Nephrology/GU Flashcards
(56 cards)
Define Nephrotic Syndrome
A glomerular disorder when the basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine.
Nephrotic syndrome Epidemiology in the UK
- 2 per 100,000 children per year
- 6-8 times higher in UK Asian populations
- twice as common in boys
- affecting children 2 – 5 years
Ohh
Nephrotic Syndrome classic Triad
- oedema
- Proteinuria > 3.5 grams/24 hours OR ACR 2.5g/mmol
- Serum albumin < 30 grams/litre
Peripheral oedema
Nephrotic Syndrome Aetiology
- Minimal Change Disease (90% of the cases)
Secondary to: intrinsic kidney disease - Focal segmental glomerulosclerosis
- Membranoproliferative glomerulonephritis
Secondary to: systemic illness - Henoch schonlein purpura (HSP)
- Diabetes
- Infection, such as HIV, hepatitis and malaria
3 Highs
Nephrotic Syndrome uncommon Triad
- High Lipid profile (chol, TGL, LDL)
- HTN
- Hyper-coagulability
Nephrotic Syndrome complications
- Hypovolaemia
- Thrombosis
- Infection
- Acute or chronic renal failure
- Relapse
How do Nephrotic Syndrome lead to hypovolaemia
occurs as fluid leaks from the intravascular space into the interstitial space causing oedema and low BP
How do Nephrotic Syndrome lead to Thrombosis
can occur because proteins that normally prevent blood clotting are lost in the kidneys, and because the liver responds to the low albumin by producing pro-thrombotic proteins.
immunosuppressant
How do Nephrotic Syndrome lead to infections
occurs as the kidneys leak immunoglobulins, weakening the capacity of the immune system to respond. This is exacerbated by treatment with medications that suppress the immune system, such as steroids.
Nephrotic Syndrome Mx
- High dose steroids (i.e. prednisolone)
- Low salt diet
- Diuretics may be used to treat oedema
- Albumin infusions may be required in severe hypoalbuminaemia
- Antibiotic prophylaxis may be given in severe cases
SEs: steroids on growth
Define Cryptorchidism
undescended testes
a congenital absence of one or both testes in the scrotum due to a failure of the testes to descend during development
Cryptorchidism Risk Factors
- FMHxof undescended testes
- Low birth weight
- Small for gestational age
- Prematurity
- Maternal smoking during pregnancy
ETA
Types of Cryptorchidism
- Ectopic testis: where the testis is found away from the normal path of decent
- True undescended testis: where testis is absent from the scrotum but lies along the line of testicular descent
- Ascending testis: where a testis previously identified in the scrotum undergoes a secondary ascent out of the scrotum
Cryptorchidism Pathophysiology
Normally, the testis descends from the abdomen to the scrotum, pulled by the gubernaculum, within the processes vaginalis
- True undescended testis: This process is incomplete
- Ectopic testis: Tracks to an abnormal position
- Bilateral cryptorchidism:, hormonal causes such as androgen insensitivity syndrome or disorder of sex development must also be excluded
True undescended testis locations
- Abdo
- Inguinal
- Suprascrotal
Ectopic undescended testis locations
- Prepenile
- Femoral
Cryptorchidism complications
- Impaired fertility – as testis are 2-3⁰ C warmer if intra-abdominal, this can effect spermatogenesis. Although fertility in unilateral undescended testis is around 90%, this has been reported to drop to around 53% if bilateral. Risk of infertility increases with delayed correction.
-
Testicular cancer – 2-3 times more common with a history of undescended testis (2-3%), and this risk double if correction is undertaken after puberty. In addition to the managing the risk of testicular cancer, orchidopexy also allows for self-examination for testicular abnormalities by the patient when they are older.
Torsion – undescended testis are at higher risk of torsion
Cryptorchidism Mx
- Watch & wait until infant is 6 months old
- By 6 months: refer to paeds
- Surgically: Orchidopexy between 6 and 12 months of age
- bilateral undescended testes - immediate paeds referral
Define Hydrocele
a collection of fluid that builds up within the tunica vaginalis that surrounds the testes
Two types of hydrocele
- Simple Hydrocele
- Communicating Hydrocele
Define Simple Hydrocele
Simple hydroceles are common in newborn males. They occurs where fluid is trapped in the tunica vaginalis. Usually this fluid gets reabsorbed over time and the hydrocele disappears.
Define Communicating hydroceles
Communicating hydroceles occur where the tunica vaginalis around the testicle is connected with the peritoneal cavity via a pathway called the processus vaginalis. This allows fluid to travel from the peritoneal cavity into the hydrocele, allowing the hydrocele to fluctuate in size.
Hydroceles clinical findings
- soft, smooth, non-tender swelling around one of the testes
- The swelling will be in front of and below the testicle
- Transilluminate with light: pen torch flat against the skin and watch as the whole thing lights up like a bulb
Hydrocele Ix
Testicular USS
