Week 11- Urological Disorders

Question 1

What are the main functions of the kidney?

Answer 1

Filtration (removing unnecessary substances and keeping important stuff eg RBCs and albumin)
Maintaining salt and water balance
Maintaining acid/base balance
Hormone synthesis: erythropoietin-needed for the synthesis of Hb
Vit D- 1- alpha hydroxylation

Question 2

What are the main ways the kidney can dysfunction?

Answer 2

Filtration failure
Hypertension, water retention
Low vit D (and secondary hyperparathyroidism)
Metabolic acidosis
Anaemia

Question 3

What are the 4 types of urinary disorder?

Answer 3

Inflammatory
Obstructive
Neoplastic
Developmental

Question 4

What can be a result of filtration failure?

Answer 4

Being unwell due to build up of toxic waste products
Proteinuria
Haematuria
Low serum protein (inc albumin)

Question 5

Describe inflammatory urinary disorders

Answer 5

Infection including cystitis

Non infective causes: metabolic or immunological (nephritic or nephrotic syndrome)

Question 6

Describe obstructive urinary disorders

Answer 6

Stones

Benign prostatic hypertrophy

Question 7

Describe neoplastic urinary disorders

Answer 7

Kidney, bladder, prostatic, testicular cancer

Question 8

Describe developmental/genetic urinary disorders

Answer 8

Polycystic kidneys

Horseshoe kidney

Question 9

How are UTIs treated?

Answer 9

Antibiotics
Pain control
Supportive treatment eg hydration
Some patients may be very ill and need to treated as an inpatient

Question 10

What is glomerulonephritis?

Answer 10

Inflammation of the microscopic filtering units of the kidney

Question 11

What is the clinical presentation of glomerulonephritis?

Answer 11

Nephritic syndrome
Proteinuria
Nephrotic syndrome

Question 12

What type of condition is glomerulonephritis?

Answer 12

Immunological

Question 13

What are patterns of organ involvement for immunological conditions?

Answer 13

Kidney only
Kidney and lung
Multiple organs/tissues

Question 14

What is the diagnostic approach for immunological kidney conditions?

Answer 14

History and physical exam
Urine test
Blood test (inc immunology tests)
Imaging (ultrasound first line)
Kidney biopsy

Question 15

What is nephritic syndrome?

Answer 15

Haematuria
Variable amount of proteinuria
Hypertension, reduced urine output
Increased urea and creatine

Question 16

What type of condition is nephritic syndrome?

Answer 16

Immunological

Question 17

What is IgA nephropathy?

Answer 17

Most common primary glomerulonephritis worldwide

Question 18

Describe what happens in patients with IgA neuropathy

Answer 18

Deposition of IgA antibody in the kidney, 30% progress to kidney failure, causes inflammation and scarring

Question 19

What is the most common type of glomerulonephritis?

Answer 19

IgA nephropathy

Question 20

What are the 2 ways IgA nephropathy is treated? Describe them

Answer 20

Supportive:
Treat hypertension and reduce proteinuria (ARB or ACEI)
Reduce sodium intake

Immunotherapy:
Renal replacement therapy- when reaching late stage kidney disease, kidney transplantation or dialysis

Question 21

What is Goodpasture’s disease?

Answer 21

Anti glomerular basement membrane antibody mediated where the lung and kidney have a common antigen (alpha 3 chain of type IV collagen)

Question 22

What autoantibodies are involved with SLE?

Answer 22

Antinuclear factor, anti-dsDNA

Question 23

What antibody is involved with vascultis?

Answer 23

Antineutrophil cytoplasm antibody

Question 24

What is diabetic neuropathy? Describe its pathogenesis

Answer 24

The most common cause of chronic kidney disease and kidney failure, pathogenesis involves inflammation and fibrosis

Question 25

What are risk factors for diabetic neuropathy?

Answer 25

Hypertension Poor diabetic control Smoking

Question 26

What are clinical features of diabetic neuropathy?

Answer 26

Microalbuminuria Proteinuria Diabetic neuropathy/retinopathy

Question 27

How is diabetic neuropathy treated?

Answer 27

``` Optimise diabetes control Optimise treatment of hypertension Reduce proteinuria w/ ARB or ACEI Stop smoking Transplantation Dialysis ```

Question 28

What are clinical features of nephrotic syndrome?

Answer 28

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

Question 29

What are some causes for nephrotic syndrome?

Answer 29

Minimal change glomerulopathy Membranous nephropathy Focal segmental glomeruloscelrosis Lupus nephritis

Question 30

How is nephrotic syndrome treated?

Answer 30

Immunotherapy: corticosterois, cyclophosphamide Diuretics: reduce peripheral oedema Prevent thrombosis: anticoagulation

Question 31

What are some key features of minimal change glomerulopathy?

Answer 31

Most common in children Podocyte effacement High risk of thrombosis

Question 32

What supportive treatment is given for stones?

Answer 32

Pain control | Hydration

Question 33

What type of condition is nephrotic syndrome?

Answer 33

Immunological

Question 34

What are possible locations for stones?

Answer 34

Kidney, ureter, bladder

Question 35

What type of condition are stones?

Answer 35

Obstructive

Question 36

What is the clinical presentation of stones?

Answer 36

Pain- abdomen and back Blood in urine Urine infection

Question 37

What are the 3 types of specific treatments for stones? Describe them

Answer 37

Shockwave lithotripsy: high energy sound waves break up large kidney stones into smaller ones Uteroscopy: Through urethra, bladder and ureter Percutaneous nephrolithotomy: Small percutaneous incision, insertion of nephroscope, stone is removed

Question 38

What is the main benign tumour/ neoplastic condition?

Answer 38

Benign prostatic hypertrophy

Question 39

What is the malignant neoplastic condition of the kidney called?

Answer 39

Renal cell carcinoma

Question 40

What is the malignant neoplastic condition of the ureter and bladder called?

Answer 40

Transitional cell carcinoma

Question 41

What is the malignant neoplastic condition of the prostate called?

Answer 41

Prostatic cancer

Question 42

What is the malignant neoplastic condition of the testes called?

Answer 42

Testicular cancer

Question 43

What are the clinical presentations of tumors?

Answer 43

Asymptomatic (often found accidentally via other imaging) Haematuria Pain

Question 44

How are tumours investigated?

Answer 44

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 45

What are the treatments for tumours?

Answer 45

To release any obstruction of the urinary tract: nephrostomy, bladder catheter or/and surgery. Chemotherapy Radiotherapy Hormonal therapy for hormone sensitive cancer (e.g. prostatic cancer). Surgery

Question 46

What is the treatment for polycystic kidney disease?

Answer 46

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 47

What type of condition is polycystic kidney disease?

Answer 47

Developmental/genetic

Question 48

What type of condition is horseshoe kidney?

Answer 48

Developmental/genetic

Question 49

How do you assess for oedema?

Answer 49

Press your thumb into the skin, leave it there for 10 seconds, indentation when you remove your thumb indicates oedema

Question 50

What are some causes of kidney stone formation?

Answer 50

Acidification Inactive/bed bound  High protein/low fibre diet Enlarged prostate

Question 51

What can cause acidification of the urine?

Answer 51

Gout (uric acid) | Protein (eg from high protein diet)

Question 52

What are the 3 types of kidney stone?

Answer 52

Calcium Uric acid Systine Struvite