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NME > Post-Renal Disease > Flashcards

Post-Renal Disease Flashcards

1
Q

Post-Renal Disease:

A
  • disease distal to the nephron
    • intrarenal collecting system
    • ureter
    • bladder
    • prostate
    • urethra
  • includes infection but for the
    purposes of this lecture main cause
    is obstruction
  • obstruction causes
    hydronephrosis/hydroureter
    (dilatation of collecting system or
    ureter)
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2
Q

Pathophysiology of Acute Ureteric Obstruction: Overall:

A
  • 3 phases
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3
Q

Pathophysiology of Acute Ureteric Obstruction: Phase 1:

A

insert
upto 90mins of obstruction

bowmans capsule pressure increases counteracting glomerular hydrostatic pressure reducing GFR

GFR increases due to counteraction

prostaglandins cause dilatation of the afferent arteriole

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4
Q

Pathophysiology of Acute Ureteric Obstruction: Phase 2:

A

insert
90mins-4hrs after obstruction
GFR decreased***
no further dilatation of the afferent arteriole

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5
Q

Pathophysiology of Acute Ureteric Obstruction: Phase 3:

A

insert
4hrs-18hrs after obstruction
GFR decreased
Glomeruli shut down

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6
Q

Pathophysiology of Chronic Obstruction: Effect:

A

after acute
- distal tubular function shuts down:
- reduced excretion of H+
(accumulation in circulation leading
to acidosis)
- reduced excretion of K+ leading to
hyperkalaemia
- difficulty concentrating urine

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7
Q

Pathophysiology of Chronic Ureteric Obstruction: events:

A
  • dilatation of tubules results in
  • interstitial fibrosis
  • glomeruli relatively preserved
  • damage to collecting ducts and
    DCTs in medulla
  • obstructive atrophy
  • nephron loss after 4-7 days
  • little recoverable renal function after
    1 month
  • urinary tract obstruction is an
    emergency
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8
Q

Urinary Tract Obstruction Symptoms:

A
  • colic, loin to groin
  • flank pain
  • UTI
  • pain after drinking
  • storage: frequency, urgency, noturia
  • ***voiding: hesitancy, poor flow,
    dribbling
  • visible haematuria: exclude cancer
  • exercise induced haematuria
  • chance finding
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9
Q

Post-Renal Disease: Investigations:

A
  • FBC: anaemia
  • renal function tests: U&E, creatinine,
    generally normal because one
    kidney will compensate
  • PSA
  • urinalysis: blood, protein (more
    renal), nitrites (infection)(empiric
    antibiotics), glucose (diabetes)
  • urine culture
  • ABG: acidosis, lactate
  • USS, CT (KUB)
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10
Q

Contrast CT disadvantage

A

stones can be missed

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11
Q

Dynamic Renography:

A
  • radioactive tag of MAG3***
  • filtered and partly secreted
  • area under curve calculated divided
    by function
  • rate of washout identifies
    obstruction
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12
Q

Emergency treatment of post renal acute obstruction

A

insert

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13
Q

Classification of post renal disease: obstruction:

A

insert

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14
Q

Urinary Tract Stones:

A

insert slide

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15
Q

Ureter Colic Pain/symptoms:

A
  • severe pain
  • intermittent colicky waves
  • loin to groin
  • blood in urine
  • frequency
  • nausea and vomiting
  • restless
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16
Q

Urinary Tract Stone Treatment:

A
  • extracorporla shockwave lithotripsy
    (ESLW)
  • Staghorn Calculus: triple phosphate
  • cystolithopalxy
  • holmium laser stone fragmentation
17
Q

Pelviureteric Junction Obstruction: Pathology:

A
  • failure of peristalsis through PUJ
  • chronic obstruction
  • congenital vs acquired
18
Q

Pelviureteric Junction Obstruction: Diagnosis:

A
  • pain with high fluid intake or alcohol
  • USS
  • CT urogram
  • MAG3 renogram
19
Q

Pelviureteric Junction Obstruction: Treatment:

A

laparoscopic or robotic pyeloplasty

20
Q

Transitional Cell Carcinoma of the Bladder

A
  • obstructive or non-obstructive
  • upper tract tumour
  • tumour at the ureteric orifice in
    bladder can cause obstruction

treatment: cystocopy and transurethral resection

21
Q

Urinary Retention:

A
  • BPH
    -complications of bladder outflow
    obstruction
22
Q

Urinary Retention: Treatment:

A
  • alpha blockers
  • 5 Alpha Reductase Inhibitor
23
Q

Prostate Carcinoma

A
  • peripheral zone of prostate gland
  • haematuria, LUTS, bone pain
24
Q

Prostate Carcinoma Diagnosis:

A
  • elevated serum prostate specific
    antigen
  • DRE: asymmetry, nodule
  • biopsy
25
Q

Uretheral Strictures:

A
  • scarring within the urethra
  • rarely causes obstructive
    nephropathy
  • Causes: congenital, post infection

Treatment: urethral dilatation, optical
urethrotomy, urethroplast

NME (52 decks)

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