Renal Therapeutics V: Important Renal Diseases Flashcards Preview

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Flashcards in Renal Therapeutics V: Important Renal Diseases Deck (43):
1

Label the renal and urinary system

Aorta - delivers blood to the kidneys
Vena cava - takes blood away from the kidneys
Renal artery - connects aorta to the kidney
Renal vein - connects the kidneys to the vena cava
Ureter - connects kidneys to bladder
Bladder - collects urine from the kidneys
Urethra - exit route of urine from the body

2

What is Obstructive Uropathy?

A structural or functional hindrance of the kidney
Urine cannot drain through a ureter
Can happen to 1 or both kidneys

3

How can urinary tract obstruction (UTO) be divided?

1. Upper UTO e.g. uteric stones
2. Lower UTO e.g. prostatic hypertrophy

4

What happens when an acute upper tract obstruction occurs?

Obstruction in ureter or above e.g. stone
= Fluid accumulation in the renal pelvis (hydronephrosis)
= Raise in hydrostatic pressure
= Reduced GFR, but continuous filtration
= Increased intra-renal pressure
= Dilation and stasis

Can lead to infection and stone formation

5

How is a UTO diagnosed?

Intravenous urogram (IVU)
CT scan

6

Why is quick relief of a UTO important?

To protect the nephrons
May be followed by massive diuresis

7

List 4 things can cause a chronic partial obstruction?

1.Incompetence of valve between bladder and ureter = chronic renal inflammation, infection
2. Lower UTO caused by e.g. bladder cancer, bladder neck obstruction
3. Benign or malignant prostatic hypertrophy
4. Reflux nephropathy = back flow of urine into kidney

8

What are the 3 most common causes of UTOs

1. Gynaecological problems
2. Prostate hypertrophy
2. Stones

9

List a symptom of upper UTOs

Renal colic, often associated with ureteric obstruction

10

List 3 symptoms of lower UTOs

Hesitancy
Frequency
Nocturia

11

What can cause polyuria?

Tubular damage

12

What are the possible consequences of chronic reflux nephropathy?

Hypertension
Renal infection

13

How are UTOs managed?

Surgery is common
Conservative treatment = non-invasive e.g ESWL, laser shattering of stones
Follow-up to ensure patient doesn't develop reflux nephropathy

14

What are renal calculi?

Kidney stones
Solid material formed in kidney from the minerals in urine

15

Define: Nephrolithiasis

Renal stone disease
When a patient has kidney stones

16

List 3 factors which enhance the risk of renal stone formation

Low intake of fluid
High intake of animal proteins
High intake of refined sugar, salt

17

What is the most common type of kidney stone made up of?

Calcium oxalate

18

How are calcium oxalate kidney stones formed?

Hypercalciuria (high levels of calcium)
OR
Excessive gastro-intestinal absorption of oxalate and alkaline urine

19

Name the 3 materials that can accumulate to cause kidney stones

Uric acid = hyperuricaemia (excessive uric acid) with acidic urine
Cystine = metabolic disorder with reduced tubular reabsorption of cystine
Infection stones = calcium oxalate or calcium phosphate stones

20

What factors can cause kidney stones to form?

Relative insolubility to urine e.g. calcium oxalate
Urinary pH dependent
Low urine volume = uric acid stones
Infection

21

List 3 symptoms of kidney stones

Sudden or gradual renal colic
Inability to lie down
Accompanied by nausea and vomiting

22

List 3 investigations which can be carried out to diagnose kidney stones

Urinanalysis = presence of blood
Imaging = kidney-ureter-bladder X-ray
Intravenous urogram (IVU), IV contrast medium

23

List the non-surgical methods used to treat kidney stones

NSAIDs (diclofenac) = pain - however risk of worsening any pre-existing renal impairment
Small stones = increase fluid intake to flush out
Penicillamine = dissolve cystine stones
Ultrasonic disruption of bigger stones
Oxalate stone = dietary calcium restricted, thiazides to increase urine flow

24

How can kidney stones be surgically treated?

Depends on the location of the stone in the ureter and its size
Distal uretic and mid-uretic stones = pass spontaneously, use calcium channel blocker and alpha receptor blocker to relax smooth muscle of distal ureter
Proximal uretic stones = flexible ureterirenoscopy

25

What is an infection of the bladder called?

Cystitis

26

What is an infection of the urethra called?

Urethritis

27

List 2 symptoms of UTIs

1. Dysuria (painful urination)
2. Frequency

28

Define: Cystitis

Bacterial infection of the bladder

29

What is the method used to diagnose UTIs

Microbiological

30

What causes UTIs?

Bacteria enter mostly via urethra = ascending infection, uncomplicated
Can enter via bloodstream
Mostly organism from bowel flora involved

31

What may be the cause of recurring UTIs?

Genetic factors

32

What may cause acute urethritis?

Sexual transmission

33

List 3 symptoms of prostatitis

Fever
Malaise
Dysuria

34

How should UTIs be managed in general?

Increased fluid intake
Oral treatment to alkalinise urine
Cranberry juice - vitamin C

35

How should acute cystitis be treated?

3-day regimens of antibiotics
e.g. trimethoprim, oral cephalosporin

36

How should prostatitis be treated?

Lipid-soluble antibiotics
e.g. trimethoprim, doxycycline, quinolones
Courses of 2-4 weeks

37

What is acute pyelonephritis?

Sudden and severe kidney infection
Causes inflammation of the kidney tissue

38

How can pyelonephritis be treated?

Oral antimicrobial therapy

39

What is chronic pyelonephritis?

Recurrent infections
Repeated acute pyelonephritis

40

Where does glomerular disease affect?

Both kidneys

41

What is polycystic disease?

Genetic disorder
Abnormal cysts develop and grown in kidneys - crush adjacent renal structures
Most caused by mutations in PKD1 gene

42

What are the consequences of polycystic disease?

ESRF developed in 10-20 years
Hypertension very common

43

How is polycystic disease diagnosed?

Ultrasound