Disease of the urinary tract 1

Question 1

What are the functions of the kidney?

Answer 1

eliminate metabolic waste products
regulate fluid, acid base balance and electrolytes
production of renin and erythropoietin

Question 2

In the mechanism of glomerular damage, immunologically what part of the glomerular is affected?

Answer 2

Basement membrane

Question 3

In the mechanism of glomerular damage, non- immunologically what part of the glomerular is affected?

Answer 3

vessels or basement membrane

Question 4

In the mechanism of tubular damage, what is affected?

Answer 4

vessels

Question 5

What 2 types of mechanisms of tubular damage occur?

Answer 5

ischemic

toxic

Question 6

What marker gives a good guide to level of damage to the tubules?

Answer 6

creatinine - The degree of damage to renal tubules correlates well with renal function

Question 7

In the mechanism of vascular damage, what is affected?

Answer 7

vessels

Question 8

What is nephrotic syndrome?

Answer 8

ALWAYS due to damage to glomerulus
Hypoalbuminaemia
Oedema
Proteinuria
\+/- hypertension
\+/- hyperlipidaemia

Question 9

What are the complications of nephrotic syndrome?

Answer 9

infection

thrombosis

Question 10

What are the 4 main causes of nephrotic syndrome in adults?

Answer 10

Membranous nephropathy - idiopathic. MAIN CAUSE
focal segmental glomerulosclerosis - various causes, mostly idiopathic
minimal change disease - biopsy normal
other: diabetes, lupus nephritis, amyloid

Question 11

What are the 2 main causes of nephrotic syndrome in children?

Answer 11

minimal change disease - biopsy normal, majority have excellent prognosis
focal segmental glomerulosclerosis - various causes, mostly idiopathic

Question 12

What is acute nephritis?

Answer 12

Hypertension
Oedema
Proteinuria
Acute renal failure

Question 13

What are the 5 main causes of acute nephritis in adults?

Answer 13

Post infective glomerulonephritis - few weeks after streptococcal throat infection
IgA nephropathy - Most common primary glomerular disease worldwide, teenagers and young adults with haematuria
Vasculitis
Lupus - Autoimmune disease, typically young women
Other forms of primary glomerulonephritis

Question 14

What are the symptoms of vasculitis?

Answer 14

fever
malasia
rash possible
myalgia - muscle ache
arthralgia - joint pain

Question 15

What are the 4 main causes of acute nephritis in children?

Answer 15

post-infective glomeulonephritis
IgA nephropathy
Henoch-Schonlein purpura
Haemolytic-uraemic syndrome

Question 16

What is Henoch-Schonlein purpura?

Answer 16

Specific type of IgA nephropathy
Typically young boys/teenagers
arthralgia
abdo pain
acute renal failure
rash
haematuria
Most recover completely

Question 17

What is Haemolytic-uraemic syndrome?

Answer 17

Typically children with E. Coli 0157 enteritis
Haemolysis
Acute nephritis
Thrombocytopaenia

Question 18

What is the diagnosis and prognosis of acute renal failure?

Answer 18

Diagnosis: anuria/oliguria + raised creatinine and urea
Prognosis: Many will recover and have good renal function if they had healthy kidneys previously

Question 19

What are the causes of acute renal failure?

Answer 19

Pre-renal: reduced blood flow to kidneys - most common
Renal: damage to the kidneys
Post-renal: obstructed urinary tract

Question 20

What are the causes of acute renal failure in adults?

Answer 20

Vasculitis
Acute interstitial nephritis/tubulointerstitial nephritis - tubular damage with inflammation, most commonly caused by drug reactions

Question 21

What are the causes of acute renal failure in children?

Answer 21

Henoch-Schonlein purpura
Haemolytic uraemic syndrome
Acute interstitial nephritis

Question 22

What do all biopsies in acute renal failure show?

Answer 22

All biopsies will show “ATN” – acute tubular necrosis/ injury/damage/acute kidney injury (ATI/ATD/AKI)

Question 23

What are the complications of acute renal failure?

Answer 23

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

Question 24

What is chronic renal failure?

Answer 24

Permanently reduced GFR – reduced number of nephrons

Question 25

What are the 3 most common causes of chronic renal failure in adults?

Answer 25

Diabetes (commonest) Glomerulonephritis Reflux nephropathy- chronic reflux of urine up the ureter

Question 26

What are the 3 most common causes of chronic renal failure in children?

Answer 26

Developmental abnormalities/malformations Reflux nephropathy Glomerulonephritis

Question 27

Why is renal biopsy often unhelpful in established chronic renal failure?

Answer 27

Kidney shows severe scarring with loss of glomeruli and tubules Similar changes are seen in end-stage renal disease due to any cause

Question 28

What are the effects of Chronic renal failure?

Answer 28

Reduced excretion of water and electrolytes = oedema, hypertension Reduced excretion of toxic metabolites = generally unwell, reduced appetite Reduced production of erythropoietin = anaemia Renal bone disease

Question 29

What would a Elderly patient with acute renal failure most likely present with?

Answer 29

Acute interstitial nephritis due to drug reactions | Myeloma

Question 30

What would a Young male with haematuria and rash most likely present with?

Answer 30

Henoch-Schonlein purpura

Question 31

What would a Teenager/young adult with haematuria most likely present with?

Answer 31

Post-infective glomerulonephritis | IgA nephropathy

Question 32

What would a Adult with acute renal failure, fever and myalgia most likely present with?

Answer 32

Vasculitis

Question 33

What would a Young woman with haematuria and facial rash most likely present with?

Answer 33

Lupus

Question 34

What would a Adult with nephrotic syndrome most likely present with?

Answer 34

Membranous nephropathy

Question 35

What would Child with nephrotic syndrome most likely present with?

Answer 35

Minimal change disease

Question 36

What may cause isolated haematuria?

Answer 36

IgA nephropathy Thin basement membrane disease Alport type hereditary nephropathy

Question 37

What may cause isolated proteinuria?

Answer 37

benign e.g. Postural, related to pyrexia or exercise | May be due to renal disease

Question 38

What is renal artery stenosis?

Answer 38

Due to atheroma (most common) or arterial dysplasia Leads to ischaemia of the affected kidney Activation of renin-angiotensin-aldosterone = hypertension Loss of renal tissue due to ischaemia = reduced renal function

Question 39

How does vasculitis affect the kidney?

Answer 39

hypoxia of the tubules

Question 40

How does diabetes affect the kidney?

Answer 40

Hyperglycaemia is the main cause of diabetic nephropathy by damaging the basement membrane Basement membrane becomes thicker - glomerulus produces excess extracellular matrix which forms nodules damages small vessels leading to ischaemia and damage to renal tubules