urological disorders Flashcards
- What are the consequences of kidney failure?
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
- What is inflammation of the bladder called?
- What are some of the non-infective causes of inflammatory urinary disorders?
cystisis
Metabolic
- Diabetic nephropathy
Immunological
- Nephritic syndrome
- Nephrotic syndrome
- 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?
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Stones
Benign prostatic hypertrophy
Kidney, bladder, prostatic or testicular cancer Polycystic kidneys, horseshoe kidney
- What are some of the potential mechanisms that immune system damage to the kidney might occur?
Through antibodies or inflammatory cells (neutrophils, monocytes, macrophages or T cells)
- What is glomerulonephritis?
Inflammation of microscopic filtering of the kidney
- How might you go about diagnosing immunogical causes of the inflammatory urological disorder?
History and physical examination
Urine Test Blood Test: including immunology tests Imaging: start with ultrasound Kidney biopsy
- 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?
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
what is the pathophysiology of a UTI
What are the symptoms of a UTI
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
How do you diagnose a UTI
History
Physical Examination
Urine dipstick - leukocyte esterase, nitrite and some blood
Urine microscopy - blood tests e.g - renal profile
Renal Ultrasound
Voiding cystourethrogram
What are the treatments of a UTI
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
What are the complications of a UTI
What are the risk factors
Complications - Pyelonephritis, Urosepsis, Septic shock
Risk Factors - Young biological females, Sexual intercourse, Postmenopausal. Diabetes mellitus, Impaired bladder emptying/urinary stasis
What is the pathophysiology of Nephritic Syndrome
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
How do you diagnose nephritic syndrome
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)
What are the treatments of nephritic syndrome
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)
what is the most common primary glomerulonephritis world-wide
IgA nephropathy
with a lot of IgA in kidney
About 30% progress to kidney failure
what is the pathogenesis of diabetic nephropathy
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
what are the symptoms of diabetic nephropathy
Worsening blood pressure control
Increased need to urinate
Swelling of feet, hands or eyes
Microalbuminuria
Proteinuria
Association with diabetic retinopathy and neuropathy
how do you diagnose diabetic nephropathy
what are its risk factors
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
What are the treatments of diabetic nephropathy
Optimised diabetic control
Optimised hypertension treatment
Reduce proteinuria using ARB or ACEI
Stop smoking
SGLT2 inhibitor
Pancreas and kidney transplantation
Dialysis
what is the pathogenesis of nephrotic syndrome
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
what are the symptoms of nephrotic syndrome
Peripheral oedema Severe proteinuria Low serum albumin Variable amount microscopic haematuria Associated with hyperlipidaemia
what are the symptoms of nephrotic syndrome
Peripheral oedema Severe proteinuria Low serum albumin Variable amount microscopic haematuria Associated with hyperlipidaemia
how do you diagnose nephrotic syndrome
Urine dipstick: ^^protein
Blood tests: very low albumin concentration
^^Urine protein : creatinine ratio
Kidney biopsy: minimal change glomerulopathy
what are the treatments of nephrotic syndrome
Immunotherapy - Corticosteriod, cyclophosphamide, tacrolimus, antibody therapy targeting B cell pathway
Diuretics - to reduce peripheral oedema
Prevention of thrombosis - anticoagulation
what are the causes of nephrotic syndrome
what is minimal change glomerulopathy
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.
How are stones in urinary tract formed
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
what are the symptoms of stones
How would you diagnose this
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
Treatments for Stones?
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).
What are examples of tumours in the urinary tract
Benign prostatic hypertrophy
Renal cell carcinoma
Transitional cell carcinoma
Prostatic cancer
Testicular cancer
Symptoms of tumour
Diagnosis?
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
Treatments of tumours in urinary tract
Release obstruction of urinary tract - nephrostomy, bladder catheter, surgery Chemotherapy
Radiotherapy
Hormonal therapy for hormone sensitive cancer (e.g prostatic cancer) Surgery
What are the three types of polycystic kidney disease
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
Symptoms of Polycystic kidney disease?
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
How would you Diagnose Polycystic Kidney disease
Ultrasound
CT scan
MRI scan
Genetic screening
Urine test and dipstick: blood and protein
Treatments of Polycystic Kidney disease?
Tolvaptan (Vasopressin 2 antagonist) to slow down cyst formation Treat hypertension, infection
Pain control
Renal replacement therapy (transplantaion, dialysis)
