Urological Disorders Flashcards
What is the normal function of the kidney?
Flitration
Control salt and water balance
Hormone production
Vitamin D
What hormones do the kidneys produce?
Erythropoietin
Essential for synthesis of Hb
How is the kidney involved in Vitamin D production?
1-alpha-hydroxylation of Vitamin D
What are the different methods of kidney dysfunction?
Filtration failure Hypertension and water retention Metabolic acidosis Anaemia Vitamin D deficiency
What are the different types of kidney conditions?
Inflammatory
Obstructive
Neoplastic
Developmental/Genetic
What does water retention cause?
Oedema e.g. ankles
Pulmonary oedema- life threatening
What are the examples of inflammatory kidney disease?
Metabolic e.g. diabetic nephropathy
Immunological e.g.
Nephritic syndrome
Nephrotic syndrome
What are the examples of obstructive kidney disease?
Stones
Benign prostatic hypertrophy
What are the examples of neoplastic kidney disease
Kidney, bladder, prostatic, testicular cancer
What are the examples of developmental/genetic kidney disease?
Polycystic kidneys
Horseshoe kidney
Who is more susceptible to infection of kidney?
Kidney transplant patients
Immunosuppressed patients
How do you make a diagnosis of kidney disorders?
Case history
Physical examination
Investigation
What would a typical history be for a UTI?
Frequent passing of urine
Fever
Lower abdominal pain
What physical examinations would be performed if you suspected a UTI?
Temperature
Blood pressure
Pulse
Abdomen
What could an abdominal examination show with UTI?
Soft
Slightly tender over suprapubic area and left loin
What investigations would you perform if you suspected a UTI?
Urine dipstick
Urine microscopy: Culture and sensitivity
Blood tests
What could be found in the investigations with UTI?
Urine dip stick:
2+ leucocytes
+ nitrate
Trace of blood
What would you look for in the bloods with a UTI?
Renal profile
Electrolyte
Urea
Creatinine
What is the treatment for UTIs?
Antibiotics
Pain control
Supportive e.g. hydration
What should be considered when prescribing antibiotics?
Depending on severity
Most common bacteria in local area
Modified when sensitivity from urine culture is available
When would you consider imaging this patient?
If other factors present
Other differentials possible
How can the immune system damage in the kidney?
Auto-immune conditions
Antibodies and inflammatory cells
How would autoimmune diseases present clinically?
Nephritic syndrome
Proteinuria
Nephrotic syndrome
What is glomerulonephritis?
Inflammation of the microscopic filtering units of the kidney
What are the different patterns f organ involvement?
Kidney only
Kidney and lung
Multiple organs/tissues involved
What are characteristic of nephritic syndrome?
Haematuria
Variable amount of proteinuria
May have hypertension, reduced urine output and increased urea and creatinine
What specific investigations would you do for nephritic syndrome?
Urine protein:creatinine ratio Blood test - Kidney function - Immunology test Possible biopsy?
What is IgA nephropathy?
No idea about cause
Most common primary glomerulonephritis world-wide
High prevalence in fast east
What happens in IgA nephropathy?
Deposition of IgA antibody in the kidney
About 30% progress to kidney failure
What supportive treatments can be given to those with IgA nephropathy?
Treat hypertension and reduce proteinuria
Angiotensin receptor inhibitor (ARB)
ACE
Reduce sodium intake
What are treatment option (not supportive) for IgA nephropathy?
Immunotherapy
Renal replacement therapy
Kidney transplantation
Dialysis
What example of kidney and lung disease?
Goodpasture’s disease
Anti-glomerular basement membrane antibody mediated
Shared common antigen between lung and kidney: alpha3chain of type IV collagen
What is an example of systemic disease involving the kidneys?
Systemic lupus erythematosus (SLE): antinuclear factor and nit-dsDNA
Vasculitis: anti-neutrophil cytoplasm antibody (ANCA)
What disease can be caused by a metabolic cause?
Diabetic nephropathy
Most common cause of kidney disease and kidney failure
What is the pathogenesis of diabetic nephropathy?
Inflammation and fibrosis
What are the clinical features of diabetic nephropathy?
Microalbuminuria
Proteinuria
Association wit diabetic retinopathy and neuropathy
What is the treatment for diabetic nephropathy?
Optimised diabetic control Optimised treatment of hypertension Reduce proteinuria using ARB and ACE Transplantation Dialysis
What is the new medication being trialed?
SGLT2 inhibitor
What is the kidney disease with an immunological cause?
Nephrotic syndrome
What are the symptoms of nephrotic syndrome?
Peripheral oedema Severe proteinuria Low serum albumin Variable amounts of microscopic haemturia Associated with hyperlipidemia
What is minimal change disease?
No changes in disease under light microscope
But abnormal structure of podocytes under electron microscope
What are the key features of minimal change glomerulopathy?
Most common in children
Complication: high risk of thrombosis
What are the causes of nephrotic syndrome?
Minimal change glomerulopahty
Membranous nephropathy
Focal segmental glomerulosclerosis
Lupus nephritis
What is the treatment for nephrotic syndrome?
Immunotherapy
Diuretics
Prevention of thrombosis: anti-coagulants
What is an example of an obstructive kidney disease?
Stones
Kidney, ureter, bladder
How would stones present clinically?
Pain
Blood in urine
Associated with urine infection
90% are radio-opaque
What investigations would you perform when suspecting kidney stones?
Urine inspection and dipstick Blood tests Imaging - plain x-ray - ultrasound - CT scan
Why might kidney function bloods be normal when someone has a kidney stone?
Only one kidney needs to be functioning for normal result
What are the treatment option for kidney stones?
Supportive: pain control and hydration
Shockwave lithotripsy
Ureterscopy
Percutaneous nephrolithotomy
What does treatment for kidney stone depend on?
Size and location of the stones
Availability of local expertise
Fitness of the patients for general anaesthetics
What is Shockwave lithotripsy?
High energy sound waves to break up large kidney stones into smaller ones
What is ureteroscopy?
Through urethra, bladder and ureter
What is Percutaneous nephrolithotomy?
Small percutaneous incision
Insertion of nephroscope
Stone is removed
What are benign kidney condition?
Benign prostatic hypertrophy
What are malignant kidney conditions?
Kidney: renal cell carcinoma
Ureter and bladder: Transitional cell carcinoma
Prostatic cancer
Testicular cancer
What is the clinical presentation of kidney tumours?
Asymptomatic
Haematuria
Pain
What investigations would you perform when suspecting cancer?
Imagine
Urine cytology
Blood test for marker (PSA)
Kidney function
Histological diagnosis: biopsy or excised tumour
Staging studies: any evidence of metastasis
What is the treatment for neoplastic conditions?
To release any obstruction of the urinary tract: nephrostomy, bladder catheter or/and surgery.
Chemotherapy
Radiotherapy
Hormonal therapy for hormone sensitive cancer (e.g. prostatic cancer).
Surgery
What is an example of a genetic disorder in the kidney?
Polycystic kidney disease?
What are the different types of polycystic kidneys?
Neonatal: autosomal recessive
Adult onset: autosomal dominant
Some patients do not had family history
What are the consequences of polycystic kidneys?
Loss of kidney function Pain Bleeding into renal cysts Infection of renal cysts Asymptomatic in some patients
What treatment is available for polycystic kidney disease?
New medication: Tolvaptan (a vasopressin receptor 2 antagonist) to slow down the cysts formation.
Treat hypertension, infection.
Pain control.
Renal replacement therapy (transplantation, dialysis)
What is an example of a developmental kidney disease?
Horseshoe kidney
How is horseshoe kidney diagnosed?
Imaging
What are the consequences of horseshoe kidney?
Increased risk of
- Obstruction
- Stones
- Infection
