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urological disorders Flashcards

1
Q
  • What are the consequences of kidney failure?
A

Filtration failure
- Unwell with accumulation of waste substance
- Haematuria and proteinuria, low serum protein, including albumin in the blood
Hypertension, water retension
Metabolic acidosis
Anaemia - lack of erythropoietin production
Vitamin D deficiency and secondary hyperparathyroidism

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2
Q
  • What is inflammation of the bladder called?

- What are some of the non-infective causes of inflammatory urinary disorders?

A

cystisis

Metabolic
      - Diabetic nephropathy
    Immunological
      - Nephritic syndrome
      - Nephrotic syndrome
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3
Q
  • What are some of the causes of obstructive urinary disorders?
  • What are some examples of neoplastic urinary disorders?
  • What are some developmental or genetic urinary disorders?

-

A

Stones
Benign prostatic hypertrophy

Kidney, bladder, prostatic or testicular cancer

Polycystic kidneys, horseshoe kidney
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4
Q
  • What are some of the potential mechanisms that immune system damage to the kidney might occur?
A

Through antibodies or inflammatory cells (neutrophils, monocytes, macrophages or T cells)

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5
Q
  • What is glomerulonephritis?
A

Inflammation of microscopic filtering of the kidney

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6
Q
  • How might you go about diagnosing immunogical causes of the inflammatory urological disorder?
A

History and physical examination

Urine Test

Blood Test: including immunology tests

Imaging: start with ultrasound

Kidney biopsy
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7
Q
  • What is horseshoe kidney?
  • When does horseshoe kidney occur?
  • How may we know a patient has horseshoe kidney?
  • What are the consequences of horseshoe kidney?
A

When 2 kidneys fuse together at the bottom

When a baby is growing in the womb as the baby's kidneys move into place

Imaging of the abdomen or pelvis

Increased risk of obstruction, stones and infection
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8
Q

what is the pathophysiology of a UTI

What are the symptoms of a UTI

A

Infection in bladder or kidney
Bacterial infection most common and the viral and fungal infections are more likley with immunocompromised patients#

Fever Suprapubic pain Frequency of passing urine Dysuria Haematuria

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9
Q

How do you diagnose a UTI

A

History
Physical Examination
Urine dipstick - leukocyte esterase, nitrite and some blood
Urine microscopy - blood tests e.g - renal profile
Renal Ultrasound
Voiding cystourethrogram

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10
Q

What are the treatments of a UTI

A

Antibiotics - depending on severity of illness and most common bacteria in local area e.g - trimethoprim-sulfamethoxazole, ciprofloxacin, ceftriaxone, azithromuxin, penicillin
Pain support
supportive e.g - hydration

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11
Q

What are the complications of a UTI

What are the risk factors

A

Complications - Pyelonephritis, Urosepsis, Septic shock

Risk Factors - Young biological females, Sexual intercourse, Postmenopausal. Diabetes mellitus, Impaired bladder emptying/urinary stasis

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12
Q

What is the pathophysiology of Nephritic Syndrome

A

Inflammation of the glomerulus that causes a sudden onset appearance of RBCs, variable amount of proteinuria and WBCs in the urine

Haematuria
Proteinuria
Hypertension
Reduced urine output
Increased urea and creatinine in blood
Sore throat

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13
Q

How do you diagnose nephritic syndrome

A

Urine dipstick: blood and protein
Blood tests: & serum urea and creatinine
reduced eGFR (GFR rate)
Urine: raised urine protein: creatinine ratio
Kidney biopsy: IgA nephropathy (example)

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14
Q

What are the treatments of nephritic syndrome

A

Supportive - angiotensin receptor inhibitor (irbesartan) or ACEI (ramipril)
reduce Na+ intake
Immunotherapy - renal replacement therapy when reaching late stage kidney disease (kidney transplantation or dialysis)

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15
Q

what is the most common primary glomerulonephritis world-wide

A

IgA nephropathy
with a lot of IgA in kidney
About 30% progress to kidney failure

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16
Q

what is the pathogenesis of diabetic nephropathy

A

Glycosuria → non-enzymatic glycation of proteins
basement membranes thicken due to excessive deposition of ECM in glomerulus → ^pressure in the glomerulus → ^glomerular filtration rate
thickening of basement membrane → glomerulus expands → filtration slits widen → increased permeability

17
Q

what are the symptoms of diabetic nephropathy

A

Worsening blood pressure control
Increased need to urinate
Swelling of feet, hands or eyes
Microalbuminuria
Proteinuria
Association with diabetic retinopathy and neuropathy

18
Q

how do you diagnose diabetic nephropathy

what are its risk factors

A

Positive results of 2 or 3 tests (30 to 300mg of albumin per g of creatinine) in a six month period

Risk factors are hypertension, poor diabetic control and smoking

19
Q

What are the treatments of diabetic nephropathy

A

Optimised diabetic control
Optimised hypertension treatment
Reduce proteinuria using ARB or ACEI
Stop smoking
SGLT2 inhibitor
Pancreas and kidney transplantation
Dialysis

20
Q

what is the pathogenesis of nephrotic syndrome

A

Hypoalbumin results when liver fails to synthesise the loss of albumin thorugh urine
which leads to low down capillary oncotic pressure
which leads to relatively unopposed capillary hydrostatic pressure and subsequent oedema formation

21
Q

what are the symptoms of nephrotic syndrome

A

Peripheral oedema Severe proteinuria Low serum albumin Variable amount microscopic haematuria Associated with hyperlipidaemia

22
Q

what are the symptoms of nephrotic syndrome

A

Peripheral oedema Severe proteinuria Low serum albumin Variable amount microscopic haematuria Associated with hyperlipidaemia

23
Q

how do you diagnose nephrotic syndrome

A

Urine dipstick: ^^protein
Blood tests: very low albumin concentration
^^Urine protein : creatinine ratio
Kidney biopsy: minimal change glomerulopathy

24
Q

what are the treatments of nephrotic syndrome

A

Immunotherapy - Corticosteriod, cyclophosphamide, tacrolimus, antibody therapy targeting B cell pathway
Diuretics - to reduce peripheral oedema
Prevention of thrombosis - anticoagulation

25
Q

what are the causes of nephrotic syndrome

what is minimal change glomerulopathy

A

Many causes - minmal change glomerulopathy, membranous nephropathy, focal segmental glomerulosclerosis and lupus nephritis

Minimal change glomerulopathy is most common in children, shows podocyte (cells in bowmans capsule) abnormal flattening on electron microscopy and faces high risk of thrombosis
damage to glomeruli cannot be seen under a regular microscope. It can only be seen under an electron microscope.

26
Q

How are stones in urinary tract formed

A

Forms when urine contains more crystal-forming substances such as calcium, oxalate and uric acid, than the fluid in your urine can dilute.

At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form

27
Q

what are the symptoms of stones

How would you diagnose this

A

Pain - abdomen and back-loin Blood in urine

Urine dipstick: blood and evidence of UTI
Blood test: kidney function reduced possibly
Imaging: Plain X-Ray, Ultrasound and CT scan

28
Q

Treatments for Stones?

A

Supportive - pain control & hydration

Shockwave Lithotripsy: High energy ultrasound waves to break up large kidney stones into smaller one.

Ureteroscopy: Through urethra, bladder and ureter

Percutaneous nephrolithotomy: Small percutaneous incision. Insertion of nephroscope. Stone is removed (may need to broken in smaller pieces).

29
Q

What are examples of tumours in the urinary tract

A

Benign prostatic hypertrophy
Renal cell carcinoma
Transitional cell carcinoma
Prostatic cancer
Testicular cancer

30
Q

Symptoms of tumour

Diagnosis?

A

Asymptomatic Haematuria Pain

Ultrasound, CT scan, MRI
Urine cytology
Prostatic specific antigen
Kidney function
Histological diagnosis: biopsy or excised tumour
Staging studies: any evidence of metastasis

31
Q

Treatments of tumours in urinary tract

A

Release obstruction of urinary tract - nephrostomy, bladder catheter, surgery Chemotherapy
Radiotherapy
Hormonal therapy for hormone sensitive cancer (e.g prostatic cancer) Surgery

32
Q

What are the three types of polycystic kidney disease

A

Neonatal: Autosomal recessive
Adult onset: Autosomal dominant
Some do not have genetic predisposition

Numerous cysts grow in the kidneys and these are filled with fluid. If too many grow or they get too big then the kidney can become damaged

33
Q

Symptoms of Polycystic kidney disease?

A

Back pain
Bleeding into renal cysts
Infection of renal cysts
Asymptomatic sometimes
Loss of kidney function
High blood pressure
Increased size of abdomen due to enlarged kidneys
Headaches
Haematuria sometimes

34
Q

How would you Diagnose Polycystic Kidney disease

A

Ultrasound
CT scan
MRI scan
Genetic screening
Urine test and dipstick: blood and protein

35
Q

Treatments of Polycystic Kidney disease?

A

Tolvaptan (Vasopressin 2 antagonist) to slow down cyst formation Treat hypertension, infection
Pain control
Renal replacement therapy (transplantaion, dialysis)

BRS (41 decks)

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