Urological disorders Flashcards
What are the 5 normal functions of kidneys?
FILTRATION-removal of waste substances
CONTROL SALT AND WATER BALANCE
CONTROL ACID AND BASE BALANCE
HORMONE-erythropoeitin production
VITAMIN D- 1-alpha-hydroxylation of vitamin D
What are the 5 consequences of kidney dysfunction?
1) Filtration failure-accumulation of waste, haematuria, proteinuria, low serum protein including albumin in blood
2) Hypertension, water retension(sometimes dehydration because unable to make concentrated urine)
3) Metabolic Acidosis
4) Anaemia-due to not producing erythropoietin
5) Vitamin D defficiency and secondary hyperthyroidism
Where are the possible locations for an infection?
What other factors would make an infection more likely to happen?
Bladder= cystisis
Kidney=pyelonephritisis
Kidney stone-would stop flow of urine into uretor(infection can happen behind stone
Cancer- blocking bladder, kidney etc, behind the cancer infection can happen
What are the potential pathogens involved in infection?
Bacteria-most common
virus/fungi-in immunocompromised patients
How do you make a diagnosis of a urinary inflection?
1) medical history check
2) Physical examination
3) Urine dipstick
4) urine microscopy, culture and sensitivity-if dipstick is postitive
What is the treatment and overall clinical management of a urinary tract infection?
ANTIBIOTICS:
- depending on the severity of the illness
- the most common bacteria in the local area
- culture urine so you cna see resistance of bacteria and give appropriate antibiotics
IMPATIENT:
-some patients are very ill so need to be treated as impatient
PAIN CONTROL
SUPPOTIVE:
-E.G. hydration
IMAGING:
-to see if there is something else going on and other treatment may be needed
How can the immune system damage the kidney?
What are the clinical presentations?
Cause INFLAMMATORY CONDITIONS VIA antibodies and inflammatory cells
Presentations:
- Neuphritic syndrome
- Neuphrotic syndrome
- Proteinuria
- GLOMERULONEPHRITIS-inflammation of the microscopic filtering units of the kidney
How would you make a diagnosis of an inflammatory condition-immunological case?
1) history and pnysical examination
2) Urine test
3) Blood test-including immunology test(used to diagnose immune disease-put on area e.g kidney)
4) imaging-start with ultrasound
5) Kidney biopsy
What is neuphritic syndrome?
Immunological inflammatory condition
- Haematuria
- variable amount of proteinuria
- may have rediced hypertension, reduced urine output, increased urea and creatine
How do you diagnose nephritic syndrome?
same steps as normal (history, physical, urine dip test, urine microscopy) + :
-urine protein:creatine ratio to quantify protein levels in urine-raised
Blood tests:kidney function and immunology test
-if appropriate do kidney biopsy-can show IgA nepropathy
What is the most common type of primary glomerulonephritis world-wide and describe it?
How is it diagnosed
IgA nephropathy:
- very high prevelance in the east
- depostition of the IgA antibody in the kidney(detected by immunohistochemistry
- dont know why it happens
- about 30% progress to kidney failure
- only diagnosed ny kidney biopsy
What is the treatment for IgA nephropathy
SUPPORTIVE:
- treat hypertension and reduce proteinuria-using Angiotensin receptor inhibit or angiotensin converting enzyme inhibitor
- Reduce salt intake
IMMUNOTHERAPY:(ongoing clinical trials)
-Renal replacement therapy-when reaching late stage of the disease and everything else is failing (kidney transplantation, dialysis)
What are organ specifc inflammatory diseases and systemic inflammatory diseases?
Organ specific-effects usually the kidneys and the lungs as they share a common antigen. It is anti-glomerular basement membran eantibody mediated(Goodpastures diseases)
Systemic:
-effects multiple organs and tissues.
- Systemic Lupus erythematosus(SLE). Detected by autoantibodies, antinuclear factors, antids-DNA(double-stranded)
- Vasculitis-detectected by measuring antineutrophil cytoplasm antibody
What is the most common cause of chronic kidney disease and kidney failure in the western world?
Diabetic Nephropathy
What are the risk factors of Diabetic neuropathy?
- hypertension
- poor diabetic control
- smoking
What are the clinical features of diabetic nephropathy?
- microalbuminuria
- proteinuria
- assosiation with other features of diabetic mellitus(diabetic retinopathy, diabetic neuropathy)
What is treatment and clinical management for diabetic nephropathy?
-optimise diabetic treatment
–optimimise treatment of hypertension
reduce proteinuria using using ARB and ACEI
- stop smoking
- new clinical trials- SGLT2 inhibitor
- Transplantation including combined pancreas and kidney transplant(kidney failure)
Dialysis(kidney failure)
What is Neuphrotic syndrome and some clinical findings?
- another inflammatory condition of the kidney
- peripheral odema
- severe proteinuria
- low serum albumin
- variable amount of microscopic haematuria
- assossiated with hyperlipidaemia
- frothy urine
How do you make a diagnosis of nepnrotic syndrome?
Normal(history, physical, urine dipstick, urine microscopy)+:
- urine protein:creatine ratio high
- Blood tests:kidney finction, immunology test, low serum albumin
- kidney biopsy
What are causes of nephrotic syndrome?
Lots of different causes e.g:
- minimal change glomerulopathy(lots of protein lost in the urine)-cuaes frothy urine
- membranous neuropathy
- focal segmental glomerulossclerosis
- lupus nephritis
- others
what is treatment for Neuphrotic syndrome?
IMMUNOTHERAPY(make you weak):
-traditionally corticteroids, cyclophosphamide
recent development-tacrolimus antoby therapy targeting B-cell pathway
DIURETICS-redice peripheral odema
PREVENTION OF THROMBOSIS-anticoagulation
What are the key features of minimal change glomerulopathy?
- most common in children
- can affect other age groups
- Normal light microscopy
- electron microscopy-podocyte effacement-abnormal flatten appearence
complication-high risk of thrombosis
What are some obstructive conditions?
stones in:
- kidney
- ureter
- bladder
Whate are the clinical presentations of obstructive stones?
Pain-abdomen and back
Blood in the urine
- urine infection
- 90% of kidney stones are radio-opaque(meaning x-rays pass through them and they are not detected)
What investigations can you do to determine if you have stones and find their location?
Urine inspection and dipstick -blood inurine=supporting evidence
Blood test-kidney function(reduced only in some patients)
Imaging-plain x-ray, ultrasound or CT -scan (find stones)
What are the treatment for obstructive stones?
what determines the type of treatment you have?
Supportive-pain control and hydration
specific treatment deponds on:
- size and location of stones
- availability of local expertise
- fitness of patient and general anaesthetics
Types of specific treatment:
SHOCKWAVE LITHOTRIPSY-high energy sound waves to break up large kidney stones into smaller ones
URETEROSCOPY-fish out the stone through ureter and bladder
PERCUTANEOUS NEPHROLITHOTOMY-surgery, small percutaneous incision, insertion of nephroscope, stone is removed(may need to be broken into smaller pieces)
What are the types of neoplatic tumours that are involved in urological disorders?
Benign-benign prostatic hypertrophy
Malignant:
- kidney(renal cell carcinoma)
- ureter and bladder(transitional cell carcinoma)
- prostatic cancer
- testicular cancer
What are the clinial presentations of tumours?
- Asymptomatic sometimes
- Haematuria
- pain
What investigations can you do to identify a tumour?
Imaging -ultrasound, CT-scan and/or MRI
Urine cytology
Blood test for marker:prostatic specific antigen (PSA)
Kidney function
Histological diagnosis:biopsy or excised tumour
Staging studies-any signs of metastisis
What are the treatment of tumours?
- to remove obstruction of the urinary tract: nephrostomy, bladder cathetor and/or surgery
- chemotherapy
- radiotherapy
- Hormonal therapy for hormone sensitve cancers e.g prostate
surgery
What is polycystic kidney disease?
What are the consequences?
GENETIC urological disorder
Consequences:
- loss of kidney function
- pain
- bleeding into renal cysts
- asymptomatic in some patients
What are different tyoes of polycystic kidneys?
neonatal:autosomal recessive
Adult Onset:automsomal dominent
Some patients without familial history
How do you treat polycystic kidney disease?
New medication-tolvaptan(a vasopressin receptor 2 antagonist)
Treat hypertension and infections
pain control
renal replacemetn therapy-transplant or dialysis if renal failure occurs
How do you know if a pateint has a horseshoe kidney?
IMAGING of abdomen or pelvis show the 2 kidneys are joined together
What are the consequences of horseshoe kidneys?
Genetic urological disorder
Increased risk of:
- obstruction
- stone
- infection
