Kidney diseases Flashcards Preview

Renal and urology > Kidney diseases > Flashcards

Flashcards in Kidney diseases Deck (80):
1

What is glomerulonephritis?

Non-infective inflammation of the glomeruli of the kidney, often with an immunological cause

2

What is pyelonephritis?

Bacterial infection of renal pelvis, calyces, tubules and interstitium

3

What is the most common causative organism of pyelonephritis?

E. coli

4

Which gender is pyelonephritis more common in?

Female

5

How does pyelonephritis occur?

Infection from haematogenous spread

Ascending infection 

6

What are the risk factors for pyelonephritis?

Urinary tract obstruction

Vesico-ureteric reflux

Diabetes

7

What would indicate chronic pyelonephritis

Symptoms often vague

Hypertension/uraemia

Large volume of urine

8

What would be seen on imaging of the kidney in chronic pyelonephritis?

Coarse cortical scarring

Distortion of calyces

9

What is chronic pyelonephritis associated with?

Chronic kidney disease

Hypertension

10

What are the symptoms of tubercular pyelonephritis?

Weight loss

Fever

Loin pain

Dysuria

11

How does tuberculosis normally reach the kidney?

Haematogenous spread from lung

12

What is sterile pyruria and what disease does it occur in?

Tubercular pyelonephritis

Pus in urine, but doesn't grow organisms on culture because TB takes weeks to grow in special medium

13

What pathology might be seen in tubercular pyelonephritis?

Caseous foci – slow growth with progressive renal destruction

Spread to ureters, bladder and other viscera

Typical caseating granulomatous inflammation

Mycobacteria may be seen on histological special stains (Zeehl-Neilsen) but absence does not exclude TB

14

What bacteria cause cystitis?

E. Coli.

Klebsiella 

Proteus

Pseudomonas
 

15

What is cystitis?

Inflammation of the bladder caused by a urine infection

16

Why is cystitis associated with outflow obstruction particulary dangerous?

Can become necrotising if associated with outlet obstruction

17

What is ureteritis/cystitis cystica?

Multiple small fluid filled cysts projecting into lumen as a result of chronic inflammation/irritation

Can resemble tumours

18

What organism can predispose to malignancy, particularly squamous cell carcinoma of the bladder?

S. Haematobium - schistosomiasis

19

What can be a result of prolonged bladder outlet obstruction?

Hypertrophy of the detrusor muscle, which can cause diverticular formation

20

Which problem in neonates can cause urethral outflow obstruction?

Posterior urethral valves

21

What is hydronephrosis?

Dilatation of pelvicalyceal system with parenchymal atrophy

22

What are the main causes of hydronephrosis?

Urinary tract obstruction

Reflux

23

What is this?

Q image thumb

Hydronephrosis

24

What is the most common cause of urinary outflow obstruction in the elderly male?

Prostatic enlargement or tumour

25

What is the inheritance pattern of adult polycystic kidney disease?

Autosomal dominant 

Abnormality on chromosome 16

26

How does adult polycystic kidney disease usually present?

Middle age

Abdominal mass

Haematuria

Hypertension

Chronic renal failure

Fatigue

27

What are the pathological characteristics of adult polycystic kidney disease?

Massive bilateral renal enlargement

Multiple cysts of varying size

Distortion of reniform shape

Cysts arise in any part of nephron

 

A image thumb
28

What other extrarenal complications is adult polycystic kidney disease associated with?

Cysts in liver, pancreas, lung

Association with berry aneurysm in the circle of Willis

29

What is the significance of increased risk of berry anuerysms associated with polycystic kidneys?

Increased risk of subarachnoid haemorrhage

30

Where are fibroma found in the kidney and what is their appearance?

Medulla

White nodules

31

Where are adenoma found in the kidney and what is their appearance?

Cortex

Yellowish nodules <2cm

 

32

What is angiomyolipoma and where might they be in the kidney?

Mixture of fat, muscle and blood vessels

Can be multiple and bilateral

33

What disease is angiomyolipoma associated with?

Tuberous sclerosis

34

How might a juxtaglomerular cell tumour present?

Secondary hypertension due to increased renin

35

What is the most common intra-abdominal tumour in children and from which tissue does it arise?

Nephroblastoma (Wilms’ Tumour)

Arises from residual primitive renal tissue

36

What is the commonest primary renal tumour in adults?

Renal cell carcinoma

37

What age and gender does renal cell carcinoma usually present in?

Age 55-60

M:F 2:1

38

How does renal cell carcinoma present?

Abdominal mass

Haematuria

Flank pain

General features of malignant disease

39

What are the paraneoplastic manifestations of renal cell carcinoma?

Polycythaemia (overproduction of red blood cells)

Hypercalcaemia

40

Where do renal cell carcinomas arise and what is their appearance?

Large, well circumscribed mass on the cortex

Yellow colour, with solid, cystic, necrotic and haemorrhagic areas

41

Where do renal cell carcinomas commonly extend into?

Renal vein

Can continue into vena cava and right atrium

42

How does renal cell carcinoma usually spread and to where?

Through blood

To lung and bone

43

What is the most common cell type in renal cell carcinoma and what are these cells?

Clear cell

Tumour cells rich in glycogen and lipid

44

Which type of carcinoma affects the renal pelvis?

Transitional cell carcinoma

45

What imaging is used to diagnose renal cell carcinoma?

Ultrasound
Triple phase contrast CT

46

What system is used to stage renal cell carcinoma?

Robson staging

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47

What surgical treatments are there for renal cell carcinoma?

Radical nephrectomy

Partial nephrectomy

Radiofrequency ablation

48

What is the definition of chronic kidney disease?

Chronically reduced GFR and evidence of kidney damage

49

How can GFR be estimated?

Creatinine clearance

50

Why is creatinine clearance only an estimate of GFR?

Secreted from tubules

Increased in muscular people

Needs to be stable - fluctuates during illness in hospital

Requires 24 hour urine collection which is often done inaccurately

51

What is the definition of stage 1 chronic kidney disease?

GFR > 90ml/min with evidence of kidney damage

52

What is the definition of stage 2 chronic kidney disease?

GFR 60-90ml/min with evidence of kidney damage

53

What is the definition of stage 3 chronic kidney disease?

GFR 30-60ml/min

(1 in 20 people will have a GFR like this normally)

54

What is the definition of stage 4 chronic kidney disease?

GFR 16-30ml/min

55

What is the definition of stage 5 chronic kidney disease?

GFR <15ml/min or renal replacement therapy

56

Which factors indicate that someone is more likely to progress to a higher stage of chronic kidney disease?

Proteinuria

Younger age at onset

57

What is the most common cause for requirement of dialysis?

Diabetic nephropathy

58

What are the common causes of CKD?

Diabetes

Hypertension

Vascular disease

Chronic glomerulonephritis

Reflux nephropathy

Polycystic kidneys

59

When do symptoms usually present in chronic kidney disease?

Late: GFR usually <20ml/min

60

What are the symptoms of chronic kidney disease?

Tiredness

Poor appetite

Itch

Sleep disturbance

Impaired urinary concentrating ability – symptoms may occur earlier - nocturia
 

61

How is progression of CKD slowed?

Reducing proteinuria and managing blood pressure:

ACEi/ARBs do both

Spironolactone

Stopping smoking

Managing diabetes

62

What side effects must you be aware of when starting a patient on ACEi or spironolactone for CKD?

Initial fall in GFR

Hyperkalaemia

63

Why does anaemia occur as a side effect of CKD?

Erythropoietin produced by the kidneys and production declines in CKD
 

64

Why is bone disease a complication of CKD?

Vitamin D hydroxylated in the kidney - impaired in CKD
Leads to reduced calcium absorption, leading to secondary hyperparathyroidism

In advanced CKD, serum phosphate rises – also increases PTH secretion
 

65

What can result from high phosphate and high calcium?

Calcified vessels and heart valves

66

How is bone disease treated in relation to CKD?

Alfacalcidol

Advice on phosphate intake

Phosphate binders

67

What is reflux nephropathy?

Angles of the ureters fail to shut the valves properly, causing reflux

Kidneys become small and scarred due to vesico-ureteric reflux 

Sometimes called chronic pyelonephritis

68

Which patients is reflux nephropathy most common in?

Children

69

When do hepatic cysts associated with polycystic kidneys tend to arise?

10 years after kidney disease

70

What cardiac disease is associated with polycystic kidney disease?

Mitral/aortic valve prolapse

Valvular disease

71

What GI disease is polycystic kidney disease associated with?

Diverticular disease

Diverticulitis and perforation are 2 important complications

72

How should polycystic kidney disease be managed?

Rigourous control of hypertension

Hydration

Proteinuria reduction

 

73

Where are cysts seen coming from in autosomal recessive polycystic kidney disease?

Seen appearing from the collecting system

74

Which pattern of inheritance is Alports syndrome?

X-linked recessive

75

What is Alports syndrome?

An inherited nephritis caused by a defect in type IV collagen matrix

76

What are the renal manifestations of Alports syndrome?

Haematuria initially

Proteinuria later

77

What renal manifestation is a bad prognostic sign in Alports disease?

Proteinuria

78

What are the extra-renal manifestations of Alports syndrome?

Sensorineural deafness

Ocular defects-anterior lenticonus

Leiomyomatosis of oesophagus/genitalia-rare 
 

79

What is the characteristic feature on biopsy of Alports syndrome?

Variable glomerular basement membrane thickness

80

What is Anderson-Fabrys disease?

An X linked disease lysosomal storage disease affecting kidneys, liver, lungs and erythrocytes