Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BRS UROLOGY & RENAL > Urological Disorders > Flashcards

Urological Disorders Flashcards

1
Q

What are the 3 categories the urological disorders can be classified into?

A

Inflammation
Obstructive
Developmental/ Genetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the functions of a normal kidney?

A
  1. Filtration
    - Removal of waste substance
    - Keeping the essential substance within the blood: e.g.
    blood cells, large protein including albumin
  2. Control salt and water balance
  3. Control of acid/base balance
  4. Hormone: erythropoietin (EPO) production:
    essential for synthesis of Haemoglobin (Hb)
    - an renin
  5. Vitamin D: 1-α-hydroxylation of vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens to kidney function with kidney dysfunction?

A
  1. Filtration failure
    - Unwell with accumulation of waste substance
    - Haematuria and proteinuria, low serum protein,
    including albumin, in blood
  2. Hypertension, water retention (sometimes
    dehydration because unable to make concentrated
    urine)
  3. Metabolic acidosis
  4. Anaemia
  5. Vitamin D deficiency and secondary
    hyperparathyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are inflammatory urinary disorders?

A

Infection, including cystitis (UTI)

Non-infective causes:
1. Metabolic, including diabetic nephropathy
2. Immunological
- Nephritic syndrome
- Nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are obstructive urinary disorders?

A

Stones
Benign prostatic hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are developmental/ genetic urinary disorders?

A

Polycystic kidneys, horseshoe kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where can urinary disorders occur?

A

Stones can occur in the ureter or in the bladder

Renal disease in the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is raised concentration of waste substance in the blood a consequence of kidney disease?

A

True: Reduction in glomerular filtration rate will result in accumulation of waste substances in the blood. The most common clinical test is to measure serum concentrations of urea and creatinine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is presence in blood cells a consequence of kidney disease?

A

True: Presence of blood cells in the urine may be due to damage glomeruli (leaking from cells into the urine) or bleeding due to structural problems, such as tumours or polycystic kidneys. The blood cells may be detected by urine dipstick or microscopy of urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is the blood pressure always high with kidney disease?

A

False: Although the blood pressure is often high due to salt and water retention in patients with kidney diseases.

In some patients, the blood pressure low in some patients who have
-dehydration
or
- low in vascular volume

because unable to make concentrated urine, or losing too much sodium in urine or dehydration due to vomiting. Blood pressure changes can be measured by blood pressure machine in the sitting or supine position. Some patients’ low blood pressure may be more obvious in the standing position (postural hypotension).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Is abnormal hormone profile a consequence of kidney disease?

A

True: Reduction of synthesis in erythropoietin or secondary hyperparathyroidism.

The patients may have low erythropoietin production result in anaemia. This may be detected in reduced concentration of haemoglobin in full blood count with the relevant medical history of late stage chronic kidney disease, despite sufficient vitamin B12, folate and iron store. Because of cost, the direct measurement of erythropoietin is only done in some atypical clinical situations.

OR increased parathyroid hormone (PTH) as a secondary response to vitamin D deficiency (secondary hyperparathyroidism). High concentration of PTH can be measured in peripheral blood in the presence of low or normal serum calcium, high or normal serum phosphate. Routine vitamin D blood test does not detect 1,25 vitamin D concentration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the possible locations for an infection?

A

Bladder: cystitis

Kidney: pyelonephritis

Consider other contributing factors e.g. obstruction, stones, prostatic hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are potential pathogens?

A

Bacteria: most common

Virus: immunocompromised patients

Fungal: immunocompromised patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does a bladder infection occur (cystitis)?

A

Harmful pathogen enter bladder causing inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we make the diagnosis of a UTI?

A

History
Physical examination
Urine dipstick (link to dipstick practical)
Urine microscopy, culture and sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the treatment and overall clinical management of a UTI?

A

Antibiotics:
❖ depending on the severity of illness
❖ the most common bacteria in the local area
❖ modified when the sensitivity from urine culture is available

Some patients may be very ill and need to be treated as inpatient.
Pain control
Supportive e.g. hydration
Consider imaging if other factors or differential diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What would you expect to see on a urine culture?

A

E.coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How can the immune system damage the kidney?

A

Potential Mechanisms:
Antibody
Inflammatory cells (neutrophils, monocytes/macrophages, T cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are clinical presentations of inflammatory condition with immunological causes of kidney damage?

A

Nephritic syndrome
Proteinuria
Nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the difference between nephritic and nephrotic syndrome?

A

The nephrItic syndrome is a clinical syndrome that presents as hematuria, elevated blood pressure, decreased urine output, and oedema. The major underlying pathology is inflammation of the glomerulus that results in nephritic syndrome.

Nephrotic syndrome has symptoms include. too much protein in your urine, called proteinuria. low levels of a protein called albumin in your blood, called hypoalbuminemia. swelling in parts of your body, called edema.

Nephritic= blood

Nephrotic= protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What Is glomerulonephritis?

A

Inflammation of the microscopic filtering units of the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can you check for inflammatory cells in the kidney?

A

Immunostaining of inflammatory cells (brown staining) in a kidney biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the potential patterns of organ involvement in imlammatroy conditions with an immunological cause?

A

Kidney only
Kidney and lung
Multiple organs/tissues involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a diagnostic approach of inflammatory conditions?

A

History and physical examination

Urine test

Blood test: including immunology tests

Imaging: start with ultrasound

Kidney biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is nephritic syndrome?

A

Haematuria

Variable amount of proteinuria

May have hypertension, reduced urine output, increased urea and creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do we make a diagnosis for nephritic syndrome?

A

History
Physical examination
Urine dipstick (link to dipstick practical)
Urine microscopy
Urine protein : creatinine ratio

Blood tests:
- kidney function
- immunology test

Kidney biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are possible symptoms for nephritic syndrome?

A

Sore throat
Red in urine
High blood pressure

in dipstick there is high blood and protein

Urine has a raised urine protein: creatinine ratio

Kidney biopsy has IgA nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is IgA nephropathy?

A

The most common primary glomerulonephritis world-wide.

Very high prevalence in Far East.

Deposition of IgA antibody in the kidney (detected by immunohistochemistry).

Inflammation and scarring.

About 30% progress to kidney failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the treatment for IgA nephropathy?

A

Supportive:
- Treat hypertension and reduce proteinuria
First line treatment: angiotensin receptor inhibitor (ARB) (e.g. irbesartan) or angiotensin converting enzyme inhibitor (ACEI) (e.g. ramipril)
- Reduce sodium intake

Immunotherapy: (Many different choices, ongoing clinical trials)
- Renal replacement therapy: when reaching late stage kidney disease
❖ Kidney transplantation
❖ Dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is an organ specific: kidney and lung disease?

A

Anti-glomerular basement membrane (GBM) antibody mediated: Good pasture’s disease.
- Shared common antigen between lung and kidney: α3chain of type IV collagen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are examples of systemic diseases: multiple organ/ tissue involved?

A

Systemic lupus erythematosus (SLE): autoantibodies: antinuclear factor, anti-dsDNA.

Vasculitis: antineutrophil cytoplasm antibody (ANCA).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is diabetic nephropathy?

A

The most common cause of chronic kidney disease and kidney failure in the Western World.

Pathogenesis: inflammation and fibrosis

33
Q

What are the risk factors for diabetic nephropathy?

A

Hypertension
Poor diabetic control
Smoking

34
Q

What are the clinical features of diabetic nephropathy?

A
  • Microalbuminuria
  • Proteinuria

Association with other complications of diabetes
mellitus
- Diabetic retinopathy
- Diabetic neuropathy

35
Q

What is the treatment and management control for diabetic nephropathy?

A

Optimised diabetic control

Optimised treatment of hypertension

Reduce proteinuria using ARB or ACEI

Stop smoking

New treatments: SGLT2 inhibitor

Transplantation (including combined pancreas and kidney transplantation)

Dialysis

36
Q

What happens to the glomerulus with diabetic nephropathy?

A

Thickened glomerular basement membrane

Deposition of extracellular matrix in the glomerulus

37
Q

What is nephrotic syndrome?

A

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

38
Q

How do we make the diagnosis for nephrotic syndrome?

A

History
Physical examination
Urine dipstick (link to dipstick practical)
Urine microscopy
Urine protein : creatinine ratio
Blood tests: kidney function, immunology test
Kidney biopsy

39
Q

What are symptoms for nephrotic syndrome?

A

Frothy urine
Periorbital oedema
ankle: pitting oedema

Urine dipstick: high protein, no blood
BLood test: very low serum albumin concentration
Very high urine protein: creatinine ratio

(minimal change glomerulopathy in kidney biopsy)

40
Q

What are the causes for nephrotic syndrome?

A

lots of reasons e.g.,

Minimal change glomerulopathy
Membranous nephropathy
Focal segmental glomerulosclerosis
Lupus nephritis

41
Q

What are the key features of minimal change glomerulopathy?

A

Most common in children, also affect other age groups
Normal light microscopy
Electron microscopy: podocyte effacement-abnormal flatten appearance (figure below)
Complication: high risk of thrombosis

42
Q

What are the treatment for nephropathy?

A

Immunotherapy
- Traditionally: corticosteroid, cyclophosphamide
- Recent development: tacrolimus, antibody therapy targeting B cell pathway

Diuretics: to reduce the peripheral oedema

Prevention of thrombosis: anticoagulation

43
Q

Is this a good approach to investigate and treat patients with possible inflammatory condition of the kidney?

“Just rush along and start some medication asap”

A

False:

It is not a good approach to rush along and start medication without appropriate medical history, physical examination and investigation.

The best approach will be to take a careful medical history and physical examination, which will guide the choice of appropriate investigation to establish the diagnosis of the possible inflammatory conditions of the kidney. Then, it will be important to discuss with the patient the prognosis and the treatment option.

44
Q

Is this a good approach to investigate and treat patients with possible inflammatory condition of the kidney?

“give antibiotics and immunosuppression to everyone”

A

False:

the choice of antibiotics or immunosuppressive medications should only be used with the relevant clinical diagnosis.

Medication history, including any previous allergy to medication, is very important. In patients with bacterial infection of the urinary tract, it will be very helpful to collect bacterial culture samples before the first dose of antibiotics, if possible. It is also important that antibiotics needs to be given as soon as possible in potentially life-threatening infection.

45
Q

Is this a good approach to investigate and treat patients with possible inflammatory condition of the kidney?

“Carry out comprehensive immunological investigation for all the patients”

A

False: this is one the hardest clinical practice questions. The history and physical examination is the best guidance to choose the appropriate immunological tests.

46
Q

Is this a good approach to investigate and treat patients with possible inflammatory condition of the kidney?

“Urine dipstick”

A

True: urine dipstick test will provide screening results within 1 minute. This quick results will be very helpful for choice for further laboratory investigation or give some indication for initial treatment (for example, patients with clinical history of urine infection, and urine dipstick for nitrite and leukocytes).

47
Q

What is an obstructive disorder example?

A

Stones

48
Q

Where are the possible locations for stones?

A

Kidney Ureter and Bladder

49
Q

What are the clinical presentation of stones?

A

Pain (abdomen, back-loin).

Blood in urine.

Associated with urine infection.

About 90% of kidney stone are radio-opaque.

50
Q

What is noticed with stones during a physical examination?

A

Tenderness of loin and lower abdomen.

51
Q

What are the investigation for stones?

A

Urine inspection and dipstick: Blood in urine, +/- evidence of urine infection.

Blood test: Kidney function (reduced only in some patients).

Imaging: Plain X ray, ultrasound or CT scan.

52
Q

What is the supportive treatment for stones?

A

Pain control and hydration

53
Q

What does the specific treatment for stones depend on?

A

Size and location of stones
Availability of local expertise
Fitness of the patient for general anaesthetics

54
Q

What are the specific treatments for stones?

A

Shockwave lithotripsy
Ureteroscopy
Percutaneous nephrolithotomy

55
Q

What is shockwave lithotripsy?

A

High energy ultrasound waves to break up large kidney stones into smaller one

56
Q

What is ureteroscopy?

A

Through urethra, bladder and ureter.
minimally invasive

57
Q

What is percutaneous nephrolithotomy?

A

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

58
Q

What are the different types of polycystic kidneys?

A

Neonatal: autosomal recessive
Adult onset: autosomal dominant
Some patients without family history

59
Q

What are the consequences of polycystic kidneys?

A

Loss of kidney function
Pain
Bleeding into the renal cysts
Infection of renal cysts
Asymptomatic in some patients

60
Q

What is the treatment of polycystic kidney disease?

A

New medication: Tolvaptan (a vasopressin receptor 2 antagonist) to slow down the cysts formation.

Treat hypertension, infection.

Pain control.

Renal replacement therapy (transplantation, dialysis).

61
Q

How do we know if a patient has a horseshoe kidney?

A

Imaging of abdomen/ pelvis

62
Q

What are the consequences of horseshoe kidney?

A

Obstruction
Stone
Infection

63
Q

What are the variety of clinical presentation of immunological kidney diseases?

A

Kidney only, e.g. IgA nephropathy
Kidney and lungs, e.g. anti-GBM disease
Systemic multiorgan/tissue e.g. SLE, vasculitis

64
Q

Can patients always go home the same day after treatments for stones in the urological systems?

A

False: Although some patients may be treated and discharge home on the same day, there are some patients who will have severe infection and dehydration.

These patients may need to be treated as inpatients with intravenous antibiotics and rehydration. If there is significant obstruction for urine outflow, the patient will also need procedure to unblock the obstruction. For example, bladder catheter for bladder outflow obstruction or nephrostomy for kidney urine outflow obstruction.

65
Q

Is past medical history not important for diagnosis and treatment of stones?

A

False: The past history, such as previous history of urological stone, urinary tract infection, previous surgery and medication history, including allergy to medications, are all important in making the diagnosis and carrying out the appropriate treatment.

66
Q

Do urine cultures have to be sent for bacterial culture when considering stones?

A

True: Bacterial culture from urine samples is very important, because the patient may have bacterial infection of the urinary tract at the same time.

67
Q

Are plain abdominal X ray not useful for stones?

A

False: About 90% of urological stones are radiopaque. A plain abdomen X ray cover the kidney, ureter and bladder region is therefore very useful. This type of X ray investigation is available in all Accident and Emergency Department and Walk-in Medical Centres.

68
Q

What does damage to the glomerulus do?

A

Glomerular damage compromises the filtration function

69
Q

What does reduced kidney functionality do?

A

Could cause tiredness (due to loss of detoxifying kidney function and reduced erythropoietin (EPO) production causing anaemia) and swollen ankles (due to water retention in the periphery as a result of loss of proteins and reduced kidney function).

70
Q

What are the pros and cons for X-rays for checking the urinary tract?

A

Quick, easy and readily available in most hospital departments, but patient is exposed to radiation

71
Q

What are the pros and cons of ultrasounds to check the urinary tract?

A

Can detect the dilation of the urinary system due to the obstruction which can be useful in spotting loss of function. Small stones cannot be detected.

72
Q

What are the pros and cons of CT scans to check the urinary tract?

A

Highly sensitive in detecting small stones but involves radiation exposure.

73
Q

What are the possible causes of stones?

A

Prostate enlargement
Any nervous system disease damaging the bladder nerves
Gout
Hydration
Diet

74
Q

Why does prostate enlargement cause stones?

A

This is a common condition in men of older age - can obstruct urine excretion, causing stones to form in the bladder from the minerals in the urine.

75
Q

Why does any nervous system disease damaging the bladder nerves cause stones?

A

This will cause partial urine excretion, causing stones to develop in the bladder. E.g., neurological disease generally affecting 60+ age adults.

76
Q

Why does gout cause stones?

A

Increased blood uric acid levels → increased risk of kidney stone development.

77
Q

Why does hydration/ dehydration cause stones?

A

Being dehydrated concentrates the urine, increasing the chances of stones

78
Q

Why does your diet cause stones?

A

A diet rich in Sodium or animal protein or poor in Calcium can lead to stone formation as it can cause an increase in Calcium, uric acid and oxalate levels (different stone types) respectively in urine.

79
Q

What are stone forming chemicals?

A

calcium, oxalate, urate, cystine, xanthine, and phosphate

BRS UROLOGY & RENAL (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions