Genitourinary Flashcards
(192 cards)
1
Q
What is nephroliathiasis?
A
Calcium oxalate stones form in the collecting duct of the kidney , can be deposited anywhere from the renal pelvis to the urethra.
2
Q
What are other types of kidney stones?
A
-calcium phosphate
-Uric acid
-struvite
-cysteine
3
Q
What is the epidemiology of nephroliathisis?
A
- very common
more common in men
-uncommon in children
-20-40y
4
Q
What are the risk factors of nephroliathisis?
A
-chronic dehydration
-UTI’s
-Primary kidney disease
-HyperPTH (hypercalcaemia/uria)
-History of previous stone
5
Q
What is the pathology of nephroliathisis?
A
-Excess solute in collecting duct leading to supersaturated urine; favours crystallisation
-Stones cause regular outflow obstruction; Hydronephrosis
-Dilation and obstruction of renal pelvis = damage and infection risk
6
Q
What is hydronephrosis?
A
a condition where one or both kidneys become stretched and swollen as the result of a build-up of urine inside them. - requires surgical decompression
7
Q
What is the presentation of nephroliathisis?
A
Loin to groin pain, unilateral and colicky - peristaltic waves
-patient can’t lie still (Ddx- peritonitis; rigidity)
-haematuria + dysuria
-Fever - suggests infection(pyelonephritis)
8
Q
What makes the nephroliathisis pain worse?
A
Diuretics and fluid
9
Q
What is the investigation and diagnosis for nephroliathisis?
A
1st line - KUB XR (80% specific for renal stones - cheap and easy)
Gold Standard - NCCT KUB (99% specific for stones therefore diagnostic )
-Bloods;FBC, U+E - could suggest hydropnephrosis, Urine dipstick = UTI
-urinalysis- haematuria, preg test
10
Q
Why would you not use contrast in a CT scan for nephroliathisis?
A
As the contact would need to be excreted by the kidneys - harmful
11
Q
What are the 3 most commonest obstruction sites?
A
- PUJ - petro-ureteric junction
- Petric brim (ureters cross over iliac vessels)
- VUJ - Vesicoureteric junction obstruction
12
Q
What is the treatment for nephroliathisis?
A
-Symptomatic –> hydrate, analgesia (NSAIDs-diclofenac)
-Abx if UTI present (Gentamycin for pyelonephritis)
-Stones normally pass if small enough <5mm
-Elective surgical Tx if too big (ESWL/PCNL) to pass
13
Q
What is ESWL?
A
Extracorporeal shock wave lithotripsy - breaks stone with sound waves
smaller stones 6-10mm up to 20mm
14
Q
What is PCNL?
A
Percutaneous nephrolithotomy - keyhole removal of larger stones - 20mm+
15
Q
What is acute kidney injury?
A
Abrupt decline in kidney function (hrs-days), characterised by increase serum creatinine + urea and decreased urine output.
16
Q
What is the classification of AKI?
A
Serum creatinine rise >26micromol/L in 48hr
OR
Rise in creatinine 1.5x baseline in 7 days
OR
Urine output <0.5ml/kg/hr for > consecutive 6hrs
17
Q
What are the different stagings of AKI?
A
Used to be rifle : risk, injury, failure, loss of functioned stage renal failure
AKIN - 3 stages
18
Q
What are the causes of AKI?
A
Pre-renal
Intra renal
Post renal
19
Q
What are the pre-renal causes of AKI?
A
Hypoperfusion- Low blood volume (cariogenic shock, dehydration, bleeding) and low effective circulating volume (liver failure, congestive heart failure)
-renal artery blockage or stenosis
-NSAIDs +ACEi= low GFR
20
Q
What are the intra-renal causes of AKI?
A
Kidney can’t filter the blood properly:
Nephron and parenchyma damage
-Tubular(mc) - acute tubular necrosis
-Interstitial - acute interstitial nephritis
-Glomerular - glomerulonephritis
-Toxins (sepsis)
21
Q
How does glomerulonephritis cause renal AKI?
A
Barrier damage, protein leakage = low oncotic damage and therefore low GFR
22
Q
How does tubular necrosis cause renal AKI?
A
Complex blood supply , tubule cells infarct, break away, low hydrostatic pressure and low GFR
23
Q
What is the presentation of acute tubular necrosis?
A
muddy brown casts in urine -dead tubular cells
24
Q
How does acute interstitial nephritis cause renal failure AKI?
A
infection, ischaemia, connective tissue diseases
-inflammation and immune cells = damage
25
What are the post renal causes of AKI?
Obstructive uropathy:
-stones (ureteral, bladder, urethra)
-BPH
-Drugs(CCBs, anticholinergic)
-occluded in dwelling catheter
26
What are the top 3 causes of AKI?
Sepsis
Cariogenic shock
major surgery
27
What are the risk factors of AKI?
- increasing age
-comorbidities (HTN,DM,CHF)
-Hypovolemia
-nephrotic drugs
28
What is the pathology of AKI?
The risk factors cause decreased blood filtration and urine output therefore there is an accumulation of (usually excreted) substances :
K+ hyperkalaemia (Arrhythmias)
Hyperuremia- pruritis+ uremic frost+ confusion
Fluid: oedema
H+ - acidosis
29
What is the presentation of AKI?
Due to substance accumulation:
uremia - encephalopathy, pericarditis, skin manifestations
Fluid overload - oedema
Oliguria + palpable bladder
H+ - acidosis
K+ - arrhythmias - hyperkalameia
Hameaturia + proteinuria
30
What is the ECG presentation of hyperkalaemia?
Tall tented T waves
P wave flattening
Wide QRS
31
What is the diagnosis of AKI?
Establish cause - pre,intra,post renal and diagnose with KDIGO classification
-Check K+,H+, urea, creatinine with U+E
FBC+CRP-check for infection
Renal biopsy will confirm intra renal cause
USS for post renal
ECG,Urine dipstick,CXR, ABG
32
What is the treatment for AKI?
-Treat complications:
Hperkalaemia - calcium glucanate
Met acidosis - sodium bicarbonate
Fluid overload - diuretics
-Treat underlying cause :
Last resort. -renal replacement therapy (Haemodialysis indicated in AFUK)
33
What is the treatment for hyperkalemia?
Iv calcium gluconate
Insulin + dextrose
34
Why is insulin and dextrose given for hyperkalaemia?
Insulin drives K+ into cells (+glucose) via Na+-K+ ATPase pump
Dextrose ensures patient doesn't become hypoglycaemic
35
Why are NSAIDs CI in AKI?
NSAIDs known to cause AKI
- renal perfusion and decreases GFR - pre renal
Can cause glomerulonephritis + interstitial nephritis - renal
36
What is AFUK indications for haemodialysis?
Acidosis - pH<7.1
Fluid overload - oedema
Ureamia - symptomatic
K+ >6.5 / ECG change
37
what is Chronic kidney disease?
Reduction of eGFR <60ml/min/1.73m^2 for 3+ months
38
What are the clinically test readings to quantify CKD?
eGFR
ACR - albumin: creatinine - more sensitive measure of proteinuria
39
What are the classified stages 1-5?
1. >90 - normal and high
2. 60-89 - mild reduction
3. a- 45-59 - mild to mederate
b- 30-44 - moderate to severe
4. 15-29 - severe
5. <15. -kidney failure
40
What are the 4 parameters for CKD classification ?
Creatinine
Age
Gender
Ethnicity
41
What is the ACR range?
<3 normal
3-30 moderately increased
>30 severely increased
42
What are the risk factors of CKD?
DM + HTN - mc
Glomerulonephritis
PKD
Nephrotoxic drugs - NSAIDs
43
What is the pathology of CKD?
1 million nephrons; in CKD many are damaged resulting in a lowered GFR therefore an increased burden on remaining nephrons
-compensatory RAAS to increase GFR but increase transglomerular pressure = shearing + loss of barrier membrane selective permeability --> proteinuria/ hameaturia
44
What causes mesangial scarring?
Angiotensin 2 regulates TGF-B and plasminogen activator -inhibitor 1 causing mesangial scarring
45
What is the presentation of CKD?
Early on - Asx
Sx due to substance accumulation + renal damage (diabetic neuropathy)
Complications:
-anaemia (low EPO)
-osteodystrophy (low vit d activation)
-Neuropathy and encephalopathy
-CVD
Hameaturia/proteinuria
46
What is the diagnosis of CKD?
FBC - anaemia of chronic disease
U+E
Urine dipstick - proteinuria
USS - bilateral renal atrophy
GFR function staging 1-5+ albumin: creatinine ratio
47
What is the treatment for CKD?
no cure so treat complications - anaemia - EPO+FE
Osteodystrophy - VIT D supplements
CVD - ACEi + statins
Oedema - diuretics
Stage 5 = RRT
if ESRF = renal transplant
Stop NSAIDs
48
What is the differences between AKI and CKD?
AKI = high serum creatinine and low urine output
- shorter Sx onset
-no anemia
-USS =normal
CKD = low eGFR
- 3months Sx
-Anaemia of CKD
-USS= bilateral renal atrophy
49
What is benign prostate hyperplasia ?
Non malignant prostate hyperplasia , normal with ageing.
50
What are the risk factors of BPH?
increasing age(Ethnicity. ;afrocaribbean = higher levels of testosterone
- castration is protective
51
What is the pathology of BPH?
inner transitional zone of prostate proliferates and narrows urethra
52
What is the presentation of BPH?
LUTS:
Storage and voiding symptoms
53
what are the storage symptoms?
frequency, urgency, nocturia, incontinence
54
What are the voiding symptoms?
poor stream, dribbling, incomplete emptying, straining, dysuria
55
What is the diagnosis of BPH?
DRE (digital rectal exam) - smooth enlarged (prostate cancer = hard and irregular)
PSA test = rule out prostate cancer - unreliable as can be raised in both but usually more in cancer
Rule out UTI's - urine dipstick
Stones
56
What is the treatment for BPH?
Lifestyle ; lower caffeine intake/ may need a catheter
Drugs :
1st line alpha blocker - Doxazosin+ Tamsulosin - relaxes bladder neck
2nd line - 5 ALPHA REDUCTASE INHIBITORS - FINASTERIDE - lower testosterone production therefore lower prostate size
Surgery: Transurethral resection of prostate
57
What is the mechanism for tamsulosin?
Blocker of alpha 1D and 1A adrenoreceptors - relaxes detrusor muscles of bladder prevent storage symptoms
58
What are the side effects of tamsulosin?
sexual dysfunction
59
What is doxazosin?
Alpha blocker - relaxes detrusor bladder neck but has side effects like postural hypotension due to increased vasodilation
60
What is the most common complication of BPH?
retrograde ejaculation
61
What is the most common renal cancer?
Renal cell carcinoma
62
What is the pathology of renal cell carcinoma?
malignant cancer of proximal convoluted tubule epithelium, can metastasise to bone, liver and lungs
63
What are the risk factors of renal cell carcinoma?
Smoking, haemodialysis, hereditary: von hippie Lindau syndrome
64
What is von hippel - Lindau syndrome?
-Autosomal dominance
-Loss of tumour suppressor gene
-Presentation- bilaterally:
renal and pancreas cysts
-cerebellum cancers
65
What is the presentation of a renal cell carcinoma?
Often asymptomatic; 25% metastasised cases at Px
Triad: Flank pain, haematuria, abdominal mass
May have left sided varicocele
Hypertension
Anaemia - low EPO
66
What is the diagnosis of renal cell carcinoma?
1st line - USS
Gold - CT chest/abdo/pelvis (more sensitive)
Staging - Robson staging 1-4
67
What is the treatment of renal cell carcinoma?
Nephrectomy (full/partial if bilateral)
68
What is Wilms tumour?
Renal mesenchymal stem cell tumour seen in children ,<3y/o, much rarer.
(Nephroblastoma)
69
What is the most common type of bladder cancer?
transitional cell carcinoma (TCC) of bladder
70
What are the risk factors of Bladder cancer?
-Occupational exposure to dyes/paints/rubber
(painter, hairdresser, mechanic working with tyres)
-smoking
-Chemo/radiotherapy
-Age (Px age = 73)
71
What is the most common subtype of bladder cancer?
Urothelial carcinoma
72
What patients are more likely to have squamous cell carcinoma bladder cancer than transitional?
If patient has schistosomiasis
73
Whats is the presentation of bladder cancer?
Painless haematuria
74
What is the diagnosis of bladder cancer?
Flexible cystoscopy and biopsy - gold standard
75
What is the treatment for bladder cancer?
Conservative - support
Medical - chemo/radio
Surgery - transurethral resection of bladder tumour or cystectomy
76
What is prostate cancer?
Adenocarcinoma - outer zone of peripheral prostate neoplastic, malignant proliferation
MC - male malignancy
77
What re the risk factors of prostate cancer?
Genetic - BRCA2 / HOXB13
Increasing age
Afrocaribbean ethnicity
FHx
78
What is the presentation of prostate cancer?
LUTS like BPH but with systemic cancer SX
-weight loss
-fatigue
-night pain
Bone pain - typically metastasises to bone(scerlotic lesions), liver, lung ,brain
79
What is the diagnosis for prostate cancer?
DRE + PSA
Transrectal USS + biopsy = diagnostic
Grading = Gleason score
80
What is the treatment for prostate cancer?
Local -->prostatectomy
Metastatic --> Hormone therapy ( lower testosterone, slows cancer growth/ even death)
-Bilateral orchidectomy
Gnrh receptor agonist - Goserelin
Chemo/Radio
81
What is the mechanism of GNRH agonist?
Agonises GnRH therefore increases LH and FSH but results in exogenous suppression of the HPG axis
82
What is the most common cancer in young men 20-45?
Testicular cancer
83
Where does testicular cancer arise from?
Germ cells -90%
Non germ cells -10%
84
What are the germ cells?
Seminoma. -mc
Teratoma
85
What are the non germ cells?
sertoli
leyding
sarcoma
86
What are the risk factors for testicular cancer?
cryptorchidism - undescended testses
Infertility
FHx
87
What is the presentation of testicular cancer?
painless lump in testicle which does not transluminate
May show lung metastasis signs - cough
88
What is the diagnosis for testicular cancer?
Urgent (doppler) USS testes - 90% diagnostic
Tumour markers:
AFP - raised in teratoma
BhCG - raised in seminoma
LDH raised in tumours
CXR if lung signs
89
what is the treatment for testicular cancer?
Urgent radical orchidectomy + offer sperm storage - always first line
Adjuvent chemo/radio
90
What is obstructive uropathy?
Blockage of urine flow, can affect one or both kidneys depending on level of obstruction - Obstructive nephropathy
91
What are the causes of obstructive uropthay?
BPH and stones - most common
92
What is the pathology of obstructive neuropathy?
obstruction --> retention + increase in KUB pressure --> refluxing/ backlogged urine in renal pelvis (hydronephrosis) - dilated renal pelvis, which is more infection prone
93
What is the presentation of obstructive neuropathy?
With obstruction - may be aSx if only 1 kidney affected
94
What is the treatment for obstructive neuropathy?
1. relieve kidney pressure --> catheterise urethra, urethral stent
2. Tx BPH or stones + infection
95
What is a urinary tract infection?
The inflammatory response of the urothelium to bacterial invasion usually associated with bacteria and pyuria. Pure growth of >10^5 organisms/ml of fresh mid stream urine
96
What are the locations of the urinary tract infections ?
Upper- Kidney
Lower- bladder onward
97
What are the upper UTIs?
Pyelonephritis
98
What are the lower UTIs?
Cystitis, prostatitis, urethritis, epididymo-orchitis
99
What organisms cause UTIs?
KEEPS:
Klebsiella
Enterobacter
E.coli - mc
Proteus
S.saprophyticus
100
What causes 80% of UTIs?
UPEC- uropathogenic E.coli
101
Why are females more effected by UTIs?
They have a shorter urethra therefore closer to anus and easier for bacteria to colonise
102
What is the diagnosis for all UTIs?
Urine dipstick
- positive leukocytes
-positive nitrites
-+/- haematuria
Gold standard - midstream MC+s = confirm UTI and pathogen
103
What is pyelonephritis?
Infection of renal parenchyma + upper ureter, ascending transurethral spread. Usually UPEC, can be other KEEPS
104
What are the risk factors for pyelonephritis?
Urine stasis(stones), renal structural abnormality, catheters
105
What is the presentation of pyelonephritis?
<35
Triad:
-loin pain
-fever
-pyuria. or N+V as pyuria seen on investigations
106
What is the diagnosis of pyelonephritis?
1st - urine dipstic
Gold- mid stream - microscopic, culture and sensitivity
Ix for stones if suspected
107
What is the treatment for pyelonephritis?
Analgesia -paracetamol
Abx - ciprofloxacin or co-amoxiclav
Cefalexin if Preg
108
What is cystitis?
UPEC infection of bladder
109
What are the risk factors of cystitis?
urine stasis, bladder lining damage, catheters
110
What is the presentation of cystitis?
>35
suprapubic tenderness and discomfort
increased frequency and urgency
visible haematuria
111
What is the diagnosis of cystitis?
urine dip
mc+S
112
What is the treatment for cystitis?
Abx; trimethoprim or nitrofurantoin
Amoxicillin if Preg
113
What is urethritis?
Urethral inflammation +/- infection - mc = a sexually acquired condition
114
What are the infective causes of urethritis?
Neisseria gonorrhoea - lc
chlamydia trachomatis - mc
115
what are the non infective cause of urethritis?
Trauma
116
What is Neisseria gonorrhoea?
Gram negative diplococcus
117
what is chlamydia trachomatis?
obligate intracellular gram negative aerobe - bacillus
118
What are the risk factors of urethritis?
MSM + unprotected sex
119
What is the presentation of urethritis?
<35
Dysuria+/- urethra discharge (blood/pus), urethral pain
120
What is the diagnosis of urethritis?
NAAT (nucleic acid amplification test ) --> detect STI (NG or CT)
Urine dip (positive if infectious UTI is indicated) + mc+s = will detect pathogen ID
121
What is the treatment of urethritis?
NG-->IM ceftriaxone +azithromycin
CT--> azythromycin (or doxycycline)
122
In what other reactive disease is urethritis seen?
Reactive arthritis
-cant see, can't pee, can't climb a tree
123
What is epididymo - orchitis?
Inflammation of the epididymis, extending to the testes. Usually due to urethritis (STI) or cystitis (KEEPS) extension
124
What is the presentation of epididymo-orchitis?
unilateral scrotal pain + swelling. -pain relieved when elevating testes and cremaster reflex intact
Ddx - rule out testicular torsion
125
What is the diagnosis of epididymo-orchitis?
NAAT
Urine dip
MC+S
126
What is the treatment for epidydmo- orchitis?
Depends on STI or UTI - Abx treatment for cystitis or standard STI treatments
127
What is polycystic Kidney Disease?
cyst formation through renal parenchyma - bilateral enlargement and damage
128
What is the aetiology of PKD?
Familial inherited :
- autosomal recessive and dominant
129
What is the autosomal recessive cause of PKD?
- less common
-a disease of infancy or rebirth with increased mortality
-many congenital abnormalities (e.g's potters sequence - clubbed feet, flattened nose)
130
What is the autosomal dominant cause of PKD?
- most common
-mutated PKD1(85%) or PKD2(15%)
-more males
-present at 20-30
131
What is the pathology of PKD?
PKD 1+2 = code for polycystic (Ca ++ channels)
-In cilia of nephron, when filtrate passes, cilia move+ polycystic on cilia open --> Ca++ inhibits excessive growth
-PKD mutation=decrease in Ca++ influx therefore cilia excessive growth - cysts -many= polycysts
132
What is the presentation of PKD?
Bilateral flank/back or abdo pain
+/- haematuria
Extrarenal cysts - particularly in circle of willis (berry aneurysm ;if ruptured = subarachnoid haemorrhage)
133
What is the diagnosis of PKD?
Kidney USS - enlarged bilateral kidneys with multiple cysts
- also genetic testing +FHx of PKD
134
What is the treatment of PKD?
Non curative, manage Sx (HTN - ACEi +ESRF- RRT or transplant )
135
What is an epididymal cyst?
extratesticular cyst - above and behind testes that will transilluminate
136
What is the diagnosis of epididymal cyst?
USS scrotum
137
What's a hydrocele?
Fluid collection in tunica vaginalis - cyst that testicle sits within that will transilluminate
138
What is the diagnosis for hydrocele?
USS scrotum
139
What is varicocele?
Distended pampiniform plexus due to increase in left renal vein pressure causing reflux
140
What is the presentation of varicocele?
bag of worms on left hand side mostly - painless, maybe painful when larger therefore more severe
141
What is the diagnosis for varicocele?
Clinical
142
What is the complication of varicocele?
Infertility
143
What is testicular torsion?
Spermatic cord twists on itself; occlusion of testicular artery - causes ischaemia -> gangrene of testis if not dealt with
144
What are the risk factors of testicular torsion?
Bell clapper deformity - horizontal lie of testes
145
What is the presentation of testicular torsion?
Severe unitesticular pain (hurts to walk), abdo pain, N+V -cremasteric reflex lost, no pain relief on elevating testes - prehns sign
146
What is the cremasteric reflex?
stroke inner thigh; ipsilateral testicle should elevate
147
What is the diagnosis of testicular torsion?
USS to check testicular blood flow - but first surgical exploration if there is a high risk
148
What is the treatment for testicular torsion?
urgent surgery within 6hr (90-100% successful)
-surgical exploration always first line
-orchidectomy +bilateral fixation - testes to scrotal sac
149
What are the types of incontinence in females?
-stress: (sphincter weakness - post pregnancy trauma) -pee leaks with intra-abdo pressure rise
-urge(detrusor muscle overactivity)
-spastic paralysis(neurological UMN lesion) - overactive reflexes + hypertonia of detrusor
150
What is the treatment for incontinence?
surgery
anti-cholinergic drugs
151
What is retention in males?
Inability to pass urine even when bladder full
152
What are the causes of retention?
Obstruction - Stones,BPH, neurological flaccid paralysis (hypotonia of detrusor as LMN)
153
What are storage symptoms?
Occur when bladder should be storing urine therefore need to pee:
Frequency, urgency, nocturia, incontinence
154
What are the voiding symptoms?
Occur when bladder outlet's obstructed - hard to pee:
Poor stream, hesitancy, incomplete emptying, dribbling
155
What are the red flags LUTs?
Hamaturia , dysuria
156
What is glomerulonephritis?
Glomerulonephritis refers to groups of parenchymal kidney diseases that all result in the inflammation of glomeruli and nephrons
157
What are the classifications of glomerulonephritis?
Nephrotic and nephritic
158
What is nephrotic syndrome?
Protein leaks due to the inflammation of podocytes.
159
What are the characteristics of nephrotic syndrome?
-proteinuria (3.5g+/24hr)
-Hypoalbuminemia
-oedema due to 3rd spacing
-hyperlipidaemia
-hypogammaglobulinameia
-hypercoaguable blood (due to loss of antithrombin 3)
160
What are the primary causes of nephrotic syndrome?
Minimal change disease - mc in children
Focal segmental glomerulosclerosis -mc in adults
Membranous nephropathy- adults, caucasian
161
What is the secondary cause of nephrotic syndrome?
mc to diabetic (nephropathy)
162
What is the presentation of nephrotic syndrome?
proteinuria, hypoalbuminemia, oedema, weight gain, hyperlipidemia
163
What is minimal change disease?
Cytokines attack foot processes of podocytes--> protein leakage
164
What is focal segmental gomerulosclerosis?
Scleosis forms in parts of the glomeruli
165
What is membranous Nephropathy?
thickening of glomeruli capillary deposition in sub-epithelial surface- damaged glomerular --> protein leaks out
166
What is the diagnosis for minimal change disease?
Take biopsy=
Light microscopy= NO CHANGE
Electron microscopy= podocyte effacement + fusion
167
What is the diagnosis of focal segmental glomerulosclerosos?
Take biopsy=
Light microscopy= segmental sclerosis ; less than 50% glomeruli affected tho
168
What is the diagnosis for membranous nephropathy?
Biopsy=
Light microscopy = thickened GBM
Electron microscopy= subpodocyte immune complex deposition, spike and dome appearance
169
What is the treatment for nephrotic syndromes?
Corticosteroids for 12 weeks - prednisolone
- minimal change respond well to them
FSG +MN= not so well
170
What is nephritic syndrome?
Glomerulonephritis pathologies that cause both haematuria and proteinuria. Increased permeability of glomeruli allows movement of RBCs in to filtrate
171
What are the characteristics of nephritic syndrome?
-Haematuria (+ little proteinuria)
-oliguria
-HTN
-Oedema - due to fluid overload
-GBM breaks - inflammation- bowman's crescents
172
What are the causes of nephritic syndrome?
IgA nephropathy (Berger's disease). -mc
Past strep glomerulonephritis
SLE
Goodpastures syndrome
Haemolytic uremic syndrome
173
What is IgA nephropathy?
most common cause of nephropathy
-IgA deposits in mesangium of kidney and kidney is attacked by anti-glycan autoantibodies
174
What is the presentation of IgA nephropathy?
visible haematuria
1-2 days after tonsillitis
Viral infection or gastroenteritis viral infection
175
What is the diagnosis of IgA nephropathy?
Immunofluorescence microscopy shows IgA complex deposition
176
What is the treatment for IgA neuropathy?
non curatvive - 30% progress to ESRF
BP control - ACEi
177
What is the Ddx of IgA neuropathy?
henloch Schonlein purpura - small cell vasculitis
Dx - exact same result
Difference
IgA= only kidney deposition
HSP= systemic - kidney, liver
178
What is the presentation of post strep glomerulonephritis?
Visible haematuria
2 weeks after pharyngitis from group A,B haemolytic strep - S.pyogenes
179
What is the diagnosis of post strep GN?
light microscope - hyper cellular glomeruli
E microscope - sub endothelial immune complex deposition
Immunofluorescence shows starry sky appearance - IgG,IgM deposition along GBM
180
What is the treatment for post strep GN?
Self limiting, sometimes may progress to rapidly progressing GN
181
What is SLE?
Lupus nephritis secondary to SLE (ANA deposition in endothelium)
182
What is the diagnosis for SLE?
ANA positive , anti double stranded DNA positive
183
What is the treatment for SLE?
steroids + immunosuppressants
184
What is good pastures?
pulmonary and alveolar haemorrhage and glomerulonephritis due to autoantibodies (anti-GBM)
185
What is the treatment for good pastures?
steroids and plasma exchange
186
What is haemolytic uremic syndrome?
a condition that can occur when the small blood vessels in your kidneys become damaged and inflamed
187
What are the causes of HUS?
Shiga toxin - e.coli, shigella
188
What is the presentation of HUS?
haemolytic anaemia
AKI therefore uraemia
Thrombocytopenia
189
What is the treatment for HUS?
mostly self limiting
med emergency - supportive fluids +Abx
190
What is rapidly progressing glomerulonephritis (RPGN?
subtype of GN that progresses to ESRF very fast
191
What are the causes of PRGN?
wegeners granulomatosis (cANCA)
MPA(pANCA)
Good pastures
192
What is the diagnosis of RPGN?
Inflammatory crescents in bowmans space
