Year2 Sem1 PPP2 renal patho

Question 1

Diagnostic Tools for renal system (Urine)

Answer 1

Dipstick (Rapid Urine Test), Urinalysis, Urine culture and sensitivity (C/ST), 24-hour-urine for Creatinine Clearance (CrCl), 24-hour-urine for Protein, Urine Cytology Test, Residual urine

Question 2

Substances can be checked by urine dipstick test

Answer 2

Normal range:
pH value (5-7)
Negative:
Protein, Sugar, Nitrate, Ketone, Bilirubin, Urobilinogen, Red blood cells
(erythrocytes), White blood cells
(Leukocytes)

Question 3

3 steps of urinalysis:

Answer 3

1. Assessment of color, cloudiness and
   concentration of the urine
2. Chemical composition examination using a test strip
3. Examination under a microscope to look for bacteria, cells and parts of cells

Question 4

24-hour-urine for Creatinine Clearance
(CrCl)

Answer 4

◦ Collecting urine over 24 hours
◦ Creatinine (Cr) is a waste product of protein
breakdown
◦ Clearance of Cr by kidneys approximates the Glomerular Filtration Rate (GFR)

Procedure
 First urine sample after waking up is NOT used, but the time of urination is noted and documented
 From then on, EVERY SINGLE DROP of urine is collected and saved in a container for the next 24 hours

Question 5

Blood test for assessing renal system

Answer 5

Blood urea nitrogen (BUN)
Creatinine (Cr)
BUN/ Creatinine ratio
Uric Acid
Sodium (Na)
Potassium (K)
Calcium (Ca)
Phosphorus
Bicarbonate (HCO3)

Question 6

Radiology tools in renal system

Answer 6

Kidneys, Ureters, Bladder (KUB) X-ray
Intravenous Pyelogram (IVP)
Renal arteriogram
Renal Ultrasound
Computed Tomography Scan (CT Urogram)
Magnetic Resonance Imaging (MRI)

Key Differences in uses
KUB X-ray: Quick assessment, best for stones and calcifications.
IVP: Focused on urinary tract function and obstructions, using contrast.
Renal Arteriogram: Detailed vascular imaging for blood supply issues.
Renal Ultrasound: Non-invasive, assesses structure and blood flow, no radiation.
CT Urogram: Detailed anatomical imaging, excellent for stones and tumors.
MRI: Superior soft tissue detail, useful for masses and vascular evaluation without radiation.

Question 7

Signs and Symptoms (S/S) of Polycystic Kidney Disease

Answer 7

◦ Haematuria
◦ Polyuria
◦ Flank & Abdominal pain
◦ High blood pressure

Question 8

Pathophysiology of Polycystic Kidney Disease

Answer 8

◦ Genetic Disorder: Mutations in one of two genes, PKD1 or PKD2, account for most cases of autosomal dominant PKD

◦ Renal tubules become structurally abnormal, resulting in the development and growth of multiple cysts within the kidney

Question 9

Diagnosis of Polycystic Kidney Disease

Answer 9

◦ S/S
◦ History (Hx)– Family Hx, Medical Hx
◦ Urinalysis
◦ USG/ CT/ MRI

Question 10

Treatment of Polycystic Kidney Disease

Answer 10

1. Supportive
   ✓ Dietary restriction
   ➢ Low salt diet – reduce hypertension
   ➢ Diet with Vit B3 to slow down rate of creatinine production
2. Antibiotics (if infection)
3. Surgical Nephrectomy
4. Percutaneous or surgical drainage of the cyst
   ✓ Not frequently necessary and hard to perform, as difficult to ascertain radiologically which of the many cysts is infected
   ✓ +/- Drainage: for a perinephric abscess (diagnosed by ultrasonography or computed tomography (CT) scan)
5. Renal replacement therapy (RRT)
   ✓ Refers to therapies to replace kidney function temporarily
   e.g. Peritoneal Dialysis, Haemodialysis
   ✓ Treat end-stage kidney disease/ ESRF

Question 11

Pathophysiology of nephritic syndrome

Answer 11

Mostly autoimmune
➢ A number of biological processes (e.g. Complement activation, Leukocyte recruitment, Release of growth factors and cytokines) → Result in glomerular inflammation and injury
➢ Capillaries swelling → ↑ permeability → inappropriate contents (e.g. blood and proteins, etc.) begin to spill into the urine
➢ ↓ GFR → Uremic symptoms, retention of sodium and water in the body → Edema and hypertension

Question 12

S/s of nephritic syndrome

Answer 12

➢ Proteinuria
➢ Hematuria
➢ Oliguria (<400mL/ day)
➢ Severe: Uremic symptoms

Question 13

Diagnosis of nephritis syndrome

Answer 13

Physical examination
Lab test: GFR, BUN, Urinalysis
Renal biopsy

Question 14

Treatment goal and treatment for nephritic syndrome

Answer 14

◦ Goal
1. Control hypertension
2. ↓ Active inflammation of kidneys
3. Prevent recurrence and CKD

Treatment:
◦ Bed rest
◦ Fluid restriction - ↓ edema
◦ Diet control - ↓ Na, K
◦ Drugs – diuretics, anti-HT, anti-inflammatory (e.g. steroids, NSAIDs)
◦ Dialysis – AKI/ end-organ damage

Question 15

Pathophysiology of glomerulonephritis

Answer 15

◦ Inflammation of the glomerular capillary membrane
◦ The damaged glomeruli cannot effectively filter waste
products and excess water from the bloodstream to make urine
◦ The kidneys appear enlarged, fatty, and congested

Question 16

S/S of Glomerulonephritis

Answer 16

◦ Mild Glomerulonephritis – no symptom

◦ Severe cases
 fatigue
 nausea and vomiting
 shortness of breath
 disturbed vision (eye exams - shows vascular or hemorrhagic changes)
 high blood pressure
 swelling (especially in the face, hands, feet, and ankles)
 blood and protein in the urine, resulting in a smoky or slightly red appearance
 kidneys may be reduced as little as 1/5 their normal size, c/o largely of fibrous tissues)

Question 17

Diagnosis of Glomerulonephritis

Answer 17

◦ Medical history
◦ Urinalysis/ Urine Dipstick Test - Proteinuria
◦ 24 hour urine collection - excretion of proteins and
creatinine
◦ Blood for Creatinine clearance - an index of the
glomerular filtration rate (GFR)
◦ Blood studies – presence of a streptococcal antibody titer
◦ Renal biopsy

Question 18

Treatment Objectives of Glomerulonephritis

Answer 18

1. decrease the damage to the glomeruli
2. decrease the metabolic demands on the kidneys
3. improve kidney function

Question 19

Treatment of Glomerulonephritis:

Answer 19

◦ Bedrest - helps in maintaining nadequate blood flow to the kidneys
◦ Antibiotic therapy - If residual infection is suspected
◦ Diuretics - if fluid overload
◦ Iron and vitamin supplements - if anemia develops
◦ Antihypertensives - if high blood pressure
◦ Fluid restrictions - according to the patient’s urinary output and body weight
◦ ↓Sodium and protein intake - to rest the kidney during the acute phase;
 Sodium limitations - depend on the amount of edema present
 Amount of protein allowed - dependent upon the amount lost in the urine, and the requirements of individual patient

Question 20

Diagnosis of UTI

Answer 20

◦ Symptoms
◦ Urinalysis
◦ Urine culture
◦ X-rays
◦ CT scans
◦ USG

Question 21

Treatment for Pyelonephritis

Answer 21

◦ Antimicrobial therapy
 Eradication of bacteria in the urinary track
 Early symptoms of pyelonephritis usually disappear within 48 to 72 hours after starting
 Choice of antibiotic is based on laboratory sensitivity studies
 Repeat urine cultures are done in order to evaluate the effectiveness of the
medication
◦ Adequate fluid intake
 prevent dehydration and increase U/O
◦ Symptom control
 fever, nausea, and pain

Question 22

S/S of Cystitis

Answer 22

◦ Dysuria
◦ Pain on urination
◦ Urinary urgency
◦ ↑ Frequency

◦ Symptoms indicate
Pyelonephritis or the
spread of infection to
the Upper Urinary
Tract
❖ Fever
❖ Shaking chills
❖ Pain (lower back and
flanks)
❖ Nausea and vomiting

Question 23

Diagnosis of Cystitis

Answer 23

➢ Medical history – check STDs as well
➢ Urine tests – RBC and WBC
➢ Imaging – KUB, USG Abdomen
➢ Cystoscopy