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Flashcards in Pathology 1 Deck (40):
1

Is glomerulonepritis or pyelonephritis infective?

Pyelonephritis - bacterial infection

2

What is glomerulonephritis?

Group of renal conditions that are usually characterised by inflammation either of the glomeruli or small blood vessels in the kidneys

3

What is pyelonephritis?

Bacterial infection of the renal eliv, calyces. tubules and interstitium
Acute or chronic (more common)

4

What is the most common infecting organism of pyelonephritis?

E. coli

5

What other organisms can cause pyelonephritis?

Pseudomonas
Strep. Faecalis

6

Give the risk factors for pyelonephritis?

Female
Pregancy - ureteric dilation
Imstrumentation or surgery
urinary tract obstruction
Vesico-ureteric reflux (VUR)
Diabetes

7

What can cause urinary tract obstruction?

Calculus
Stricture
Neoplasm
Congenital anomaly - duplex systems, posterior urethral valves
Prostatic disease (BPH)
Uretheral pathology

8

What is Vesico-ureteric reflux (VUR)?

Incompetence of uretero-vsical valves - ureter enters bladder more perpendicularly
congenital or acquired

9

What can conribute to chronic pyelonephritis?

Hypertensio
Uraemia

10

Do patients with chronic pyelonephritis produce large volumes of urine?

Yes - can't concentrate urine as nephrons don't work

11

What is the spread of TB to cause tuberculus pyelonephritis?

Haematogenous spread usually from the lung

12

What oraganisms can cause cystitis?

E. coli
Klebseilla
Proteus
Pseudomonas

13

What is cystitis?

Lower urinary tract infection
acute inflammation but can become necrotizing if associated with outlet obtruction (prostatic disease in males)

14

What organism causes Schistosomiasis?

S. Haematobium

15

What does chronic Schistosomiasis predispose a pateint to?

Urothelial maligancy - esp. squamous carcinoma

16

What is hydronephrosis?

Water inside the kidney
urine back pressure into the calyces compresses the nephrons within the medullary pyramids leading to renal failure

17

What are the main causes of hydronephrosis?

Urinary tract obstruction and reflux

18

Which muscle is associated with bladder hypertrophy?

detrusor muscle

19

What is the Nephrotic syndrome?

Proteinuria >3g per day
Hypoalbuminaemia
Oedema

20

What is the Nephritic sydrome?

Acute Kidney injury
Oliguria
Oedema/ fluid retention
Hypertension
Active urinary sediment

21

What is Stage 1 CKD?

GFR >90ml/min with evidence of kidney damage

22

What is Stage 2 CKD?

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

23

Stage 3 CKD.

GFR 30-60ml/min

24

How is stage 3 CKD broken down?

3A - 45-60ml/min
3B - 30-44ml/min

25

Stage 4 CKD

GFR 15-30ml/min

26

Stage 5 CKD

GFR <15ml/min

27

What can cause CKD?

DM
Vascular disease
HTN
Rflux nephropathy
Chronic GN
PKD
Unknown cause

28

Paients with CKD often present late. What symptoms do they tend to present with?

Tiredness
Poor appetite
Itch
Sleep disturbance
If nocturia pt may resent earlier

29

What 2 drug classes are used to control BP and proteinuria in CKD?

ACEinhibitor
ARB

30

If using ACEi for CKD what should be noted and what should be monitored?

Initial fall in GFR
Hyperkalaemia - monitor

31

Apart from managing BP and proteinuria, what other management options are available for CKD?

Good glycaemic control
Stop smoking
reduce CV risk
Identify and treat complications of CKD

32

What are the complications of CKD?

Anaemia
Renal bone disease
Hyperparathyroidism

33

What else could be anaemia in CKD apart from reduced EPO production?

Iron deficiency

34

What other deficiences should be checked for in a CKD patient with the complication of anaemia?

Vit B12
Folate

35

Waht is the target haemoglobin for a patient with CKD and anaemia?

10.5-12.5g/dl

36

What mechanism leads to rena bone disease in CKD?

Reduced Vit D hydroxylation in the kidney whihc leads ot reduced calcium absorption which causes secondary hyperparathyroidism

37

In advanced CKD, what other mechanism leads to secondary hyperparathyroidism?

Serum phosphate rises which increases PTH secretion (2y hyperparathyroidism)

38

What are the treatment options for renal bone disease?

Alfaccalcidol - hydroxylated Vit D
Phosphate intake - dietary advice
Phosphate binders - taken with meals to decrease gut absorption

39

At what stage is dialysis considered in CKD?

GFR ~20ml/min (deffos when <15ml/min)
Earlier if disease is progressing fast

40

What are the indications for dialysis?

A - Acidosis - acute setting
E - Electrolyte abnormalities (hyperkalaemia, hyponatraemia, hyperalcaemia)
I - Intoxicants (methanol, lithium, salicism)
O - Overload
U - Uraemia