Urological Disorders Flashcards
Main functions of 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
Inflammation of bladder
Cystitis
Infections
- bladder- cystitis
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kidney- pyelonephritis/UTI
Bacteria is most commonly found and virus/fungal infections occur in immune compromised patients
Diagnosed:high temperature,soft tender abdomen
Urine dipstick will be positive for leucocytes and nitrite and traces of blood
Urine will appear cloudy
Give antibiotics,hydration,pain control
Metabolic (diabetic nephropathy) (inflammatory)
Inflammation and fibrosis of kidney and damaged glomerulus of nephron
Causes thicker glomerular basement membrane and deposits ECM in glomerulus
Clinical features include microalbuminuria,proteinuria,diabetic retinopathy and neuropathy
Treatment control diabetes and hypertension,reduce proteinuria by using ARB or ACEI,stop smoking,SGLT2 inhibitor,transplant or dialysis
Immunological cause-nephritic syndrome
Have haematuria,proteinuria,hypertension,reduced urine output and increased urea and creatinine
Urine dipstick will be positive for blood and protein,blood tests will show raised serum urea and creatinine,reduced eGFR,kidney biopsy shows IgA nephropathy
What is IgA nephropathy
- Most common primary glomerulonephritis world-wide → high prevalence in Far East
- Deposition of IgA antibody in kidney → detected by immunohistochemistry
- Inflammation & scarring
- About 30% progress to kidney failure
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Treat hypertension and reduce proteinuria
- First line treatment is angiotensin receptor inhibitor (ARB) e.g. irbesartan OR angiotensin converting enzyme inhibitor (ACEI) e.g. ramipril
-
Reduce sodium intake
May need transplant or dialysis
Nephrotic syndrome
- Peripheral oedema (can rupture skin and is uncomfortable)
- Severe proteinuria
- Low serum albumin
- Variable amount of microscopic haematuria
-
Associated with hyperlipidaemia
Most common in children can see podocyte effacement and there’s a high risk of thrombosis
Treat via immunotherapy traditionally corticosteroids,cyclophosphamide and tacrolimus,diuretic to reduce odema
Nephrotic syndrome examination
Pitting odema in ankle
No blood in dipstick,proteins present
In blood test very low serum alubumin
Kidney biopsy shows minimal change glomerulopathy
- Give an example of an organ specific immunological condition
Goodpasture’s disease: anti-glomerular basement membrane (GBM) antibody mediated, anti-GBM-antibody
Occurs because of a shared common antigen between lung and kidney- alpha-3-chain of type IV collagen
- Give 2 examples of systemic diseases (multiple tissues/organs involved)
-
- Systemic lupus erythematosus (SLE)- autoantibodies → antinuclear factor (ANF), anti-dsDNA
- Vasculitis: antineutrophil cytoplasm antibody (ANCA)
- What is glomerulonephritis?
A term used to refer to several kidney diseases, describing inflammation of the microscopic filtering units of the kidney. Encompasses nephritic syndrome, nephrotic syndrome etc.
Stones
Found in kidney,ureter,bladder
Abdominal pain,blood in urine,associated with urine infection
- X-ray → quick, easy, readily available in hospitals- but patient exposed to radiation
- Ultrasound → can detect dilation of urinary system due to obstruction which can be useful in spotting loss of function
- CT scan → Highly sensitive in detecting small stones but involves radiation exposure
Causes for stone formation
- Prostate enlargement- common condition in older men- can obstruct urine excretion, causing stones to form in bladder from minerals in urine
- Any nervous system disease damaging the bladder nerves- causes partial urine excretion, causing stones to form in bladder e.g. motor neurone disease affects 60+ adults
- Gout- increased blood uric acid levels → increased risk of kidney stone development
- Dehydration- Being dehydrated concentrates the urine, increasing the chances of stones
- Diet- a diet rich in sodium/animal protein/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
3 treatments for stones
Shockwave lithotripsy- high energy sound waves to break up large kidney stones into smaller ones
Uteroscopy
Percutaneous nephrolithotomy- small percutaneous incision. Insertion of nephroscope. Stone is removed (may need to be broken into smaller pieces)
Neoplastic conditions
Benign prostatic hypertrophy
Malignant include
- Kidney- renal cell carcinoma
- Ureter & bladder- transitional cell carcinoma
- Prostatic cancer
- ## Testicular cancer
