Urological disorders (46) Flashcards
What are the normal functions of the kidney and what happens in kidney dysfunction?
- filtration–> failure leads to accumulation of waste substance, haematuria and proteinuria, low serum protein e.g. albumin
- control of salt and water balance–> hypertension, water retention (sometimes dehydration)
- control of acid/base balance–> metabolic acidosis
- hormones (erythropoietin production)–> anaemia bc dec. Hb production
- vitamin D (1-alpha hydroxylation of vit D)–> vit D deficiency and secondary hyperparathyroidism
What are possible locations and pathogens for infections in the urinary tract?
- bladder= cystitis
- kidney= pyelonephritis
- bacteria most common
- virus and fungus in immunocompromised patients
- pathogen enters causing inflammation
How do we diagnose a urinary tract infection?
- history
- physical examination
- urine dipstick
- urine microscopy, culture and sensitivity
How do we treat a urinary tract infection?
- antibiotics: depending on severity of illness, most common bacteria in local area, modified when sensitivity from urine culture is available
- pain control
- supportive care e.g. rehydration
- consider imaging if other factors or differential diagnosis
How can the immune system damage the kidney?
via antibodies or inflammatory cells (neutrophils, monocytes/macrophages, T cells)
How will an inflammatory condition with an immunological cause present clinically?
- nephritic syndrome
- proteinuria
- nephrotic syndrome
What is glomerulonephritis?
inflammation of the microscopic filtering units of the kidney (glomeruli)
How do we diagnose an inflammatory condition with an immunological cause?
- history and physical examination
- urine test
- blood test incl. immunology tests
- imaging: start w/ ultrasound
- kidney biopsy
What are the signs of nephritic syndrome?
- haematuria (blood in urine)
- variable amount of proteinuria
- may have hypertension, reduced urine output, inc. urea and creatinine
How do we diagnose nephritic syndrome?
- history physical examination
- urine dipstick
- urine microscopu
- urine protein:creatinine ratio
- blood tests: kidney function and immunology test
- kidney biopsy
What is IgA nephropathy?
- most common primary glomerulonephritis
- v high prevalence in far east
- deposition of IgA antibody in kidney , only detected by biopsy
- inflammation and scarring
- about 30% progress to kidney failure
How do we treat IgA nephropathy?
supportive:
- treat hypertension and reduce proteinuria using ARB or ACEI
- reduce sodium intake
immunotherapy: many different choices, ongoing clinical trials - renal replacement therapy–> at late stage : kidney transplantation or dialysis
What is an example of a disease that affects the kidney and lung specifically?
- Goodpasture’s disease
- antibody mediated anti-glomerular basement membrane (autoantibody)
- bc shared common antigen between lung and kidney
What are examples of diseases that affect multiple organs/tissues?
- systemic lupus erythematosus (SLE) caused by autoantibodies e.g. antinuclear factor, anti-dsDNA
- vasculitis caused by autoantibodies called ANCAs
What is diabetic nephropathy?
most common cause of chronic kidney disease and kidney failure in west
- pathogenesis: inflammation and fibrosis (deposition of extracellular matrix in glomerulus)
What are the clinical features of diabetic nephropathy?
- microalbuminuria
- proteinuria
- association w/other diabetic complications e.g. diabetic retinopathy
How is diabetic nephropathy treated?
- optimised diabetic control
- optimised treatment of hypertension
- stop smoking
- reduce proteinuria using ARB or ACEI
- new clinical trials: SGLT2 inhibitor
- transplantation
- dialysis
What are risk factors for diabetic nephropathy?
- hypertension
- poor diabetic control
- smoking
What are the clinical signs of a nephrotic syndrome?
- peripheral oedema
- severe proteinuria
- low serum albumin
- variable amount of microscopic haematuria
- associated w/ hyperlipiaemia
How do we diagnose nephrotic syndrome?
- history
- physical examination
- urine dipstick
- urine microscopy
- urien protein:creatinine ratio
- blood tests: kidney function and immunology test
- kidney biopsy
What are causes of nephrotic syndrome?
- minimal change glomerulopahty
- membranous nephropathy
- focal segmental glomerulosclerosis
- lupus nephritis
- otherssss
leaking of protein…
How do we treat nephrotic syndrome?
- immunotherapy
- diuretics to reduce peripheral oedema
- prevent thrombosis w/ anticoagulation
What are the possible locations of obstructive stones?
- kidney
- ureter
- bladder
How do stones present?
- pain in abdomen, back loin
- blood in urine
- associated w/ urine infection
- about 90% of kidney stones are radio-opaque
How do we treat stones?
supportive:
- pain control
- hydration
specific treatment:
- shockwave lithotripsy–> high energy sound waves to break up large kidney stones
- utereoscopy through urethra, bladder and ureter
- percutaneous nephrolithotomy–> small percutaneous incision, insertion of nephroscope, stone is removed
What benign condition can be seen in the urinary tract?
benign prostatic hypertrophy
What malignant conditions can be seen in the urinary tract?
- kidney: renal cell carcinoma
- ureter and bladder: transitional cell carcinoma
- prostatic cancer
- testicular cancer
How do neoplastic conditions present clinically?
- asymptomatic (incidental finding during other investigation)
- haematuria
- pain
What investigations are used to detect neoplastic conditions?
- imaging (ultrasound, CT and/or MRI)
- urine cytology
- blood test for marker: prostatic specific antigen
- kidney function
- histological diagnosis by biopsy or excised tumour
- staging studies: any evidence of metastasis
How are neoplastic conditions treated?
- to release any obstruction of the urinary tract: nephrostomy, bladder catheter and/or surgery
- chemotherapy
- radiotherapy
- hormonal therapy for hormone sensitive cancer e.g. prostate
- surgery
What are the different types of polycystic kidney and their inheritance patterns?
- neonatal: autosomal recessive
- adult onset: autosomal dominant
- some patients have no family history
What are the consequences of polycystic kidneys?
- loss of kidney function
- pain
- bleeding into renal cysts (bc has vessels)
- infection of renal cysts
- asymptomatic in some patients
How is polycystic kidney disease treated?
- new medication: tolvaptan- vasopressin receptor 2 antagonist- to slow down cyst formation
- treat hypertension and infection
- pain control
- renal replacement therapy: transplantation and dialysis
How can we detect a horseshoe kidney?
imaging of abdomen/pelvis
What are the consequences of horseshoe kidney?
inc. risk of
- obstruction
- stones
- infection
