Renal Therapeutics V: Important Renal Diseases Flashcards
Label the renal and urinary system
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
What is Obstructive Uropathy?
A structural or functional hindrance of the kidney
Urine cannot drain through a ureter
Can happen to 1 or both kidneys
How can urinary tract obstruction (UTO) be divided?
- Upper UTO e.g. uteric stones
2. Lower UTO e.g. prostatic hypertrophy
What happens when an acute upper tract obstruction occurs?
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
How is a UTO diagnosed?
Intravenous urogram (IVU) CT scan
Why is quick relief of a UTO important?
To protect the nephrons
May be followed by massive diuresis
List 4 things can cause a chronic partial obstruction?
- Incompetence of valve between bladder and ureter = chronic renal inflammation, infection
- Lower UTO caused by e.g. bladder cancer, bladder neck obstruction
- Benign or malignant prostatic hypertrophy
- Reflux nephropathy = back flow of urine into kidney
What are the 3 most common causes of UTOs
- Gynaecological problems
- Prostate hypertrophy
- Stones
List a symptom of upper UTOs
Renal colic, often associated with ureteric obstruction
List 3 symptoms of lower UTOs
Hesitancy
Frequency
Nocturia
What can cause polyuria?
Tubular damage
What are the possible consequences of chronic reflux nephropathy?
Hypertension
Renal infection
How are UTOs managed?
Surgery is common
Conservative treatment = non-invasive e.g ESWL, laser shattering of stones
Follow-up to ensure patient doesn’t develop reflux nephropathy
What are renal calculi?
Kidney stones
Solid material formed in kidney from the minerals in urine
Define: Nephrolithiasis
Renal stone disease
When a patient has kidney stones
List 3 factors which enhance the risk of renal stone formation
Low intake of fluid
High intake of animal proteins
High intake of refined sugar, salt
What is the most common type of kidney stone made up of?
Calcium oxalate
How are calcium oxalate kidney stones formed?
Hypercalciuria (high levels of calcium)
OR
Excessive gastro-intestinal absorption of oxalate and alkaline urine
Name the 3 materials that can accumulate to cause kidney stones
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
What factors can cause kidney stones to form?
Relative insolubility to urine e.g. calcium oxalate
Urinary pH dependent
Low urine volume = uric acid stones
Infection
List 3 symptoms of kidney stones
Sudden or gradual renal colic
Inability to lie down
Accompanied by nausea and vomiting
List 3 investigations which can be carried out to diagnose kidney stones
Urinanalysis = presence of blood Imaging = kidney-ureter-bladder X-ray Intravenous urogram (IVU), IV contrast medium
List the non-surgical methods used to treat kidney stones
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
How can kidney stones be surgically treated?
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
What is an infection of the bladder called?
Cystitis
What is an infection of the urethra called?
Urethritis
List 2 symptoms of UTIs
- Dysuria (painful urination)
2. Frequency
Define: Cystitis
Bacterial infection of the bladder
What is the method used to diagnose UTIs
Microbiological
What causes UTIs?
Bacteria enter mostly via urethra = ascending infection, uncomplicated
Can enter via bloodstream
Mostly organism from bowel flora involved
What may be the cause of recurring UTIs?
Genetic factors
What may cause acute urethritis?
Sexual transmission
List 3 symptoms of prostatitis
Fever
Malaise
Dysuria
How should UTIs be managed in general?
Increased fluid intake
Oral treatment to alkalinise urine
Cranberry juice - vitamin C
How should acute cystitis be treated?
3-day regimens of antibiotics
e.g. trimethoprim, oral cephalosporin
How should prostatitis be treated?
Lipid-soluble antibiotics
e.g. trimethoprim, doxycycline, quinolones
Courses of 2-4 weeks
What is acute pyelonephritis?
Sudden and severe kidney infection
Causes inflammation of the kidney tissue
How can pyelonephritis be treated?
Oral antimicrobial therapy
What is chronic pyelonephritis?
Recurrent infections
Repeated acute pyelonephritis
Where does glomerular disease affect?
Both kidneys
What is polycystic disease?
Genetic disorder
Abnormal cysts develop and grown in kidneys - crush adjacent renal structures
Most caused by mutations in PKD1 gene
What are the consequences of polycystic disease?
ESRF developed in 10-20 years
Hypertension very common
How is polycystic disease diagnosed?
Ultrasound
