Urological disorders Flashcards
What 5 physiological changes occur in kidney dysfunction?
Filtration failure
Unwell with accumulation of waste substance
Haematuria and proteinuria, low serum protein, including albumin, in blood
Hypertension, water retention (sometimes dehydration because unable to make concentrated urine)
Metabolic acidosis
Anaemia
Vitamin D deficiency and secondary
hyperparathyroidism
What are the 3 types of urinary disorders and give some examples of each
Inflammatory
Infection, including cystitis
Non-infective causes:
1. Metabolic, including diabetic nephropathy
- Immunological
Nephritic syndrome
Nephrotic syndrome
Obstructive
Stones
Benign prostatic hypertrophy
Developmental /Genetic
Polycystic kidneys, horseshoe kidney
What are the names of inflammation of the bladder and kidney?
Bladder:Cystitis
Kidney:Pyelonephritis
What 4 factors do you consider when making a UTI diagnosis?
History
Physical examination
Urine dipstick (link to dipstick practical)
Urine microscopy, culture and sensitivity
What management do you consider for treating a UTI?
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.
What 2 ways can the immune system damage the kidneys and how does it present clinically?
Antibody
Inflammatory cells (neutrophils, monocytes/macrophages, T cells)
Presentation:
Nephritic syndrome
Proteinuria
Nephrotic syndrome
Glomerulonephritis def
Inflammation of the nephrons
3 syndromes/symptoms in immunologically caused kidney inflammation
Nephritic syndrome
Proteinuria
Nephrotic syndrome
What are the 5 steps for investigation of immune mediated kidney disease
- History and physical examination
- Urine test
- Blood test: including immunology tests
- Imaging: start with ultrasound
- Kidney biopsy
How does nephritic syndrome present?
Haematuria
Variable amount of proteinuria
May have hypertension, reduced urine output, increased urea and creatinine
What is the epidemiology of IgA nephropathy like?
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.
What are the 2 categories of IgA nephropathy treatment and what is involved in them?
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
Give an organ specific(kidney and lung) disease and how the disease is shared between the organs
Anti-glomerular basement membrane (GBM) antibody mediated: Goodpasture’s disease.
Shared common antigen between lung and kidney: α3chain of type IV collagen
Give 2 conditions immunologically caused inflammatory conds. and their organ-relating factors
Systemic lupus erythematosus (SLE): autoantibodies: antinuclear factor, anti-dsDNA.
Vasculitis: antineutrophil cytoplasm antibody (ANCA).
What are the risk factors and clinical features of diabetic nephropathy
The most common cause of chronic kidney disease and kidney failure in the Western World.
Pathogenesis: inflammation and fibrosis
Hypertension
Poor diabetic control
Smoking
Microalbuminuria
Proteinuria
Association with other complications of diabetes mellitus
Diabetic retinopathy
Diabetic neuropathy
What are the features of polycystic kidney disease?
Loss of kidney function
Pain
Bleeding into the renal cysts
Infection of renal cysts
Asymptomatic in some patients
What is horseshoe kidney and what does it increase the risk of?
Obstruction
Stone
Infection
