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Flashcards in Diseases of urinary tract 2 Deck (35):
1

What are the common causes of obstruction at the renal pelvis?

Calculi - renal stone

Tumour

Ureteropelvic stricture

2

What stones are large, difficult to remove and have to be broken down?

Staghorn

3

What are the main intrinsic causes of acute obstruction at the level of the ureter?

Calculi

Tumours

Slough (from inflammation)

Clots (usually road traffic accidents)

4

What type of obstructions are there?

Intrinsic

Extrinsic - from outside the ureter

5

What are the main extrinsic causes of obstruction at level of ureter?

Pregnancy

Tumours e.g. cervix

Retriponeal fibrosis

6

What is vesicoureteral reflux?

Usually occurs in young gilder (male, congenital)

Reflux of urine due to dysfunction; ureteral valves)

7

What is an important cause of obstruction in older males? (>60yrs)

Prostate - hyperplasia, carcinoma, prostatitis - constricts urethra

8

What happens if there is an obstruction at level of urethra?

Whole system gets dilated (children)

9

Name a functional cause of renal obstruction?

Neurological conditions e.g. spinal cord injury

10

What are the main sequelae of renal obstruction and renal stasis?

Stone/calculi formation

Urinary tract infection - cystitis, pyelonephritis

Kidney damage

11

What can obstruction at the urethral level cause? What it caused by?

Bladder hypertrophy (detrusor hypertrophy)

Due to prostatic hyperplasia

12

What is the main consequence of obstruction to the kidney? Whats it characterised by?

Hydronephrosis
-Cortical atrophy
- Dilated pelvis and calyces

13

What can acute complete obstruction cause to the kidney? How is it characterised?

Can reduce GFR and cause acute renal failure

Mild hydronephrosis mild dilatation of pelvis and calyces (not enough time for large dilation)

14

What can chronic intermitted obstruction cause to the kidney? How is it characterised?

Eventual (slow) cortical atrophy, reduced renal filtration and renal failure

15

What are the clinic features of complete acute obstruction?

-Acute renal failure
-Anuria
-Pain (VERY)

16

What are the clinical features of chronic unilateral obstruction?

-asymptomatic
- Eventual cortical atrophy and reduced renal function

17

What are the features of bilateral partial obstruction?

Polyuria and progressive scarring/reduced function

18

What is the pathogenesis for renl calculi?

Excess substances in URINE precipitating out e.g. calcium

Change in urine constituents causing substance precipitation e.g. pH

Poor urine output - supersaturation

- reduced citrate

19

What are the main types of renal stones that can occur?

Calcium (80%)

Struvite (15%) - infections (staghorn)

Urate (5%) - acidic urine

Cystine (1%)

20

What are the main causes of calcium stones?

- Hypercalcaemia due to bone disease, excessive PTH, sarcoidosis

- Excessive Ca absorption from intestine

-Inability to reabsorb tubular Ca

Idiopathic

Gout - allows Ca to accumulate!

21

Whats the pathogenesis of struvite stones?

Urease producing bacteria infection -> convert urea to ammonium -> increases urine pH -> precipitates Mg ammonium phosphate salts -> stag horn stones

22

What are the main cause of urate stones?

Gout -Hyperuricaemia

Idiopathic

23

What are the main cause of cystine stones?

Rare

Inability of kidneys to reabsorb AAs

24

What is the gold standard means of investigating for renal calculi?

Non-contrast CT scan

25

What are the sequelae of renal calculi?

Obstruction

Haematuria

Infection

Squamous metaplasia (squamous cell carcinoma)

26

What is the most common type of renal carcinoma?

Clear cell carcinoma

27

What is the most important risk factor for renal carcinoma?

-TOBACCO
-obesity
-hypertension
-oestrogen
-Acquired cystic kidney disease
-asbestos exposure

28

What is the most common cancer syndrome observed in renal cell carcinoma?

Von Hippel Lindau syndrome

29

What are the clinical presentations of renal cell carcinoma?

Haematuria

Palpable ab mass

Vertebral pain

MOSTLY INCIDENTAL finding


Metastasis

Paraneoplastic syndromes

30

Provides some examples of paraneoplastic syndromes associated with RCC

Cushing syndrome - ACTH

Hypercalcamia - PTH

Polycythaemia - EPO production

31

What is the characteristics of a clear cell carcinoma?

Well defined, yellow tumour

Often with haemorrhagic areas

May extend into perinephric fat or into renal vein (poorer prognosis)

32

Where do the majority of urothelial cell carcinomas arise?

Most commonly bladder but can come from the renal pelvis to urethra

33

What is the most common risk factor for urothelial carcinoma?

Smoking

34

How do urothelial cancers present?

Haematuria

Urinary frequency

Pain on urination

Urinary tract obstruction

35

What if the cancer has invaded the lamina propria, what is the treatment?

Removal of the bladder (resection if lower)

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