Urological disorders (46) Flashcards
What are the normal functions of the kidney and what happens in kidney dysfunction?
- filtration–> failure leads to accumulation of waste substance, haematuria and proteinuria, low serum protein e.g. albumin
- control of salt and water balance–> hypertension, water retention (sometimes dehydration)
- control of acid/base balance–> metabolic acidosis
- hormones (erythropoietin production)–> anaemia bc dec. Hb production
- vitamin D (1-alpha hydroxylation of vit D)–> vit D deficiency and secondary hyperparathyroidism
What are possible locations and pathogens for infections in the urinary tract?
- bladder= cystitis
- kidney= pyelonephritis
- bacteria most common
- virus and fungus in immunocompromised patients
- pathogen enters causing inflammation
How do we diagnose a urinary tract infection?
- history
- physical examination
- urine dipstick
- urine microscopy, culture and sensitivity
How do we treat a urinary tract infection?
- 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
How can the immune system damage the kidney?
via antibodies or inflammatory cells (neutrophils, monocytes/macrophages, T cells)
How will an inflammatory condition with an immunological cause present clinically?
- nephritic syndrome
- proteinuria
- nephrotic syndrome
What is glomerulonephritis?
inflammation of the microscopic filtering units of the kidney (glomeruli)
How do we diagnose an inflammatory condition with an immunological cause?
- history and physical examination
- urine test
- blood test incl. immunology tests
- imaging: start w/ ultrasound
- kidney biopsy
What are the signs of nephritic syndrome?
- haematuria (blood in urine)
- variable amount of proteinuria
- may have hypertension, reduced urine output, inc. urea and creatinine
How do we diagnose nephritic syndrome?
- history physical examination
- urine dipstick
- urine microscopu
- urine protein:creatinine ratio
- blood tests: kidney function and immunology test
- kidney biopsy
What is IgA nephropathy?
- 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
How do we treat IgA nephropathy?
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
What is an example of a disease that affects the kidney and lung specifically?
- Goodpasture’s disease
- antibody mediated anti-glomerular basement membrane (autoantibody)
- bc shared common antigen between lung and kidney
What are examples of diseases that affect multiple organs/tissues?
- systemic lupus erythematosus (SLE) caused by autoantibodies e.g. antinuclear factor, anti-dsDNA
- vasculitis caused by autoantibodies called ANCAs
What is diabetic nephropathy?
most common cause of chronic kidney disease and kidney failure in west
- pathogenesis: inflammation and fibrosis (deposition of extracellular matrix in glomerulus)
What are the clinical features of diabetic nephropathy?
- microalbuminuria
- proteinuria
- association w/other diabetic complications e.g. diabetic retinopathy
How is diabetic nephropathy treated?
- optimised diabetic control
- optimised treatment of hypertension
- stop smoking
- reduce proteinuria using ARB or ACEI
- new clinical trials: SGLT2 inhibitor
- transplantation
- dialysis
What are risk factors for diabetic nephropathy?
- hypertension
- poor diabetic control
- smoking
What are the clinical signs of a nephrotic syndrome?
- peripheral oedema
- severe proteinuria
- low serum albumin
- variable amount of microscopic haematuria
- associated w/ hyperlipiaemia
How do we diagnose nephrotic syndrome?
- history
- physical examination
- urine dipstick
- urine microscopy
- urien protein:creatinine ratio
- blood tests: kidney function and immunology test
- kidney biopsy
What are causes of nephrotic syndrome?
- minimal change glomerulopahty
- membranous nephropathy
- focal segmental glomerulosclerosis
- lupus nephritis
- otherssss
leaking of protein…
How do we treat nephrotic syndrome?
- immunotherapy
- diuretics to reduce peripheral oedema
- prevent thrombosis w/ anticoagulation
What are the possible locations of obstructive stones?
- kidney
- ureter
- bladder
How do stones present?
- pain in abdomen, back loin
- blood in urine
- associated w/ urine infection
- about 90% of kidney stones are radio-opaque
