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BRS > Urological disorders > Flashcards

Urological disorders Flashcards

1
Q

What is the role of the kidney in a healthy individual?

A

Filtration:
-removal of waste substance
-keeping essential substances within blood e.g. large proteins including albumin
Control of salts and water balance
Control of acid/base balance
Hormone: erythropoietin production for Hb synthesis
Vitamin D: 1-alpha-hydroxylation of vit D

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2
Q

What happens to the kidney in kidney dysfunction?

A

Filtration failure:
-Unwell with accumulation of waste substance
-Haematuria (blood in urine) and proteinuria, low serum proteins inc. albumin in blood
Hypotension and water retention (sometimes dehydration because unable to make concentrated urine)
Metabolic acidosis
Anaemia
Vitamin D deficiency and secondary hyperparathyroidism

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3
Q

What are the causes of inflammatory urinary disorders?

A

Infection including cystitis
Non-infectious causes:
-metabolic including diabetic nephropathy
-immunological : Nephritic syndrome and nephrotic syndrome

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4
Q

What are the examples of obstructive urinary disorders?

A

Stones and benign prostatic hypertrophy

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5
Q

What are the examples of neoplastic urinary disorders?

A

Kidney, bladder, prostatic, testicular cancer

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6
Q

What are the examples of developmental/genetic urinary disorders?

A

Polycystic kidneys

Horseshoe kidney

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7
Q

What are possible locations for a urinary infection?

A

Bladder: cystitis
Kidney: pyelonephritis

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8
Q

What are potential pathogens of a urinary infection?

A

Bacteria: most common
Virus: immunocompromised patients
Fungal: immunocompromised patients

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9
Q

How is diagnosis made for a UTI?

A

History
Physical examination
Urine dipstick
Urine microscopy, culture and sensitivity

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10
Q

How is a UTI treated?

A

Antibiotics:
-depends on severity of illness
-given for the most common bacteria in the area
-modified when sensitivity from urine culture is available
Pain control
Impatient treatment if they’re very ill
Supportitive e.g. hydration

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11
Q

How can the immune system damage the kidney?

A

Potential mechanisms:

  • antibody
  • inflammatory cells (neutrophils, monocytes/macrophages, T cells)
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12
Q

How does an immunological inflammatory condition present?

A

Nephritic syndrome
Proteinuria
Nephrotic syndrome

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13
Q

What is glomerulonephritis?

A

Inflammation of the microscopic filtering units of the kidney

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14
Q

How would you diagnose an immunological urinary problem?

A 
History
Physical inflammation
Urine test
Blood Test: inc immunology tests
Imaging: start with US
Kidney biopsy
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15
Q

How does nephritic syndrome present?

A

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

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16
Q

How would you diagnose nephritic syndrome?

A 
History
Physical examination
Urine dipstick
Urine microscopy
Urine protein: creatinine ratio
Blood tests: kidney function, immunological test
Kidney biopsy
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17
Q

What is a very common type of nephritic syndrome?

A

IgA nephropathy
Deposition of IgA in the kidney
Inflammation and scarring
about 30% progress to kidney failure

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18
Q

What are supportive treatments for IgA neuropathy?

A

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

19
Q

What are immunotherapy treatments for IgA neuropathy?

A

Renal replacement therapy: when reaching late stage kidney disease
kidney transplantation
dialysis

20
Q

What is an example of an organ specific inflammatory urinary disease?

A

Organs involved: Kidney and lung
Anti- glomerular basement membrane (GBM) antibody mediated: Goodpasture’s disease
Shared common antigen between lung and kidney is the alpha-3-chain of type IV collagen

21
Q

What is an example of a systemic inflammatory urinary disease?

A

Systemic Lupus erythematosus: autoantibodies include antinuclear factor, anti-dsDNA

Vasculitis: antineutrophil cytoplasm antibody

22
Q

What is the pathogenesis of diabetic neuropathy?

A

Inflammation and fibrosis

23
Q

What are risk factors of diabetic nephropathy?

A

Hypertension
Poor diabetic control
Smoking

24
Q

What are clinical features of diabetic nephropathy?

A 
Microalbuminuria
Proteinuria
Associated with other complications of diabetes mellitus:
- diabetic retinopathy
-diabetic neuropathy
25
Q

What are treatments of diabetic nephropathy?

A 
Optimised diabetic control
Optimised treatment of hypertension
Reduced proteinuria using ARB or ACEI
Stop smoking
New clinical trials: SGLT2 inhibitor
Transplantation (inc. combined pancreas and kidney transplantation)
Dialysis
26
Q

What are clinical presentations of nephrotic syndrome?

A 
Peripheral oedema
Severe proteinuria
Low serum albumin
Variable amounts of microscopic haematuria
Associated with hyperlipidaemia
27
Q

How do we diagnose nephrotic syndrome?

A 
History
Physical inflammation
Urine dipstick
Urine microscopy
Urine protein: creatinine ratio
Blood Test: kidney function and immunological
Kidney biopsy
28
Q

What are causes of nephrotic syndrome?

A

Minimal change glomerulopathy
Membranous nephropathy
Focal segmental glomerulosclerosis
Lupus nephritis

29
Q

What are treatments of nephrotic syndrome?

A

Immunotherapy:

  • traditionally corticosteroids and cyclophosphamide
  • recent development: tacrolimus and antibody therapy targeting B cell pathway

Diuretics: to reduce peripheral oedema

Prevention of thrombosis: anticoagulation

30
Q

What are possible locations of stones?

A

Kidney
Ureter
Bladder

31
Q

What are clinical presentations of stones?

A

Pain (abdomen and back)
Blood in urine
Associated with UTI
About 90% of kidney stones are radio-opaque

32
Q

What are supportive treatments of stones?

A

Pain control

Hydration

33
Q

What are specific treatments for stones?

A

Shockwave lithotripsy: high energy sounds waves used to break down large kidney stones

Ureteroscopy: through urethra, bladder and ureter

Percutaneous nephrolithotomy: small percutaneous incision. Insertion of nephroscope. Stone is removed (may need to be broken to smaller pieces)

34
Q

What is an example of a benign neoplasm?

A

Benign prostatic hypertrophy

35
Q

What are examples of malignant neoplasms?

A

Kidney: Renal cell carcinoma
Ureter and bladder: transitional cell carcinoma
Prostatic cancer
Testicular cancer

36
Q

What are clinical presentations of a neoplasm tumour?

A

Asymptomatic (incidental finding during other investigations)
Haematuria
Pain

37
Q

What investigations are used to diagnose neoplasms?

A

Imaging (US, CT, MRI)
Urine cytology
Blood test for marker: prostatic specific antigen (PSA)- can have false positives
Kidney function
Histological diagnosis: biopsy or excised tumour
Staging studies: any evidence of metastasis

38
Q

What are treatments of a neoplasm?

A

To release obstruction: nephrostomy, bladder catheter and/or surgery
Chemotherapy
Radiology
Hormonal therapy for hormone sensitive cancers e.g. prostatic cancer
Surgery

39
Q

What are different types of polycystic kidneys?

A

Neonatal: autosomal recessive
Adult onset: autosomal dominant
Some patients without family history

40
Q

What are consequences of polycystic kidneys?

A 
Loss of kidney function
Pain
Bleeding into renal cysts
Infection of renal cysts
Asymptomatic in some patients
41
Q

What are treatments for polycystic kidney disease?

A

New medication: Tolvaptan (vasopressin receptor 2 antagonist) to slow down cyst formation
Treat hypertension, infection
Pain control
Renal replacement therapy (transplantation, dialysis)

42
Q

How can we find out if a patient has a horseshoe kidney?

A

Imaging of abdomen/ pelvis

43
Q

What are consequences of a horseshoe kidney?

A

increased risk of:
obstruction
stones
infection

BRS (60 decks)

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