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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
Q

What is the commonest primary renal tumour in adults?

A

Renal cell carcinoma 55-60 years, m:f is 2:1

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26
Q

What three things does a patient with RCC present with?

A
  1. Abdominal mass
  2. Haematuria
  3. Flank pain
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27
Q

Give two paraneoplastic manifestations of RCC?

A
  1. Polycythaemia, erythropoietic stimulating substance (raised red cell count)
  2. Hypercalcaemia
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28
Q

How would you describe a renal cell carcinoma?

A

Large, well circumscribed mass centred on cortex.

Yellow, with solid, cystic, necrotic and haemorrhagic areas.

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29
Q

Where can RCC commonly extend to?

A

Renal vein and then to vena cava to right atrium

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30
Q

Where can RCC blood born spread to?

A

Lungs and bone

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31
Q

What are clear cell type RCC (commonest) rich in?

A

Glycogen and lipid

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32
Q

Where does transitonal epithelium run to and from?

A

From pelvicalyceal system to urethra

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33
Q

What are 90% of bladder tumours?

A

Transitional cell carcinomas, common, > 50 years

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34
Q

Name 5 risk factors for transitional cell carcinomas (bladder cancer)?

A
  1. Dye industry
  2. Rubber industry
  3. Analgesics
  4. Schistosomiasis
  5. Smoking
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35
Q

Where do 75% of transitional cell carcinomas occur?

A

In trigone - ureteric obstruction

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36
Q

In TCC what can be said about the papillae?

A

Thicker lining than normal urothelium

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37
Q

What two places can TCC invade to?

A

Stroma and detrusor muscle (pT2)

38
Q

A TCC carcinoma-in-situ can occur in what epihtelium?

39
Q

Name three places TCC can spread to?

A

Obturator lymph nodes
Lungs
Liver

40
Q

Is recurrence frequent in transitional cell carcinoma?

41
Q

Name the malignant tumour: extroversion (glandular metaplasia), urachal remnants, long standing cystitis cystica

A

Adenocarcinoma

42
Q

Name the malignant tumour: calculi (squamous metaplasia), schistosomiasis?

A

Squamous carcinoma

43
Q

What is the commonest malignant bladder tumour in children?

A

Embryonal rhabdomyosarcoma

44
Q

What is the definition of urinary incontinence?

A

The complaint of any involuntary leakage of urine

45
Q

What are two ways urine may leak extra-urethral?

A

Ectopic ureter

Fistula

46
Q

What level of the spinal cord is the spinal baldder centre at?

47
Q

What two sets of nerves are involved in the reflex arcs of the bladder?

A
  1. Pelvic parasympathetic nerves

2. Pudendal nerve

48
Q

What type of incontinence - bladder outflow obstruction, huge palpable bladder, chronic retention, often wet at night and renal impairment?

A

Overflow incontinence

49
Q

What type of incontinence involves frequency and small voided volumes, urgency, enuresis and urge urinary incontinence?

A

Urge incontinence

50
Q

What might urge incontinence be due to?

A

Detrusor overactivity

51
Q

How is detrusor overactivity diagnosed?

A

Urodynamics

52
Q

What happens to the bladder if S2 and 3 centre is destroyed?

A

Becomes an inery bag

53
Q

What type of incontinence involves urine leaking duriong increased intra-abdominal pressure, without a detrusor contraction?

A

Stress incontinence

54
Q

What can cause stress incontinence?

A

Damage to pelvic floor or urethral function - child birth

55
Q

How is stress incontinence diagnosed?

A

Urodynamic diagnosis

56
Q

What is a painless palpable mass arising from the pelvis in which you cannot get below, also dull to percuss?

57
Q

How is overflow incontinence treated?

A
  1. Assess renal function
  2. Treat obstruction - catheterise
  3. Rehabilitate the bladder - teach intermittenet self cathetirisation
58
Q

How is urge urinary incontinence treated?

A
  1. Dietary discretion - caffeine
  2. Biofeedback
  3. Bladder retraining
  4. Pharmacotherapy
  5. Neuromodulation
  6. Surgery
59
Q

What surgery can be used for urge incontinence?

A

Enterocystoplasty

60
Q

What two drug classes can treat urge incontinsnece?

A
  1. Antimuscarinics

2. Beta-3-adrenergics

61
Q

How is stress incontinence treated?

A
  1. Weight loss
  2. Smoking
  3. Pelvic floor exercises
  4. Pharmacotherapy - Duloxetine
  5. Surgery - tape procedures
62
Q

What countries are vesico-vaginal fistulas common in?

A

Developing countries due to prolonged obstructed labour.

63
Q

What does a frequency volume chart do?

A

Records volumes voided as well as time of each micturition, day and night for at least 24 hours

64
Q

What results from an imbalance between rate of formation and absorption of interstitial fluid?

65
Q

Name three diseases which cause oedema?

A
  1. Nephrotic syndrome
  2. Congestive heart failure
  3. Hepatic cirrhosis with ascites
66
Q

What involves a disorder of glomerular filtration, allowing protein (albumin) to appear in the filtrate (proteinuria)?

A

Nephrotic syndrome

67
Q

What diuretics work on the proximal convoluted tubule to block Na/H exchange?

A

Carbonic anhydrase inhibiors

68
Q

What diuretics work on thick ascending limb of loop of Henle to block Na/K/2Cl co-transport?

A

Loop diuretics

69
Q

What two diuretics work on the distal convoluted tubule?

A
  1. Carbonic anhydrase inhibitors

2. Thiazide diuretics

70
Q

What transport in the distal convoluted tubule to thiazide diuretics blocks?

A

Na/Cl co-transport

71
Q

What diuretics work on the collecting duct to block Na/K exchange?

A

Potassium sparing diuretics

72
Q

Where is the site of action of many diuretics?

A

Apical membrane of tubular cells

73
Q

What transport systems transport acidic drugs such as thiazides and loop agents?

A

Organic anion transporters

74
Q

In relation to organic anion transporters: at the basolateral membrane organic anions enter cell by diffusion or in exchange for what via OATs?

A

Alpha-ketoglutarate/a-KG

75
Q

In relation to organic anion transporters: after the OA has entered the cell, how is another alpha-KG transported into the cell too?

A

Via Na-dicarboxylate transporter

76
Q

In relation to organic anion transporters: how does OA enter the lumen at teh APICAL membrane?

A

Via either MRP2 (multidrug resistance protein 2) or OAT4 (in exchange for a-KG)

77
Q

In relation to organic cation transporters: how does OC enter the lumen at the APICAL membrane?

A

Via either MRP1 (multidrug resistance protein 1) or OC/H antiporters (OCTN)

78
Q

What do loop diuretics block?

A

Triple transporter (Na/K/2Cl coo transporter; NKCC2) - in thick ascending limb

79
Q

What kind of drug is furosemide?

A

loop diuretic

80
Q

What does a loop diuretic bind to to inhibit Na/K/2Cl?

81
Q

How do loop diuretics enter the nephron?

A

Via OAT mechanism

82
Q

Other than reducing salt and water overlaod, what else can loop diuretics reduce?

A

Acute hypercalcaemia

83
Q

Give three side effects of loop diuretics?

A
  1. Potassium loss
  2. Depletion of calcium and magnesium
  3. Hyperuricaemia
84
Q

What do thiazide diuretics block?

A

Na/Cl - cotransporter

85
Q

What do thiazides increase the reabsorption of?

86
Q

Name two conditions thiazide diuretics are used in?

A
  1. Renal stone disease

2. Nephrogenic diabetes insipidus

87
Q

List some adverse affects of thiazide diuretics?

A
  1. Potassium loss
  2. Metabolic alkalosis
  3. Depletion of magnesium
  4. Hyperuricaemia
  5. Male sexual dysfunction
  6. Imparied glucose tolerance
88
Q

Name a drug which competes with aldosterone for binding to intracellular receptors?

A

Spironolactone

89
Q

Name a potassium sparing diuretic?

A

Spironolactone

90
Q

What can aldosterone antagonists be used in the treatment of?

A

Primary hyperaldosteronism - conns

JL Renal and Urology (9 decks)

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