urological disorders Flashcards
what are normal functions of the kidney
- 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
what are features of kidney dysfunction
- 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)
what are some inflammatory urological disorders
- infection including cystitis
- non infective causes : metabolic - including diabetic nephropathy, immunological - nephritic syndrome, nephrotic syndrome
what are some obstructive urological disorders
- stones
- benign prostatic hypertrophy
what are some developmental/genetic urological disorders
polycystic kidneys
horseshoe kidney
what are 4 ways to detect kidney disease
1) raised conc of waste substances
2) presence of blood in urine
3) low blood pressure/high
4) abnormal hormone profile
explain what having a raised conc of waste substances shows
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
explain what the presence of blood in the urine shows
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
why is blood pressure low in patients who may have a urological disorder
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)
explain what having an abnormal hormone profile means
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)
what are some possible locations for an infection
bladder - cystitis
kidney - pyelonephritis
the bladder kidney and ureter are connected
what are some other contributing factors to infection/inflammatory conditions
obstruction
stones
prostatic hypertrophy
what are some potential pathogens
bacteria = most common virus = immunocompromised patients fungal = immunocompromised patients
how do we make the diagnosis for a UTI
urinary tract infection history physical examination urine dipstick urine microscopy, culture and sensitivity
what are some investigations that need to take place in case of a UTI
urine dipstick 2+ leukocytes \+ nitrate trace of blood urine microscopy culture and sensitivity (blood tests eg renal profile : electrolyte, urea and creatinine)
what are treatments for UTI
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
how can the immune system damage the kidney
antibody inflammatory cells (neutrophils, monocytes/macrophages, T cells) - recruitment and further inflammation
what are some clinical presentations of immunologically caused inflammatory conditions of the kidney
nephritic syndrome
proteinuria
nephrotic syndrome
glomerulonephritis (inflammation of the microscopic filtering units of the kidney)
what is the pattern for organ involvement of kidney inflammatory conditions
kidney only
kidney and lung
multiple organs/tissues involved
what is the diagnostic approach for suspected kidney disease
history and physical examination urine test blood test - including immunology tests imaging - start with ultrasound kidney biopsy
what are some features of nephritic syndrome
haematuria - blood in urine
variable amount of proteinuria
may have hypertension, reduced urine output, increased urea and creatinine
how do we make the diagnosis for nephritic syndrome
history and physical examination urine dipstick and microscopy urine protein : creatinine ratio blood test - including immunology tests, kidney function kidney biopsy
what is nephritic syndrome : IgA nephropathy
most common primary glomerulonephritis world wide
esp in far east
deposition of IgA antibody in the kidney (detected by immunohistochemistry)
inflammation and scarring
what is the disease for the inflammatory condition affecting both the kidney and lungs (organ specific) and what links the lung and kidney
anti-glomerular basement membrane (GBM) antibody mediated : Goodpasture’s disease
shared common antigen between the lung and kidney : a3chain of type 4 collagen
what is the systemic disease for when multiple organ/tissue are involved
systemic lupus erythematosus (SLE) - autoantibodies : antinuclear factor, anti-dsDNA
vasculitis : antineutrophil cytoplasm antibody (ANCA)
what is the pathogenesis for diabetic nephropathy
inflammation and fibrosis
what are the risk factors for diabetic nephropathy
hypertension
poor diabetic control
smoking
what are some clinical features of diabetic nephropathy
microalbuminuria - measure albumin : creatinine to measure albumin
proteinuria
association with other complications of diabetes mellitus : diabetic retinopathy/neuropathy
what is the treatment and clinical management for diabetic nephropathy
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
what are the features for nephrotic syndrome
peripheral oedema (face/ankle = most common)
severe proteinuria
low serum albumin
variable amount of microscopic haematuria
associated with hyperlipidaemia
how do you make the diagnosis
history physical examination urine dipstick urine microscopy urine protein : creatinine ratio blood tests : kidney function, immunology test kidney biopsy
what are some causes for nephrotic syndrome
minimal change glomerulopathy membranous nephropathy focal segmental glomerulosclerosis lupus nephritis others
treatment for nephrotic syndrome
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)
what are some key features of minimal change glomerulopathy
most common in children, also affects other age groups
normal light microscopy
electron microscopy : podocyte effacement - abnormal flattened appearance
complication - high risk of thrombosis
what are some possible locations for obstructive stone conditions
kidney
ureter
bladder
what is the clinical presentation for someone with stones
pain (abdomen, back loin)
blood in urine
associated with urine infection
about 90% of kidney stones are radio opaque
what is the treatment for patients with stones
supportive
pain control
hydration
specific treatment - depending on size and location of stones
availability of local expertise and fitness of patient for general anaesthetics
what is shockwave lithotripsy
high energy ultrasound waves to break up large kidney stones into smaller ones
what is ureteroscopy
through the urethra, bladder and ureter = scope
what is percutaneous nephrolithotomy
small percutaneous incision - insertion of nephroscope, stone is removed (may need to be broken into smaller pieces)
what are the types of polycystic kidney disease and what are their inhertiances
neonatal - autosomal recessive
adult onset - autosomal dominant
some patients without family history
what are the consequences of polycystic kidneys
loss of kidney function pain bleeding into renal cysts infection of renal cysts asymptomatic in some patients
what are some treatments for polycystic kidneys
new med - tolvaptan (a vasopressin receptor 2 antagonist) to slow down cyst formation
treat hypertension and infection
pain control
renal replacement therapy - transplantation, dialysis
what is the developmental/genetic condition horseshoe kidney
kidneys are not separated and are slightly lower
imaging of abdomen/pelvis
what are the consequences for horseshoe kidneys
increased risk of
obstruction
stone
infection
