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
Why does diabetic nephropathy occur?
Hyperglycaemia results in hypertension within the afferent arteriole and glomerular capillaries, this increases the GFR, damages the mesangial glomerular cells; and glomerular basement membrane, thus increasing the fenestration size -> Reduces efficacy of ultrafiltration as plasma proteins and RBCs pass through
What are the clinical features of diabetic nephropathy?
Microalbuminuria
Proteinuria
How can diabetic nephropathy be controlled?
Optimised diabetic control Optimised treatment of hypertension Reduced proteinuria using ARB or ACEI Smoking cessation SGTL2 inhibitor Transplantation Dialysis.
What is nephrotic syndrome?
Conditioned defined by the triad of peripheral oedema, severe proteinuria, and hypoalbuminemia (low serum albumin). Variable amount of microscopy haematuria. Nephrotic syndrome is associated with hyperlipidaemia.
What are the electron microscopic investigations of nephrotic syndrome?
Podocyte effacement; flattened appearance
What are the four main causes of nephrotic syndrome?
Minimal change glomerulopathy
Membranous nephropathy
Focal segment glomerulosclerosis
Lupus nephritis
What are the possible immunotherapy treatments for treating nephrotic syndrome?
Corticosteroid, cyclophosphamide.
What is tacrolimus?
Tacrolimus: Antibody therapy targeting B cell pathway.
What treatment can be used to treat peripheral oedema in nephrotic syndrome?
Diuretics
What 3 main molecules form kidney stones
Uric acid
Calcium
Oxalate
Where are the common locations for kidney stones?
ureter
bladder
kidney
What are the clinical features of kidney stones?
Pain (abdomen, back-loin)
Haematuria, associated urine infections
90% radiopaque
What are the the urine investigations conducted for kidney stones?
Urine dipstick
Blood in urine
How can shockwave lithotripsy be used to treat kidney stones?
High frequency longitudinal sound waves to degrade kidney stones into minute pieces
What is ureteroscopy?
Through urethra, bladder and ureter
What are percutaneous nephrolithotomy?
Small percutaneous incision, insertion of nephroscope stone is removed
What are the most common benign renal tumours?
Prostatic hypertrophy
What are the most common malignant tumours?
Renal cell carcinoma. Ureter and bladder: Transitional cell carcinoma. Prostatic & testicular cancer.
What are the clinical features for kidney tumours?
Asymptomatic (incidental finding during clinical examination), haematuria
pain
What are the 6 main investigations?
Imaging Urine cytology Blood test for marker Kidney function histological diagnosis Staging studies
What antigen test is conducted to detect for prostatic cancer?
PSA
Prostatic specific antigen
What are the common treatments for renal tumour?
Treatment: Release obstruction of the urinary tract: Nephrostomy, bladder catheter; chemotherapy, radiotherapy, hormonal therapy (hormone sensitive cancer); surgery.
What is the inheritance pattern for neonatal polycystic kidney disease?
Autosomal recessive
What is the inheritance pattern of adult onset polycystic kidney disease?
Autosomal dominant
What is tolvapatan?
Vasopressin receptor 2 antagonist , reduces cyst formation
