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BRS - Bioregulatory Systems Week 7 > Urological Disorders > Flashcards

Urological Disorders Flashcards

1
Q

What is the normal function of the kidney?

A

Flitration
Control salt and water balance
Hormone production
Vitamin D

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2
Q

What hormones do the kidneys produce?

A

Erythropoietin

Essential for synthesis of Hb

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3
Q

How is the kidney involved in Vitamin D production?

A

1-alpha-hydroxylation of Vitamin D

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4
Q

What are the different methods of kidney dysfunction?

A 
Filtration failure
Hypertension and water retention
Metabolic acidosis
Anaemia
Vitamin D deficiency
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5
Q

What are the different types of kidney conditions?

A

Inflammatory
Obstructive
Neoplastic
Developmental/Genetic

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6
Q

What does water retention cause?

A

Oedema e.g. ankles

Pulmonary oedema- life threatening

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7
Q

What are the examples of inflammatory kidney disease?

A

Metabolic e.g. diabetic nephropathy
Immunological e.g.
Nephritic syndrome
Nephrotic syndrome

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8
Q

What are the examples of obstructive kidney disease?

A

Stones

Benign prostatic hypertrophy

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9
Q

What are the examples of neoplastic kidney disease

A

Kidney, bladder, prostatic, testicular cancer

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10
Q

What are the examples of developmental/genetic kidney disease?

A

Polycystic kidneys

Horseshoe kidney

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11
Q

Who is more susceptible to infection of kidney?

A

Kidney transplant patients

Immunosuppressed patients

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12
Q

How do you make a diagnosis of kidney disorders?

A

Case history
Physical examination
Investigation

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13
Q

What would a typical history be for a UTI?

A

Frequent passing of urine
Fever
Lower abdominal pain

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14
Q

What physical examinations would be performed if you suspected a UTI?

A

Temperature
Blood pressure
Pulse
Abdomen

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15
Q

What could an abdominal examination show with UTI?

A

Soft

Slightly tender over suprapubic area and left loin

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16
Q

What investigations would you perform if you suspected a UTI?

A

Urine dipstick
Urine microscopy: Culture and sensitivity
Blood tests

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17
Q

What could be found in the investigations with UTI?

A

Urine dip stick:
2+ leucocytes
+ nitrate
Trace of blood

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18
Q

What would you look for in the bloods with a UTI?

A

Renal profile
Electrolyte
Urea
Creatinine

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19
Q

What is the treatment for UTIs?

A

Antibiotics
Pain control
Supportive e.g. hydration

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20
Q

What should be considered when prescribing antibiotics?

A

Depending on severity
Most common bacteria in local area
Modified when sensitivity from urine culture is available

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21
Q

When would you consider imaging this patient?

A

If other factors present

Other differentials possible

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22
Q

How can the immune system damage in the kidney?

A

Auto-immune conditions

Antibodies and inflammatory cells

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23
Q

How would autoimmune diseases present clinically?

A

Nephritic syndrome
Proteinuria
Nephrotic syndrome

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24
Q

What is glomerulonephritis?

A

Inflammation of the microscopic filtering units of the kidney

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25
What are the different patterns f organ involvement?
Kidney only Kidney and lung Multiple organs/tissues involved
26
What are characteristic of nephritic syndrome?
Haematuria Variable amount of proteinuria May have hypertension, reduced urine output and increased urea and creatinine
27
What specific investigations would you do for nephritic syndrome?
``` Urine protein:creatinine ratio Blood test - Kidney function - Immunology test Possible biopsy? ```
28
What is IgA nephropathy?
No idea about cause Most common primary glomerulonephritis world-wide High prevalence in fast east
29
What happens in IgA nephropathy?
Deposition of IgA antibody in the kidney | About 30% progress to kidney failure
30
What supportive treatments can be given to those with IgA nephropathy?
Treat hypertension and reduce proteinuria Angiotensin receptor inhibitor (ARB) ACE Reduce sodium intake
31
What are treatment option (not supportive) for IgA nephropathy?
Immunotherapy Renal replacement therapy Kidney transplantation Dialysis
32
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
33
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)
34
What disease can be caused by a metabolic cause?
Diabetic nephropathy | Most common cause of kidney disease and kidney failure
35
What is the pathogenesis of diabetic nephropathy?
Inflammation and fibrosis
36
What are the clinical features of diabetic nephropathy?
Microalbuminuria Proteinuria Association wit diabetic retinopathy and neuropathy
37
What is the treatment for diabetic nephropathy?
``` Optimised diabetic control Optimised treatment of hypertension Reduce proteinuria using ARB and ACE Transplantation Dialysis ```
38
What is the new medication being trialed?
SGLT2 inhibitor
39
What is the kidney disease with an immunological cause?
Nephrotic syndrome
40
What are the symptoms of nephrotic syndrome?
``` Peripheral oedema Severe proteinuria Low serum albumin Variable amounts of microscopic haemturia Associated with hyperlipidemia ```
41
What is minimal change disease?
No changes in disease under light microscope | But abnormal structure of podocytes under electron microscope
42
What are the key features of minimal change glomerulopathy?
Most common in children | Complication: high risk of thrombosis
43
What are the causes of nephrotic syndrome?
Minimal change glomerulopahty Membranous nephropathy Focal segmental glomerulosclerosis Lupus nephritis
44
What is the treatment for nephrotic syndrome?
Immunotherapy Diuretics Prevention of thrombosis: anti-coagulants
45
What is an example of an obstructive kidney disease?
Stones | Kidney, ureter, bladder
46
How would stones present clinically?
Pain Blood in urine Associated with urine infection 90% are radio-opaque
47
What investigations would you perform when suspecting kidney stones?
``` Urine inspection and dipstick Blood tests Imaging - plain x-ray - ultrasound - CT scan ```
48
Why might kidney function bloods be normal when someone has a kidney stone?
Only one kidney needs to be functioning for normal result
49
What are the treatment option for kidney stones?
Supportive: pain control and hydration Shockwave lithotripsy Ureterscopy Percutaneous nephrolithotomy
50
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
51
What is Shockwave lithotripsy?
High energy sound waves to break up large kidney stones into smaller ones
52
What is ureteroscopy?
Through urethra, bladder and ureter
53
What is Percutaneous nephrolithotomy?
Small percutaneous incision Insertion of nephroscope Stone is removed
54
What are benign kidney condition?
Benign prostatic hypertrophy
55
What are malignant kidney conditions?
Kidney: renal cell carcinoma Ureter and bladder: Transitional cell carcinoma Prostatic cancer Testicular cancer
56
What is the clinical presentation of kidney tumours?
Asymptomatic Haematuria Pain
57
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
58
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
59
What is an example of a genetic disorder in the kidney?
Polycystic kidney disease?
60
What are the different types of polycystic kidneys?
Neonatal: autosomal recessive Adult onset: autosomal dominant Some patients do not had family history
61
What are the consequences of polycystic kidneys?
``` Loss of kidney function Pain Bleeding into renal cysts Infection of renal cysts Asymptomatic in some patients ```
62
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)
63
What is an example of a developmental kidney disease?
Horseshoe kidney
64
How is horseshoe kidney diagnosed?
Imaging
65
What are the consequences of horseshoe kidney?
Increased risk of - Obstruction - Stones - Infection

BRS - Bioregulatory Systems Week 7 (16 decks)

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