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IMED3002 > Urinary Tract Congenital Anomalies, Cystic Disease, Urolithiasis and Obstructive Diseases > Flashcards

Urinary Tract Congenital Anomalies, Cystic Disease, Urolithiasis and Obstructive Diseases Flashcards

1
Q

What percentage of renal failure in children is caused by congenital kidney malformations?

A

20%

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2
Q

What percentage of people are born with potentially significant malformation of the kidney/urinary tract?

A

10%

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3
Q

What percentage of chronic renal failure is due to ADPKD?

A

10%

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4
Q

What are the types of malformation of the kidneys?

A

Agenesis of the kidney

Hypoplasia

Ectopic kidneys Horseshoe kidneys

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5
Q

What is kidney hypoplasia?

A

Formed kidneys but very small

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6
Q

What is ectopic kidneys?

A

Kidneys that are misplaced

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7
Q

What is horseshoe kidney?

A

malformed kidneys that join together and never separate forming a horseshoe shape

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8
Q

What causes agenesis of the kidney?

A

Major disruption of metanephric development at an early stage

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9
Q

What is potter’s syndrome?

A

Bilateral agenesis of kidneys.

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10
Q

What happens to babies without kidneys?

A

They develop without much amniotic fluid around it. This condition is called oligohydramnios.

They also get hypoplastic lungs if there is not enough amniotic fluid to breath in for them to open

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11
Q

What does potter’s facies refer to?

A

A particular appearance associated with low exposure to amniotic fluid.

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12
Q

What does potter’s facies look like?

A

Large low set ears

Wide set eyes

Flattened nose

Receding chin

Prominent skin fold below the eyes

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13
Q

What does unilateral agenesis do to foetus?

A

Usually asymptomatic

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14
Q

What happens to the present kidney in unilateral agenesis?

A

It undergoes compensatory hypertrophy.

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15
Q

What happens to the ureter of the abscent kidney?

A

It disappears completely

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16
Q

What causes ectopic kidneys?

A

Kidneys usually ascend during development to their position and end up staying around the pelvis.

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17
Q

What are the cystic diseases of the kidney?

A

Cystic renal disease

Polycystic kidney disease (autosomal dominant PKD and autosomal recessive PKD)

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18
Q

What are simple renal cysts?

A

Very common in normal kidneys especially people older than 50 years old.

Usually they cause no symptoms or signs

Occasionally they can rupture, cause haematuria, pain, abdominal mass, infection, and hypertension.

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19
Q

How are cystic renal lesions diagnosed as tumours?

A

Multiple septa

Thickened cyst

Solid areas within or around the cyst

20
Q

What is cystic renal dysplasia?

A

Malformation of the kidney results inirregular cysts of varying sizes in the kidneys and is a common cause of an abdominal mass in infants

21
Q

What kind of cells can be found in cystic renal dysplasia?

A

Persistence of abnormal structures like cartilage and mesenchyme

22
Q

How do people get polycystic kidney disease?

A

It’s a congenital defect a dominant form (1 in 500 live births 10% of end stage renal failure have this disease) and recessive form.

23
Q

What happens to cysts over time in ADPCK?

A

They grow continuously

24
Q

At what age do patients present with ADPCK?

A

Patients start experiencing symptoms between 30 and 50 years old.

25
Q

What are the symptoms of ADPCK?

A

Flank pain due to abdominal mass or renal stones

Pain from haemorrhage into a cyst

Haematuria

Hypertension

26
Q

What are other associated congenital abnormalities associated with APCKD?

A

Cysts in liver, pancreas, spleen, and lungs

Intracranial berry aneurysms

Mitral valve prolapse

27
Q

How are cysts different in Autosomal recessive polycystic kidney disease?

A

Smooth kidneys that have smaller cysts.

They also get cysts on the liver causing fibrosis

28
Q

Autosomal recessive PKD:

A

rare and presents early in life

29
Q

What is obstructive uropathy?

A

Obstruction of urine to the urinary tract

30
Q

What are the modes of damage caused by obstructive uropathy?

A

Acute (stone) / chronic (prostate enlargement)

Partial / complete

Unilateral / bilateral

Any level from the urethra to the renal pelvis

Intrinsic / Extrinsic

31
Q

What is a common cause of extrinsic compression of the ureter?

A

Growth of lymph nodes caused by lymphoma

32
Q

What are some common causes of obstructive uropathy?

A
  • Congenital anomalies such as posterior urethral valves
  • Urinary calculi
  • Benign prostatic hypertrophy
  • Tumours of prostate bladder lymph nodes and inflammation
  • Sloughed renal papillae (renal papillae can just die and pop off and block shit) / blood clots
  • Normal pregnancy

Uterine prolapse and cystocoele

Functional causes such as defects in muscle wall

*: means common

33
Q

What happens to kidneys when obstruction takes place?

A

They kidneys get larger

Renal pelvis and calyces get larger

Ureters get big

Hydronephrosis

Bladder can get very thick

34
Q

What does hydronephrosis refers to?

A

Water inside kidney

Distension of the walls and in turn can lead to atrophy of the kidney by squishing the renal parenchyma

35
Q

What are the symptoms of obstructive uropathy?

A

Pain from dilation of the renal capsule/ureter/bladder

UTIs

Urinary calculi (lead to precipitation of stuff in urine)

Renal failure (can’t concnetrate urine because kidney is failing)

Partial bilateral obstruction causes an inability to concentrate urine

Complete bilateral obstruction can be fatal

36
Q

What age groups get kidney stones most commonly?

A

20 - 30

37
Q

Who gets urolithiasis most commonly?

A

Men in their 20s with a family history (ME YAY….)

38
Q

What are the types of kidney stones?

A

Calcium oxalate

Uric acid

Struvite (associated with infections)

Calcium phosphate

Others

39
Q

What causes people to develop kidney stones?

A

Stones are solutes that occur in amounts too high to stay dissolved in urine so solutes precipitate and aggregate to form concretions (stones)

40
Q

What are the risk factors for calcium oxalate stones?

A

Dehydration

Hypercalciuria (with or without hypercacaemia)

Hyperoxaluric (odd diet into spinach, rhubarb, oxalate foods in general i.e superfoods)

Hyperuricosuric

Low urine volume

41
Q

What causes uric acid stones?

A

Dehydration

Acidic urine

Hypericaemia

Chronic diarrhoea

Diabetes

Increased urinary excretion of uric acid (So anything that leads to rapid cell death and birth can cause it due to increased metabolism)

42
Q

What are struvite stones?

A

UTIs such as proteus and klebsiella have properties that can split urea in the urine creating ammonia which alters pH of urine which causes magnesium ammonium phosphate precipitation and causes formation of a cast of renal pelvis as well as caluses which come from tissue of renal pelvis.

These stones are often called staghorn calculi due to filling of calyceal space in the kidney.

43
Q

What are the complications of urolithiasis?

A

Silent often (they can sit there for a long time without symptoms)

If they pass into ureters they are very painful and cause bleeding

Ulceration and bleeding

Infection

44
Q

What is the pain associated with renal calculi known as?

A

Renal colic

45
Q

Where is pain associated with in renal colic?

A

Excruciating intermittent pain which radiates from the flank to the groin

46
Q

What other symptoms do people with renal colic get?

A

Urinary urgency

Restlessness

Haematuria

Sweating

Nausea

Vomiting

47
Q

Summary

A

Structural or functional hindrance of urine flow which can lead to renal dysfunction

Can occur at any point in the urinary tract or can affect one or both kidneys

Comon cause is stones

Common presentation of stones is renal colic

Complications of renal colic include infection and renal failure

IMED3002 (46 decks)

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