What is the most common malignant kidney tumour?
Renal cell carcinoma
Which type of stone is formed due to dehydration or hypercalcaemia?
Calcium stones; Calcium oxolate and Calcium phosphate
What makes up the juxtaglomerular apparatus?
- Macula densa
- Lacis cells
- Juxtaglomerular cells; renin-secreting
What is metabolic acidosis?
The accumulation of any acid other than carbonic acid in the serum, usually with a decrease in HCO3 seen
What are the risk factors for developing TCC?
- Male over 50 years old
- Chemicals such as β-naphthylamine, chemotherapy
- Chronic infection/irritation of bladder
What are some genetic conditions linked to RCC?
- Von Hippel Lindau
- Hereditary (familial) clear cell RCC
- Hereditary papillary RCC
What are the different types of RCC and where are they found?
- Clear cell; proximal tubules
- Papillary; distal convoluted tubules
- Chromophobe and collecting duct; intercalated cells of CD in medulla
What are the criteria for urological referral of haematuria?
- All patients with visible haematuria
- All patients with symptomatic non-visible haematuria
- Patients over 40 with asymptomatic non-visible haematuria
What are the main medical renal causes of haematuria?
A serum K level over 7.0mmol/L
In which part of the nephron is the macula densa found? and what is in close contact to?
It is found in the distal convoluted tubule and is in close contact with the afferent arteriole of its own nephron
What nerve roots contribute to the sympathetic nervous supply of the bladder?
T12-L2, and the pudendal nerves
Apart from TCC, what other cancers can affect the bladder?
- Squamous cell carcinoma
What are the 4 main types of calculi found in the urinary system?
- Struvite (Magnesium Ammonium Phosphate)
- Uric acid
What are the main causative organisms of UTIs?
- E. coli; most common
- Entercoccus faecalis
Which pole of the kidney is RCC usually found?
Where can Transitional Cell Carcinoma (TCC) develop?
Anywhere from the renal pelvis to the end of the urethra.
What is homeostasis?
The tendency of an organism to regulate its internal conditions, usually by a system of feedback controls, so as to stabilise health and functioning, regardless of outside conditions.
What are the signs and symptoms of RCC?
- Costovertebral pain
- Palpable mass
- Paraneoplastic syndromes
What 3 places along the ureters are calculi likely to become stuck?
- Pelviureteric junction
- Where ureter cross iliac vessels and enters pelvic brim
- Vesicoureteric junction
What are the 3 types of Haematuria?
- Visible haematuria
- Symptomatic non-visible haematuria
- Asymptomatic non-visible haematuria
What spinal roots contribute to the parasympathetic nervous supply of the bladder?
What are the treatment options of calculi that are unlikely to pass?
- Extracorporeal Shock Wave Lithotripsy
- Percutaneous nephrolithotomy (PCNL)
- Open surgical removal
In what age group do majority of people develop kidney stones first?
30-50 years old
What is the glomerular filtration rate in healthy individuals?
Which organ is the most common site of TCC?
What are the symptoms of renal colic?
Acute excruciating pain, beginning in the abdomen and radiating to the hypochondium (T10-L1), that is colicky in nature
- Unable to get into a comfortable position
- Sepsis if caused by infection
What investigations should be performed for conformation of diagnosis of RCC?
- Dipstick urine
- CT scan
Name 2 types of nuclear imaging that can be used to determine the anatomy and function of the kidneys?
What 5 hormones affect the amount of Na, Cl, Ca and water reabsorbed by the kidneys?
- Angiotensin II
- Atrial Natriuretic Hormone (ANP)
- Parathyroid hormone
What percentage of kidney stones are mineral in nature?
What are the symptoms of TCC?
- Painless haematuria in 85%
- Increased urination
- Dysuria in 20%
What 3 ways can angiotensin II affect renal physiology?
- Vasoconstriction of afferent arteriole causing decrease in glomerular filtration
- Enhances Na, Cl and water reabsorption by activating Na-K antipoters
- Stimulates Aldosterone release from adrenal cortex, causing P cells to reabsorb more Na, Cl and water and secrete more K.
What is the normal limit of RBC excretion in the urine?
Up to 2RBC per high power field is normal
What is the main cause of cysteine stones forming?
Genetic defect that results in abnormalities in amino acid reabsorbption including cysteine.
What important endocrine functions does the kidney perform?
- Secretion of renin
- Production of erythropoietin
- Activation of Vit D
What transporters and channels are involved in Na movement in the kidneys?
- Na-K ATPase
- Na-H exchanger
- Na-2Cl-K exchanger
- Na-Cl cotransporter
- ENac channels
Which investigations would be performed to diagnose TCC of the bladder?
- Urine cytology
- Cystoscopy and biopsy; is tumour pedunculated or sessile?
- CT scan if metastases suspected
What are the risk factors for UTIs?
- Local infection from GIT or sex
- Indwelling catheters
- Mechanical obstruction of UT
What are the causes of nephrological haematuria?
- Glomerular disease
- Tubulointerstitial disease
- Renovascular disease
- Systemic diseases
Which group of patients is a IV urogram (IV pyelogram) not suitable for? (Think diabetics)
Patients on Metformin, as it interacts with contrast
What is the most common form of RCC?
Clear cell - 75% of cases
Which type of stone is precipitated by hyperuricaemia or low urinary pH?
Uric acid stones
What are the initial investigations of renal colic?
- Urine analysis; mid-stream (MSD) for microscopy and dipstick
- Blood tests; FBC, U&Es, Ca, Urate and albumin
- KUB X-Ray
- CT scan
What are the main surgical causes of haematuria?
- Prostatic hyperplasia
- Urethral stricture
What 2 cells make up the epithelium of the collecting ducts, and what does each 1 do?
Principle cells (P cells); Na reabsorption & ADH stimulated water reuptake
Intercalated cells (I cells); Acid and HCO3 secretion
Which stones are linked to infections from Staphylococci and proteus bacteria?
Struvite; these bacteria convert urea into ammonia that crystallises within the tubules
Which type of stone is radio-lucent (can't be seen on X-Ray)?
Uric acid stones
What are the risk factors for Renal Cell Carcinoma (RCC)?
- Over 50 years old
- Certain genetic conditions
What are the functions of mesangial cells in the kidney?
Control glomerular filtration as they can contract and constrict the arterioles.
The excretion of 3 or more RBC per high power field in freshly voided centrifuged urine, over 3 samples
Moderate hypernatraemia is a serum Na over 150 mmol/L
Severe hypernatraemia is a serum Na over 170 mmol/L
Which type of stone are the most likely to form large staghorn calculi?
What are the common benign kidney tumours?
- Papillary adenoma
What are the treatment options of RCC?