Kidney

Question 1

Hydronephrosis

Answer 1

Hydronephrosis is usually caused by a blockage in the urinary tract or something disrupting the normal workings of the urinary tract. The urinary tract is made up of the kidneys, the bladder, the ureters (the tubes that run from the kidney to the bladder) and the urethra (the tube that carries urine out of the body).

Question 2

Membranous nephropathy

Answer 2

Def:

1. Is a common cause of nephrotic syndrome (causes proteinuria)
2. Is a risk factor for acute RVT
3. Membranous nephropathy occurs when the small blood vessels in the kidney (glomeruli), which filter wastes from the blood, become damaged and thickened. As a result, proteins leak from the damaged blood vessels into the urine (proteinuria).

Treatment:

1. Supportive care with the use of diuretics and angiotensin-converting enzyme inhibitors in combination with angiotensin II receptor blocker is recommended, but these agents have only a limited effect.

Question 3

Nephrolithiasis

Answer 3

Def.

Clinical:

1. Flank pain
2. Hematuria
3. No enlarged kidneys (imaging)
4. Paroxysmal pain

Question 4

Pyelonephritits

Answer 4

Clinical:

1. Dysuria
2. Hematuria
3. Fever
4. Flank pain
5. Urinary leukocytes or nitrites

Question 5

Renal infraction

Answer 5

Def:
1. Occurs due to cardio-embolic disease (eg, atrial fibrillation)

Diagnosis:

1. Incomplete infraction
2. Wedge-shaped area of ischemia on imaging

Clinical:

1. Abdominal pain
2. Flank pain
3. HTN ( due to renin release)

Question 6

Renal vein thrombosis (RVT)

Answer 6

DEF:
1. Caused by increased glomerular pressure leading to reno-vascular congestion, capsular stretch (manifest as flank pain), and hematuria

Risk factors:

1. Hypercoagulability
   
   • nephrotic syndrome
   • malignancy (particularly renal)
   • OCP
2. Volume depletion
3. Trauma

Clinical features:

1. Hematuria
2. Flank or abdominal pain
3. Elevated LDH +/- AKI
4. Enlarged kidney on imaging
5. Dull & constant pain

Diagnosis:

1. CT OR MRI. Angiography
2. Renal venography

Treatment:

1. Anti-coagulation
2. Thrombolysis/ thrombectomy (if AKI present)

Note:

• LDH: Lactate dehydrogenase
• AKI: acute kidney injury
• OCP: oral contraceptive pills