Urological Disorders Flashcards by Amii O

What are the 5 main functions of the kidney?

Filtration- removal of waste substance and keeping essential things in blood like blood cells, large proteins including albumin
Control salt and water balance
Control of acid/base balance
Hormones e.g. erythropoietin production- essential for haemoglobin synthesis
Vitamin D- 1-alpha-hydroxylation of vitamin D

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What happens when each of these functions go wrong?
(kidney dysfunction?

Filtration failure- unwell with accumulation of waste substance, haematuria & proteinuria, low serum protein, inc. albumin in blood
Hypertension, water retention (sometimes dehydration cuz unable to make concentrated urine)
Metabolic acidosis
Anaemia
Vitamin D deficiency & secondary hyperparathyroidism

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What are the 3 main types of urinary disorders?

Inflammatory
Obstructive
Developmental/Genetic

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What are the 3 subtypes of inflammatory urinary disorders?

Infectious cause
Immunological cause
Metabolic cause

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What are the (2) possible locations for infection in urological system, and what diseases do they cause (2)?

Bladder - Cystitis
Kidney - pyelonephritis

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What are the 2 potential pathogens that cause inflammation conditions of the genitourinary system

Bacteria - Most common
Virus and Fungi - Immunocompromised patients

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How is a diagnosis for a UTI made?

History
Physical exam
Urine dipstick
Urine microscopy, culture and sensitivity

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What are the tests in a physical exam that confirms UTI?

Temperature: 38℃
Blood pressure: 105/70 mmHg
Pulse: 80/min
Abdomen: soft, slightly tender over suprapubic area and left loin

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What is a positive result for a urine dipstick test for UTI?

2+ leucocytes, + nitrite, trace of blood

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What tests are done as part of urine microscopy, culture and sensitivity?

Blood tests:
- Renal profile
- Electrolytes
- Urea
- Creatinine

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What is the treatment for UTIs?

Antibiotics - Depending on severity
Pain control
Hydration
Imaging for differential diagnosis

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How can the immune system damage the kidney in immunological causes of inflammatory conditions?

Antibody
Inflammatory cells (neutrophils, monocytes, macrophages, Tcells)

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What is glomerulonephritis?

inflammation of the microscopic filtering units of the kidney

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What are three clinical presentations of glomerulonephritis?

Nephritic syndrome
Proteinuria
Nephrotic Syndrome

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

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

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What are the three patterns of organ involvement?

Kidney, Kidney and Lung, Whole organs and Other Tissues

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What is the dagnostic approach for treating immunological causes of inflammatory conditions?

History and physical exam
Urine test
Blood test- including immunology tests
Imaging- start with ultrasound
Kidney biopsy

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What is nephritic syndrome?

Haematuria
Variable amount of proteinuria
May have hypertension, reduced urine output, increased urea and creatinine

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What are positive investigation results of nephritis?

Urine Dipstick: 3+ blood, 2+ protein

Blood tests: raised serum urea and creatinine concentration, reduced eGFR. Autoantibodies were not detected.

Urine: raised urine protein : creatinine ratio

Kidney biopsy: IgA nephropathy

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

Nephritis

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What is IgA Nephropathy?

Deposition of IgA antibody in the kidney causing inflammation and scarring

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How can IgA Nephropathy be detected?

Immunohistochemistry

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How is IgA Nephropathy treated?

Supportive - ACE inhibitor or angiotensin receptor inhibitor
- Treat hypertension and reduce proteinuria
- Reduce sodium intake
Immunotherapy- late stage kidney disease
- Renal replacement therapy
- Kidney transplant
- Dialysis

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What immunological disease affects the kidneys and lungs?

Goodpasture’s Disease

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What is the pathophysiology behind Goodpastures disease?

it is anti-glomerular basement membrane antibody mediated.

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

There is a shared common antigen - alpha3 chain of type 4 collagen

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

Systemic Lupus Erythematosus - SLE due to autoantibodies: anti-dsDNA and antinuclear factor Vasculitis: due to ANCA - anti-neutrophil cytoplasm antibody

What is the pathogenesis of diabetic nephropathy?

Inflammation and fibroseis

What are three risk factors of diabetic nephropathy?

Poorly managed Diabetes Hypertension Smoking

What are the 3 clinical features of diabetic nephropathy

- Microalbuminuria - small amount of albumin in the urine - Proteinuria - Association with other complications of diabetes mellitus - Diabetic retinopathy/neuropathy

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

Deposition of ECM in Glomeruli Thickened glomerular basement membrane

What is the treatment and clinical management for diabetic nephropathy?

- **Optimised diabetic control** - Optimised treatment of hypertension - Reduce proteinuria using ARB or ACEI - Stop smoking - New clinical trials: SGLT2 inhibitor - Transplantation (including combined pancreas and kidney transplantation) - **Dialysis**

What are the key features of nephrotic syndrome?

Peripheral Oedema, Very severe Proteinuria Low Serum Albumin Variable amount of microscopic haematuria Hyperlipidaemia associations

What are the causes for nephrotic syndrome?

- Minimal change glomerulopathy - Membranous nephropathy - Focal segmental glomerulosclerosis - Lupus nephritis - Others

What are the key features of minimal change glomerulopathy?

- Most **common in children** - under **electron microscope** we see **podocyte effacement**- **abnormal flattened appearance** - **high risk of thrombosis**

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

Frothy urine face swelling - periorbital oedema leg swelling - pitting oedema of ankle Low - ish BP

What are do investigations show that indicate nephrotic syndrome?

Urine dipstick: No blood, 4+ protein Blood tests - Very low serum albumin Hight protein to creatinine ratio Kidney biopsy: minimal change glomerulopathy

How is nephrotic syndrome treated?

Immunotherapy Diuretics - reduces peripheral oedema Prevention of thrombosis - anticoags

What are the traditional treatments for nephrotic syndrome?

Corticosteroid Cyclophosphamide

What are the newer treatments for nephrotic syndrome?

Tacrolimus Antibodies that target B cell pathway

What are three possible locations for kidney stones?

Kidneys, bladder, ureter

What are some clinical presentations of obstructive stones?

Pain in back-loin and abdomen, blood in urine often associated w urine infection often stones are radio-opaque

What investigations are done for patients with kidney stones?

**Urine dip stick** - Blood in urine **Blood test** - Kidney function - reduced in some. **Imaging**:X ray CT or ultrasound

What does specific treatments for stones depend on?

- Size and location of stones - Local expertise - Fitness for anaesthetics

What are the three specific treatments for stones?

Shockwave lithotripsy Percutaneous Nephrolithotomy Ureteroscopy

What does shockwave lithotripsy involve?

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

What does percutaneous nephrolithotomy involve?

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

How does ureteroscopy work to remove stones?

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

What supportive treatment can be provided for kidney stones?

Hydration and pain medication

What neoplastic conditions can occur in the urinary system?

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

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

1. Polycystic kidney 2. horseshoe kidney

What are the two types of polycystic kidneys?

1. Neonatal - autosomal recessive 2. Adult - autosomal dominant

Can you get polycystic kidneys without family history?

yes

What are the three main consequences of polycystic kidneys?

Loss of kidney function pain bleeding in renal cysts or infection

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

Tolvaptan

How does tolvaptan work?

Vasopressin receptor 2 antagonist to slow down cyst formation

How can polycystic kidney disease be treated? other than tolvaptan?

Treat hypertension and infection Pain control Renal replacement therapy (transplantation dialysis)

How are polycystic kidneys detected?

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

What is horseshoe kidney?

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

What are the three consequences of horse show kidney?

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

How is horse shoe kidney diagnosed?

Through imaging eg CT scan