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Clinical Pathology > 31 - Diseases of the urinary tract > Flashcards

31 - Diseases of the urinary tract Flashcards

1
Q

Functions of kidney

A

Eliminating metabolic waste products
Regulating fluid and electrolyte balance
Influencing acid-base balance
Production of some hormones - renin, EPO

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2
Q

Acute renal failure - clinical presentation

A

Rapid rise in creatinine and urea

Generally unwell

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3
Q

Nephrotic syndrome - clinical presentation

A

Oedema
Proteinuria
Hypoalbuminaemia
Proteinuria >3g per 24hr (mostly albumin)

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4
Q

Acute nephritis - clinical presentation

A

Oedema
Proteinuria
Haematuria
Renal failure

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5
Q

Chronic renal failure - clinical presentation

A

Slowly declining renal function

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6
Q

Mechanisms of glomerular damage - two categories

A

Immunological

Non-immunological

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7
Q

Mechanisms of glomerular damage - immunological

A

Deposition of circulating immune complexes in glomerulus
Deposition of circulating antigens in glomerulus
Antibodies to basement membrane

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8
Q

Mechanisms of glomerular damage - why immunological damages glomerulus

A

Complement activation
Neutrophil activation
Reactive oxygen species
Clotting factors

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9
Q

Mechanisms of glomerular damage - non-immunological

A

Injury to endothelium
Altered basement membrane due to hyperglycaemia
Abnormal basement membrane or podocytes
Deposition of abnormal proteins in the kidney

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10
Q

Mechanisms of tubular damage - two types

A

Ischaemic

Toxic

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11
Q

Mechanisms of tubular damage - ischaemic

A

Hypotension
Damage to vessels within kidney
Glomerular damage

Reduces blood supply

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12
Q

Mechanisms of tubular damage - toxic

A

Direct toxins
Hypersensitivity
Deposition of crystals in tubules
Deposition of abnormal proteins

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13
Q

Mechanisms of vascular damage

A

Thrombotic microangiopathy (e.g. haemolytic uraemic syndrome)
Vasculitis (e.g. Wegener’s granulomatosis)
Hypertension
Diabetes
Atheroma e.g. renal artery stenosis

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14
Q

Immunological e.gs

A 
Membranous
Anti-GBM disease
IgA nephropathy
Lupus nephritis
Post-infective
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15
Q

Direct toxicity e.g.s

A

Gentamicin

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16
Q

Nephrotic syndrome - why, clinical presentation, complications

A

Always due to glomerular damage
CP - oedema, proteinuria (>3g in 24hr), +/- hypertension, +/- hyperlipidaemia

Complications - infection, thrombosis

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17
Q

Nephrotic syndrome - causes

A 
Membranous nephropathy (most common, idiopathic, M>F)
Focal segmental glomerulosclerosis (FSGS, idiopathic, genetic, heroin use, HIV, M>F)
Minimal change disease

Diabetes, lupus nephritis, amyloid

18
Q

Nephrotic syndrome - child causes

A

Minimal change disease

Focal segmental glomerulosclerosis

19
Q

Acute nephritis - clinical presentation

A 
Oedema
Haematuria
Proteinuria
Hypertension
Acute renal failure
20
Q

Acute nephritis - common causes

A

Post-infective glomerulonephritis (weeks after Strep throat)
IgA nephropathy (most common primary disease)
Vasculitis
Lupus

21
Q

Acute nephritis - causes for children

A

Post-infective glomerulonephritis
IgA nephropathy
Henoch-Schonlein purpura
Haemolytic-uraemic syndrome

22
Q

Henoch-Schonlein purpura

A

Specific type of IgA nephropathy
M>F
Typically young boys with arthralgia, abdo pain, rash, haematuria, acute renal failure

23
Q

Haemolytic-uraemic syndrome

A

Typically children with E.Coli enteritis

Acute nephritis + haemolysis + thrombocytopoenia

24
Q

Acute renal failure - diagnosis

A

Anuria/oliguria + raised creatinine and urea

25
Q

Acute renal failure - causes

A

Pre-renal: reduced blood flow = most common. E.g. severe dehydration, hypotension, bleeding, septic shock, LV failure

Renal

Post-renal: obstructed urinary tract e.g. tumours of urinary tract, tumours in pelvis, bladder stones, prostatic enlargement

26
Q

Acute renal failure - causes

A

All biopsies show acute tubular necrosis

Adult - vasculitis, acute interstitial nephritis

Children - henoch-schonlein purpura, haemolytic uraemic syndrome, acute interstitial nephritis

27
Q

Acute renal failure - complications

A 
Cardiac failure
Arrythmias
GI bleeding
Jaundice
Infection
28
Q

Acute renal failure - treatment

A

Short term dialysis if needed

Treat underlying cause

29
Q

Chronic renal failure - what is it

A

Stages of permanently reduced GFR

30
Q

Chronic renal failure - causes

A

Diabetes (commonest)
Glomerulonephritis
Reflux nephropathy

31
Q

Chronic renal failure - causes for children

A

Developmental abnormalities
Reflux nephropathy
Glomerulonephritis

32
Q

Chronic renal failure - effects

A

Reduced excretion of water and electrolytes = oedema, hypertension
Reduced excretion of toxic metabolites
Reduced production of EPO
Renal bone disease

33
Q

Clinical scenario: elderly patient w/ acute renal failure

A

Drug rxn

Myeloma

34
Q

Clinical scenario: young male with haematuria + rash

A

Henoch-Schonlein purpura

35
Q

Clinical scenario: teenager/young adult with haematuria

A

Post-infective glomerulonephritis

IgA nephropathy

36
Q

Clinical scenario: adult w/ acute renal failure, fever and myalgia

A

Vasculitis

37
Q

Clinical scenario: young woman with haematuria and facial rash

A

Lupus

38
Q

Clinical scenario: adult w/ nephrotic syndrome

A

Membranous nephropathy

39
Q

Clinical scenario: child w/ nephrotic syndrome

A

Minimal change disease

40
Q

SLIDES 32 ONWARDS ARE IN LECTURE

A

BUT SHE DID NOT PRESENT THEM

Clinical Pathology (65 decks)

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