Urological and Renal Disorders (Tutorial)

Question 1

Case 1: (info card)

Mr Kent, a 45-year old man was diagnosed with Type 2 Diabetes Mellitus 10 years ago. Recently, he visited his GP complaining of chronic tiredness and swollen ankles. He has a history of smoking and being erratic with his medications. GP noticed the patient was looking pale, his blood pressure measurement is 140/100 mmHg, and urine dipstick test was positive for protein, ketones and glucose

Question 2

What are the risk factors in Mr Kent’s case history that would increase the chances of him developing a kidney disease?

Answer 2

Smoking

Taking his medications irregularly - poor management of his diabetes

T2DM

Hypertension

Question 3

Why might Mr Kent have glucose, ketones and protein in his urine?

Answer 3

Glucose = may be due to the poorly controlled diabetes

Protein = suggests a filtration issue (in the glomerulus)

Ketones = may be due to a misdiagnosis, as T2DM does not usually result in ketosis, it is generally caused by T1DM

Question 4

What kidney disease does Mr Kent most likely have?

Answer 4

Diabetic nephropathy / diabetic kidney disease

Question 5

Explain his symptoms / the pathology of diabetic nephropathy:

Answer 5

Proteinuria

Hypertension

Glycated haemoglobin

Swollen ankles = losing protein from the blood impacts oncotic pressure that normally draws fluid back into the capillaries results in more fluid lost in the tissues (oedema); ankles = gravity

Pale = anaemia; linked to reduction in erythropoietin production from the kidneys, so reduced Hb production

Hyperlipidemia = loss of plasma proteins results in the liver trying to compensate for it, liver ends up also making more lipoproteins

Thrombotic risk = loss of plasma proteins, coagulant proteins are selectively retained

Immunocompromised = immunoglobins are also lost

Question 6

What are the management plans for diabetic neuropathy?

Answer 6

Vegan diet / Mediterranean diet = low fat to control cholesterol levels

Reduced sugar intake, reduce salt in diet = reduce hypertension

Meal prep = still require a balanced diet

Drinking lots of water

Complex carbohydrates have a positive impact on BGL

Exercise = 30 min walking a day can help stimulate blood flow to help with insulin resistance

Stop smoking = can contribute to kidney issues so can refer him to smoking cessation specialists etc.

Check diabetic markers

Trying to reduce stress = reduce cortisol levels as cortisol increases BGL

At home monitoring of BGL, urination, BP and weight

Medications: anti-diabetic medications = e.g. metformin, anti-hypertensive medications, potentially statins

Adhere to medications = pill boxes, DOCIT box

Question 7

Case 2: (info card)

Mr Owen, a 60-year old man, woke up in the middle of the night complaining of pain in his back radiating to lower abdominal area. He went to see his GP in the morning, who performed a urine dipstick test which tested positive for blood

Question 8

What is the likely diagnosis for Mr Jones?

Answer 8

Kidney stones

Question 9

What are some different tests that could be suitable to confirming the diagnosis?

Answer 9

Imaging - e.g. X-ray, ultrasound, CT scan

Make choice by balancing pros and cons: X-ray and CT increases harm to patient due to radiation, ultrasound = less clear image

Question 10

What are some potential different causes for developing kidney stones?

Answer 10

Not drinking enough water - dehydration

Obesity = risk factor for stone formation

High protein diets leads to more acidic urine

Anything impacting pH of the tubular fluid (esp. making it more acidic) can contribute to stone formation due to gout (uric acid build-up)

Gout