Urological Disorders Flashcards
What are the consequences of kidney dysfunction?
- Filtration failure
Accumulation of waste substances
Haematuria, proteinuria, low serum protein including albumin in blood. (Essential substances that can’t usually leak out do)
- Hypertension, water retention
Sometimes dehydration because unable to make concentrated urine
- Metabolic acidosis
- Anaemia (erythropoietin is produced in the kidneys, essential for haemaglobin synthesis)
- Vitamin D deficiency and secondary hyperparathyroidism (as 1-a-hydroxylarion of vitamin D occurs in the kidney)
What are the types of urological disorders?
Inflammatory:
Infection including cystitis
Non infective causes - metabolic (including diabetic nephropathy). Immunological (nephrotic syndrome, nephrotic syndrome)
Obstructive:
Stones, benign prostatic hypertrophy
Neoplastic:
Kidney, bladder, prostatic, testicular cancer
Developmental/genetic:
Polycystic kidnets, horseshoe kidney
What are the possible locations for infection in the urological system? An the potential pathogens?
Bladder - cystitis
Kidney - pyelonephritis
Bacteria most commontly
Fungi and viruses in immunocompromised patients
How are urinary tract infections diagnosed?
History
Physical examination
Urine dipstick
Urine microscopy, culture and sensitivity
How are urinanry tract infections treated and managed?
Antibiotics:
Depending on - the severity, most common bacteria in 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
If inflammatory urological tract conditions are not caused by infection what might they be caused by?
Immune system: antibodies, inflammatory cells (neutrophils, macrophages, T cells)
Presents as:
Nephritic syndrome
Proteinuria
Nephrotic syndrome
Glomerularnephritis: inflammation of the microscopic filtering units of the kidney
What is the pattern of organ involvement and diagnostic approach of immunological inflammatory conditions?
Patterns of organ involvement:
Kidney only
Kidney and lung
Multiple organs/tissues
Diagnostic approach:
History
Physical examination
Urine test
Blood test (including immunology)
Imagining (starting with ultrasound)
Kidney biopsy
What is nephritic syndrome? (Symptoms and diagnosis)
Synptoms:
Haematuria
Variable amount of proteinuria
May have hypertension, reduced urine output, increased urea and creatinine
Diagnosis:
History, physical examination, urine dipstick, urine microscopy, urine protein, blood tests (kidney function, immunology test),
Kidney biopsy
What are some facts and the treatment of nephritic syndrome?
IgA nephropathy
Most common primary glomerulonephritis worldwide. Very high prevalence in far East
Deposition of IgA antibody in kidney
Inflammation and scarring
About 30% progress to kidney failure
Treatment:
Supportive - treat hypertension and reduce proteinuria. First line treatment is angiotensin receptor inhibitor (ARB) or angiotensin converting enzyme inhibitor (ACEI - ramipril). Reduce sodium intake
Immunotherapy: renal replacement therapy- when reaching late stage kidney disease - kidney transplantation or dialysis
What are the organ specific and systemic immunological inflammatory conditions?
Organ specific: kidney and lung
Anti glomerular basement membrane Antony mediated - goodpastures disease
Shared common antigen between lung and kidney: a3chain of type IV collagen
Systemic:
Systemic lupus erythematosus (SLE) : autoantibodies: antinuclear factor, anti-dsDNA
Vasculitis: antineutrophil cytoplasm antobody (ANCA)
What is diabetic nephropathy?
Inflammatory condition with metabolic cause
Most common cause of chronic kidney disease and kidney Faliure in the western world
Pathogenesis: inflammation and fibrosis
Risk factors: hypertension, Poor diabetic control, smoking
Clinical features:
Microalbuminuria
Proteinuria
Associated with other complications of diabetes mellitus: diabetic retinopathy, diabetic neuropathy
Treatment:
Optimised diabetic control
Treatment of hypersensitivity
Reduce proteinuria with ARB or ACEI
Stop smoking
Transplant
Dialysis
What is nephrotic syndrome?
Immunological inflammatory condition
Symptoms: peripheral oedema, severe proteinuria, low serum albumin, microscopic haematuria, hyperlipidaemia
Diagnosis: history, physical examination, urine dipstick, you’re in microscopy, urine protein: creatinine ratio, blood tests, kidney biopsy
What are the causes and treatment of nephrotic syndrome?
Causes:
Minimal change glomerulopathy
Membranous nephropathy
Focal segmental glomerulosclerosis
Lupus nephritis
Others
Treatment:
Immunotherapy - corticosteroid, cyclophosphamide, tacrolimus
Diuretics- to reduce peripheral oedema
Prevention of thrombosis - anticoagulants
(Minimal change glomerulopathy - most common In children, normal light microscopy, electron microscopy: podocyte effacement, high risk of thrombosis)
What are stones?
Obstructive condition
Locations: kidney, ureter, bladder
Clinical presentation: pain, blood in urine, adssociated with urine infection, 9/10 are radio opaque
Diagnosis: history, physical, urine dipstick, blood tests, imaging (x ray, ultrasound, CT)
What is the treatment of stones?
Treatment:
Supportive - pain control, hydration
Specific - depends on size, location, availability of local expertise, fitness of patient for general anaesthetics
->
Shockwave lithotripsy - high energy sound waves to break large kidney stones into smaller ones
Uteroscopy - through urethra, bladder and ureter
Percutanious neohrolithotomy - small percutaneous knwo ion. Insertion of nephroscope, stone is removed
