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BRS 12 Urology and renal > Urological Disorders > Flashcards

Urological Disorders Flashcards

1
Q

What two problems can arise from filtration failure?

A

Haematuria and proteinuria
or accumulation of waste substances

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2
Q

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

A

By measuring the serum concentrations of urea and creatinine

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3
Q

How is haematouria detected?

A

Through a urine dipstick

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4
Q

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

A

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

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5
Q

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

A

Unable to make concentrated urine
Losing too much sodium in urine
Dehydration due to vomiting

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6
Q

What hormonal problems might urological conditions lead to?

A

Reduced erythropoietin
Secondary hyperparathyroidism

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7
Q

What is the consequence of reduced EPO with kidney disease?

A

Reduction in erythropoiesis, leading to anaemia

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8
Q

How does vitamin D synthesis get affected by kidney disease?

A

The kidneys are responsible for the activation of Vitamin D by the 1-alpha hydroxylation of 25-hydroxycholecalciferol
In kidney disease this might not occur

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9
Q

Why is PTH raised in patients with kidney disease?

A

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

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10
Q

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

A

Fungi and virus

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11
Q

What are the most common pathogens for a kidney problem?

A

Bacteria

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12
Q

What is an infection of the bladder called?

A

Cystitis

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13
Q

What is an infection of the kidney called?

A

Pylonephritis

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14
Q

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

A

Stones, obstructions and prostatic hypertrophy

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15
Q

What are signs and symptoms of a UTI?

A

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

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16
Q

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

A

High leucocytes, high nitrite and traces of blood

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17
Q

How are UTIs treated?

A

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

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18
Q

What two ways can the immune system damage the kidneys?

A

Antibodies
Inflammatory cells (neutrophils, macrophages, T cells)

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19
Q

What is glomerulonephritis?

A

Inflammation of the microscopic filtering units of the kidney

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20
Q

What are three clinical presentations of glomerulonephritis?

A

Nephritic syndrome
Proteinuria
Nephrotic syndrome

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21
Q

What are the three patterns of organ involvement?

A

Kidney
Kidney and lung
Whole organs and other tissues

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22
Q

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

A

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

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23
Q

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

A
  1. History
  2. Physical Examination
  3. Urine dip stick
  4. Urine microscopy
  5. Urine protein to creatinine ratio
  6. Blood tests
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24
Q

What is nephritic syndrome?

A

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

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25
Q

What are some symptoms of nephritis?

A

Blood in urine, variable protein in urine
Increased urea and creatinine
Hypertension

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26
Q

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

A

Nephritis

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27
Q

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

A
  1. High serum urea and creatinine
  2. Low GFR
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28
Q

What is IgA Nephropathy?

A

Deposition of IgA antibody in the kidney causing inflammation and scarring

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29
Q

How can IgA Nephropathy be detected?

A

Immunohistochemistry

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30
Q

How is IgA Nephropathy treated?

A

Supportive treatment to reduce hypertension (e.g. angiotensin receptor inhibitors, angiotensin converting enzyme inhibitor)
Reduce sodium intake

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31
Q

How can IgA nephropathy be treated with immunotherapy?

A

Renal Replacement Therapy (transplantation or dialysis)

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32
Q

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

A

Inflammation and scarring

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33
Q

What disease affects the kidneys and lungs?

A

Goodpasture’s disease

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34
Q

What might a smoker with goodpasture’s disease experience?

A

Kidney failure, coughing up blood

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35
Q

What is the pathophysiology behind Goodpastures disease?

A

It is anti-glomerular basement membrane antibody mediated

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36
Q

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

A

There is a shared common antigen
(Alpha-3-chain of type IV collagen)

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37
Q

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

A

Systemic lupus erythmatous due to autoantibodies (anti-double stranded DNA, antinuclear factor)
Vasculitis due to anti-neutrophil cytoplasm antibody (ANCA)

38
Q

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

A

Diabetic Nephropathy

39
Q

What is the pathogenesis of diabetic nephropathy?

A

Inflammation and fibrosis

40
Q

What are three risk factors of diabetic nephropathy?

A

Poorly managed diabetes
Pooly managed hypertension
Smoking

41
Q

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

A

Microalbuminuria - small amount of albumin in the urine
Proteinuria

42
Q

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

A

Deposition of ECM in glomeruli
Thickened glomerular basement membrane

43
Q

What are the key features of nephrotic syndrome?

A

Oedema, Very severe Proteinuria, Low Serum Albumin

44
Q

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

A

Frothy urine, and face and leg swelling

45
Q

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

A

Pitting ankle oedema

46
Q

What is the main cause of nephrotic syndrome?

A

Minimal change glomerulopathy

47
Q

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

A

Electron microscope

48
Q

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

A

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

49
Q

Who is minimal change glomerulopathy most common in?

A

Children

50
Q

How is nephrotic syndrome treated?

A

First give broad spectrum immunosuppresants like corticosteroid and cyclosporin

51
Q

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

A

Diuretics

52
Q

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

A

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

53
Q

What thrombotic conditions can present in patients with nephrotic syndrome?

A

DVT and Major Pulmonary Embolism

54
Q

What are some recent advancements in treatment for nephrotic syndrome?

A

Tacrolimus - antibody treatment targeting B cell pathway

55
Q

What are three possible locations for kidney stones?

A

Kidneys, bladder, ureter

56
Q

What are some clinical presentations of obstructive stones?

A

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

57
Q

Why should urine of patients with stones be cultured?

A

UTI’s are very common in patients with stones

58
Q

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

A

90% of stones are radio-opaque

59
Q

What investigations are done for patients with kidney stones?

A

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

60
Q

What are the three possible treatments for stones?

A

Shockwave lithotripsy
Percutaneous nephrolithotomy
Ureteroscopy

61
Q

What does shockwave lithotripsy involve?

A

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

62
Q

What does percutaneous nephrolithotomy involve?

A

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

63
Q

How does ureteroscopy work to remove stones?

A

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

64
Q

What supportive treatment can be provided for kidney stones?

A

Hydration and pain medication

65
Q

What neoplastic conditions can occur in the urinary system?

A

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

66
Q

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

A
  1. Polycystic kidney
  2. Horseshoe kidney
67
Q

What are the two types of polycystic kidneys?

A
  1. Neonatal
  2. Adult
68
Q

What is the genetic inheritance pattern of neonatal polycystic kidneys?

A

Autosomal recessive

69
Q

What is the genetic inheritance pattern of adult polycystic kidneys?

A

Autosomal dominant

70
Q

Can you get polycystic kidneys with family history?

A

Yes

71
Q

What are the three main consequences of polycystic kidneys?

A

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

72
Q

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

A

Tolvaptan

73
Q

How does tolvaptan work?

A

Vasopressin receptor 2 antagonist to slow down cyst formation

74
Q

How can polycystic kidney disease be treated?

A

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

75
Q

How are polycystic kidneys detected?

A

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

76
Q

What is horseshoe kidney?

A

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

77
Q

When does horseshoe kidney occur?

A

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

78
Q

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

A

Flanking or abdominal pain

79
Q

What are the three consequences of horse show kidney?

A

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

80
Q

How is horse shoe kidney diagnosed?

A

Through imaging eg CT scan

81
Q

What are the risk factors associated with diabetic nephropathy?

A

Uncontrolled type 2 Diabetes and Hypertension

82
Q

What are the pathological features of diabetic nephropathy?

A

Damaged glomerulus of the nephron
Reduced kidney functionality

83
Q

Why does reduced kidney functioning caused tiredness?

A

Reduced EPO production leads to anaemia = tiredness

84
Q

Why does reduced kidney function lead to swollen ankles?

A

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

85
Q

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

A
  • 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
86
Q

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

A

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

87
Q

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

A

Highly sensitive in detecting small stones but involves radiation exposure

88
Q

How does prostate enlargement lead to kidney stones?

A

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

89
Q

How do neurological conditions affect kidney stones?

A

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

90
Q

How does gout cause kidney stones?

A

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

91
Q

How does dehydration affect stones?

A

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

92
Q

How does diet affect kidney stone formation?

A

Diet rich in sodium - cause increase in calcium
Animal protein - cause increase in uric acid
Low in calcium - cause increase in oxalate
All increase risk of stone formation

BRS 12 Urology and renal (11 decks)

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