithotripsy (ESWL) for the treatment of larger stones (>0.5cm)
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10
Q

Signs and symptoms of lower urinary tract infection

A
  • dysuria
  • frequency
  • urgency
  • suprapubic pain
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11
Q

Signs and symptoms of upper urinary tract infection

A
  • fever
  • flank pain
  • haematuria
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12
Q

Risk factors for UTI

A
  • female gender
  • sexual intercourse
  • catheterisation
  • pregnancy
  • menopause
  • diabetes
  • genitourinary malformation
  • immunosupression
  • urinary tract obstruction
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13
Q

UTI causative organisms

A
  • Escherichia coli: leading cause of UTI in the community and also nosocomial infection
  • Staphylococcus saprophyticus: 2nd leading cause in sexually active females
  • Klebsiella pneumonie: 3rd leading cause
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14
Q

UTI investigations

A
  • Urine dipstick: positive for leucucytes and nitrates
  • Urine culture: for diagnosis of causative organism (>10^5 organisms per mL of midstream urine)
  • Radiology: consider ultrasound scan or cystoscopy if UTI occurs in children, in men or if UTI recurrent
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15
Q

UTI treatment

A
  • Trimethoprim twice daily
  • Consider prophylactic antibiotics if UTI recurrent
  • If recurrent ie >4 times per year, seek to exclude anatomical variant or abnormality of the renal tract
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16
Q

UTI complications

A
  • Pyelonephritis
  • Renal failure
  • Sepsis
17
Q

Give examples of congenital kidney abnormalities

A

HERD

  • Horseshoe kidney
  • Ectopic kidney
  • Renal agenesis
  • Duplex ureters
18
Q

What is a horseshoe kidney?

A

This occurs during development when the lower poles of both kidneys fuse, resulting in the formation of one horseshoe shaped kidney. This cannon ascend to the normal anatomical position due to the central portion catching the inferior mesenteric artery.

19
Q

Signs and symptoms of horeshoe kidney

A
  • Asymptomatic
  • Recurrent urinary tract infection
  • Renal calculi
  • Obstructive uropathy
20
Q

Investigations for horseshoe kidney

A

Ultrasound is diagnostic

21
Q

Horseshoe kidney complications

A
  • Susceptible to trauma
  • Renal calculi formation
  • Increased risk of transitional cell carcinoma of the renal pelvis
22
Q

What is an ectopic kidney?

A

This is a congenital abnormality in which the kidney lies above the pelvic brim or within the pelvis

23
Q

Signs and symptoms of an ectopic kidney

A

Usually asymptomtic

24
Q

Causes of ectoptic kidney

A
  • Genetic abnormalities
  • Poor development of the metanephrogenic diverticulum
  • Teratogen exposure
25
Q

Investigations for ectopic kidney

A

Ultrasound scan is diagnostic

26
Q

Treatment for ectopic kidney

A

None, treat symptoms should they develop

27
Q

Complications of ectopic kidney

A
  • UTI
  • Renal caluli
28
Q

What are duplex ureters?

A

This occurs when the ureteric bud splits during embryonic develpment and results in the development of two ureters, which drain one kidney.

29
Q

Signs and symptoms of duplex ureters

A
  • Asymptomatic
  • Recurrent UTI
30
Q

Investigations for duplex ureters

A

Ultrasound scan and excretory urography is diagnostic

31
Q

Treatment for duplex ureters

A

Treatment of complications

32
Q

Complications of duplex ureters

A
  • Vesicoureteral reflux
  • Ureterocele
  • UTI
33
Q

What is renal agenesis?

A

Bilateral and unilateral absence of the kidney

34
Q

Signs and symptoms of bilateral absence of kidneys

A

Potter’s syndrome

  • Low set ears
  • Limb defects
  • Receding chin
  • Flat, broad nose
35
Q

Signs and symptoms of unilateral absence of kidneys

A
  • hypertension
  • increased risk of respiratory failure
  • proteinuria
  • haematuria
36
Q

Investigations for renal agenesis

A

Antenatal screening

37
Q

Treatment for bilateral renal agenesis

A
  • Neonates usually die a few days after birth
  • If they survive they require chronic peritoneal dialysis

Year 2 revision (15 decks)

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