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Z YEAR 1 BRS Gastroentology > Urological Disorders > Flashcards

Urological Disorders Flashcards

1
Q

What are the normal function of the kidney?

A

1.Filtration
•Removal of waste substance
•Keeping the essential substance within the blood: e.g. blood cells, large protein including albumin
2.Control salt and water balance
3.Control of acid/base balance
4.Hormone: erythropoietin (EPO) production: essential for synthesis of Haemoglobin (Hb)
5.Vitamin D: 1-α-hydroxylation of vitamin D

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2
Q

What is kidney dysfunction?

A

1.Filtration failure
•Unwell with accumulation of waste substance
•Haematuria and proteinuria, low serum protein, including albumin, in blood
2.Hypertension, water retention (sometimes dehydration because unable to make concentrated urine)
3.Metabolic acidosis
4.Anaemia
5.Vitamin D deficiency and secondary hyperparathyroidism

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3
Q

What is inflammatory disease?

A 
Infection, including cystitis
Non-infective causes:
1.Metabolic, including diabetic nephropathy
2.Immunological
•Nephritic syndrome
•Nephrotic syndrome
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4
Q

What are obstructive disease?

A

Stones

Benign prostatic hypertrophy

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5
Q

What are neoplastic disease?

A

Kidney, bladder, prostatic, testicular cancer

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6
Q

What is developmental and genetic disease?

A

Polycystic kidneys, horseshoe kidney

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7
Q

What would show in the physical examination of a UTI?

A

Temperature: 38℃
Blood pressure: 105/70 mmHg
Pulse: 80/min
Abdomen: soft, slightly tender over suprapubic area and left loin

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8
Q

What are some investigation of a UTI?

A

Urine dipstick: 2+ leucocytes, + nitrite, trace of blood
Urine microscopy, culture and sensitivity
(blood tests e.g. renal profile: electrolyte, urea and creatinine

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9
Q

What is the treatment and overall clinical management of UTI?

A

-Antibiotics:
-depending on the severity of illness
-the most common bacteria in the local area
-modified when the sensitivity from urine culture is available
•Some patients may be very ill and need to be treated as inpatient.
•Pain control
•Supportive e.g. hydration
•Consider imaging if other factors or differential diagnosis.

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10
Q

What is Glomerulonephritis?

A

Inflammation of the microscopic filtering units of the kidney

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11
Q

What is the clinical presentation of Glomerulonephritis?

A
  • Nephritic syndrome
  • Proteinuria
  • Nephrotic syndrome
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12
Q

What is the patterns of organ involvement of Glomerulonephritis?

A
  • Kidney only
  • Kidney and lung
  • Multiple organs/tissues involved
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13
Q

What is the diagnostic approach of Glomerulonephritis?

A
  • History and physical examination
  • Urine test
  • Blood test: including immunology tests
  • Imaging: start with ultrasound
  • Kidney biopsy
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14
Q

What is nephritic syndrome?

A
  • Haematuria
  • Variable amount of proteinuria
  • May have hypertension, reduced urine output, increased urea and creatinine
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15
Q

What is the physical examination of nephritic syndrome?

A

Temperature: normal; Inflamed tonsil;
Blood pressure 140/100; pulse 70/min;
Chest: normal; Abdomen: normal; Ankle: no peripheral oedema.

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16
Q

What is the investigation of nephritic syndrome?

A

Urine Dipstick: 3+ blood, 2+ protein
Blood tests: raised serum urea and creatinine concentration, reduced eGFR. Autoantibodies were not detected.
Urine: raised urine protein : creatinine ratio
Kidney biopsy: IgA nephropathy

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17
Q

What is IgA nephropathy?

A
  • The most common primary glomerulonephritis world-wide.
  • Very high prevalence in Far East.
  • Deposition of IgA antibody in the kidney (detected by immunohistochemistry).
  • Inflammation and scarring.
  • About 30% progress to kidney failure.
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18
Q

What is the supportive treatment of IgA nephropathy?

A

•Treat hypertension and reduce proteinuria
First line treatment: angiotensin receptor inhibitor (ARB) (e.g. irbesartan) or angiotensin converting enzyme inhibitor (ACEI) (e.g. ramipril)
•Reduce sodium intake

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19
Q

What is the immunotherapy treatment of IgA nephropathy?

A

Immunotherapy: (Many different choices, ongoing clinical trials)
•Renal replacement therapy: when reaching late stage kidney disease
-Kidney transplantation
-Dialysis

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20
Q

What are locations of infections?

A
  • Bladder: cystitis

- Kidney: pyelonephritis

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21
Q

What are potential pathogens?

A
  • Bacteria: most common

- Virus and Fungal: immunocompromised patients

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22
Q

How do you make diagnosis?

A
  • History
  • Physical examination
  • Urine dipstick
  • Urine microscopy, culture and sensitivity
23
Q

What is an organ specific inflammatory condition?

A

Organ specific: kidney and lung
•Anti-glomerular basement membrane (GBM) antibody mediated: Goodpasture’s disease.
•Shared common antigen between lung and kidney: α3chain of type IV collagen.

24
Q

What is systemic inflammatory condition?

A

Systemic disease: multiple organ/tissue involved:
•Systemic lupus erythematosus (SLE): autoantibodies: antinuclear factor, anti-dsDNA.
•Vasculitis: antineutrophil cytoplasm antibody (ANCA)

25
Q

What is diabetic nephropathy?

A
  • The most common cause of chronic kidney disease and kidney failure in the Western World.
  • Pathogenesis: inflammation and fibrosis
26
Q

What are the risk factors of diabetic nephropathy?

A
  • Hypertension
  • Poor diabetic control
  • Smoking
27
Q

What are the clinical features of diabetic nephropathy?

A
  • Microalbuminuria
  • Proteinuria
  • Association with other complications of diabetes mellitus
  • Diabetic retinopathy
  • Diabetic neuropathy
28
Q

What is the treatment and clinical management of diabetic nephropathy?

A
  • Optimised diabetic control
  • Optimised treatment of hypertension
  • Reduce proteinuria using ARB or ACEI
  • Stop smoking
  • New clinical trials: SGLT2 inhibitor
  • Transplantation (including combined pancreas and kidney transplantation
  • Dialysis
29
Q

What are the potential mechanism of immune system damage?

A
  • Antibody

- Inflammatory cells (neutrophils, monocytes/macrophages, T cells)

30
Q

What is nephrotic syndrome?

A
  • Peripheral oedema
  • Severe proteinuria
  • Low serum albumin
  • Variable amount of microscopic haematuria
  • Associated with hyperlipidaemia
31
Q

What does the physical examination of someone with nephritic syndrome?

A
  • Periorbital oedema
  • Temperature normal, Blood pressure 110/70
  • Ankle: pitting oedema
32
Q

What is the investigation of nephritic syndrome?

A
  • Urine dipstick: no blood, 4+ protein.
  • Blood tests: normal serum urea and creatinine concentration; normal eGFR; very low serum albumin concentration (11 g/L); Autoantibodies were not detected.
  • Very high urine protein : creatinine ratio 1000mg/mmol.
  • Kidney biopsy: minimal change glomerulopathy.
33
Q

What are some causes for nephrotic syndrome?

A 
Many different causes, just some examples:
•Minimal change glomerulopathy
•Membranous nephropathy
•Focal segmental glomerulosclerosis
•Lupus nephritis
•Others
34
Q

What are the key features of minimal change glomerulopathy?

A
  • Most common in children, also affect other age groups
  • Normal light microscopy
  • Electron microscopy: podocyte effacement- abnormal flatten appearance (figure below)
  • Complication: high risk of thrombosis
35
Q

What is the treatment of nephritic syndrome?

A

•Immunotherapy
•Traditionally: corticosteroid, cyclophosphamide.
•Recent development: tacrolimus, antibody therapy targeting B cell pathway.
•Diuretics: to reduce the peripheral oedema.
Prevention of thrombosis: anticoagulation

36
Q

What are the possible location of the obstructive stones?

A
  • Kidney
  • Ureter
  • bladde
37
Q

What is the clinical presentation of obstructive stones?

A
  • Pain (abdomen, back-loin).
  • Blood in urine.
  • Associated with urine infection.
  • About 90% of kidney stone are radio-opaque.
38
Q

What is the physical examination of investigation stones?

A

Tenderness of loin and lower abdomen

39
Q

What is the investigation of obstructive stones?

A

-Urine inspection and dipstick: Blood in urine,
+/- evidence of urine infection.
-Blood test: Kidney function (reduced only in some patients).
-Imaging: Plain X ray, ultrasound or CT scan.

40
Q

What is the supportive treatment of stones?

A
  • Pain control

- Hydration

41
Q

What is the specific treatment of stones dependent upon?

A
  • Size and location of stones
  • Availability of local expertise
  • Fitness of patient for GA
42
Q

What is shockwave lithotripsy?

A

High energy sound waves to break up large kidney stones into smaller one

43
Q

What is ureterscopy?

A

Through urthera, baller and ureter

44
Q

What is percutaneous nephrolithotomy?

A

Small percutaenuos incise, insertion of nephroscope, stone is removed (may need to broken in smaller pieces)

45
Q

What are benign neoplastic conditions?

A

•Benign prostatic hypertrophy

46
Q

What are malignant neoplastic conditions?

A
  • Kidney: Renal cell carcinoma
  • Ureter and bladder: Transitional cell carcinoma
  • Prostatic cancer
  • Testicular cancer
47
Q

What is the clinical presentation of neoplastic conditions?

A
  • Asymptomatic (incidental finding during other investigation).
  • Haematuria.
  • Pain
48
Q

What are the investigation of neoplastic conditions?

A
  • 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 evidence of metastasis
49
Q

What is the treatment of neoplastic conditions?

A
  • 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
50
Q

What is the different types of polycystic kidney?

A
  • Neonatal: autosomal recessive
  • Adult onset: autosomal dominant
  • Some patients without family history
51
Q

What is the consequences of polycystic kidneys?

A
  • loss of kidney function
  • Pain
  • Bleeding into renal cysts
  • Infection of renal cysts
  • Asympotamic in some patients
52
Q

What is the treatment of polycystic kidney?

A
  • New medication: tolvaptan (a vasopressin receptor 2 antagonist)to slow down the cyts formation
  • Treta hypertension, infection
  • Pain control
  • Renal replacement therapy (transplantation, dialysis)
53
Q

What are consequences of a horseshoe kidney?

A
  • increased risk of
    1. Obstruction
    2. stone
    3. Infection

Z YEAR 1 BRS Gastroentology (11 decks)

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