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URO not zara > Urological Disorders > Flashcards

Urological Disorders Flashcards

1
Q

What are the 5 main functions of the kidney?

A
  • 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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2
Q

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

A
  • 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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3
Q

What are the 3 main types of urinary disorders?

A

Inflammatory
Obstructive
Developmental/Genetic

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4
Q

What are the 3 subtypes of inflammatory urinary disorders?

A

Infectious cause
Immunological cause
Metabolic cause

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5
Q

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

A

Bladder - Cystitis
Kidney - pyelonephritis

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6
Q

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

A

Bacteria - Most common
Virus and Fungi - Immunocompromised patients

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7
Q

How is a diagnosis for a UTI made?

A
  • History
  • Physical exam
  • Urine dipstick
  • Urine microscopy, culture and sensitivity
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8
Q

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

A
  • Temperature: 38℃
  • Blood pressure: 105/70 mmHg
  • Pulse: 80/min
  • Abdomen: soft, slightly tender over suprapubic area and left loin
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9
Q

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

A

2+ leucocytes, + nitrite, trace of blood

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10
Q

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

A

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

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11
Q

What is the treatment for UTIs?

A

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

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12
Q

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

A
  • Antibody
  • Inflammatory cells (neutrophils, monocytes, macrophages, Tcells)
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13
Q

What is glomerulonephritis?

A

inflammation of the microscopic filtering units of the kidney

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14
Q

What are three clinical presentations of glomerulonephritis?

A

Nephritic syndrome
Proteinuria
Nephrotic Syndrome

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15
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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16
Q

What are the three patterns of organ involvement?

A

Kidney, Kidney and Lung, Whole organs and Other Tissues

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17
Q

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

A
  • History and physical exam
  • Urine test
  • Blood test- including immunology tests
  • Imaging- start with ultrasound
  • Kidney biopsy
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18
Q

What is nephritic syndrome?

A
  • Haematuria
  • Variable amount of proteinuria
  • May have hypertension, reduced urine output, increased urea and creatinine
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19
Q

What are positive investigation results of nephritis?

A

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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20
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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21
Q

What is IgA Nephropathy?

A

Deposition of IgA antibody in the kidney causing inflammation and scarring

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22
Q

How can IgA Nephropathy be detected?

A

Immunohistochemistry

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23
Q

How is IgA Nephropathy treated?

A

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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24
Q

What immunological disease affects the kidneys and lungs?

A

Goodpasture’s Disease

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25
Q

What is the pathophysiology behind Goodpastures disease?

A

it is anti-glomerular basement membrane antibody mediated.

26
Q

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

A

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

27
Q

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

A

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

28
Q

What is the pathogenesis of diabetic nephropathy?

A

Inflammation and fibroseis

29
Q

What are three risk factors of diabetic nephropathy?

A

Poorly managed Diabetes
Hypertension
Smoking

30
Q

What are the 3 clinical features of diabetic nephropathy

A
  • Microalbuminuria - small amount of albumin in the urine
  • Proteinuria
  • Association with other complications of diabetes mellitus
    - Diabetic retinopathy/neuropathy
31
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

32
Q

What is the treatment and clinical management for diabetic nephropathy?

A
  • 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
33
Q

What are the key features of nephrotic syndrome?

A

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

34
Q

What are the causes for nephrotic syndrome?

A
  • Minimal change glomerulopathy
  • Membranous nephropathy
  • Focal segmental glomerulosclerosis
  • Lupus nephritis
  • Others
35
Q

What are the key features of minimal change glomerulopathy?

A
  • Most common in children
  • under electron microscope we see podocyte effacement- abnormal flattened appearance
  • high risk of thrombosis
36
Q

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

A

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

37
Q

What are do investigations show that indicate nephrotic syndrome?

A

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

38
Q

How is nephrotic syndrome treated?

A

Immunotherapy
Diuretics - reduces peripheral oedema
Prevention of thrombosis - anticoags

39
Q

What are the traditional treatments for nephrotic syndrome?

A

Corticosteroid
Cyclophosphamide

40
Q

What are the newer treatments for nephrotic syndrome?

A

Tacrolimus
Antibodies that target B cell pathway

41
Q

What are three possible locations for kidney stones?

A

Kidneys, bladder, ureter

42
Q

What are some clinical presentations of obstructive stones?

A

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

43
Q

What investigations are done for patients with kidney stones?

A

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

44
Q

What does specific treatments for stones depend on?

A
  • Size and location of stones
  • Local expertise
  • Fitness for anaesthetics
45
Q

What are the three specific treatments for stones?

A

Shockwave lithotripsy
Percutaneous Nephrolithotomy
Ureteroscopy

46
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

47
Q

What does percutaneous nephrolithotomy involve?

A

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

48
Q

How does ureteroscopy work to remove stones?

A

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

49
Q

What supportive treatment can be provided for kidney stones?

A

Hydration and pain medication

50
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

51
Q

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

A
  1. Polycystic kidney
  2. horseshoe kidney
52
Q

What are the two types of polycystic kidneys?

A
  1. Neonatal - autosomal recessive
  2. Adult - autosomal dominant
53
Q

Can you get polycystic kidneys without family history?

A

yes

54
Q

What are the three main consequences of polycystic kidneys?

A

Loss of kidney function
pain
bleeding in renal cysts or infection

55
Q

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

A

Tolvaptan

56
Q

How does tolvaptan work?

A

Vasopressin receptor 2 antagonist to slow down cyst formation

57
Q

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

A

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

58
Q

How are polycystic kidneys detected?

A

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

59
Q

What is horseshoe kidney?

A

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

60
Q

What are the three consequences of horse show kidney?

A

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

61
Q

How is horse shoe kidney diagnosed?

A

Through imaging eg CT scan

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