Nephro-urology Flashcards
(27 cards)
Which kidney is slightly lower down and why?
The liver pushes the right kidney more down compared to the left
Where does maximum reabsorption take place in the tubules?
Proximal tubule
What are the features of fanconi syndrome?
Growth faltering, polyuria, and rickets
What are some congenittal causes of fanconi syndrome?
Cystinosis, tyrosinaemia, galactossaemia
What are acquired causes of fanconi syndrome?
Aminoglycosides, sodium valproate, poisoning such as toluene or paraquat
What is the commonest cause of fanconi syndrome?
Nephropathic cystinosis which is an autosomal recessive condition where there is a disorder of lysosomal cystine transport resulting in excess accumulation of free cystine in many organs including kidneys, eyes and thryoid
How do you manage nephropathic cystinosis?
Mercaptamine which prevents the accumulation of lysosomal cystine
What are lysosomes
Found in all cells expcet RBCs and have digestive enzymes to break down cellular waste and debris
What are the channels implicated in Barterr and Gitelman syndrome?
Barterr- NKCC2, Gitelman - NCCT
Name one physiological difference between Barterr and Gitelman syndrome
Gitelman syndrome - will present with hypocalciuria and hypomagnesemia whereas in barterr there is no hypomagnessemia
What are symptoms of Barterr syndrome?
growth faltering, dehydration, hypotonia and lethargy, antenatal polydramnios
What are symptoms of Gitelamn syndrome?
weakness, cramps, short stature
How much of filtered bicarbonate is reabsorbed in the proximal tubule?
90%
Where is acid secretion mainly done?
Distal convuluted tubule
What are buffers that bind to hydrogen ions in the tubular lumen?
Ammonia and phosphate
What is the most common form of renal tubular acidosis?
Primary distal RTA
Why is the urinary PH different in proximal vs distal renal tubular acidosis?
Distal- hydrogen ions are not secreted into the tubule so the urine remains alkaline >5.5
Proxima- initially because bicarbonate is not being reabsorbed the urine will be >5.5 alkaline but soon the body conserves bicarb so urine will become acidosis <5.5
What is considered a significant anomaly and dilatation of renal tract?
> /=7mm of anterior-posterior diameter
What is the volume of the fetal bladder by 40 weeks?
35-50ml by 40 weeks and empties every 30 minutes by 20 weeks gestation. Fetus at term produces around 50ml per urine per hour
What is the commonest anomaly of the upper urinary tract?
Hydronephrosis secondary to pelvi-ureteric junction obstruction
Why are newborns suscpetible to dehydration?
Because their urine concentrating ability is quite poor and only reached adult capacity at 1-2 years
Why is a morning urine protein sample preferred in children vs during the day?
Due to orthostatic (standing up) proteinuria
Leucocytes vs nitrites for dipstick
Leucocytes- suggestive of UTI but not diagnostic because can also be secondary to fever
Nitrites - pathogenic bacteria produce nitrites. Nitrites may also be negative in infants and young children due to increased urinary frequency which does not give nitrites enough time to form
What is the most common pathogen for UTI?
E.coli
