Urological Disorders Flashcards
What are the 3 types of urological disorders?
- Inflammatory
- Infection: UTI
- Immunological: nephritic, nephrotic
- Metabolic: diabetic nephropathy
- Obstructive
- stones
- benign prostatic hypertrophy
- Developmental/genetic
- polycystic
- horseshoe
What are the 3 types of inflammatory urological disorders and examples?
- Infection —> cystitis
- Immunological —> nephritic
—> nephrotic - Metabolic —> diabetic nephropathy
What are 2 examples of obstructive urological disorders?
- Stones
- Benign prostatic hypertrophy
What are the 2 examples of genetic urological disorders?
- Polycystic kidneys
- Horseshoe
What are 5 functions of the kidneys that get altered by urological disorders?
- Filtration —> accumulation of waste protucts
—> haematuria
—> proteinuria —> low serum protein
(albumin) - Salt and water balance —> hypertension
—> dehydration - pH balance —> metabolic acidosis
- Hormones (EPO for Hb synthesis) —> anaemia
- Vit D (1-α-hydroxylation) —> deficiency
—> hyperparathyroidism
(secondary)
What are the 6 steps of making a differential urological diagnoses?
- History
- Physical exam
- Urine tests - dipstick
- MC&S —> inflammatory
- protein : creatinine —> immunological - Blood tests - renal function
- immunology —> immunological - Imaging (X-ray, US, CT) —> obstructive
—> genetic - Kidney biopsy —> inflammation
What is a UTI?
Urinary Tract Infection
- Kidney infection —> pyelonephritiscystitis
Bladder infection —> cystitis
- Usually bacteria (virus/fungal possible in
immunocompromised)
- Symptoms - polyuria —> low blood pressure
- fever —> high temp
- abdominal pain
How is a UTI diagnosed? (5)
- History —> polyuria
—> fever
—> abdominal pain - Physical exam —> high temp
—> low blood pressure
—> tender abdomen - Urine tests - dipstick —> leukocytes
—> nitrite
—> haematuria
- MC&S —> urine culture - Blood tests - renal function —> electrolytes
—> urea
—> creatinine - Imaging
How is a UTI treated? (3)
Support:
1. Pain control
2. Hydration —> may need to be inpatient
Treat:
3. Antibiotics - severity
- commonest bacteria locally
- urine culture results
What is nephritic syndrome?
Immunological inflammation of kidneys causing haematuria
- Glomerulonephritis = inflammation of glomeruli
- Symptoms - haematuria
- proteinuria
- oliguria —> inc serum urea
—> inc serum
creatinine
- hypertension
How is nephritic syndrome diagnosed? (5)
- History —> red urine (haematuria)
- Physical exam —> high blood pressure
- Urine tests - dipstick —> haematuria
—> proteinuria
- protein : creatinine —> high - Blood tests - renal function —> high urea
—> high creatinine
—> low eGFR - Kidney biopsy
What is IgA nephropathy?
Primary glomerulonephritis due to IgA antibody deposition in the kidneys
- diagnosis via biopsy
—> Inflammation
—> Scarring
—> Kidney failure (30%)
How is IgA nephropathy treated?
Support:
1. Hypertension —> ARB (angiotensin receptor
inhibitor) eg. irbesartan
—> ACEI (angiotensin converting
enzyme inhibitor) eg. ramipril
—> dec sodium intake
Treat:
2. Immunotherapy —> renal replacement therapy
- kidney transplant
- dialysis
What is nephrotic syndrome?
Immunological inflammation of kidneys causing severe proteinuria
- Glomerular filtration affected
- Symptoms - severe proteinuria —> low serum
albumin
- peripheral oedema eg. face/leg swelling
- microscopic haematuria
- hyperlipidaemia
What are 4 examples of diseases manifesting as nephritic syndrome?
Organ-specific:
1. IgA nephropathy
- IgA antibodies
2. Goodpasture’s disease
- anti-GBM antibody (Glomerular Basement
Membrane)
- antigen in α3 chain of type IV collagen —> affects
kidneys and lungs
Systemic:
3. SLE
- autoantibodies —> antinuclear factor
—> anti-dsDNA
4. Vasculitis
- ANCA (AntiNeutrophil Cytoplasm Antibody)
How is nephrotic syndrome diagnosed? (5)
- History —> frothy urine (proteinuria)
—> swelling - Physical exam —> oedema (face/legs)
- Urine tests - dipstick —> proteinuria
—> no haematuria
- protein : creatinine —> very high - Blood tests - renal function —> v. low albumin
- Kidney biopsy
What is minimal change glomerulopathy?
Damaged glomeruli —> nephrotic syndrome
- only seen via electron microscope (“minimal”)
—> podocytes have flattened foot processes
- most common in children
- high risk of thrombosis
What are 4 examples of diseases manifesting as nephrotic syndrome?
- Minimal change glomerulopathy
- Membranous nephropathy
- Focal segmental glomerulosclerosis
- Lupus nephritis
How is minimal change glomerulopathy treated? (4)
Support:
1. Peripheral oedema —> diuretics
2. Thrombosis —> anticoagulants
Treat (immunotherapy):
3. Old drug: corticosteroid + cyclophosphamide
4. New drug: tacrolimus + antibody therapy (targets B
cell pathway)
What is diabetic nephropathy?
Diabetes mellitus associated inflammation and fibrosis of the kidneys
- Inflammation —> thickened GBM
Fibrosis —> ECM deposited in glomerulus
- Features - microalbuminuria
- proteinuria
- diabetic retinopathy/neuropathy
How is diabetic nephropathy treated? (5)
Support:
1. Diabetes control
2. Hypertension
3. Proteinuria —> ARB
—> ACEI
Treat:
4. SGLT2 inhibitors
5. Immunotherapy —> renal replacement therapy
- kidney transplant
- dialysis
What are kidney stones?
Hard mineral deposits in kidneys/ureter/bladder
- Symptoms - abdomen/back pain
- haematuria
How are kidney stones diagnosed?
- History —> red urine (haematuria)
—> abdomen/back pain - Physical exam —> tender loin/lower abdomen
- Urine tests - dipstick —> haematuria
—> infection - Blood tests - renal function
- Imaging - X-ray —> radio-opaque
- US
- CT
How are kidney stones treated?
Support:
1. Pain control
2. Hydration
Treat:
- look at: size, location, availability, anaesthetic fitness
3. Shockwave lithotripsy
- high energy US waves break up stones —> pass
4. Ureteroscopy
- camera + scoop up urethra
5. Percutaneous nephrolithotomy
- incision —> nephroscope to stones
How is polycystic kidney disease treated? (5)
Support:
1. Pain control
2. Hypertension treatment
3. Infection treatment
Treat:
4. Tolvaptan (vasopressin receptor 2 antagonist) —>
slow cyst formation
5. Immunotherapy —> renal replacement therapy
- kidney transplant
- dialysis
What is polycystic kidney disease?
Genetic condition leading to cysts forming in kidneys
- Neonatal —> autosomal recessive
Adult-onset —> autosomal dominant
Some —> no family history
- Consequences - lose kidney function
- pain
- bleeding into cysts
- May be asymptomatic
What is horseshoe kidney?
Fused kidneys (lower down)
- Developmental issue —> kidneys don’t separate
- Diagnosis via imaging
- Inc risk of obstructions, stones, infection
- No treatment —> may need supportive surgeries
