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autumn amy L pm2c (copied) > Renal Therapeutics V: Important Renal Diseases > Flashcards

Renal Therapeutics V: Important Renal Diseases Flashcards

1
Q

Label the renal and urinary system

A

Aorta - delivers blood to the kidneys
Vena cava - takes blood away from the kidneys
Renal artery - connects aorta to the kidney
Renal vein - connects the kidneys to the vena cava
Ureter - connects kidneys to bladder
Bladder - collects urine from the kidneys
Urethra - exit route of urine from the body

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2
Q

What is Obstructive Uropathy?

A

A structural or functional hindrance of the kidney
Urine cannot drain through a ureter
Can happen to 1 or both kidneys

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3
Q

How can urinary tract obstruction (UTO) be divided?

A
  1. Upper UTO e.g. uteric stones

2. Lower UTO e.g. prostatic hypertrophy

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4
Q

What happens when an acute upper tract obstruction occurs?

A

Obstruction in ureter or above e.g. stone
= Fluid accumulation in the renal pelvis (hydronephrosis)
= Raise in hydrostatic pressure
= Reduced GFR, but continuous filtration
= Increased intra-renal pressure
= Dilation and stasis

Can lead to infection and stone formation

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5
Q

How is a UTO diagnosed?

A 
Intravenous urogram (IVU)
CT scan
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6
Q

Why is quick relief of a UTO important?

A

To protect the nephrons

May be followed by massive diuresis

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7
Q

List 4 things can cause a chronic partial obstruction?

A
  1. Incompetence of valve between bladder and ureter = chronic renal inflammation, infection
  2. Lower UTO caused by e.g. bladder cancer, bladder neck obstruction
  3. Benign or malignant prostatic hypertrophy
  4. Reflux nephropathy = back flow of urine into kidney
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8
Q

What are the 3 most common causes of UTOs

A
  1. Gynaecological problems
  2. Prostate hypertrophy
  3. Stones
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9
Q

List a symptom of upper UTOs

A

Renal colic, often associated with ureteric obstruction

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10
Q

List 3 symptoms of lower UTOs

A

Hesitancy
Frequency
Nocturia

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11
Q

What can cause polyuria?

A

Tubular damage

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12
Q

What are the possible consequences of chronic reflux nephropathy?

A

Hypertension

Renal infection

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13
Q

How are UTOs managed?

A

Surgery is common
Conservative treatment = non-invasive e.g ESWL, laser shattering of stones
Follow-up to ensure patient doesn’t develop reflux nephropathy

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14
Q

What are renal calculi?

A

Kidney stones

Solid material formed in kidney from the minerals in urine

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15
Q

Define: Nephrolithiasis

A

Renal stone disease

When a patient has kidney stones

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16
Q

List 3 factors which enhance the risk of renal stone formation

A

Low intake of fluid
High intake of animal proteins
High intake of refined sugar, salt

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17
Q

What is the most common type of kidney stone made up of?

A

Calcium oxalate

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18
Q

How are calcium oxalate kidney stones formed?

A

Hypercalciuria (high levels of calcium)
OR
Excessive gastro-intestinal absorption of oxalate and alkaline urine

19
Q

Name the 3 materials that can accumulate to cause kidney stones

A

Uric acid = hyperuricaemia (excessive uric acid) with acidic urine
Cystine = metabolic disorder with reduced tubular reabsorption of cystine
Infection stones = calcium oxalate or calcium phosphate stones

20
Q

What factors can cause kidney stones to form?

A

Relative insolubility to urine e.g. calcium oxalate
Urinary pH dependent
Low urine volume = uric acid stones
Infection

21
Q

List 3 symptoms of kidney stones

A

Sudden or gradual renal colic
Inability to lie down
Accompanied by nausea and vomiting

22
Q

List 3 investigations which can be carried out to diagnose kidney stones

A 
Urinanalysis = presence of blood
Imaging = kidney-ureter-bladder X-ray
Intravenous urogram (IVU), IV contrast medium
23
Q

List the non-surgical methods used to treat kidney stones

A

NSAIDs (diclofenac) = pain - however risk of worsening any pre-existing renal impairment
Small stones = increase fluid intake to flush out
Penicillamine = dissolve cystine stones
Ultrasonic disruption of bigger stones
Oxalate stone = dietary calcium restricted, thiazides to increase urine flow

24
Q

How can kidney stones be surgically treated?

A

Depends on the location of the stone in the ureter and its size
Distal uretic and mid-uretic stones = pass spontaneously, use calcium channel blocker and alpha receptor blocker to relax smooth muscle of distal ureter
Proximal uretic stones = flexible ureterirenoscopy

25
Q

What is an infection of the bladder called?

A

Cystitis

26
Q

What is an infection of the urethra called?

A

Urethritis

27
Q

List 2 symptoms of UTIs

A
  1. Dysuria (painful urination)

2. Frequency

28
Q

Define: Cystitis

A

Bacterial infection of the bladder

29
Q

What is the method used to diagnose UTIs

A

Microbiological

30
Q

What causes UTIs?

A

Bacteria enter mostly via urethra = ascending infection, uncomplicated
Can enter via bloodstream
Mostly organism from bowel flora involved

31
Q

What may be the cause of recurring UTIs?

A

Genetic factors

32
Q

What may cause acute urethritis?

A

Sexual transmission

33
Q

List 3 symptoms of prostatitis

A

Fever
Malaise
Dysuria

34
Q

How should UTIs be managed in general?

A

Increased fluid intake
Oral treatment to alkalinise urine
Cranberry juice - vitamin C

35
Q

How should acute cystitis be treated?

A

3-day regimens of antibiotics

e.g. trimethoprim, oral cephalosporin

36
Q

How should prostatitis be treated?

A

Lipid-soluble antibiotics
e.g. trimethoprim, doxycycline, quinolones
Courses of 2-4 weeks

37
Q

What is acute pyelonephritis?

A

Sudden and severe kidney infection

Causes inflammation of the kidney tissue

38
Q

How can pyelonephritis be treated?

A

Oral antimicrobial therapy

39
Q

What is chronic pyelonephritis?

A

Recurrent infections

Repeated acute pyelonephritis

40
Q

Where does glomerular disease affect?

A

Both kidneys

41
Q

What is polycystic disease?

A

Genetic disorder
Abnormal cysts develop and grown in kidneys - crush adjacent renal structures
Most caused by mutations in PKD1 gene

42
Q

What are the consequences of polycystic disease?

A

ESRF developed in 10-20 years

Hypertension very common

43
Q

How is polycystic disease diagnosed?

A

Ultrasound

autumn amy L pm2c (copied) (16 decks)

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