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BRS 9: Urology and Renal Medicine > 9.3: Lecture: Urological disorders (part 1of2) > Flashcards

9.3: Lecture: Urological disorders (part 1of2) Flashcards

1
Q

5 consequences of kidney failure

A

Filtration failure
Hypertension, water retention
Metabolic acidosis
Anaemia
Vit. D deficiency and secondary hyperparathyroidism

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2
Q

What does anaemia arise from

A

Lack of erythropoietin production

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3
Q

What happens if there is filtration faliure of the kidneys

A

Unwell with accumulation of waste substances
Haematuria and proteinuria, low serum protein including albumin in the blood

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4
Q

What is inflammation of the bladder called?

A

Cystisis

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5
Q

2main non-infective causes of inflammatory urinary disorders + examples

A

Metabolic - diabetic nephropathy
Immunological - nephrotic syndrome, nephritic syndrome

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6
Q

2 causes of obstructive urinary disorders

A

Stones
Benign prostatic hypertrophy

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7
Q

4 neoplasticism urinary disorders

A

Kidney
Bladder
Prostate
Testicular

Cancer

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8
Q

2 developmental or genetic urinary disorders

A

Polycystic kidneys
Horseshoe kidney

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9
Q

Potential mechanisms by which immune system damage to kidney may occur

A

Antibodies or inflammatory cells (neutrophils, monocytes, macrophages, T cells)

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10
Q

3 clinical presentations of immunological disorders

A

Nephritic syndrome
Proteinuria
Nephrotic syndrome

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11
Q

What is glomerulonephritis

A

Inflammation of microscopic filtering of the kidney

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12
Q

5 steps in diagnosing immunological causes of inflammatory urological disorders

A

History and physical exam
Urine test
Blood test: immunology test included
Imaging: start w ultrasound
Kidney biopsy

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13
Q

What is horseshoe kidney

A

When 2 kidneys fuse together at the bottom

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14
Q

When does horseshoe kidney occur?

A

As a babies kidneys move into place as it grows in the womb

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15
Q

How is horseshoe kidney identified

A

Abdomen or pelvis imagining

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16
Q

3 consequences of horseshoe kidney

A

Increased risk of obstruction, stones and infection

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17
Q

Method for testing for raised concentration of waste substances in blood

A

Measure serum concentrations of urea and creatinine (blood test)

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18
Q

Reasoning behind why there is raised concentrations of waste substances in blood with kidney failure

A

Reduction in golmerular filtration rate results in accumulation of waste substances in blood

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19
Q

Reading behind why there is blood cells in urine in kidney failure

A

Damaged glomeruli (leaking from cells into urine) or bleeding due to structural problems (tumours, polycystic kidneys)

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20
Q

How would you tests for blood cell presence in someone with kidney damage

A

Urine dipstick
Urine microscopy

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21
Q

Why is constant high blood pressure not a consequence of kidney disease

A

Often high due to salt and water retention
Some patients experience hypotension - if they have dehydration (due to vomiting) or low vascular volume (unable to produce concentrated urine, loosing too much Na+ in urine)

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22
Q

Why is an abnormal hormone profile a consequence of kidney disease

A

Reduction of synthesis in erythropoietin or secondary hyperparathyroidism

(Anaemia - reduced haem conc.
history of late stage chronic kidney disease, despite sufficient B12, folate and iron )

(Increased PTH as secondary response to Vit D. Deficiency - measured In peripheral blood in presence of low or normal serum calcium)

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23
Q

2 possible locations for an infection

A

Bladder - cystitis
Kidney - pyelonephritis

24
Q

3 potential pathogens of kidney disease?

A

Bacteria (most common)
Virus (immunocompromised patients)
Fungal (immunocompromised patients)

25
4 step diagnosis of UTIs
History Physical examina Urine dipstick Urine microscopy, culture and sensitivity
26
5 symptoms of UTIs
Fever Suprapubic pain Frequency of passing urine Dysuria (painful urination) Haematuria
27
UTI treatment
Antibiotics- depend on illness severity, and most commonly found bacteria e.g. trimethopimsulfamethoxazole, ciprofloxacin, penicillin, (If urine culture available- modified with sensitivity) Pain support Supportive e.g hydration
28
3 UTI complications
Pyelonephritis Uprosepsis Septic shock
29
5 risk factors for UTIs
Young biological females Sexual intercourse Post menopausal Diabetes mellitus, impaired bladder emptying / urinary stasis
30
Pathophysiology of UTIs
Inflection in bladder or kidney Bacterial infection most common and the viral and fungal infections are most likely with immunocompromised patients
31
Pathophysiology of Nephritic syndrome
Inflammation of glomerulus that causes sudden onset appearance of RBCs, variable proteinuria, WBC in urine
32
6 symptoms of nephritic syndrome
Haematuria Proteinuria Hypertension Reduced urine output Increased urea and creative Sore throat
33
4 steps in diagnosing nephritic syndrome
Urine dipstick: blood and protein Blood test: serum urea and creative, reduced eGFR Urine: raised urine protein:creating ratio Kidney biopsy: IgA nephropathy
34
Treatment of nephritic syndrome
Supportive- angiotensin receptor inhibitor (irbesartan) or ACEI (remipril) reduce Na+ intake Immunotherapy - renal replacement therapy - late stage kidney disease (transplant or dialysis)
35
Influence of nephritic syndrome on kidney failure
30% of patients with nephritic syndrome progress to kidney failure
36
What disease is the most common glomerulonephritis world wide
IgA nephropathy (lot of IgA in kidney)
37
Pathophysiology of diabetic nephropathy
Glycosuria - basement membrane thickens, hyaline arteriosclerosis, afferent dilation, increased pressure in glomerulus, increased glomerular filtration rate, thickens basement membrane , glomerulus expands, filtration slits widen and increase permeability High pressure - supportive structural matrix - kimmelstiel-wilson nodules
38
Symptoms of diabetic nephropathy
Worsening blood pressure control Polyuria Swelling of feet,hand,eyes Microalbuminuria Proteinuria Association with diabetic retinopathy and neuropathy
39
Diagnosis of diabetic nephropathy
Positive result of 2/3 tests (30-300mg albumin per g of creating in 6month period)
40
8 Treatments of diabetic nephropathy
Optimised diabetic control - metformin Optimised hypertension treatment Reduce proteinuria using ARB or ACEI Stop smoking SGLT2 inhibitor Pancreas or kidney transplant Dialysis
41
3 risk factors of diabetic nephropathy
Hypertension Poor diabetic control Smoking
42
Pathophysiology of nephrotic syndrome
Hypoalbumin results when liver fails to synthesis loss of albumin through urine - leads to low down capillary on optic pressure leading to unopposed capillary hydrostatic pressure and subsequent oedema formation
43
5 symptoms of nephrotic syndrome
Peripheral oedema Severe proteinuria Low serum albumin Variable microscopic Haematuria Associated with hyperlipidaemia (give statins for this)
44
4 diagnosis of Nephrotic syndrome
Urine dipstick: high protien Blood tests: very low albumin conc. High urine protein to creating ratio Kidney biopsy: minimal change glomerulopathy
45
3 Treatments of nephrotic syndrome
Immunotherapy- corticosteroid, cyclophosphamide, tacrolimus, antibody therapy targeting B cell pathway Diuretics- to reduce peripheral oedema Prevention of thrombosis - anticoagulation
46
Pathophysiology of stones
Form when urine contains more Crystal-forming substances (e.g Ca2+, oxalate and uric acid than urine can dilute) Urine can also lack substances preventing crystals from sticking together - ideal env. For stone formation
47
2 symptoms of stones
Pain - abdomen and back Blood in urine
48
3 methods of diagnosing stones
Urine dipstick : blood and evidence of UTI Blood test: kidney function reduced (possibly) Imagining- Plain X ray Ultrasound (best imagining method- easier to see but cannot identify very small stones) and CT scan
49
4 treatments for stones
Supportive - pain control and hydration Shockwave lithotripsy Uteroscopy Precutaneous nephrolithotomy
50
5 types of urological cancers
Benign prostatic hypertrophy Renal cell carcinoma Transitional cell carcinoma Prostatic cancer Testicular cancer
51
3 symptoms of urological cancers
Asymptomatic Haematuria Pain
52
Diagnosing urological cancers
Ultrasound, CT scan, MRI Urine cytology Prostatic specific antigen Histological diagnosis : any evidence of metastasis
53
Treatments of urological cancers
Release obstruction of urinary tract - nephrostomy, bladder catheter, surgery Chemotherapy Radiotherapy Hormonal therapy for hormone sensitive cancer Surgery
54
Pathophysiology of Polycystic Kidney Disease
Neonatal - autosomal recessive Adult onset: autosomal dominant Numerous cysts grow in kidneys, filled with fluid, grow and enlarge kidney damaged
55
9 Symptoms of Polycystic kidney disease
Back pain Bleeding into renal cysts Infection of renal cysts Asymptomatic (sometimes) Loss of kidney function High blood pressure Increased size of abdomen due to enlarged kidneys Headaches Haematuria (sometimes)
56
5 methods of diagnosing Polycystic kidney disease
Ultrasound CT scan MRI Genetic screening Urine test- blood and protein
57
4 Treatments of Polycystic kidney disease
Tolvaptan (Vasopressin 2 antagonist) to slow down cyst formation Treat hypertension / infection Pain control Renal replacement therapy - transplant, dialysis

BRS 9: Urology and Renal Medicine (2 decks)

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