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bioregulatory systems 🦠 > urological disorders > Flashcards

urological disorders Flashcards

1
Q

what are normal functions of the kidney

A
  • filtration (removal of waste and keeping essentials in blood)
  • control salt and water balance
  • control of acid/base balance
  • hormone (EPO production)
  • vitamin D - 1 alpha hydroxylation of vitamin D
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2
Q

what are features of kidney dysfunction

A
  • filtration failure (accumulation of waste substance, haematuria, proteinuria, low serum protein inc albumin in blood)
  • hypertension, water retention (sometimes dehydration because unable to make concentrated urine)
  • metabolic acidosis
  • anaemia
  • vitamin D deficiency (and secondary hyperparathyroidism)
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3
Q

what are some inflammatory urological disorders

A
  • infection including cystitis
  • non infective causes : metabolic - including diabetic nephropathy, immunological - nephritic syndrome, nephrotic syndrome
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4
Q

what are some obstructive urological disorders

A
  • stones

- benign prostatic hypertrophy

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5
Q

what are some developmental/genetic urological disorders

A

polycystic kidneys

horseshoe kidney

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6
Q

what are 4 ways to detect kidney disease

A

1) raised conc of waste substances
2) presence of blood in urine
3) low blood pressure/high
4) abnormal hormone profile

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7
Q

explain what having a raised conc of waste substances shows

A

raised conc of waste substances in the blood
reduction in GFR > accumulation of waste in blood
CLINICAL test = measure serum concentrations of urea and creatinine

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8
Q

explain what the presence of blood in the urine shows

A

may be due to damaged glomeruli (leaking from cells into the urine) or bleeding due to structural problems - tumours, polycystic kidneys
CLINICAL tests = urine dipstick or microscopy of urine

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9
Q

why is blood pressure low in patients who may have a urological disorder

A

normally blood pressure is often high due to salt and water retention in patients
some have low due to dehydration or have low in vascular volume because they are unable to make concentrated urine or losing too much sodium in urine or dehydration due to vomiting
may be more obvious in standing position (postural hypotension)

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10
Q

explain what having an abnormal hormone profile means

A 
reduction of synthesis in erythropoietin (result in anaemia - detected in reduced conc of Hb in FBC) 
secondary hyperparathyroidism (increased PTH as a secondary response to vit D deficiency - high conc of PTH can be measured in peripheral blood in presence of low or normal serum calcium, high or normal serum phosphate, routine vit D - blood test does not detect 1,25 vit D conc)
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11
Q

what are some possible locations for an infection

A

bladder - cystitis
kidney - pyelonephritis
the bladder kidney and ureter are connected

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12
Q

what are some other contributing factors to infection/inflammatory conditions

A

obstruction
stones
prostatic hypertrophy

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13
Q

what are some potential pathogens

A 
bacteria = most common
virus = immunocompromised patients
fungal = immunocompromised patients
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14
Q

how do we make the diagnosis for a UTI

A 
urinary tract infection
history
physical examination
urine dipstick
urine microscopy, culture and sensitivity
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15
Q

what are some investigations that need to take place in case of a UTI

A 
urine dipstick
2+ leukocytes
\+ nitrate
trace of blood
urine microscopy
culture and sensitivity 
(blood tests eg renal profile : electrolyte, urea and creatinine)
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16
Q

what are treatments for UTI

A

antibiotics (depend on severity, most common bacteria in local area, modified when sensitivity from culture is available)
some need to be treated as inpatient (severe)
pain control
supportive treatments - hydration
consider imaging

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17
Q

how can the immune system damage the kidney

A 
antibody
inflammatory cells (neutrophils, monocytes/macrophages, T cells) - recruitment and further inflammation
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18
Q

what are some clinical presentations of immunologically caused inflammatory conditions of the kidney

A

nephritic syndrome
proteinuria
nephrotic syndrome
glomerulonephritis (inflammation of the microscopic filtering units of the kidney)

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19
Q

what is the pattern for organ involvement of kidney inflammatory conditions

A

kidney only
kidney and lung
multiple organs/tissues involved

20
Q

what is the diagnostic approach for suspected kidney disease

A 
history and physical examination
urine test
blood test - including immunology tests
imaging - start with ultrasound
kidney biopsy
21
Q

what are some features of nephritic syndrome

A

haematuria - blood in urine
variable amount of proteinuria
may have hypertension, reduced urine output, increased urea and creatinine

22
Q

how do we make the diagnosis for nephritic syndrome

A 
history and physical examination
urine dipstick and microscopy
urine protein : creatinine ratio
blood test - including immunology tests, kidney function
kidney biopsy
23
Q

what is nephritic syndrome : IgA nephropathy

A

most common primary glomerulonephritis world wide
esp in far east
deposition of IgA antibody in the kidney (detected by immunohistochemistry)
inflammation and scarring

24
Q

what is the disease for the inflammatory condition affecting both the kidney and lungs (organ specific) and what links the lung and kidney

A

anti-glomerular basement membrane (GBM) antibody mediated : Goodpasture’s disease
shared common antigen between the lung and kidney : a3chain of type 4 collagen

25
Q

what is the systemic disease for when multiple organ/tissue are involved

A

systemic lupus erythematosus (SLE) - autoantibodies : antinuclear factor, anti-dsDNA
vasculitis : antineutrophil cytoplasm antibody (ANCA)

26
Q

what is the pathogenesis for diabetic nephropathy

A

inflammation and fibrosis

27
Q

what are the risk factors for diabetic nephropathy

A

hypertension
poor diabetic control
smoking

28
Q

what are some clinical features of diabetic nephropathy

A

microalbuminuria - measure albumin : creatinine to measure albumin
proteinuria
association with other complications of diabetes mellitus : diabetic retinopathy/neuropathy

29
Q

what is the treatment and clinical management for diabetic nephropathy

A 
optimised diabetic control
optimised treatment of hypertension
reduce proteinuria using ARB or ACEI
stop smoking
new treatments - SGLT2 inhibitor
transplantation (inc combined pancreas and kidney transplantation)
dialysis
30
Q

what are the features for nephrotic syndrome

A

peripheral oedema (face/ankle = most common)
severe proteinuria
low serum albumin
variable amount of microscopic haematuria
associated with hyperlipidaemia

31
Q

how do you make the diagnosis

A 
history
physical examination
urine dipstick 
urine microscopy
urine protein : creatinine ratio
blood tests : kidney function, immunology test
kidney biopsy
32
Q

what are some causes for nephrotic syndrome

A 
minimal change glomerulopathy
membranous nephropathy
focal segmental glomerulosclerosis
lupus nephritis
others
33
Q

treatment for nephrotic syndrome

A

immunotherapy (corticosteroid, cyclophosphamide, recently = tacrolimus, antibody therapy targeting B cell pathway)
diuretics - to reduce the peripheral oedema
prevention of thrombosis - anticoagulation (deep vein thrombosis and pulmonary embolism)

34
Q

what are some key features of minimal change glomerulopathy

A

most common in children, also affects other age groups
normal light microscopy
electron microscopy : podocyte effacement - abnormal flattened appearance
complication - high risk of thrombosis

35
Q

what are some possible locations for obstructive stone conditions

A

kidney
ureter
bladder

36
Q

what is the clinical presentation for someone with stones

A

pain (abdomen, back loin)
blood in urine
associated with urine infection
about 90% of kidney stones are radio opaque

37
Q

what is the treatment for patients with stones

A

supportive
pain control
hydration
specific treatment - depending on size and location of stones
availability of local expertise and fitness of patient for general anaesthetics

38
Q

what is shockwave lithotripsy

A

high energy ultrasound waves to break up large kidney stones into smaller ones

39
Q

what is ureteroscopy

A

through the urethra, bladder and ureter = scope

40
Q

what is percutaneous nephrolithotomy

A

small percutaneous incision - insertion of nephroscope, stone is removed (may need to be broken into smaller pieces)

41
Q

what are the types of polycystic kidney disease and what are their inhertiances

A

neonatal - autosomal recessive
adult onset - autosomal dominant
some patients without family history

42
Q

what are the consequences of polycystic kidneys

A 
loss of kidney function
pain
bleeding into renal cysts
infection of renal cysts
asymptomatic in some patients
43
Q

what are some treatments for polycystic kidneys

A

new med - tolvaptan (a vasopressin receptor 2 antagonist) to slow down cyst formation
treat hypertension and infection
pain control
renal replacement therapy - transplantation, dialysis

44
Q

what is the developmental/genetic condition horseshoe kidney

A

kidneys are not separated and are slightly lower

imaging of abdomen/pelvis

45
Q

what are the consequences for horseshoe kidneys

A

increased risk of
obstruction
stone
infection

bioregulatory systems 🦠 (54 decks)

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