31 - Diseases of the urinary tract Flashcards Preview

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Flashcards in 31 - Diseases of the urinary tract Deck (40):
1

Functions of kidney

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

2

Acute renal failure - clinical presentation

Rapid rise in creatinine and urea
Generally unwell

3

Nephrotic syndrome - clinical presentation

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

4

Acute nephritis - clinical presentation

Oedema
Proteinuria
Haematuria
Renal failure

5

Chronic renal failure - clinical presentation

Slowly declining renal function

6

Mechanisms of glomerular damage - two categories

Immunological
Non-immunological

7

Mechanisms of glomerular damage - immunological

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

8

Mechanisms of glomerular damage - why immunological damages glomerulus

Complement activation
Neutrophil activation
Reactive oxygen species
Clotting factors

9

Mechanisms of glomerular damage - non-immunological

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

10

Mechanisms of tubular damage - two types

Ischaemic
Toxic

11

Mechanisms of tubular damage - ischaemic

Hypotension
Damage to vessels within kidney
Glomerular damage

Reduces blood supply

12

Mechanisms of tubular damage - toxic

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

13

Mechanisms of vascular damage

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

14

Immunological e.gs

Membranous
Anti-GBM disease
IgA nephropathy
Lupus nephritis
Post-infective

15

Direct toxicity e.g.s

Gentamicin

16

Nephrotic syndrome - why, clinical presentation, complications

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

Complications - infection, thrombosis

17

Nephrotic syndrome - causes

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

Nephrotic syndrome - child causes

Minimal change disease
Focal segmental glomerulosclerosis

19

Acute nephritis - clinical presentation

Oedema
Haematuria
Proteinuria
Hypertension
Acute renal failure

20

Acute nephritis - common causes

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

21

Acute nephritis - causes for children

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

22

Henoch-Schonlein purpura

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

23

Haemolytic-uraemic syndrome

Typically children with E.Coli enteritis
Acute nephritis + haemolysis + thrombocytopoenia

24

Acute renal failure - diagnosis

Anuria/oliguria + raised creatinine and urea

25

Acute renal failure - causes

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

Acute renal failure - causes

All biopsies show acute tubular necrosis

Adult - vasculitis, acute interstitial nephritis

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

27

Acute renal failure - complications

Cardiac failure
Arrythmias
GI bleeding
Jaundice
Infection

28

Acute renal failure - treatment

Short term dialysis if needed
Treat underlying cause

29

Chronic renal failure - what is it

Stages of permanently reduced GFR

30

Chronic renal failure - causes

Diabetes (commonest)
Glomerulonephritis
Reflux nephropathy

31

Chronic renal failure - causes for children

Developmental abnormalities
Reflux nephropathy
Glomerulonephritis

32

Chronic renal failure - effects

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

33

Clinical scenario: elderly patient w/ acute renal failure

Drug rxn
Myeloma

34

Clinical scenario: young male with haematuria + rash

Henoch-Schonlein purpura

35

Clinical scenario: teenager/young adult with haematuria

Post-infective glomerulonephritis
IgA nephropathy

36

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

Vasculitis

37

Clinical scenario: young woman with haematuria and facial rash

Lupus

38

Clinical scenario: adult w/ nephrotic syndrome

Membranous nephropathy

39

Clinical scenario: child w/ nephrotic syndrome

Minimal change disease

40

SLIDES 32 ONWARDS ARE IN LECTURE

BUT SHE DID NOT PRESENT THEM

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