Week 11- Urological Disorders Flashcards
What are the main functions of the kidney?
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
What are the main ways the kidney can dysfunction?
Filtration failure Hypertension, water retention Low vit D (and secondary hyperparathyroidism) Metabolic acidosis Anaemia
What are the 4 types of urinary disorder?
Inflammatory
Obstructive
Neoplastic
Developmental
What can be a result of filtration failure?
Being unwell due to build up of toxic waste products
Proteinuria
Haematuria
Low serum protein (inc albumin)
Describe inflammatory urinary disorders
Infection including cystitis
Non infective causes: metabolic or immunological (nephritic or nephrotic syndrome)
Describe obstructive urinary disorders
Stones
Benign prostatic hypertrophy
Describe neoplastic urinary disorders
Kidney, bladder, prostatic, testicular cancer
Describe developmental/genetic urinary disorders
Polycystic kidneys
Horseshoe kidney
How are UTIs treated?
Antibiotics
Pain control
Supportive treatment eg hydration
Some patients may be very ill and need to treated as an inpatient
What is glomerulonephritis?
Inflammation of the microscopic filtering units of the kidney
What is the clinical presentation of glomerulonephritis?
Nephritic syndrome
Proteinuria
Nephrotic syndrome
What type of condition is glomerulonephritis?
Immunological
What are patterns of organ involvement for immunological conditions?
Kidney only
Kidney and lung
Multiple organs/tissues
What is the diagnostic approach for immunological kidney conditions?
History and physical exam Urine test Blood test (inc immunology tests) Imaging (ultrasound first line) Kidney biopsy
What is nephritic syndrome?
Haematuria
Variable amount of proteinuria
Hypertension, reduced urine output
Increased urea and creatine
What type of condition is nephritic syndrome?
Immunological
What is IgA nephropathy?
Most common primary glomerulonephritis worldwide
Describe what happens in patients with IgA neuropathy
Deposition of IgA antibody in the kidney, 30% progress to kidney failure, causes inflammation and scarring
What is the most common type of glomerulonephritis?
IgA nephropathy
What are the 2 ways IgA nephropathy is treated? Describe them
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
What is Goodpasture’s disease?
Anti glomerular basement membrane antibody mediated where the lung and kidney have a common antigen (alpha 3 chain of type IV collagen)
What autoantibodies are involved with SLE?
Antinuclear factor, anti-dsDNA
What antibody is involved with vascultis?
Antineutrophil cytoplasm antibody
What is diabetic neuropathy? Describe its pathogenesis
The most common cause of chronic kidney disease and kidney failure, pathogenesis involves inflammation and fibrosis
What are risk factors for diabetic neuropathy?
Hypertension
Poor diabetic control
Smoking
What are clinical features of diabetic neuropathy?
Microalbuminuria
Proteinuria
Diabetic neuropathy/retinopathy
How is diabetic neuropathy treated?
Optimise diabetes control Optimise treatment of hypertension Reduce proteinuria w/ ARB or ACEI Stop smoking Transplantation Dialysis
What are clinical features of nephrotic syndrome?
Peripheral oedema Low serum albumin Severe proteinuria Variable microscopic haematuria Associated with hyperlipidaemia
What are some causes for nephrotic syndrome?
Minimal change glomerulopathy
Membranous nephropathy
Focal segmental glomeruloscelrosis
Lupus nephritis
How is nephrotic syndrome treated?
Immunotherapy: corticosterois, cyclophosphamide
Diuretics: reduce peripheral oedema
Prevent thrombosis: anticoagulation
What are some key features of minimal change glomerulopathy?
Most common in children
Podocyte effacement
High risk of thrombosis
What supportive treatment is given for stones?
Pain control
Hydration
What type of condition is nephrotic syndrome?
Immunological
What are possible locations for stones?
Kidney, ureter, bladder
What type of condition are stones?
Obstructive
What is the clinical presentation of stones?
Pain- abdomen and back
Blood in urine
Urine infection
What are the 3 types of specific treatments for stones? Describe them
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
What is the main benign tumour/ neoplastic condition?
Benign prostatic hypertrophy
What is the malignant neoplastic condition of the kidney called?
Renal cell carcinoma
What is the malignant neoplastic condition of the ureter and bladder called?
Transitional cell carcinoma
What is the malignant neoplastic condition of the prostate called?
Prostatic cancer
What is the malignant neoplastic condition of the testes called?
Testicular cancer
What are the clinical presentations of tumors?
Asymptomatic (often found accidentally via other imaging)
Haematuria
Pain
How are tumours investigated?
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
What are the treatments for tumours?
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
What is the treatment for 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)
What type of condition is polycystic kidney disease?
Developmental/genetic
What type of condition is horseshoe kidney?
Developmental/genetic
How do you assess for oedema?
Press your thumb into the skin, leave it there for 10 seconds, indentation when you remove your thumb indicates oedema
What are some causes of kidney stone formation?
Acidification
Inactive/bed bound
High protein/low fibre diet
Enlarged prostate
What can cause acidification of the urine?
Gout (uric acid)
Protein (eg from high protein diet)
What are the 3 types of kidney stone?
Calcium
Uric acid
Systine
Struvite
