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Clinical Pathology > Kidney & Urinary Tract > Flashcards

Flashcards in Kidney & Urinary Tract Deck (76):
1

Summary of Renal Pathology

Functions of kidney
Presentation of renal D
Mechanisms of glomerular/tubular/vascular damage
AKI, CKD, Nephrotic/Nephritic S
Obstructive Uropathy
Urogenital pathology
UTIs

2

List the 5 functions of the kidney

Regulate BP
Remove waste
Release hormones: renin, EPO
Fluid & electrolyte balance
Acid-base metabolism

3

A typical presentation of renal disease would be...?

Increased [creatinine], [urea]
Proteinuria
Hypoalbuminaemia
Oedema
Haematuria

4

Glomerular damage to the kidneys can occur by immunological mediators such as..?

Circulating immune-complexes depositing -- Vasculitis, SLE, Endocarditis, post-infective

Anti-GBM Disease

5

Non-immunological damage to the glomerulus can occur by...?

HTN
DM - alters
Desposition of ab proteins - amyloid

6

Ischaemia and toxins are prone to damaging which part of the kidney?

Tubules

7

Damage to the glomerulus (blood vessel) can also damage what?

Tubules

8

List ways vascular damage can occur in the kidneys.

HTN
Atheroma
DM
Vasculitis
Thrombotic microangiopathy

9

Glomerular D have unclear aetiology and are often named by microscopic appearence.

Which Glomerular D is a common cause of nephrotic syndrome in adults?

Membranous nephropathy

10

Minimal change disease commonly causes nephrotic syndrome in which group of people?

Children

11

Post-infective Glomerulonephritis occurs weeks after what?

Strep throat infection

12

Anti-GBM Disease is anautoimmune attack on glomerulus. T/F?

T

13

IgA nephropathy has a typical presentation of...?

Teens/adult + haematuria

14

Which subtype of IgA nephropathy is often seen in young male + haematuria + rash?

Henoch-Schonlein Purpura

15

Elderly + AKI = ?

Myeloma or Acute Interstitial Nephritis

16

Young women + haematuria + facial rash = ?

Lupus Nephritis

17

Adult + AKI + Fever + Myalgia

Vasculitis

18

Nephrotic syndrome is always caused by damage to the glomerulus. What acronym is used for its presentation?

HHOP
Hypoalbuminaemia
(Hyperlipidaemia)
Oedema
Proteinuria

19

2 complications of Nephrotic syndrome?

Infection (oedema)

Thrombosis (hyperlipidaemia)

20

Another phrase for Nephritic syndrome is..?

Acute Nephritis

21

What acronym is used for Nephritic syndrome?

HHOP + AKI
HTN
Haematuria
Oedema
Proteinuria

22

The causes of AKI are split into which categories?

Pre-renal (decreased blood flow)

Renal

Post-renal (obstructive)

23

Increased [creatinine], [urea] + Anuria/Oliguria is typical of what?

AKI

24

Complications of AKI?

Heart failure (fluid overload)
Arrythmias
infection
Jaundice
GI bleeding

25

How would you treat AKI?

Treat underlying cause

Dialysis

26

CKD results from permanently reduced GFR from decreased nephrons. How would the patient present?

HTN
Tired/poor appetite (waste)
Anaemia
Renal bone D

27

The 2 options for managing CKD are...?

Dialysis
Transplant

28

Obstruction in the urinary tract can occur from the renal pelvis --> urethral meatus. What are some causes?

Stones
Tumour
Stricture
Prostate enlargement
Preg

29

Does acute or chronic obstruction in the urinary tract present with PAIN + AKI + anuria?

ACUTE

30

How does chronic urinary obstruction present initially?

Initially asymptomatic

--> Cortical atrophy --> Renal function decline

31

List 3 consequences of urinary tract obstruction.

Infection
Stone formation
Kidney damage

32

For each effect of obstruction state where the obstruction would be:
1. Hydronephrosis

2. Hydroureter

3. Detrusor atrophy

1. Pelvuic-ureter junction (PUJ) obstruction

2. Ureteric

3. Urethral

33

Renal stones affect M > F, esp 20-30 yrs. What are 3 ways that they can develop?

Increased Ca2+ in urine

Supersaturation

Decreased [citrate] (binds to Ca2+)

34

What is the classic presentation of renal stones?

Loin --> groin pain

EXTREMELY PAINFUL

35

The consequences of renal stones are:
-obstruction
-haematuria
-infection
-squamous metaplasia
-carcinoma

How would you diagnose it?

Non-contrast CT

USS (preg)

IV Urography

36

Classification of renal stones?

Calcium
Struvite
Urate
Cystine

37

Which renal stone displays a staghorn calculi on X-ray?

Struvite

38

Two most common cancers in Kidney/Urinary tract?

Renal Cell Carcinoma (RCC)

Urothelial Cell Carcinoma (UCC)

39

Most cancer syndromes in RCC are caused by which syndrome?

Von Hippel-Lindau syndrome

(TSG mutation)

40

Risk factors for RCC?

SMOKING*
HTN
Obesity
Oestrogens
Asbestos
Accquired cystic kidney D

41

This presentation correlates with which cancer?
Haematuria
Palpable abdo mass
Costovertebral pain

RCC

42

Are mets common in RCC?

YES

Poor prognosis

43

Where do UCC arise from?

Most common one?

Lining of pelvis/ureter/BLADDER/urethra

44

Risk factors of UCC?

Smoking
Dyes
RT
M > F

45

Presentation of UCC?

Haematuria
Dysuria
Urinary obstruction

46

Whats another name for BPH?

Nodular hyperplasia

47

Whats the phrase for the symptoms experienced in BPH?

LUTS (Lower urinary tract symptoms)

-Hesistency
-Frequency
-Urgency
-Nocturia
-Incomplete bladder emptying

48

95 % of Prostate cancer is...?

ADENOCARCINOMA

49

What are the risk factors for PC?

> 40yrs
FH
BRCA2 mutation
[Androgens]
Black

50

Which grading system is used in PC?

Gleason scoring system

51

Testes 2 main functions?

Produce sperm
Produce androgens

52

Testicular tumours (TT) can be divided into 3 group..?

1" = within testes

2" = mets

Haematopoietic (mimic TT, common)

53

Germ cell TT are a subdivision of 1" TT. State some conditions associated with it.

Prior one in other testes
Cryptochidism
Inguinal hernia
Disorders of sex dev
Hydrocele
Testicular atrophy

54

Two commontypes of Germ cell TT?

Seminoma

Teratoma

55

Which Germ cell TT is often asymptomatic or has testicular enlargemen +/- pain?

Seminoma

35-45yrs

56

How would diagnose seminoma?

Increased [PLAP]
Increased [hCG]

57

Gradual testicular swelling +/- pain in boys/young men is characteristic of what?

Teratoma

58

List inflammatory conditions of the testes

A/C Epididymoorchitis
Idiopathic granulomatous orchitis
Sarcoidois of testes
Malakoplakia of testes
Sperm granuloma
Tuberculous testes

59

List 3 complications of inflammatory conditions of testes.

Testicular atrophy --> failure
Infertility
Germ cell TT

60

Name 1" causes of testicular failure/hypogonadism.

Kleinfelter's syndrome
Cryptochidism
Orchitis
Trauma
CF

61

What are 2" causes of testicular failure?

Pituitary tumour
Glucocorticoids, chemo
Obesity
Age

62

80% of UTI are caused by Staph Saprophyticus. T/F?

F

E.Coli

(also Proteus mirabilis in kidney stones)

63

Risk factors for UTI?

F > M
Urinary stasis: preg, obstructions
Sex
Congenitl ab
Instrumentation

64

Common cause of paediatric UTIs is?

VUR
Vescio-ureteric reflux

65

Cystitis = inflamm of bladder.
Symptoms?

LUTS:
Haematuria
Dysuria
Frequency
Nocturia
Supra-pubic tenderness

66

Which infection present as LUTS + loin/abdo pain + fever + N/V/diarrhoea

PYELONEPHRITIS

67

Urethral syndrome = ?

Abacterial urethritis

(LUTS without infection)

68

Significant bacteriuria = ?

> 10^5 cfu/mL

more likely to get UTI

69

Significant bacteriuria + no UTI symptoms = ?

Asymptomatic bacteriuria

70

Who does asymptomatic bacteriuria occur in?

Long-term catheter
Elderly
DM

71

pus in urine BUT no organisms = ?

Sterile pyuria

72

List causes of sterile pyuria

Inflammation from non-infectious causes:
Stones
Trauma
Vascultiis
renal D

73

What are the 4 kinds of investigations that can be done in suspected UTIs?

Urinalysis (Blood, protein, WBC, nitrites)

Bloods (pyelonephritis)

Microbiology (MSU, CSU, clean, SPA)

Imaging

74

When would you use imaging when investigating UTIs?

Recurrent UTI
UTI in male
UTI in child
Pyelonephritis

75

Treatment for UTI in F/M?

Nitrofurantoin
Trimethoprim
Amoxicillin

F: 3 days
M: 7 days

76

When would you treat asymptomatic bacteriuria?

Preg
Infants
Prior to urological procedures