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2.9 BRS Urology and Renal > Urological Disorders > Flashcards

Urological Disorders Flashcards

1
Q

What are the 3 types of urological disorders?

A
  1. Inflammatory
    • Infection: UTI
    • Immunological: nephritic, nephrotic
    • Metabolic: diabetic nephropathy
  2. Obstructive
    • stones
    • benign prostatic hypertrophy
  3. Developmental/genetic
    • polycystic
    • horseshoe
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2
Q

What are the 3 types of inflammatory urological disorders and examples?

A
  1. Infection —> cystitis
  2. Immunological —> nephritic
    —> nephrotic
  3. Metabolic —> diabetic nephropathy
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3
Q

What are 2 examples of obstructive urological disorders?

A
  1. Stones
  2. Benign prostatic hypertrophy
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4
Q

What are the 2 examples of genetic urological disorders?

A
  1. Polycystic kidneys
  2. Horseshoe
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5
Q

What are 5 functions of the kidneys that get altered by urological disorders?

A
  1. Filtration —> accumulation of waste protucts
    —> haematuria
    —> proteinuria —> low serum protein
    (albumin)
  2. Salt and water balance —> hypertension
    —> dehydration
  3. pH balance —> metabolic acidosis
  4. Hormones (EPO for Hb synthesis) —> anaemia
  5. Vit D (1-α-hydroxylation) —> deficiency
    —> hyperparathyroidism
    (secondary)
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6
Q

What are the 6 steps of making a differential urological diagnoses?

A
  1. History
  2. Physical exam
  3. Urine tests - dipstick
    - MC&S —> inflammatory
    - protein : creatinine —> immunological
  4. Blood tests - renal function
    - immunology —> immunological
  5. Imaging (X-ray, US, CT) —> obstructive
    —> genetic
  6. Kidney biopsy —> inflammation
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7
Q

What is a UTI?

A

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

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8
Q

How is a UTI diagnosed? (5)

A
  1. History —> polyuria
    —> fever
    —> abdominal pain
  2. Physical exam —> high temp
    —> low blood pressure
    —> tender abdomen
  3. Urine tests - dipstick —> leukocytes
    —> nitrite
    —> haematuria
    - MC&S —> urine culture
  4. Blood tests - renal function —> electrolytes
    —> urea
    —> creatinine
  5. Imaging
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9
Q

How is a UTI treated? (3)

A

Support:
1. Pain control
2. Hydration —> may need to be inpatient

Treat:
3. Antibiotics - severity
- commonest bacteria locally
- urine culture results

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10
Q

What is nephritic syndrome?

A

Immunological inflammation of kidneys causing haematuria
- Glomerulonephritis = inflammation of glomeruli
- Symptoms - haematuria
- proteinuria
- oliguria —> inc serum urea
—> inc serum
creatinine
- hypertension

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11
Q

How is nephritic syndrome diagnosed? (5)

A
  1. History —> red urine (haematuria)
  2. Physical exam —> high blood pressure
  3. Urine tests - dipstick —> haematuria
    —> proteinuria
    - protein : creatinine —> high
  4. Blood tests - renal function —> high urea
    —> high creatinine
    —> low eGFR
  5. Kidney biopsy
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12
Q

What is IgA nephropathy?

A

Primary glomerulonephritis due to IgA antibody deposition in the kidneys
- diagnosis via biopsy
—> Inflammation
—> Scarring
—> Kidney failure (30%)

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13
Q

How is IgA nephropathy treated?

A

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

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14
Q

What is nephrotic syndrome?

A

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

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15
Q

What are 4 examples of diseases manifesting as nephritic syndrome?

A

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)

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16
Q

How is nephrotic syndrome diagnosed? (5)

A
  1. History —> frothy urine (proteinuria)
    —> swelling
  2. Physical exam —> oedema (face/legs)
  3. Urine tests - dipstick —> proteinuria
    —> no haematuria
    - protein : creatinine —> very high
  4. Blood tests - renal function —> v. low albumin
  5. Kidney biopsy
17
Q

What is minimal change glomerulopathy?

A

Damaged glomeruli —> nephrotic syndrome
- only seen via electron microscope (“minimal”)
—> podocytes have flattened foot processes
- most common in children
- high risk of thrombosis

18
Q

What are 4 examples of diseases manifesting as nephrotic syndrome?

A
  1. Minimal change glomerulopathy
  2. Membranous nephropathy
  3. Focal segmental glomerulosclerosis
  4. Lupus nephritis
19
Q

How is minimal change glomerulopathy treated? (4)

A

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)

20
Q

What is diabetic nephropathy?

A

Diabetes mellitus associated inflammation and fibrosis of the kidneys
- Inflammation —> thickened GBM
Fibrosis —> ECM deposited in glomerulus
- Features - microalbuminuria
- proteinuria
- diabetic retinopathy/neuropathy

21
Q

How is diabetic nephropathy treated? (5)

A

Support:
1. Diabetes control
2. Hypertension
3. Proteinuria —> ARB
—> ACEI

Treat:
4. SGLT2 inhibitors
5. Immunotherapy —> renal replacement therapy
- kidney transplant
- dialysis

22
Q

What are kidney stones?

A

Hard mineral deposits in kidneys/ureter/bladder
- Symptoms - abdomen/back pain
- haematuria

23
Q

How are kidney stones diagnosed?

A
  1. History —> red urine (haematuria)
    —> abdomen/back pain
  2. Physical exam —> tender loin/lower abdomen
  3. Urine tests - dipstick —> haematuria
    —> infection
  4. Blood tests - renal function
  5. Imaging - X-ray —> radio-opaque
    - US
    - CT
23
Q

How are kidney stones treated?

A

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

24
Q

How is polycystic kidney disease treated? (5)

A

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

24
Q

What is polycystic kidney disease?

A

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

25
Q

What is horseshoe kidney?

A

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

2.9 BRS Urology and Renal (4 decks)

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