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JL Renal and Urology > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What is agenesis?

A

Absence of one or both kidneys

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2
Q

What is hypoplasia?

A

Small kidneys but normaly development

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3
Q

What is a horseshoe kidney?

A

Fusion at either pole, usually lower

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4
Q

What long term clinical condition can lead to secondary cystic disease?

A

Native kidneys in long term dialysis

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5
Q

What disease is rare and causes terminal renal failure?

A

Infantile type polycystic disease

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6
Q

What inheritance is infantile polycystic kidney disease?

A

Autosomal recessive

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7
Q

In infantile type polycystic disease - how would you describe the kidneys?

A

Bilateral renal enlargement, elongated cysts - dilatation of medullary collecting ducts

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8
Q

What is infantile polycystic kidney disease associated with?

A

Congenital Hepatic Fibrosis

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9
Q

What inheritance is adult polycystic disease?

A

Autosomal dominant

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10
Q

What is the most common defect in adult polycystic disease?

A

Chromosome 16 in 90% - type 1

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11
Q

What is the second most common defect in adult polycystic disease?

A

Chromosome 4 - type II

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12
Q

Give four presentation features of a patient with adult polycystic disease?

A
  1. Abdominal mass
  2. Haematuria
  3. Hypertension
  4. CRF
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13
Q

Give two descriptive features of adult polycystic disease?

A
  1. Massive bilateral renal enlargement > 1kg

2. Multiple cysts of varying size > distortion of reniform shape, cysts arise in any part of nephron

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14
Q

What is adult polycystic disease associated with?

A

Berry aneurysms in circle of Willis which predisposes to subarachnoid haemorrhage

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15
Q

Name a benign tumour: common, medullary origin, white nodules

A

Fibroma

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16
Q

Name a benign tumour: yellowish nodules, less than two centimetres and cortical

A

Adenoma

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17
Q

Name a benign tumour: a mixture of fat, muscle and blood vessels. can be multiple and bilateral?

A

Angiomyolipoma

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18
Q

What is angiomyolipoma (benign tumour) associated with?

A

Tuberous scerosis

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19
Q

What benign tumour causes increased renin production, which in turn causes secondary hypertension?

A

JGCT

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20
Q

What is the commonest malignant renal tumour in children?

A

Nephroblastoma (Wilms tumour)

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21
Q

What malignant renal tumour presents with abdominal mass and arises from residual primitive renal tissue?

A

Nephroblastoma

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22
Q

What maignant renal tumours occur in the renal pelvis and calyces?

A

Urothelial carcinomas

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23
Q

What malignant renal tumour arises from renal tubular epithelium?

A

Renacl cell carcinoma

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24
Q

What is the other term for a renal cell carcinoma?

A

Clear cell

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25
What is the commonest primary renal tumour in adults?
Renal cell carcinoma 55-60 years, m:f is 2:1
26
What three things does a patient with RCC present with?
1. Abdominal mass 2. Haematuria 3. Flank pain
27
Give two paraneoplastic manifestations of RCC?
1. Polycythaemia, erythropoietic stimulating substance (raised red cell count) 2. Hypercalcaemia
28
How would you describe a renal cell carcinoma?
Large, well circumscribed mass centred on cortex. | Yellow, with solid, cystic, necrotic and haemorrhagic areas.
29
Where can RCC commonly extend to?
Renal vein and then to vena cava to right atrium
30
Where can RCC blood born spread to?
Lungs and bone
31
What are clear cell type RCC (commonest) rich in?
Glycogen and lipid
32
Where does transitonal epithelium run to and from?
From pelvicalyceal system to urethra
33
What are 90% of bladder tumours?
Transitional cell carcinomas, common, > 50 years
34
Name 5 risk factors for transitional cell carcinomas (bladder cancer)?
1. Dye industry 2. Rubber industry 3. Analgesics 4. Schistosomiasis 5. Smoking
35
Where do 75% of transitional cell carcinomas occur?
In trigone - ureteric obstruction
36
In TCC what can be said about the papillae?
Thicker lining than normal urothelium
37
What two places can TCC invade to?
Stroma and detrusor muscle (pT2)
38
A TCC carcinoma-in-situ can occur in what epihtelium?
FFlat
39
Name three places TCC can spread to?
Obturator lymph nodes Lungs Liver
40
Is recurrence frequent in transitional cell carcinoma?
YES
41
Name the malignant tumour: extroversion (glandular metaplasia), urachal remnants, long standing cystitis cystica
Adenocarcinoma
42
Name the malignant tumour: calculi (squamous metaplasia), schistosomiasis?
Squamous carcinoma
43
What is the commonest malignant bladder tumour in children?
Embryonal rhabdomyosarcoma
44
What is the definition of urinary incontinence?
The complaint of any involuntary leakage of urine
45
What are two ways urine may leak extra-urethral?
Ectopic ureter | Fistula
46
What level of the spinal cord is the spinal baldder centre at?
S2 and S3
47
What two sets of nerves are involved in the reflex arcs of the bladder?
1. Pelvic parasympathetic nerves | 2. Pudendal nerve
48
What type of incontinence - bladder outflow obstruction, huge palpable bladder, chronic retention, often wet at night and renal impairment?
Overflow incontinence
49
What type of incontinence involves frequency and small voided volumes, urgency, enuresis and urge urinary incontinence?
Urge incontinence
50
What might urge incontinence be due to?
Detrusor overactivity
51
How is detrusor overactivity diagnosed?
Urodynamics
52
What happens to the bladder if S2 and 3 centre is destroyed?
Becomes an inery bag
53
What type of incontinence involves urine leaking duriong increased intra-abdominal pressure, without a detrusor contraction?
Stress incontinence
54
What can cause stress incontinence?
Damage to pelvic floor or urethral function - child birth
55
How is stress incontinence diagnosed?
Urodynamic diagnosis
56
What is a painless palpable mass arising from the pelvis in which you cannot get below, also dull to percuss?
Bladder
57
How is overflow incontinence treated?
1. Assess renal function 2. Treat obstruction - catheterise 3. Rehabilitate the bladder - teach intermittenet self cathetirisation
58
How is urge urinary incontinence treated?
1. Dietary discretion - caffeine 2. Biofeedback 3. Bladder retraining 4. Pharmacotherapy 5. Neuromodulation 6. Surgery
59
What surgery can be used for urge incontinence?
Enterocystoplasty
60
What two drug classes can treat urge incontinsnece?
1. Antimuscarinics | 2. Beta-3-adrenergics
61
How is stress incontinence treated?
1. Weight loss 2. Smoking 3. Pelvic floor exercises 4. Pharmacotherapy - Duloxetine 5. Surgery - tape procedures
62
What countries are vesico-vaginal fistulas common in?
Developing countries due to prolonged obstructed labour.
63
What does a frequency volume chart do?
Records volumes voided as well as time of each micturition, day and night for at least 24 hours
64
What results from an imbalance between rate of formation and absorption of interstitial fluid?
Oedema
65
Name three diseases which cause oedema?
1. Nephrotic syndrome 2. Congestive heart failure 3. Hepatic cirrhosis with ascites
66
What involves a disorder of glomerular filtration, allowing protein (albumin) to appear in the filtrate (proteinuria)?
Nephrotic syndrome
67
What diuretics work on the proximal convoluted tubule to block Na/H exchange?
Carbonic anhydrase inhibiors
68
What diuretics work on thick ascending limb of loop of Henle to block Na/K/2Cl co-transport?
Loop diuretics
69
What two diuretics work on the distal convoluted tubule?
1. Carbonic anhydrase inhibitors | 2. Thiazide diuretics
70
What transport in the distal convoluted tubule to thiazide diuretics blocks?
Na/Cl co-transport
71
What diuretics work on the collecting duct to block Na/K exchange?
Potassium sparing diuretics
72
Where is the site of action of many diuretics?
Apical membrane of tubular cells
73
What transport systems transport acidic drugs such as thiazides and loop agents?
Organic anion transporters
74
In relation to organic anion transporters: at the basolateral membrane organic anions enter cell by diffusion or in exchange for what via OATs?
Alpha-ketoglutarate/a-KG
75
In relation to organic anion transporters: after the OA has entered the cell, how is another alpha-KG transported into the cell too?
Via Na-dicarboxylate transporter
76
In relation to organic anion transporters: how does OA enter the lumen at teh APICAL membrane?
Via either MRP2 (multidrug resistance protein 2) or OAT4 (in exchange for a-KG)
77
In relation to organic cation transporters: how does OC enter the lumen at the APICAL membrane?
Via either MRP1 (multidrug resistance protein 1) or OC/H antiporters (OCTN)
78
What do loop diuretics block?
Triple transporter (Na/K/2Cl coo transporter; NKCC2) - in thick ascending limb
79
What kind of drug is furosemide?
loop diuretic
80
What does a loop diuretic bind to to inhibit Na/K/2Cl?
Cl
81
How do loop diuretics enter the nephron?
Via OAT mechanism
82
Other than reducing salt and water overlaod, what else can loop diuretics reduce?
Acute hypercalcaemia
83
Give three side effects of loop diuretics?
1. Potassium loss 2. Depletion of calcium and magnesium 3. Hyperuricaemia
84
What do thiazide diuretics block?
Na/Cl - cotransporter
85
What do thiazides increase the reabsorption of?
Calcium
86
Name two conditions thiazide diuretics are used in?
1. Renal stone disease | 2. Nephrogenic diabetes insipidus
87
List some adverse affects of thiazide diuretics?
1. Potassium loss 2. Metabolic alkalosis 3. Depletion of magnesium 4. Hyperuricaemia 5. Male sexual dysfunction 6. Imparied glucose tolerance
88
Name a drug which competes with aldosterone for binding to intracellular receptors?
Spironolactone
89
Name a potassium sparing diuretic?
Spironolactone
90
What can aldosterone antagonists be used in the treatment of?
Primary hyperaldosteronism - conns

JL Renal and Urology (9 decks)

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