Urological Disorders

Question 1

What two problems can arise from filtration failure?

Answer 1

Haematuria and proteinuria

or accumulation of waste substances

Question 2

How is the presence of waste products in the urine detected?

Answer 2

By measuring the serum concentrations of Urea and Creatinine

Question 3

How is haematouria detected?

Answer 3

Through a urine dipstick

Question 4

Why might the blood pressure of patient with a urological condition be high?

Answer 4

Due to salt and water retention in the blood which increases blood volume, and therefore leads to high blood pressure

Question 5

Why might the blood pressure of patients with a urological condition be low?

Answer 5

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

Question 6

What hormonal problems might urological conditions lead to?

Answer 6

Reduced EPO and Secondary Hyperparathyroidism

Question 7

What is the consequence of reduced EPO with kidney disease?

Answer 7

Reduction in erythropoiesis, leading to anaemia

Question 8

How does vitamin D synthesis get affected by kidney disease?

Answer 8

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

Question 9

Why is PTH raised in patients with kidney disease?

Answer 9

Kidney disease = no 1-alpha-hydroxylation of Vitamin D
Therefore Vitamin D defiency
Therefore less Ca2+ absorbed
With Less Ca2+ absorbed, PTH levels rise

Question 10

What are the most common pathogens for kidney infections in immunocompromised patients?

Answer 10

Fungi and virus

Question 11

What are the most common pathogens for a kidney problem?

Answer 11

Bacteria

Question 12

What is an infection of the bladder called?

Answer 12

Bladder - cystitis

Question 13

What is an infection of the kidney called?

Answer 13

Pylonephritis

Question 14

What are three other factors which could contribute to an infection of the urinary system?

Answer 14

Stones, obstructions and prostatic hypertrophy

Question 15

What are signs and symptoms of a UTI?

Answer 15

Blood in urine, high temperature, soft and tender abdomen, especially over the suprapubic area

Question 16

What is commonly found on a urine dip stick of a patient with a UTI?

Answer 16

High leucocytes, high nitrite and traces of blood

Question 17

How are UTIs treated?

Answer 17

Broad Spectrum antibiotics initally, and then once culture has been completed prescribe specific antibiotics for the type of bacteria

Question 18

What two ways can the immune system damage the kidneys?

Answer 18

Antibodies

Inflammatory cells - Neutrophils, macrophages and T cells

Question 19

What is glomerulonephritis?

Answer 19

inflammation of the microscopic filtering units of the kidney

Question 20

What are three clinical presentations of glomerulonephritis?

Answer 20

Nephritic syndrome
Proteinurin
Nephrotic Syndrome

Question 21

What are the three patterns of organ involvement?

Answer 21

Kidney, Kidney and Lung, Whole organs and Other Tissues

Question 22

What is seen in an immunostaining slide of a patient with glomerulonephritis?

Answer 22

brown stains indicate the presence of monocyte and macrophages that have invaded the glomeruli

Question 23

What are the steps involved in the diagnostic approach to reaching a conclusion about a patients condition?

Answer 23

1. History
2. Physical Examination
3. Urine dip stick
4. Urine microscopy
5. Urine protein to creatinine ration
6. Blood tests

Question 24

What is nephritic syndrome?

Answer 24

A condition comprising of signs of nephritis, which is kidney disease involving inflammation, and often occurs in the glomeruli

Question 25

What are some symptoms of nephritis?

Answer 25

Blood in urine, variable protein in urine - increased urea and creatinine, may have hypertension,

Question 26

Patient presents with a sore throat, high blood pressure and blood in their urine. What urological disease do they have?

Answer 26

Nephritis

Question 27

What might a blood test show in a patient with nephritis?

Answer 27

1. High serum urea and creatinine | 2. Low GFR

Question 28

What is IgA Nephropathy?

Answer 28

Deposition of IgA antibody in the kidney causing inflammation and scarring

Question 29

How can IgA Nephropathy be detected?

Answer 29

Immunohistochemistry

Question 30

How is IgA Nephropathy treated?

Answer 30

Supportive treatment to reduce hypertension eg ACEi or ARBs, and reduce sodium intake

Question 31

How can IgA nephropathy be treated with immunotherapy?

Answer 31

Renal Replacement Therapy - Transplantation or dialysis

Question 32

What two features are seem on a histological slide of a kidney with IgA nephropathy?

Answer 32

inflammation and scarring

Question 33

What disease affects the kidneys and lungs?

Answer 33

Goodpasture's Disease

Question 34

What might a smoker with goodpasture's disease experience?

Answer 34

Kidney failure, and coughing up blood

Question 35

What is the pathophysiology behind Goodpastures disease?

Answer 35

it is anti-glomerular basement membrane antibody mediated

Question 36

How does Goodpasture's disease affect the lung and the kidney?

Answer 36

There is a shared common antigen - alpha3 chain of type 4 collagen

Question 37

What are two systemic diseases that affect the kidneys and other whole organ systems?

Answer 37

Systemic Lupus Erythematosus - SLE due to autoantibodies: anti-dsDNA Vasculitis: due to ANCA - anti-neutrophil cytoplasm antibody

Question 38

What is the most common cause of chronic kidney disease in the Western World?

Answer 38

Diabetic Nephropathy

Question 39

What is the pathogenesis of diabetic nephropathy?

Answer 39

Inflammation and fibrosis

Question 40

What are three risk factors of diabetic nephropathy?

Answer 40

Poorly managed Diabetes Pooly managed hypertension Smoking

Question 41

What are two clinical features of diabetic nephropathy which can been identified on a urine test?

Answer 41

Microalbuminuria - small amount of albumin in the urine | Proteinuria

Question 42

What might be seen on a histological slide of a kidney with diabetic nephropahy?

Answer 42

Deposition of ECM in Glomeruli | Thickened glomerular basement membrane

Question 43

What are the key features of nephrotic syndrome?

Answer 43

Oedema, Very severe Proteinuria, Low Serum Albumin

Question 44

What might patients present with physical if they have nephrotic syndrome?

Answer 44

Frothy urine, and face and leg swelling

Question 45

Why type of oedema might be seen in patients with nephrotic syndrome?

Answer 45

Pitting ankle oedema

Question 46

What is the main cause of nephrotic syndrome?

Answer 46

Minimal change glomerulopathy

Question 47

What type of microscope has to be used to identify minimal change nephropathy?

Answer 47

Electron microscope

Question 48

What histological changes might be seen in a patient with minimal change glomerulopathy?

Answer 48

Podocyte effacement - the normal podocyte foot processes become flattened in appearance

Question 49

Who is minimal change glomerulopathy most common in?

Answer 49

Children

Question 50

How is nephrotic syndrome treated?

Answer 50

First give broad spectrum immunosuppresants like corticosteroid and cyclosporin

Question 51

What medication can be given to reduce the peripheral oedema seen with nephrotic syndrome?

Answer 51

Diuretics

Question 52

What is an important consideration to make when a patient presents with nephrotic syndrome?

Answer 52

give preventative treatment for thrombosis like anticoagulation as the risk fo thrombosis is very high

Question 53

What thrombotic conditions can present in patients with nephrotic syndrome?

Answer 53

DVT and Major Pulmonary Embolism

Question 54

What are some recent advancements in treatment for nephrotic syndrome?

Answer 54

Tacrolimus - antibody treatment targetting B cell pathway

Question 55

What are three possible locations for kidney stones?

Answer 55

Kidneys, bladder, ureter

Question 56

What are some clinical presentations of obstructive stones?

Answer 56

Pain in back-loin and abdomen, blood in urine, tenderness of lower abdomen

Question 57

Why should urine of patients with stones be cultured?

Answer 57

UTI's are very common in patients with stones

Question 58

Why are plain X-Rays useful in the diagnosis of obstructive stones?

Answer 58

90% of stones are radio-opaque

Question 59

What investigations are done for patients with kidney stones?

Answer 59

Urine dip stick, urine culture for UTI, X ray CT or ultrasound

Question 60

What are the three possible treatments for stones?

Answer 60

Shockwave lithotripsy Percutaneous Nephrolithotomy Ureteroscopy

Question 61

What does shockwave lithotripsy involve?

Answer 61

The use of high energy shockwaves to break the larger stones into smaller ones so they can easily pass out the ureters

Question 62

What does percutaneous nephrolithotomy involve?

Answer 62

Insertion of nephroscope into the skin via an incision to enter kidney and remove stone

Question 63

How does ureteroscopy work to remove stones?

Answer 63

ureteroscope is passed through urethra, bladder and ureter to reach the stones and remove them

Question 64

What supportive treatment can be provided for kidney stones?

Answer 64

Hydration and pain medication

Question 65

What neoplastic conditions can occur in the urinary system?

Answer 65

Benign - benign prostatic hypertrophy Malignant - Renal cell carcinoma Transitional cell carcinoma Prostatic cancer Testicular cancer

Question 66

What are two developmental conditions which can occur in the kidneys?

Answer 66

1. Polycystic kidney | 2. horseshoe kidney

Question 67

What are the two types of polycystic kidneys?

Answer 67

1. Neonatal | 2. Adult

Question 68

What is the genetic inheritance pattern of neonatal polycystic kidneys?

Answer 68

Autosomal recessive

Question 69

What is the genetic inheritance pattern of adult polycystic kidneys?

Answer 69

Autosomal dominant

Question 70

Can you get polycystic kidneys with family history?

Answer 70

yes

Question 71

What are the three main consequences of polycystic kidneys?

Answer 71

Loss of kidney function, pain, bleeding in renal cysts or infection

Question 72

What is a new medication which can be used to treat polycystic kidneys?

Answer 72

Tolvaptan

Question 73

How does tolvaptan work?

Answer 73

Vasopressin receptor 2 antagonist to slow down cyst formation

Question 74

How can polycystic kidney disease be treated?

Answer 74

Tolvaptan, treat high blood pressure, pain management, and renal replacement therapy

Question 75

How are polycystic kidneys detected?

Answer 75

Through a non-invasive Ultrasound - cysts appear black on ultrasound

Question 76

What is horseshoe kidney?

Answer 76

When the kidneys fuse together at the bottom and form a horseshoe shape = renal fusion

Question 77

When does horseshoe kidney occur?

Answer 77

when the baby is developing in the womb - the kidneys fail to move into place properly

Question 78

Although often asymptomatic, what isarethe most common physical symptoms of horse shoe kidney?

Answer 78

Flanking or abdominal pain

Question 79

What are the three consequences of horse show kidney?

Answer 79

Increased risk of 1. Obstruction, 2. Stone, 3. Infection

Question 80

How is horse shoe kidney diagnosed?

Answer 80

Through imaging eg CT scan

Question 81

What are the risk factors associated with diabetic nephropathy?

Answer 81

Uncontrolled type 2 Diabetes and Hypertension

Question 82

What are the pathological features of diabetic nephropathy?

Answer 82

Damaged glomerulus of the nephron | Reduced Kidney Functionality

Question 83

Why does reduced kidney functioning caused tiredness?

Answer 83

Reduced EPO production leads to anaemia = tiredness

Question 84

Why does reduced kidney function lead to swollen ankles?

Answer 84

Due to water retention in the periphery as a result of loss of proteins and reduced kidney function

Question 85

What are the pros and cons of using ultrasound to detect kidney stones?

Answer 85

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

Question 86

What are the pros and cons of using X Rays to detect kidney stones?

Answer 86

Pros: Quick, easy and reliable and available in most hospital departments Cons: Involves radiation

Question 87

What are the pros and cons of using a CT scan to detect kidney stones?

Answer 87

Highly sensitive in detecting small stones but involves radiation exposure

Question 88

How does prostate enlargement lead to kidney stones?

Answer 88

The prostate enlargement can obstruct urine excretion, causing stones to form in the bladder from the minerals in the urine

Question 89

How do neurological conditions affect kidney stones?

Answer 89

Damage to bladder nerves means urine might not be excreted, causing partial urine to be retained = stones develop in the bladder

Question 90

How does gout cause kidney stones?

Answer 90

Increased uric acid in the blood increases the risk of kidney stones forming

Question 91

How does dehydration affect stones?

Answer 91

Being dehydrated makes the urine more concentrated which increases the risk of kidney stone development

Question 92

How does diet affect kidney stone formation?

Answer 92

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