Session 9

Question 1

What is nephrotic syndrome?

Answer 1

(Leaky filter)

Loss of protein in urine -> hypoalbuminaemia -> oedema

Question 2

What is nephritic syndrome?

Answer 2

(Blocked filter)

Blockage of glomerulus -> reduced eGFR -> haematuria (usually AKI) -> hypotension

Question 3

Where in the glomerulus can injury occur?

Answer 3

Sub epithelial (podocytes)
GB!
Subendothelial
Mesangial (supporting stalk)

Question 4

What site of glomerular injury in commonest in nephrotic syndrome?

Answer 4

Podocytes because they do most of the selective filtering

Question 5

What are secondary (systemic) causes of nephrotic syndrome?

Answer 5

Diabetes or amyloidisis

Question 6

What are primary causes of nephrotic syndrome?

Answer 6

Minimal change glomeruloneohritis: childhood/adolescence mostly. Responds to steroids. Usually no progression to renal failure. Damaged podocytes, unknown pathogenesis.
Focal segmental glomerulosclerosis: adults. Results from minimal change. Scarred glomerulus. Circulating factor damaging podocytes. Progressive to renal failure.
Membranous glomerulonephritis: commonest cause in adults. 1/3 get better, stay same and progress to renal failure. Immune complex deposits. Thick capillary membranes. Affects podocytes.

Question 7

What can cause haematuria?

Answer 7

IgA nepropathy (commonest) Alport’s syndrome or thin GBM disease (hereditary)

Question 8

What can cause nephrotic syndrome?

Answer 8

Goodpasture syndrome (anti GBM) - acute onset of severe nephritic syndrome. Autoantibody to GBM. Treatable by immunosuppression if caught early
Vasculitis - inflammation of vessels caused by antibodies that activate neutrophils

Question 9

What is the commonest cancer in men in the UK?

Answer 9

Prostate

Question 10

What are risk factors for prostate cancer?

Answer 10

Increased age, family history (BRCA2), ethnicity (black>white>Asian)

Question 11

What are the clinical features of prostate cancer?

Answer 11

Asymptomatic
Lower UT symptoms
Bone pain (spreads to bone)
Haematuria (advanced)

Question 12

How is the diagnosis of prostate cancer made?

Answer 12

DR exam + serum PSA + guided biopsy of prostate

Question 13

What factors influence the treatment for prostate cancer?

Answer 13

Age, size of tumour, PSA level, grade (using biopsy), MRI and bone scan for metastasis

Question 14

What are the treatments for localised CaP?

Answer 14

Surveillance, robotic radical prostatectomy, radiotherapy

Question 15

What are the treatments for metastatic CaP?

Answer 15

Hormones +/- chemotherapy, palliation

Question 16

How is haematuria classified?

Answer 16

Visible 
Non visible (symptomatic/asymptomatic)

Question 17

What are the causes of haematuria?

Answer 17

Urological - cancer, stones, infection

Nephrological (glomerular)

Question 18

What is the relevant history and examination for haematuria?

Answer 18

Smoking, occupation, family history, BP, abdo mass, prostate enlargement by DR exam

Question 19

What are the investigations for haematuria?

Answer 19

Blood (FBC, U&E), urine culture, ultrasound, endoscopy

Question 20

What is the commonest bladder cancer, what are the risk factors and how is it treated?

Answer 20

Transitional cell carcinoma (90%)
Risks - smoking, occupation
Treatment - transurethral resection of bladder cancer. Muscle invasive bladder cancer can be treated by radical cystectomy or radiotherapy but also palliative.

Question 21

What are the PST common upper UT tumours?

Answer 21

Renal cell carcinoma (95%) - more common in males. 30% metastasis on presentation. Risks = smoking, obesity, dialysis. Can spread to lymph node, right atrium via IVC and perinephric regions. Localised treatment = surveillance, radial/partial nephrectomy
Upper tract transitional cell carcinoma (5%) - e.g. Renal pelvis. 40% lead to bladder cancer