Urology disorders Flashcards
What are the results of kidney dysfunction?
Filtration failure - haematuria, proteinuria, low serum protein, low albumin
Hypertension water retention
metabolic acidosis
anaemia
vit D deficiency and secondary hyperparathryroidism
Inflammatory reasons?
Cystitis infection
Metabolic diabetic nephropathy
Immunological Nephritic syndrome / nephrotic sundrome
Obstructive reasons?
Stones, benign prostatic hypertrophy
neoplastic reasons?
Kidney, balder, prostatic, testicular cancer
Developmental / genetic reasons?
Polycystic kidneys, horseshoe kidney
Where are the locations for infection and what pathogen?
Bladder: cystitis
Kidney: pyelonephritis
Consider other contributing factors e.g. obstruction, stones, prostatic hypertrophy, cancer.
Bacteria: most common
Virus: immunocompromised patients
Fungal: immunocompromised patients
URI for infectious condition management?
2+ leucocytes + nitrate, trace of blood in dipstick
urine microscopy, culture and sensitivity
Give antibiotics, pain control, hydration
Clinical presentation of immunological cause?
Nephritic syndrome
Proteinuria
Nephrotic syndrome
Immunostaining of inflammatory cells - brown stains - in biopsy
Potential mechanisms : antibody, neutrophils, monocytes, macrophages, t cells
Nephritic syndrome signs?
Haematuria
Variable amount of proteinuria
May have hypertension, reduced urine output, increased urea and creatinine
What is IgA nephropathy?
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
What is Goodpasture’s disease
Anti-glomerular basement membrane (GBM) antibody mediated: Goodpasture’s disease.
Shared common antigen between lung and kidney: α3chain of type IV collagen.
SLE?
Systemic lupus erythematosus (SLE): autoantibodies: antinuclear factor, anti-dsDNA.
Vasculitis: antineutrophil cytoplasm antibody (ANCA).
Nephrotic syndrome signs?
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
Causes of nephrotic syndrome?
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.
What is minimal change glomerulopathy?
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
Clinical presentation of stones causing kidney failure?
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.
how to treat stones
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).
tumour examples?
Benign prostatic hypertrophy
Malignant: Kidney: Renal cell carcinoma Ureter and bladder: Transitional cell carcinoma Prostatic cancer Testicular cancer
Clinical presentation of tumours?
Investigations?
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
Types of polycystic kidney disease?
Neonatal: autosomal recessive
Adult onset: autosomal dominant
Some patients without family history
consequences of polycystic kidney disease?
Loss of kidney function Pain Bleeding into the renal cysts Infection of renal cysts Asymptomatic in some patients
How to treat polycystic kidney disease?
New medication: Tolvaptan (a vasopressin receptor 2 antagonist) to slow down the cysts formation.
Treat hypertension, infection.
Pain control.
Renal replacement therapy (transplantation, dialysis).
Consequences of horsehoe kidney?
Increased risk of:
Obstruction
Stone
Infection
