Urological Disorders Flashcards
What two problems can arise from filtration failure?
Haematuria and proteinuria
or accumulation of waste substances
How is the presence of waste products in the urine detected?
By measuring the serum concentrations of Urea and Creatinine
How is haematouria detected?
Through a urine dipstick
Why might the blood pressure of patient with a urological condition be high?
Due to salt and water retention in the blood which increases blood volume, and therefore leads to high blood pressure
Why might the blood pressure of patients with a urological condition be low?
Some patients who have dehydration or low in vascular volume because unable to make concentrated urine, or losing too much sodium in urine or dehydration due to vomiting
What hormonal problems might urological conditions lead to?
Reduced EPO and Secondary Hyperparathyroidism
What is the consequence of reduced EPO with kidney disease?
Reduction in erythropoiesis, leading to anaemia
How does vitamin D synthesis get affected by kidney disease?
The kidneys are responsible for the activation of Vitamin D through the 1-alpha-hydroxylation of Vitamin D - in kidney disease this might not occur
Why is PTH raised in patients with kidney disease?
Kidney disease = no 1-alpha-hydroxylation of Vitamin D
Therefore Vitamin D defiency
Therefore less Ca2+ absorbed
With Less Ca2+ absorbed, PTH levels rise
What are the most common pathogens for kidney infections in immunocompromised patients?
Fungi and virus
What are the most common pathogens for a kidney problem?
Bacteria
What is an infection of the bladder called?
Bladder - cystitis
What is an infection of the kidney called?
Pylonephritis
What are three other factors which could contribute to an infection of the urinary system?
Stones, obstructions and prostatic hypertrophy
What are signs and symptoms of a UTI?
Blood in urine, high temperature, soft and tender abdomen, especially over the suprapubic area
What is commonly found on a urine dip stick of a patient with a UTI?
High leucocytes, high nitrite and traces of blood
How are UTIs treated?
Broad Spectrum antibiotics initally, and then once culture has been completed prescribe specific antibiotics for the type of bacteria
What two ways can the immune system damage the kidneys?
Antibodies
Inflammatory cells - Neutrophils, macrophages and T cells
What is glomerulonephritis?
inflammation of the microscopic filtering units of the kidney
What are three clinical presentations of glomerulonephritis?
Nephritic syndrome
Proteinurin
Nephrotic Syndrome
What are the three patterns of organ involvement?
Kidney, Kidney and Lung, Whole organs and Other Tissues
What is seen in an immunostaining slide of a patient with glomerulonephritis?
brown stains indicate the presence of monocyte and macrophages that have invaded the glomeruli
What are the steps involved in the diagnostic approach to reaching a conclusion about a patients condition?
- History
- Physical Examination
- Urine dip stick
- Urine microscopy
- Urine protein to creatinine ration
- Blood tests
What is nephritic syndrome?
A condition comprising of signs of nephritis, which is kidney disease involving inflammation, and often occurs in the glomeruli
What are some symptoms of nephritis?
Blood in urine, variable protein in urine - increased urea and creatinine, may have hypertension,
Patient presents with a sore throat, high blood pressure and blood in their urine. What urological disease do they have?
Nephritis
What might a blood test show in a patient with nephritis?
- High serum urea and creatinine
2. Low GFR
What is IgA Nephropathy?
Deposition of IgA antibody in the kidney causing inflammation and scarring
How can IgA Nephropathy be detected?
Immunohistochemistry
How is IgA Nephropathy treated?
Supportive treatment to reduce hypertension eg ACEi or ARBs, and reduce sodium intake
How can IgA nephropathy be treated with immunotherapy?
Renal Replacement Therapy - Transplantation or dialysis
What two features are seem on a histological slide of a kidney with IgA nephropathy?
inflammation and scarring
What disease affects the kidneys and lungs?
Goodpasture’s Disease
What might a smoker with goodpasture’s disease experience?
Kidney failure, and coughing up blood
What is the pathophysiology behind Goodpastures disease?
it is anti-glomerular basement membrane antibody mediated
How does Goodpasture’s disease affect the lung and the kidney?
There is a shared common antigen - alpha3 chain of type 4 collagen
What are two systemic diseases that affect the kidneys and other whole organ systems?
Systemic Lupus Erythematosus - SLE due to autoantibodies: anti-dsDNA
Vasculitis: due to ANCA - anti-neutrophil cytoplasm antibody
What is the most common cause of chronic kidney disease in the Western World?
Diabetic Nephropathy
What is the pathogenesis of diabetic nephropathy?
Inflammation and fibrosis
What are three risk factors of diabetic nephropathy?
Poorly managed Diabetes
Pooly managed hypertension
Smoking
What are two clinical features of diabetic nephropathy which can been identified on a urine test?
Microalbuminuria - small amount of albumin in the urine
Proteinuria
What might be seen on a histological slide of a kidney with diabetic nephropahy?
Deposition of ECM in Glomeruli
Thickened glomerular basement membrane
What are the key features of nephrotic syndrome?
Oedema, Very severe Proteinuria, Low Serum Albumin
What might patients present with physical if they have nephrotic syndrome?
Frothy urine, and face and leg swelling
Why type of oedema might be seen in patients with nephrotic syndrome?
Pitting ankle oedema
What is the main cause of nephrotic syndrome?
Minimal change glomerulopathy
What type of microscope has to be used to identify minimal change nephropathy?
Electron microscope
What histological changes might be seen in a patient with minimal change glomerulopathy?
Podocyte effacement - the normal podocyte foot processes become flattened in appearance
Who is minimal change glomerulopathy most common in?
Children
How is nephrotic syndrome treated?
First give broad spectrum immunosuppresants like corticosteroid and cyclosporin
What medication can be given to reduce the peripheral oedema seen with nephrotic syndrome?
Diuretics
What is an important consideration to make when a patient presents with nephrotic syndrome?
give preventative treatment for thrombosis like anticoagulation as the risk fo thrombosis is very high
What thrombotic conditions can present in patients with nephrotic syndrome?
DVT and Major Pulmonary Embolism
What are some recent advancements in treatment for nephrotic syndrome?
Tacrolimus - antibody treatment targetting B cell pathway
What are three possible locations for kidney stones?
Kidneys, bladder, ureter
What are some clinical presentations of obstructive stones?
Pain in back-loin and abdomen, blood in urine, tenderness of lower abdomen
Why should urine of patients with stones be cultured?
UTI’s are very common in patients with stones
Why are plain X-Rays useful in the diagnosis of obstructive stones?
90% of stones are radio-opaque
What investigations are done for patients with kidney stones?
Urine dip stick, urine culture for UTI, X ray CT or ultrasound
What are the three possible treatments for stones?
Shockwave lithotripsy
Percutaneous Nephrolithotomy
Ureteroscopy
What does shockwave lithotripsy involve?
The use of high energy shockwaves to break the larger stones into smaller ones so they can easily pass out the ureters
What does percutaneous nephrolithotomy involve?
Insertion of nephroscope into the skin via an incision to enter kidney and remove stone
How does ureteroscopy work to remove stones?
ureteroscope is passed through urethra, bladder and ureter to reach the stones and remove them
What supportive treatment can be provided for kidney stones?
Hydration and pain medication
What neoplastic conditions can occur in the urinary system?
Benign - benign prostatic hypertrophy
Malignant - Renal cell carcinoma
Transitional cell carcinoma
Prostatic cancer
Testicular cancer
What are two developmental conditions which can occur in the kidneys?
- Polycystic kidney
2. horseshoe kidney
What are the two types of polycystic kidneys?
- Neonatal
2. Adult
What is the genetic inheritance pattern of neonatal polycystic kidneys?
Autosomal recessive
What is the genetic inheritance pattern of adult polycystic kidneys?
Autosomal dominant
Can you get polycystic kidneys with family history?
yes
What are the three main consequences of polycystic kidneys?
Loss of kidney function, pain, bleeding in renal cysts or infection
What is a new medication which can be used to treat polycystic kidneys?
Tolvaptan
How does tolvaptan work?
Vasopressin receptor 2 antagonist to slow down cyst formation
How can polycystic kidney disease be treated?
Tolvaptan, treat high blood pressure, pain management, and renal replacement therapy
How are polycystic kidneys detected?
Through a non-invasive Ultrasound - cysts appear black on ultrasound
What is horseshoe kidney?
When the kidneys fuse together at the bottom and form a horseshoe shape = renal fusion
When does horseshoe kidney occur?
when the baby is developing in the womb - the kidneys fail to move into place properly
Although often asymptomatic, what isarethe most common physical symptoms of horse shoe kidney?
Flanking or abdominal pain
What are the three consequences of horse show kidney?
Increased risk of 1. Obstruction, 2. Stone, 3. Infection
How is horse shoe kidney diagnosed?
Through imaging eg CT scan
What are the risk factors associated with diabetic nephropathy?
Uncontrolled type 2 Diabetes and Hypertension
What are the pathological features of diabetic nephropathy?
Damaged glomerulus of the nephron
Reduced Kidney Functionality
Why does reduced kidney functioning caused tiredness?
Reduced EPO production leads to anaemia = tiredness
Why does reduced kidney function lead to swollen ankles?
Due to water retention in the periphery as a result of loss of proteins and reduced kidney function
What are the pros and cons of using ultrasound to detect kidney stones?
Pros: Can detect the dilation of the urinary system due to the obstruction which can be useful in spotting loss of function
Cons: Small stones cannot be detected, might not be available in every healthcare facility
What are the pros and cons of using X Rays to detect kidney stones?
Pros: Quick, easy and reliable and available in most hospital departments
Cons: Involves radiation
What are the pros and cons of using a CT scan to detect kidney stones?
Highly sensitive in detecting small stones but involves radiation exposure
How does prostate enlargement lead to kidney stones?
The prostate enlargement can obstruct urine excretion, causing stones to form in the bladder from the minerals in the urine
How do neurological conditions affect kidney stones?
Damage to bladder nerves means urine might not be excreted, causing partial urine to be retained = stones develop in the bladder
How does gout cause kidney stones?
Increased uric acid in the blood increases the risk of kidney stones forming
How does dehydration affect stones?
Being dehydrated makes the urine more concentrated which increases the risk of kidney stone development
How does diet affect kidney stone formation?
Diet rich in sodium - cause increase in calcium
Aminal protein - cause increase in uric acid
Low in calcium - cause increase in oxalate
All increase risk of stone formation
