Urological disorders (46)

Question 1

What are the normal functions of the kidney and what happens in kidney dysfunction?

Answer 1

1. filtration–> failure leads to accumulation of waste substance, haematuria and proteinuria, low serum protein e.g. albumin
2. control of salt and water balance–> hypertension, water retention (sometimes dehydration)
3. control of acid/base balance–> metabolic acidosis
4. hormones (erythropoietin production)–> anaemia bc dec. Hb production
5. vitamin D (1-alpha hydroxylation of vit D)–> vit D deficiency and secondary hyperparathyroidism

Question 2

What are possible locations and pathogens for infections in the urinary tract?

Answer 2

• bladder= cystitis
• kidney= pyelonephritis
• bacteria most common
• virus and fungus in immunocompromised patients
• pathogen enters causing inflammation

Question 3

How do we diagnose a urinary tract infection?

Answer 3

• history
• physical examination
• urine dipstick
• urine microscopy, culture and sensitivity

Question 4

How do we treat a urinary tract infection?

Answer 4

• antibiotics: depending on severity of illness, most common bacteria in local area, modified when sensitivity from urine culture is available
• pain control
• supportive care e.g. rehydration
• consider imaging if other factors or differential diagnosis

Question 5

How can the immune system damage the kidney?

Answer 5

via antibodies or inflammatory cells (neutrophils, monocytes/macrophages, T cells)

Question 6

How will an inflammatory condition with an immunological cause present clinically?

Answer 6

• nephritic syndrome
• proteinuria
• nephrotic syndrome

Question 7

What is glomerulonephritis?

Answer 7

inflammation of the microscopic filtering units of the kidney (glomeruli)

Question 8

How do we diagnose an inflammatory condition with an immunological cause?

Answer 8

• history and physical examination
• urine test
• blood test incl. immunology tests
• imaging: start w/ ultrasound
• kidney biopsy

Question 9

What are the signs of nephritic syndrome?

Answer 9

• haematuria (blood in urine)
• variable amount of proteinuria
• may have hypertension, reduced urine output, inc. urea and creatinine

Question 10

How do we diagnose nephritic syndrome?

Answer 10

• history physical examination
• urine dipstick
• urine microscopu
• urine protein:creatinine ratio
• blood tests: kidney function and immunology test
• kidney biopsy

Question 11

What is IgA nephropathy?

Answer 11

• most common primary glomerulonephritis
• v high prevalence in far east
• deposition of IgA antibody in kidney , only detected by biopsy
• inflammation and scarring
• about 30% progress to kidney failure

Question 12

How do we treat IgA nephropathy?

Answer 12

supportive:

• treat hypertension and reduce proteinuria using ARB or ACEI
• reduce sodium intake
  immunotherapy: many different choices, ongoing clinical trials
• renal replacement therapy–> at late stage : kidney transplantation or dialysis

Question 13

What is an example of a disease that affects the kidney and lung specifically?

Answer 13

• Goodpasture’s disease
• antibody mediated anti-glomerular basement membrane (autoantibody)
• bc shared common antigen between lung and kidney

Question 14

What are examples of diseases that affect multiple organs/tissues?

Answer 14

• systemic lupus erythematosus (SLE) caused by autoantibodies e.g. antinuclear factor, anti-dsDNA
• vasculitis caused by autoantibodies called ANCAs

Question 15

What is diabetic nephropathy?

Answer 15

most common cause of chronic kidney disease and kidney failure in west
- pathogenesis: inflammation and fibrosis (deposition of extracellular matrix in glomerulus)

Question 16

What are the clinical features of diabetic nephropathy?

Answer 16

• microalbuminuria
• proteinuria
• association w/other diabetic complications e.g. diabetic retinopathy

Question 17

How is diabetic nephropathy treated?

Answer 17

• optimised diabetic control
• optimised treatment of hypertension
• stop smoking
• reduce proteinuria using ARB or ACEI
• new clinical trials: SGLT2 inhibitor
• transplantation
• dialysis

Question 18

What are risk factors for diabetic nephropathy?

Answer 18

• hypertension
• poor diabetic control
• smoking

Question 19

What are the clinical signs of a nephrotic syndrome?

Answer 19

• peripheral oedema
• severe proteinuria
• low serum albumin
• variable amount of microscopic haematuria
• associated w/ hyperlipiaemia

Question 20

How do we diagnose nephrotic syndrome?

Answer 20

• history
• physical examination
• urine dipstick
• urine microscopy
• urien protein:creatinine ratio
• blood tests: kidney function and immunology test
• kidney biopsy

Question 21

What are causes of nephrotic syndrome?

Answer 21

• minimal change glomerulopahty
• membranous nephropathy
• focal segmental glomerulosclerosis
• lupus nephritis
• otherssss
  leaking of protein…

Question 22

How do we treat nephrotic syndrome?

Answer 22

• immunotherapy
• diuretics to reduce peripheral oedema
• prevent thrombosis w/ anticoagulation

Question 23

What are the possible locations of obstructive stones?

Answer 23

• kidney
• ureter
• bladder

Question 24

How do stones present?

Answer 24

• pain in abdomen, back loin
• blood in urine
• associated w/ urine infection
• about 90% of kidney stones are radio-opaque

Question 25

How do we treat stones?

Answer 25

supportive: - pain control - hydration specific treatment: - shockwave lithotripsy--> high energy sound waves to break up large kidney stones - utereoscopy through urethra, bladder and ureter - percutaneous nephrolithotomy--> small percutaneous incision, insertion of nephroscope, stone is removed

Question 26

What benign condition can be seen in the urinary tract?

Answer 26

benign prostatic hypertrophy

Question 27

What malignant conditions can be seen in the urinary tract?

Answer 27

- kidney: renal cell carcinoma - ureter and bladder: transitional cell carcinoma - prostatic cancer - testicular cancer

Question 28

How do neoplastic conditions present clinically?

Answer 28

- asymptomatic (incidental finding during other investigation) - haematuria - pain

Question 29

What investigations are used to detect neoplastic conditions?

Answer 29

- imaging (ultrasound, CT and/or MRI) - urine cytology - blood test for marker: prostatic specific antigen - kidney function - histological diagnosis by biopsy or excised tumour - staging studies: any evidence of metastasis

Question 30

How are neoplastic conditions treated?

Answer 30

- to release any obstruction of the urinary tract: nephrostomy, bladder catheter and/or surgery - chemotherapy - radiotherapy - hormonal therapy for hormone sensitive cancer e.g. prostate - surgery

Question 31

What are the different types of polycystic kidney and their inheritance patterns?

Answer 31

- neonatal: autosomal recessive - adult onset: autosomal dominant - some patients have no family history

Question 32

What are the consequences of polycystic kidneys?

Answer 32

- loss of kidney function - pain - bleeding into renal cysts (bc has vessels) - infection of renal cysts - asymptomatic in some patients

Question 33

How is polycystic kidney disease treated?

Answer 33

- new medication: tolvaptan- vasopressin receptor 2 antagonist- to slow down cyst formation - treat hypertension and infection - pain control - renal replacement therapy: transplantation and dialysis

Question 34

How can we detect a horseshoe kidney?

Answer 34

imaging of abdomen/pelvis

Question 35

What are the consequences of horseshoe kidney?

Answer 35

inc. risk of - obstruction - stones - infection