Urinary 9 Flashcards by Alyssa Conte

Label the image.

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What is glomerulonephritis? What can it cause?

a renal disease characterised by inflammation and damage to the glomeruli

glomerular damage can lead to proteinuria and/or haematuria

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What typically presents with nephritic syndrome?

List 4 conditions.

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What typically presents with nephrotic syndrome?

List 3 conditions.

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What is the difference between nephritic and nephrotic syndrome?

nephritic: proliferative glomerulonephritis - INFLAMMATION AND CROWING - BLOOD LEAKS OUT
- increased number of cells in the glomerulus
- condition involving haematuria, mild to moderature proteinuria <3.5g/day
- hypertension
- oliguria
- red cell cast

nephrotic: non-proliferative glomerulonephritis - NON-INFLAMMATORY BARRIER FAILURE - PROTEIN LEAKS OUT
- lack of glomerular cell with proliferation
- loss of significant volumes of protein via kidneys due to increased permeability of the filtration barrier

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Explain what happens in nephrotic syndrome.

The definition of nephrotic syndrome includes what?

increased permeability of the glomerular filtration barrier which leads to a loss of significant volumes of protein into the tubules and urine (proteinuria)
includes both massive proteinuria (>3.5 g/day) and hypoalbuminaemia (serum albumin <30 g/L)

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Nephrotic syndrome includes what?

massive proteinuria - >3.5g/L

hypoalbuminaemia - <30 g/L

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What is the most common primary cause of nephrotic syndrome in children and adults?

children: minimal change disease

adults: FSGS and membranous nephropathy

(FSGS: focal segmental glomerulosclerosis)
(membranous nephropathy: thickened GBM due to immune complex deposition)

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What is minimal change disease? What is the treatment?

a glomerular disease and the most common cause of nephrotic syndrome in children

podocyte injury: loss of negative charge in glomerular basement membrane
massive proteinuria
called “minimal change” because glomeruli look normal under light microscopy - only EFFACEMENT OF FOOT PROCESSES on electron microscopy

first line: high-dose corticosteroids

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Effacement of foot processes on electron microscopy refers to what condition?

minimal change disease

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What are the nephrotic syndrome triad for minimal change disease?

What does it often follow?

proteinuria >3.5g/day
hypoalbuminemia
oedema

often follows VIRAL INFECTION, ALLERGY OR IMMUNISATION

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What often precedes minimal change disease?

viral infection

allergy

immunisation

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What is FSGS and how does it present?

What is the primary cause and what is the secondary cause?

focal segmental glomerulosclerosis: kidney disease which causes scarring in the glomeruli - proteinuria, haematuria, hypertension

primary cause: idiopathic
secondary causes: HIV, heroin, sickle cell disease, obesity, reflux nephropathy

MOST COMMON CAUSE OF NEPHROTIC SYNDROME IN ADULTS esp African descent

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List 5 symptoms of Nephrotic Syndrome.

peripheral oedema (more common in adults)
facial oedema (more common in children)
frothiness of urine
fatigue
poor appetite
recurrent infections (due to immune dysfunction)
venous or arterial thrombosis

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List 5 signs/clinical features of nephrotic syndrome.

What would be seen on the urinalysis?

oedema

xanthelasma

leukonychia

SOB (with associated chest signs of pleural effusion)

urinalysis:
- proteinuria (protein +++)
- frothy appearance of urine

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What are the most common causes of nephritic syndrome in children and in adults?

Children: post-streptococcal GN

Adults: IgA nephropathy (Berger’s disease)

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What are clinical signs of nephritic syndrome? And what would the urinalysis show?

Signs:
- Haematuria
- Oedema
- Hypertension
- Oliguria (<300ml/day)

Urinalysis:
- Blood +++
- Protein (+/++)
- Red cells casts

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What are risk factors for urinary tract malignancies? List 5 at least.

Occupational
Environmental
Genetic
Age
Sex
Smoking
Alcohol
Obesity

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What are red flags for urinary tract malignancy? List 5 at least.

Abdominal pain
Fatigue
Lower back pain
Appetite or weight loss
Iron deficiency
Haematuria
Erectile dysfunction
Change in bladder habit
Poor stream
Bone pain

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Cancer of the kidneys is also known as what?

renal cell carcinoma

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What is the most common childhood renal tumour?

Nephroblastoma tumour, known as Wilms tumour

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What is RCC? What is the classic triad for this condition?

Malignant epithelial tumour of renal tubular origin
Haematuria
Loin pain
Flank mass

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How do you diagnose/investigate RCC? What is the treatment?

ultrasound/CT scan/MRI

What is the most common renal malignancy in children aged 2-5 years old?

nephroblastoma - Wilm's tumour

Wilm's Tumour arises from which embryological tissue?

the metanephric blastema

In regards to Wilm's Tumour, answer the following: 1. Clinical features 2. Diagnosis 3. Treatment 4. Survival

1. abdominal mass, abdominal pain, haematuria, fever, hypertension 2. USS, CT/MRI, chest CT (lungs common site of metastasis) 3. multimodal (surgery/chemo/radiotherapy) 4. excellent >90% 5-year survival in localised disease

Why are chest CT scans usually done when someone presents with Wilm's Tumour or RCC?

because lungs are common site of metastasis

What is ureteric cancer? Most are what? What is the peak age? What are the risk factors? (List 4)

malignant tumours of the ureter - most are transitional cell carcinomas 60-70 smoking, occupational exposure, chronic irritation, genetic predisposition

In regards to ureteric cancer, answer the following: 1. What are the clinical features? 2. How is it diagnosed? 3. What is the management and prognosis?

What is the 7th most common cancer in the UK?

bladder cancer

>90% of bladder cancer are what type of cancer? What are the risk factors for bladder cancer?

urothelial carcinomas (previously called transitional cell carcinomas) smoking, exposure to aromatic amines, chronic bladder inflammation, pelvic radiotherapy

What are the clinical features of bladder cancer?

What must be treated as a urinary tract malignancy until proven otherwise?

painless haematuria

In regards to bladder cancer, answer the following: 1. How is it diagnosed? 2. What is the treatment?

1. cystoscopy, tissue sample, radiologic tests, stage and grade 2. transurethral resection of a bladder tumour (TURBT), radical cystectomy

What do the following grades indicate and what is the appropriate treatment for each?: 1. Tis/Ta/T1 2. T2-T3 3. T4

1. low grade - unlikely to spread further TURBT and intravesical cytotoxics 2. moderately invasive spread to muscle layer radical cystectomy +/- radiotherapy, post op chemo and neo-adjuvant chemo 3. high grade - spread beyond bladder palliative chemo/radiotherapy

What is the difference in the grades and stages shown on the image? What is the meaning of "staging" and what is the meaning of "grading"?

staging: how deeply the tumour has invaded into the bladder wall and beyond grading: how abnormal/aggressive the cancer cells look under the microscope

What is the most common cancer in men in the UK and the second leading cause of male cancer death? What are risk factors for this cancer? List 5.

prostate cancer risk factors: - >50 years old - black ethnicity - family history - genetics - lifestyle - geography - socioeconomics

There is no national screening programme for prostate cancer but what is available instead?

PSA testing available via informed choice NHS Prostate Cancer Risk Management Programme

What are the clinical features of prostate cancer? What investigations can be done? What treatment options are available?

What do the following PSA values indicate?

What is somewhat a disadvantage with using PSA for diagnosis of prostate cancer?

What does a normal PSA not rule out? PSA testing is not recommended in which type of patients?

normal PSA does NOT rule out cancer - <40 years old - elderly (asymptomatic, co-morbidities) - patients with UTI

What type of enzyme is PSA and what does it do? Why can it be used as a marker for prostate cancer?

serine protease - protein-cutting enzyme which breaks down proteins in the semen clot and make it liquid again -> this liquefaction helps sperm swim freely

What is the diagnostic test for prostate cancer (aside from PSA levels)?

DRE (abnormal DRE = 42.3% chance of malignancy)

In regards to biopsies for prostate cancer, answer the following: 1. List 2 limitations. 2. List 2 types of biopsy taking methods. 3. List 3 complications of biopsy taking.

1. does not guarantee detection of all cancer present, even with MRI targeting AND particularly important if MRI shows suspicious lesion 2. transperineal (TP) biopsy and transrectal USS guided 3. sepsis, acute urinary retention, haematuria, rectal bleeding, blood in semen, perineal pain

What do the following Gleason Scores indicate?

What grading system is used to describe how aggressive prostate cancer looks under a microscope? What is it based on?

Gleason score - based on glandular architecture

What is the Gleason Score and how it is used?

grading system used to describe how aggressive prostate cancer looks under the microscope - based on glandular architecture of tumour cells (not how deep it has invaded) pathologist looks at the TWO MOST common patterns in the biopsy, patterns graded 1-5: 1 = nearly normal (well-differentiated) 5 = very abnormal, no glandular structure (poorly differentiated) - those scores are then added together and range from 2-10

What Gleason score corresponds to Grade Group 1, and what does it mean?

gleason 6 (3+3) - cells look similar to normal prostate cells; cancer grows very slowly if at all

A man’s biopsy shows Gleason 7 (3+4). What Grade Group is this, and how aggressive is it?

grade group 2 - most cells still look fairly normal, cancer is likely to grow

What is the difference between Gleason 7 (3+4) and Gleason 7 (4+3)?

3+4 = grade group 2 - slower growth 4+3 = grade group 3 - cells less like normal, grows at moderate rate

Which Gleason score corresponds to Grade Group 4, and what does it imply?

gleason 8 (4+4) - some cells look abnormal; cancer may grow quickly or at moderate rate

What is the most aggressive category of Gleason grade, and how does it appear histologically?

grade group 5 (Gleason 9–10: 4+5, 5+4, or 5+5) - cells look very abnormal, cancer is likely to grow quickly

What is the commonest cancer in men between 15-35? List 3 risk factors for this cancer.

testicular cancer testicular maldescent family history male infertility infantile hernia klinefelters

95% of testicular cancers arise from which embryological structure?

germ cells

Most penile cancers are what? What do they present as?

squamous cell carcinomas - non-tender swelling of the glans penis - purulent and/or bleeding from under foreskin

Testicular cancer presents as what? List 3 other possible associated symptoms.

Explain also why these physical examinations can aid the detection of an enlarged prostate.

DRE and abdominal examination

Why does enlargement of the prostate cause men to complain of a weak urinary stream and a sensation of incomplete urinary bladder emptying?

Name the perfect measure of GFR and name another substance used to measure the GFR. What properties would a substance need to make them suitable for GFR calculations?

inulin (gold standard), then creatinine substances that are not reabsorbed nor secreted in the nephron after being freely filtrated are good candidates - creatinine has relatively stable plasma concentration, is freely filtered and it is only a little bit reabsorbed but not secreted or metabolised

What is the kidneys’ response to a drop in systemic blood pressure?

Urinary 9 Flashcards

(63 cards)