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BRS1 - Valentine > Urological disorders > Flashcards

Urological disorders Flashcards

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1
Q

What are the consequences of kidney dysfunction?

A

Anaemia - No erythropoietin

Metabolic acidosis

Vit D deficiency and secondary hyperparathyroidism

Hypertension- too much salt remain in body hence water retention

sometimes there’s dehydration

Flitration failure

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2
Q

Describe what happens in filtration failure

A

You’re unwell due to accumulation of waste substance

theres:

  • Hameaturia
  • Proteinuria
  • low serum protein
  • low serum albumin
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3
Q

What are the different pathology and pathophysiology of urinary disorders

A

Inflammatory

Obstructive

Neoplastic- cancer of kidney, bladder, prostate and testes

Developmental/Genetic

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4
Q

Give examples of obstructive and developmental/genetic urinary disorders

A

Obstrucitve:

  • Stones
  • Benign prostatic hypertrophy

Developmental/Genetic

  • Polycystic kidneys
  • horseshoe kidney
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5
Q

Describe are the causes of inflammatory urinary disorders

A

Infection including cystitis

Non infective causes like

1) Metabolic - including diabetic nephropathy
2) immunological like:

  • Nephritic syndrome
  • Nephrotic syndrome
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6
Q

What are the possible locations for infection in urinary disorder: common sense

A

Bladder- cystitis

Kidney- pyelonephritis

etc

all these could contribute to obstructive disorders like stones etc

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7
Q

What are the potential pathogens and give significance to urinary disorders

A

Bacteria - most common

Virus and fungi- occurs in immunocompromised patients

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8
Q

For urinary tract infection, what are the results of the physical examination will you expect?

A

NORMAL temperature , BP and pulse

however abdomen could be soft, slightly tender over suprapubic area and left loin- due to pain

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9
Q

What investigations do you need to do and what results will you find if there’s UTI

A

Urine dipstick: 2+ leukocytes, +nitrite, trace of blood

Urine microscopy, culture and sensitivity- to look for AB resistance

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10
Q

What is the treatment and overall clinical management for UTIs

A

Antibiotic depending on:

  • severity of illness
  • the most common bacteria in local area
  • sensntivity in urine culture

pain control

supportive treatment like hydration

some patient might be very ill and may need to be treated as inpatient

consider imaging if there are any other significant differential diagnosis

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11
Q

How can the immune system damage the kidney

A

Antibody mediated

inflammatory cells like neutrophils or macrophages

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12
Q

What are the clinical presentation of immunological causes of urinary disorders. Is uncovering the syndrome alone good enough for diagnosis

A

Nephritic syndrome

Nephrotic syndrome

Proteinuria

N.B founding this out is the FIRST step in investigations; you need to find out exactly whats causing these clinical presentations

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13
Q

How can inflammation be spotted on kidney biopsy

A

Brown staining is postive if theres macrophages (in kidney biopsy)

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14
Q

Define glomerulonephritis

A

Inflammation of microscopic filtering units of the kidneys

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15
Q

What are the patterns of organ involvement for immunological causes of urinary disorders

A

Kidney only

kidney and lung

multiple organs/tissues involved

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16
Q

What is the diagnostic approach for diagnosing urinary disorders

A

Look at diagram

imaging- to check kidney condition

biopsy- not for every patient; only those who need it, ie. it will change management due to results

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17
Q

Describe what occurs in NEPHRITIC syndrome

A

Hameaturia

Variable amount of proteinuria

May have hypertension

there’s reduced urine output

increased serum urea and creaitnine

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18
Q

What are the physical examinations and results for it that confirms Nephritic syndrome

A

Normal temperature

inflamed tonsil- maybe

BP- 140/100 - high

Sore throat

normal HR

chest and abdomen normal.

NO peripheral oedema

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19
Q

What investigations do you need to do to confirm Nephritic syndrome- what results confirms this

A

Urine Dipstick: 3+ blood, 2+ protein

Blood tests: reduced eGFR, raised serum urea and creatinine concentration. Autoantibodies not detected

Urine: raised urine protein: creaitnine ratio

Kidney biopsy: IgA nephropathy

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20
Q

Describe the epidemiology and component of IgA nephropathy

A
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21
Q

What are the treatment principles and options for a patient with IgA nephropathy- nephritis

A

Supportive

  • treat hypertension and reduce proteinuria - using ARB or ACEI
  • Reduce sodium intake

immunotherapy- different pharmacological options

Renal replacement therapy- when reaching late stage kidney disease.

  • Dialysis
  • kidney transplantation
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22
Q

Give an example of a immunological cause of urnary disorder that affects BOTH kidneys and lungs. What mediates this?

A

Goodpasture disease- mediated by GBM (Anti-glomerular basement membrane) antibody

the kidney and lungs share the same common antigen: a3 chain of type IV collagen

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23
Q

Give examples of systemic manifestions of immunological cause of urinary disorders and what mediates it.

Study These Flashcards
A

SLE- caused by antinuclear factor or anti-dsDNA- AUTOANTIBODIES

Vasculitis- caused by antineutrophil cytoplasm antibody (ANCA)

24
Q

What are the characteristics of Nephrotic syndrome

25
What are the results of the physical examination you will see in a patient with only nephrotic syndrome
**Periorbital oedema** **Ankle: pitting oedema** **Frothy urine- too much albumin** Normal temperature and BP
26
What investigations would you perform on a patient with suspected Nephrotic syndrome? What results would you expect to see in a patient with nephrotic syndrome
Urine dipstick: **NO BLOOD and 4+ protein** Blood tests: **very low serum albumin concentration.** Normal eGFR. Normal serum Urea and creatinine concentration. VERY HIGH URINE protein : creaitnine ration (1000mg/mmol) kidney biopsy: **minimal change glomerulopathy**
27
What are the causes of Nephrotic syndrome
28
What are the key features of minimal change glomerulopathy
NOTE: podocyte foot process **becomes flattened** when seen under electron microscope High risk of thrombosis as kidney losses a lot of antithrombin proteins
29
What are the treatment options for nephrotic syndrome
Diuretics- reduce peripheral oedema Prevention of complication of thrombosis- anticoagulation Immunotherapy - traditionally corticosteroid but now it's **tacrolimus** - an antibody therapy targeting B cell pathway
30
What are the possible locations of stones
Kidney ureter bladder
31
What are the clinical presentations of stones
Blood in urine- not normal but not unheard of **Pain** in abdomen and back- hence it's tender. Start in back and radiate to abdomen Associated with **urine infection** About 90% of kidney stones are **radio opaque** - hence can use X-ray or CT **kidney functions** (from blood test) **reduced** only in some patients
32
What are the supportive treatment of stones
Pain control and hydration
33
What are the specific treatment of stones ? what does specific treatment depend on?
Shockwave lithotripsy - high energy sound waves to break down large kidney stones into smaller ones Ureteroscopy percutaneus nephrolithotomy: small incision, insert nephroscope and remove stone. Stones may need to be broken down
34
Give examples of benign and malignant tumours that leads to urinary disorders
35
What are the clinical presentations of tumour that cause urinary disorders
36
What are the investigations needed to be performed (and results ) for suspected tumour leading to urinary disorder
**Prostratic specific antigen**
37
What are the treatment options / procedures for someone with tumour that causes urinary disorder
38
What are the different types of polycystic kidney disease- genetic
* Neonatal- autosomal recessive * Adult onset- autosomal dominant * some patients dont have family history
39
What are the potential consequences for polyscystic kidney disease
* Loss of kidney function * Pain * Bleeding into renal cysts * infection into renal cyst * asympotmatic in some patients
40
What are the treatment procedure for polycystic kidney disease
41
What is horse shoe kidney and how can you tell whether a patient has it
Kidney didnt separate in embryological development hence can only tell by imaging The horseshoe **kidney isthmus (connective tissue or parenchymal)** is below the ***inferior*** mesenteric artery. Hence kidney is lower than normal
42
What are the consequences of horse shoe kidney
Infection stones obstruction
43
What are the treatment and clinical management for diabetic nephropathy
44
What are the risk factors for diabetic nephropathy
Hypertension poor diabetic control smoking Age
45
What are the clinical features of diabetic nephropathy
Microalbuminuria Proteinuria Glycosuria ketonuria- prob type 1 or latent autoimmune diabetes pitting oedema could be associated with: Diabetic neuropathy and retinopathy
46
What are the different causes of stones (urinary disorder)
Obesity Cystinuria Factors that make urine more acidic: * protein in diet - leads to more acidic urine as pH of tubular fluid goes down and can form stones * Dehydration can decrease urinary pH
47
Explain how pitting oedema can form from urinary disorder - diabetic nephropathy
Losing protein to gloemrulus less protein in blood and hence less Oncotic pressure in blood more fluid stays in tissues and accumulate to feet due to gravity
48
How can chronic tiredness occurs in diabetic nephropathy
1) anaemia (as patient is pale) due to lack of kidney making erythropoietin 2) kidney not clearing toxins - this can go to blood and cause encephalopathy
49
How can exercise mitigate diabetic nephropathy
More blood flow through skeletal muscle and bone less vascular resistance in kidneys, lowers BP
50
Explain the effect of glycosylated Hb on BP
Glycosylated Hb inhibit Nitric oxide synthase less NO made, less vasodilation and more vasoconstriction Increase in BP
51
What are the other effects of NO in the body except vasodilation
Help to fight infection keep health of endothelial lining
52
How can proteinuria lead to hyperlipidaemia
Body tries to make more proteins hence more lipoprotiens made Also albumin binds to lipids so if there's less albumin hence more lipid in blood
53
For someone with diabetic nephropathy, how can you determine whether you need a renal biopsy
Check CRP levels - if high enough to have renal biopsy if there's more damage and inflammation it can lead to liver failure inflammation leads to fibrosis and deposition of ECM; levels of inflammation is critical to know whether nephropathy can progress to a more serious disease like kidney failure
54
Draw flowchart for management of patient in tutorial
55
What can cause stones

BRS1 - Valentine (54 decks)

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