31 Urinary diseases 1 Flashcards

1
Q

What are the functions of the kidney? (4)

A

Eliminating waster products.
Regulating fluid and electrolyte levels.
Influencing acid-base balance.
Production of erythropoietin and renin.

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2
Q

Which three structures allow filtration in the kidney?

A

Podocyte foot processes.
Basement membrane.
Endothelial cells.

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3
Q

What are the immunological mechanisms of glomerular damage? (2).

A

Deposition of circulating immune complexes/ antigens.

Autoantibodies to components of glomerulus.

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4
Q

What are the non immunological mechanisms of glomerular damage? (4).

A

Injury to endothelium.
Altered basement membrane due to hyperglycaemia in diabetes.
Abnormal basement membrane/podocyte structure.
Deposition of abnormal proteins.

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5
Q

What are the mechanisms of tubular damage in the kidney? (7)

A

Ischaemic: hypotension, damage to vessels, glomerular damage.
Toxic: direct, hypersensitivity, protein deposition, crystal deposition (gout).

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6
Q

Describe how microthrombotic angiopathy induces vascular damage in the kidney.

A

Damage to endothelial wall leads to thrombi in capillaries and small arterioles.
Abnormal clotting proteins, bacterial drugs and toxins.

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7
Q

What is nephrotic syndrome?

Simple cause?

A

Oedema, proteinuria, hypoalbuminaemia.
±hypertension ± hyperlipidaemia
Always due to glomerular damage.

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8
Q

What are the common causes of nephrotic syndrome in adults? (6).

A

Membranous nephropathy. M>F. Most common.
Focal segmental glomerulosclerosis. M>F.
Minimal change disease.
Amyloid, diabetes, lupus nephritis.

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9
Q

What are the most common causes of nephrotic syndrome in children? (2).

A

Minimal change disease. Most common.

Focal segmental glomerulosclerosis.

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10
Q

What is acute nephritis? (5)

A
Oedema.
Haematuria.
Proteinuria.
Hypertension.
Acute renal failure.
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11
Q

What are the most common causes of acute nephritis in adults? (4).

A

Post-infective glomerulonephritis (strep throat).
IgA nephropathy (teens with haematuria).
Vasculitis (+ rash, myalgia, arthralgia).
Lupus (young women).

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12
Q

What are the common causes of acute nephritis in children? (4).

A

Post-infective glomerulonephritis.
IgA neuropathy.
Henonch-Schonlein purpura. Specific IgA nephropathy. M>F.
Haemolytic uraemia syndrome (E.coli O157 enteritis + haemolysis + thrombocytopenia).

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13
Q

What is the diagnostic criteria for acute renal failure?

A

Anuria/oliguria and raised serum creatinine/urea.

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14
Q

What are the general causes of acute renal failure? (4)

A

Pre renal: dehydration, any hypotensive cause.
Renal.
Post renal: urinary obstruction: tumour, bladder stones, prostate enlargement.

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15
Q

What do biopsies of kidneys with acute renal failure show?

A

Acute tubular necrosis.

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16
Q

What are three causes of acute renal failure in adults?

A

Vasculitis.
Acute interstitial nephritis.
Acute tubulointerstitial nephritis (mostly drug rxns).

17
Q

What are the three causes of acute renal failure in children?

A

Henonch-Schonlein purpura.
Haemolytic uraemic syndrome.
Acute interstitial nephritis.

18
Q

What are the complications of acute renal failure? (5).

A
Cardiac failure (fluid overload).
Arrythmias (electrolyte imbalance).
GI bleeding.
Jaundice (hepatic venous congestion).
Infection, especially lung and urinary tract.
19
Q

What is chronic renal failure?

A

Permanently reduced glomerular filtrate rate.

Reduced number of nephrons.

20
Q

What are the common causes of chronic renal failure in adults?

A

Diabetes.
Glomerulonephritis.
Reflux nephropathy (reflux-infection-scarring).

21
Q

Why is a biopsy unhelpful in end stage renal disease?

A

Will show the same regardless of cause.

Scarring with loss of glomeruli and tubules.

22
Q

What are the systemic effects of chronic renal failure?

A

Reduced excretion - oedema, hypertension.
Reduced toxic metabolite excretion.
Reduced production of erythropoietin - anaemia.
Renal bone disease.

23
Q

What are the causes of isolated haematuria ± proteinuria with normal kidney function? (3).

A

IgA nephropathy.
Thin basement membrane disease.
Alport type hereditary nephropathy. Collagen IV defect. ± deafness, ± ocular problems.

24
Q

What are the causes of isolated proteinuria?

3 benign, 4 diseases

A

Benign: postural, pyrexia, exercise.
Disease: FSGS, Diabetes, Lupus, Henoch-Schonlein purpura.

25
Q

What is acute pyelonephritis associated with?

A

Women.
Diabetes.
Structural urinary tract abnormalities.

26
Q

What is chronic pyelonephritis associated with?

A

Obstruction of urinary tract and fibrosis.

27
Q

How does renal artery stenosis affect the kidney? (2)

A

Causes infarction, killing kidney tissue.

Activates RAAS system, causing hypertension.

28
Q

How does hypertension affect the kidney? (3)

A

Damages vessel walls leading to increased thickness and reduction in lumen.
Induces chronic hypoxia which leads to loss of renal tubules.
Reduction in flow activates RAAS, exacerbating the hypoxia.

29
Q

How does diabetes affect the kidney? (3)

A

Hyperglycaemia damages the basement membrane, becoming thicker.
Glomerulus produces extra extracellular matrix, forming nodules.
Small vessel damage leading to ischaemia.

30
Q

How does myeloma affect the kidney?

A

Excess immunoglobulin production. Deposition in the kidney tubules, causing inflammation and fibrosis.
Renal impairment is irreversible.

31
Q

Name toxins that directly damage kidney tubules (6).

A
Drugs e.g. antibiotics, NSAIDs.
Organic solvents.
Heavy metals.
Ethylene glycol (anti-freeze).
Pesticides.
Iodine containing radiographic contrast medium.