Urological disorders Flashcards
Consequences of kidney dysfunction?
Filtration failure. Hypertension (water retention), metabolic acidosis, anaemia, vitamin D deficiency and secondary hyperparathyroidism.
How does kidney dysfunction cause anaemia?
Kidneys produces EPO which stimulates production of erythrocytes.
How does kidney dysfunction lead to secondary hyperparathyroidism?
Kidneys have enzyme 1 alpha hydroxylase to convert 25(OH)D3 into calcitriol. Calcitriol inhibits PTH release and so without calcitriol you will have high amounts of PTH in blood.
What are signs of filtration failure in kidney dysfunction?
Haematuria and proteinuria. Low serum albumin.
What are the 3 classes of kidney disorders?
Inflammatory, obstructive and genetic.
What is inflammation of the bladder called?
Cystitis.
What is inflammation of the kidney called?
Pyelonephritis.
Urine dipstick for UTI?
2+ leucocytes, + nitrite, trace of blood
What is the most common pathogen for inflammatory urological disorders?
Bacteria.
What pathogens can cause inflammatory urological disorders in immunocompromised patients?
Viruses and fungi.
What is the prescription strategy for a urinary tract infection?
Antibiotics. Look at most common bacteria in local area and then modify when urine culture results are available.
What is glomerulonephritis?
Inflammation of filtering units in kidney.
What other organs would you check for when looking at inflammatory urological disorders?
Lungs.
What imaging technique would start off with when looking at inflammatory urological disorders?
Ultrasound.
What are the key features of nephritic syndrome?
Haematuria, proteinuria.
Urine Dipstick for nephritic syndrome?
3+ blood, 2+ protein
Tests for nephritic syndrome and nephrotic syndrome?
Urine dipstick, urine microscopy, urine protein : creatinine ratio.
Blood tests : kidney function and immunological tests.
What test would confirm an IgA nephropathy?
Kidney biopsy and immunohistochemistry.
What kind of disease is IgA nephropathy?
Nephritic syndrome.
What is the first line treatment for nephropathy?
ACE inhibitor or angiotensin receptor inhibitor.
What lifestyle advice for nephropathy?
Reduce sodium intake.
How does an ACE inhibitor treat nephropathy?
Reduces hypertension. Reduce proteinuria by lowering the intraglomerular pressure, reducing hyperfiltration.
In good pasture syndrome what is targeted?
Alpha 3 chain of type IV collagen in Glomerular basement membrane and alveolar basement membrane.
Autoimmune conditions that can cause nephropathy?
Goodpasture’s disease, systemic lupus erythematosus and vasculitis.
Autoantibodies for SLE?
Antinuclear antibodies and anti double stranded DNA.
Autoantibody for vasculitis?
Anti-neutrophil cytoplasm antibody.
Urine markers for diabetic nephropathy?
Microalbuminuria and proteinuria.
Treatments for diabetic nephropathy?
ACE inhibitor, Angiotensin receptor inhibitor and SGLT2 inhibitor.
What histological features in diabetic nephropathy?
Thickened glomerular basement membrane. Deposition of extracellular matrix in the glomerulus (fibrotic tissue).
Key features of nephrotic syndrome?
Peripheral oedema, severe proteinuria, low serum albumin. Low blood pressure.
Urine dipstick for nephrotic syndrome?
no blood, 4+ protein.
Blood test for nephrotic syndrome?
Very low serum albumin concentration
What is nephrotic syndrome associated with?
Hyperlipidaemia.
What would the urine protein:creatine ratio be in individuals who have nephritic or nephrotic syndrome?
Raised protein:creatinine ratio.
Minimal change glomerulopathy is what kind of nephropathy?
Nephrotic syndrome.
Treatment for nephrotic syndrome?
Corticosteroid, cyclophosphamide, tacrolimus. Diuretics. Anticoagulants.
How does tacrolimus help treat nephrotic syndrome?
Targets B cell pathway.
How do diuretics help treat nephrotic syndrome?
Reduce oedema.
How do anticoagulants help treat nephrotic syndrome?
Prevent thrombosis.
Who does minimal change glomerulopathy usually affect?
Children.
What needs to be used in the kidney biopsy of minimal change glomerulopathy?
Electron microscope.
What is seen in the kidney biopsy of minimal change glomerulopathy when using an electron microscope?
Flattened podocyte foot processes.
Major complication of minimal change glomerulopathy?
Thrombosis.
Where can kidney stones be found?
Kidney, ureter and bladder.
Presentation of kidney stones?
Pain in abdomen. Blood in urine.
What do kidney stones increase risk of?
UTI.
How would you check for kidney stones?
Physical examination to see if there is tenderness in loin or back area. Dipstick to see if there is blood in urine. Blood tests for kidney function. X ray, ultrasound or CT scan.
Treatment for kidney stones?
Shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy.
What is the inheritance pattern of polycystic kidney disease that develops in a neonatal?
Autosomal recessive.
What is the inheritance pattern of polycystic kidney disease that develops in an adult?
Autosomal dominant.
Consequence of polycystic kidney disease?
Bleeding and infection of the cysts.
What medications is used to treat polycystic kidney disease? What kind of drug is it?
Tolvaptan - vasopressin receptor 2 antagonist.
How does tolvaptan treat polycystic kidney disease?
Slows down formation of cysts.
What is a horseshoe kidney?
Horseshoe kidney happens when the two kidneys are fused.
Consequences of horseshoe kidney?
Kidneys stones and infection.
Causes of kidney stones?
Prostate enlargement, gout and dehydration.
