Urology disorders

Question 1

What are the results of kidney dysfunction?

Answer 1

Filtration failure - haematuria, proteinuria, low serum protein, low albumin

Hypertension water retention

metabolic acidosis

anaemia

vit D deficiency and secondary hyperparathryroidism

Question 2

Inflammatory reasons?

Answer 2

Cystitis infection

Metabolic diabetic nephropathy

Immunological Nephritic syndrome / nephrotic sundrome

Question 3

Obstructive reasons?

Answer 3

Stones, benign prostatic hypertrophy

Question 4

neoplastic reasons?

Answer 4

Kidney, balder, prostatic, testicular cancer

Question 5

Developmental / genetic reasons?

Answer 5

Polycystic kidneys, horseshoe kidney

Question 6

Where are the locations for infection and what pathogen?

Answer 6

Bladder: cystitis
Kidney: pyelonephritis
Consider other contributing factors e.g. obstruction, stones, prostatic hypertrophy, cancer.

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

Question 7

URI for infectious condition management?

Answer 7

2+ leucocytes + nitrate, trace of blood in dipstick

urine microscopy, culture and sensitivity

Give antibiotics, pain control, hydration

Question 8

Clinical presentation of immunological cause?

Answer 8

Nephritic syndrome

Proteinuria

Nephrotic syndrome

Immunostaining of inflammatory cells - brown stains - in biopsy

Potential mechanisms : antibody, neutrophils, monocytes, macrophages, t cells

Question 9

Nephritic syndrome signs?

Answer 9

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

Question 10

What is IgA nephropathy?

Answer 10

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.

treat the hypertension and reduce proteinuria

• : angiotensin receptor inhibitor (ARB) (e.g. irbesartan) or angiotensin converting enzyme inhibitor (ACEI) (e.g. ramipril)
  Reduce sodium intake

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

Question 11

What is Goodpasture’s disease

Answer 11

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

Question 12

SLE?

Answer 12

Systemic lupus erythematosus (SLE): autoantibodies: antinuclear factor, anti-dsDNA.
Vasculitis: antineutrophil cytoplasm antibody (ANCA).

Question 13

Nephrotic syndrome signs?

Answer 13

Peripheral oedema
Severe proteinuria
Low serum albumin
Variable amount of microscopic haematuria
Associated with hyperlipidaemia

Facial and leg swelling with frothy urine

Low BP

No blood but yes protein in urine

on biopsy - very minimal change to glomerulopathy

Question 14

Causes of nephrotic syndrome?

Answer 14

Minimal change glomerulopathy
Membranous nephropathy
Focal segmental glomerulosclerosis
Lupus nephritis
Others

treat : corticosteroids, cyclophosphamide

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

Question 15

What is minimal change glomerulopathy?

Answer 15

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

Question 16

Clinical presentation of stones causing kidney failure?

Answer 16

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

Tenderness of loin and lower abdomen.

Question 17

how to treat stones

Answer 17

pain and hydration

Shockwave Lithotripsy: High energy sound waves to break up large kidney stones into smaller one.

Ureteroscopy: Through urethra, bladder and ureter.

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

Question 18

tumour examples?

Answer 18

Benign prostatic hypertrophy

Malignant:
Kidney: Renal cell carcinoma
Ureter and bladder: Transitional cell carcinoma
Prostatic cancer
Testicular cancer

Question 19

Clinical presentation of tumours?

Investigations?

Answer 19

Asymptomatic (incidental finding during other investigation).
Haematuria.
Pain.

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

Question 20

Types of polycystic kidney disease?

Answer 20

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

Question 21

consequences of polycystic kidney disease?

Answer 21

Loss of kidney function
Pain
Bleeding into the renal cysts
Infection of renal cysts
Asymptomatic in some patients

Question 22

How to treat polycystic kidney disease?

Answer 22

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

Question 23

Consequences of horsehoe kidney?

Answer 23

Increased risk of:
Obstruction
Stone
Infection