Urological disorders Flashcards
What are the five main functions of the kidney?
Filtration: Removal of metabolic waste products, and maintaining essential substances within circulation (Erythrocytes, large plasma proteins, albumin)
2) Control of salt & water balance
3) Control of acid-base balance
4) EPO production is essential for the synthesis of haemoglobin and erythrocyte production
5) Vitamin D synthesis: 1-alpha-hydroxylase within the proximal convoluted tubule for the second hydroxyls of 25-cholecaliciferol into calcitriol
What is associated with a disrupted filtration mechanism within the kidney?
Haematuria
Proteinura
Low serum albumin
What occurs due to dysfunctional salt & water balance?
Hypertension
What are the effects of a disrupted renal acid/base balance?
Metabolic acidosis
Why does renal dysfunctional cause anaemia?
There is a deficiency in EPO production, thus this reduces the rate of erythropoiesis .
Why does kidney dysfunction lead to secondary hyperparathyroidism?
A reduction in the synthesis of calcitriol, reduces the negative feedback effect upon PTH, thus this increases the secretion of pTH released from chief cells to accommodate for hypocalcaemia
What is the effect on phosphate regulation during renal dysfunction?
Decreased phosphate retention, hyperparathyroidism causes increased phosphate secretion from the distal convoluted tubule
What are the two main inflammatory diseases that cause renal dysfunction?
Bladder cystitis
Kidney pyelonephritis
What are the physical examinations of patients with inflammatory renal disorders?
Temperature
High blood pressure and pulse
Abdomen is tender within the suprapubic area
Urine dipstick: Leucocytes, nitrite, blood and protein presence
What is conducted to evaluate the type and dose of antibiotics in terms of renal dysfunction?
Conduct urine culture
What is the conservative model of treating renal inflammation?
Hydration and pain control
What are the potential differential diagnoses of inflammatory renal disroder?
Obstruction -> Stones
Hypertrophy
Cancer
What are the metabolic non-infective causes of renal inflammation?
Diabetic nephropathy
What are the genetic conditions associated with renal dysfunction?
Polycystic kidney
Horshoe kidney
What is glomeruonephritis?
Inflammation of the microscopic filtering units of the kidney
What is nephritic syndrome?
Inflammation of glomeruli of the kidneys resulting in a reduction of the glomerular filtration rate -> Oedema, hypertension (salt.& water retention) reduced urine output, and increase urea and plasma creatine
What is IgA nephropathy?
Deposition of IgA antibody in the kidney (detected by immunohistochemistry) Causes inflammation and scarring 30% cases progress to kidney failure.
What can be used to treat hypertension and help reduce proteinuria in nephritic syndrome?
Angiotensin receptor inhibitor
Angiotensin converting enzyme inhibitor (ramipril)
How do ACE inhibitors work?
ACE inhibitors reduce the synthesis of angiotensin-II therefore this reduces the vasoconstrictive effects in addition to the reduced synthesis of aldosterone from the zone glomerulosa of the adrenal cortex (less sodium reabsorption from the collecting duct and the distal convoluted tubule) -> Reduce sodium uptake
What immunotherapy and renal replacement therapy is available for patients with nephritic syndrome?
Kidney transplantation and dialysis
What urine analytical results are indicative of nephritic syndrome?
Haematuria
Proteinuria
Raised urine Protein:Creatine ratio
What happens during good pastures disease in terms of collagen?
Organ specific: Anti-glomerular basement membrane antibody mediated: Goodpasture’s disease. Shared common antigen between lung and kidney: ⍺-3 chain of type IV collagen.
Which type of collagen is involved with Goodpasture’s disease?
Type IV collagen
What are the auto-antibodies in systemic diseases of the kidney?
Antinuclear factor
Anti-dsDNA
