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BRS Y1 > Week 11- Urological Disorders > Flashcards

Week 11- Urological Disorders Flashcards

1
Q

What are the main functions of the kidney?

A

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

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2
Q

What are the main ways the kidney can dysfunction?

A 
Filtration failure
Hypertension, water retention
Low vit D (and secondary hyperparathyroidism)
Metabolic acidosis
Anaemia
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3
Q

What are the 4 types of urinary disorder?

A

Inflammatory
Obstructive
Neoplastic
Developmental

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4
Q

What can be a result of filtration failure?

A

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

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5
Q

Describe inflammatory urinary disorders

A

Infection including cystitis

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

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6
Q

Describe obstructive urinary disorders

A

Stones

Benign prostatic hypertrophy

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7
Q

Describe neoplastic urinary disorders

A

Kidney, bladder, prostatic, testicular cancer

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8
Q

Describe developmental/genetic urinary disorders

A

Polycystic kidneys

Horseshoe kidney

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9
Q

How are UTIs treated?

A

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

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10
Q

What is glomerulonephritis?

A

Inflammation of the microscopic filtering units of the kidney

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11
Q

What is the clinical presentation of glomerulonephritis?

A

Nephritic syndrome
Proteinuria
Nephrotic syndrome

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12
Q

What type of condition is glomerulonephritis?

A

Immunological

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13
Q

What are patterns of organ involvement for immunological conditions?

A

Kidney only
Kidney and lung
Multiple organs/tissues

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14
Q

What is the diagnostic approach for immunological kidney conditions?

A 
History and physical exam
Urine test
Blood test (inc immunology tests)
Imaging (ultrasound first line)
Kidney biopsy
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15
Q

What is nephritic syndrome?

A

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

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16
Q

What type of condition is nephritic syndrome?

A

Immunological

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17
Q

What is IgA nephropathy?

A

Most common primary glomerulonephritis worldwide

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18
Q

Describe what happens in patients with IgA neuropathy

A

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

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19
Q

What is the most common type of glomerulonephritis?

A

IgA nephropathy

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20
Q

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

A

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

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21
Q

What is Goodpasture’s disease?

A

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

22
Q

What autoantibodies are involved with SLE?

A

Antinuclear factor, anti-dsDNA

23
Q

What antibody is involved with vascultis?

A

Antineutrophil cytoplasm antibody

24
Q

What is diabetic neuropathy? Describe its pathogenesis

A

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

25
Q

What are risk factors for diabetic neuropathy?

A

Hypertension
Poor diabetic control
Smoking

26
Q

What are clinical features of diabetic neuropathy?

A

Microalbuminuria
Proteinuria
Diabetic neuropathy/retinopathy

27
Q

How is diabetic neuropathy treated?

A 
Optimise diabetes control
Optimise treatment of hypertension
Reduce proteinuria w/ ARB or ACEI
Stop smoking
Transplantation
Dialysis
28
Q

What are clinical features of nephrotic syndrome?

A 
Peripheral oedema
Low serum albumin
Severe proteinuria
Variable microscopic haematuria
Associated with hyperlipidaemia
29
Q

What are some causes for nephrotic syndrome?

A

Minimal change glomerulopathy
Membranous nephropathy
Focal segmental glomeruloscelrosis
Lupus nephritis

30
Q

How is nephrotic syndrome treated?

A

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

31
Q

What are some key features of minimal change glomerulopathy?

A

Most common in children
Podocyte effacement
High risk of thrombosis

32
Q

What supportive treatment is given for stones?

A

Pain control

Hydration

33
Q

What type of condition is nephrotic syndrome?

A

Immunological

34
Q

What are possible locations for stones?

A

Kidney, ureter, bladder

35
Q

What type of condition are stones?

A

Obstructive

36
Q

What is the clinical presentation of stones?

A

Pain- abdomen and back
Blood in urine
Urine infection

37
Q

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

A

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

38
Q

What is the main benign tumour/ neoplastic condition?

A

Benign prostatic hypertrophy

39
Q

What is the malignant neoplastic condition of the kidney called?

A

Renal cell carcinoma

40
Q

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

A

Transitional cell carcinoma

41
Q

What is the malignant neoplastic condition of the prostate called?

A

Prostatic cancer

42
Q

What is the malignant neoplastic condition of the testes called?

A

Testicular cancer

43
Q

What are the clinical presentations of tumors?

A

Asymptomatic (often found accidentally via other imaging)
Haematuria
Pain

44
Q

How are tumours investigated?

A

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

45
Q

What are the treatments for tumours?

A

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

46
Q

What is the treatment for polycystic kidney disease?

A

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

47
Q

What type of condition is polycystic kidney disease?

A

Developmental/genetic

48
Q

What type of condition is horseshoe kidney?

A

Developmental/genetic

49
Q

How do you assess for oedema?

A

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

50
Q

What are some causes of kidney stone formation?

A

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

51
Q

What can cause acidification of the urine?

A

Gout (uric acid)

Protein (eg from high protein diet)

52
Q

What are the 3 types of kidney stone?

A

Calcium
Uric acid
Systine
Struvite

BRS Y1 (52 decks)

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