Urology 1

oelomar's version from 2016-02-27 14:43


Question Answer
What is the normal range for specific gravity (as part of a urine test)?1.002-1.030.
When would one ever need to measure the urine specific gravity/osmolality?In the differential diagnosis of oliguric renal failure or the investigation of polyuria or SIADH (syndrome of inappropriate anti-diuretic hormone).
What is SIADH?Syndrome of inappropriate anti-diuretic hormone. It is characterised by excessive release of ADH from the posterior pituitary. The two primary functions of ADH are to retain water in the body and constrict blood vessels. As such, SIADH leads to hypervolaemia which often results in dilutional hyponatraemia.
When using a Stix test to detect protein in the urine, which protein is the one which is primarily reacted to?Albumin.
Transient proteinuria may occur during febrile illnesses or after exercise and does not require investigation. True or false?True.
What is microalbuminuria and what is it an indicator of?Excretion of 30-300mg of albumin in the urine per 24 hours. It is an early indicator of diabetic glomerular disease and is a useful prognostic marker for future cardiovascular events.
Presence of casts in urine indicates that haematuria/pyuria is of renal origin. True or false?True.
What do RBC casts in the urine indicate?Glomerular damage, which can occur in glomerulonephritis, ischaemia, malignant hypertension, etc.
What do WBC casts in the urine indicate?Inflammation or infection, strongly suggesting pyelonephritis, a direct infection of the kidneys.
What do granular (“muddy brown”) casts in the urine indicate?Acute tubular necrosis. This is the second most common type of cast and can also be seen for a short time following strenuous exercise.


Question Answer
What do waxy casts in the urine indicate?Long-standing kidney disease such as renal failure.
What do hyaline casts in the urine indicate?They are non-specific. This is the most common type of cast and can also be seen for a short time following strenuous exercise.
What is nephrotic syndrome?A non-specific disease of the kidney characterised by massive proteinuria, hypoalbuminaemia, and generalised oedema (and hyperlipidaemia).
How is nephrotic syndrome managed?Dietary sodium restriction, thiazide diuretic, ACE inhibitors (ARBs if tolerated) (to decrease proteinuria), statin (for hyperlipidaemia).
Where do osmotic diuretics act?Late PCT and descending limb of the loop of Henle.
Where do loop diuretics act?Ascending limb of the loop of Henle.
Where do thiazide diuretics act?DCT.
Where do potassium-sparing diuretics act?Late DCT and early collecting tubule.
What is nephritic syndrome?Nephritic syndrome is a collection of signs (known as a syndrome) associated with disorders affecting the kidneys, more specifically glomerular disorders. Patients present with haematuria with RBC casts. It is also associated with oliguria, hypertension (due to salt retention), and proteinuria.
What is minimal change nephropathy and what causes it?Minimal change nephropathy nearly always presents as nephrotic syndrome, accounting for 75% of cases in children and 25% in adults. The majority of cases are idiopathic, but it may be triggered by a recent infection or an immune stimulus. No changes are seen when viewing specimens under light microscopy, hence the name minimal change nephropathy.


Question Answer
How do the glomeruli appear on light microscopy with minimal change nephropathy?Normal.
How do the glomeruli appear on electron microscopy with minimal change nephropathy?The foot processes of the podocytes are fused (a non-specific finding).
How is minimal change nephropathy treated?80% of cases are steroid responsive. Cyclophosphamide is the next step for steroid resistant cases.
How do the glomeruli appear on light microscopy with membranous glomerulopathy?Diffuse capillary and GBM thickening.
How do the glomeruli appear on electron microscopy with membranous glomerulopathy?“Spike and dome” appearance with subepithelial deposits.
How is membranous glomerulopathy treated?Corticosteroids and cyclophosphamide.
Membranous glomerulopathy is the most common cause of adult nephrotic syndrome. True or false?True.
What is focal segmental glomerulosclerosis (FSGS) and what causes it?The most important cause of nephrotic syndrome in children, and an important cause of kidney failure in adults. It can be idiopathic or secondary. The individual components of the name refer to the appearance of the kidney tissue on biopsy.
What is shown through a light microscope with FSGS?Segmental glomerusclerosis, which later progresses to global glomerusclerosis.
What is immunofluorescence?A technique used for light microscopy with a fluorescence microscope and is used primarily on microbiological samples.


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What does immunofluorescence shows deposits of in FSGS?Complement component 3 (c3) and IgM in affected portions of the glomerulus.
FSGS is the most common glomerular disease in HIV patients. True or false?True.
What is the leading cause of end-stage renal failure in the western world?Diabetic nephropathy.
What are the stages of injury in diabetic nephropathy?The kidneys enlarge initially and there is glomerular hyperfiltration. The major early histological lesions seen are glomerular basement membrane thickening and mesangial expansion. Eventually there will be microalbuminuria, followed by macroalbuminuria, followed by proteinuria, followed by declining renal function.
What is a Kimmelstiel-Wilson disease?A kidney condition associated with long-standing diabetes. It affects the network of tiny blood vessels (the microvasculature) in the glomerulus.
What is PSGN?Post-streptococcal glomerulonephritis. The patient, usually a child, suffers a streptococcal infection 1–3 weeks before the onset of the acute nephritic syndrome.
What is Goodpasture syndrome?A rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure. It is thought to attack the alpha-3 subunit of type IV collagen, which has therefore been referred to as Goodpasture's antigen. Goodpasture syndrome may quickly result in permanent lung and kidney damage, often leading to death.
How is Goodpasture syndrome treated?It is treated with immunosuppressant drugs such as corticosteroids and cyclophosphamide, and with plasmapheresis, in which the antibodies are removed from the blood.
What is Berger’s disease?Also known as IgA nephropathy, this is the most common form of glomerulonephritis world-wide. IgA is deposited in the glomerulus. The classic presentation (in 40-50% of the cases) is episodic haematuria which usually starts within a day or two of a non-specific upper respiratory tract infection as opposed to post-streptococcal glomerulonephritis which occurs some time (weeks) after initial infection.
How is Berger’s disease managed?ACE inhibitor, ARB, and steroids (to reduce proteinuria and stabilise renal function).


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What is Alport’s syndrome?Alport’s syndrome is characterised by hereditary nephritis with glomerulonephritis, end-stage kidney disease, and hearing loss. Approximately 15% of cases may have ocular abnormalities including cataracts and lenticonus.
How does one differentiate between IgA nephropathy and post-streptococcal glomerulonephritis?PSGN is associated with low complement levels. The main symptom in PSGN is proteinuria (although haematuria can occur) whereas the classic presentation in IgA nephropathy is episodic haematuria. In PSGN, there is typically an interval between the upper respiratory tract infection and the onset of renal problems (normally a few weeks) whereas in IgA nephropathy the interval is very short.
What is haemolytic uraemic syndrome?A disease which predominantly, but not exclusively, affects children. It is characterised by a triad of acute renal failure, microangiopathic haemolytic anaemia (anaemia caused by destruction of RBCs), and thrombocytopenia (low platelet count).
What causes haemolytic uraemic syndrome?HUS occurs after ingestion of a strain of bacteria that expresses “Shiga-like toxin”, which is a toxin generated by some strains of E. coli.
Urinary tract infections are more common in men. True or false?False. They are more 10 times common in women (due to shorter urethra, so shorter distance for bacteria to travel to reach the bladder).
Which organism is the main causal agent of UTIs?E. coli.
What does a urinary tract infection present with?Dysuria (pain with urination), urgency, frequency, suprapubic pain and tenderness, haematuria, smelly urine, and WBCs (but not WBC casts) in urine.
What is Murphy’s punch sign/Pasternacki’s sign?Also known as costovertebral angle tenderness, this is a medical test in which pain is elicited by percussion of the area overlying the kidney. The test is positive in people with an infection around the kidney, pyelonephritis, haemorrhagic fever with renal syndrome, or renal stone.
UTIs can lead to end-stage renal failure and sepsis. True or False?True.
What would urine analysis show with someone with pyelonephritis?Nitrite and white blood cells.


Question Answer
What is reflux nephropathy and what causes it?Reflux nephropathy is a term applied when the kidneys are damaged by the backward flow of urine into the kidney (vesico-ureteric reflux). It can also result as a result of an infection acquired in infancy and childhood.
What are the differential diagnoses of a UTI?Vaginitis, STDs, urethritis, acute urethral syndrome, prostatitis.
What would a positive leukocyte esterase test indicate?Bacterial UTI.
What would a positive nitrite test indicate?Gram-negative bacterial UTI.
What is urethral syndrome?A set of symptoms that may suggest a lower UTI. However, urethral syndrome is different since there is no significant presence of bacteriuria with a conventional pathogen.
What can cause urethral syndrome?Trauma, allergies, anatomical features such as diverticula, and post-surgical scarring and adhesions.
What is interstitial cystitis and what causes it?Also known as bladder pain syndrome, this is a chronic inflammatory condition of the submucosal and muscular layers of the bladder. The cause is unknown, and the condition is regarded as a diagnosis of exclusion.
What does interstitial cystitis present with?Suprapubic pain, urinary frequency, and painful sexual intercourse.
What is a “Hunner’s ulcer” and how is it diagnosed?These are ulcers that occur in 5-10% of people who have the bladder disease interstitial cystitis. They form on the wall of the bladder. They can only be accurately diagnosed via cystoscopy with hydrodistention.
What is meant by the term “diagnosis of exclusion”?A diagnosis of a medical condition reached by a process of elimination.


Question Answer
What is the first line treatment for an uncomplicated UTI?Nitrofurantoin.
What is the second line treatment for an uncomplicated UTI?Trimethoprim.
What is the third line treatment for an uncomplicated UTI?Cefalexin.
What is the first line treatment for a complicated UTI if the patient is systemically unwell?Gentamicin.
What is the first line treatment for a complicated UTI if the patient is not systemically unwell?Withhold treatment until the results of the MSU (midstream specimen of urine) are available.
How can a UTI be prevented from occurring?Drink more water. Antibiotic prophylaxis continuously or post-coital. Drinking cranberry juice (only in women; avoid if taking warfarin).
What percentage of pregnant women have asymptomatic bacteriuria?5%.
What is trimethoprim?A synthetic antibiotic used mainly in the treatment of UTIs.
What are the potential side effects of trimethoprim?Thrombocytopenia, megaloblastic anaemia.
What are aminoglycosides?Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial therapeutic agents that inhibit protein synthesis.
Give examples of aminoglycosidesStreptomycin, gentamycin.
Streptomycin was the first effective treatment for what disease?Tuberculosis.
What are the potential side effects of aminoglycosides?Nephrotoxicity, ototoxicity, teratogenic.


Question Answer
What is xanthogranulomatous pyelonephritis?This is an uncommon chronic interstitial infection of the kidney, most often due to Proteus, in which there is fever, weight loss, loin pain and a palpable enlarged kidney. It is usually unilateral. It is an unusual form of chronic pyelonephritis characterised by granulomatous abscess formation, severe kidney destruction, and a clinical picture that may resemble renal cell carcinoma.
What is the treatment of choice for xanthogranulomatous pyelonephritis?Nephrectomy.
Pathogens of the Proteus genus are known to cause what type of infection?Urinary tract infections.
What is acute tubulointerstitial nephritis and what causes it?This is acute interstitial renal inflammation. In 71-92% of cases acute TIN is due to a hypersensitivity reaction to drugs, usually a penicillin or NSAIDs.
What does drug-induced acute tubulointerstitial nephritis present with?Patients present with fever, arthralgia, skin rashes and acute oliguric or non-oliguric renal failure. Many have eosinophilia and eosinophiluria.
What is the recommended treatment for acute pyelonephritis?Broad-spectrum cephalosporin or quinolone.
What is the recommended treatment for acute prostatitis?Quinolone or trimethoprim.
What is hyperuricemia and what is the most important factor contributing towards it?Hyperuricemia is an abnormally high level of uric acid in the blood. The most important factor contributing towards it is alcohol consumption.
What does hyperuricemia predispose to?Gout, and if very high, renal failure.
What drug is given for the treatment of hyperuricemia?Allopurinol.
What is the main cause of renal artery stenosis in older patients?Atherosclerosis.
What is the main cause of renal artery stenosis in younger patients?Fibromuscular dysplasia.
What is fibromuscular dysplasia and what does it primarily affect?A condition that causes narrowing (stenosis) and enlargement (aneurysm) of the medium-sized arteries in your body. The areas of narrowing and bulging occur next to each other and can cause the artery to narrow so much that organs that receive blood from the artery are damaged. It most commonly affects the renal and carotid arteries.
What does renal artery stenosis present with?Most cases are asymptomatic. Otherwise, patients present with hypertension that is resistant to treatment, and episodes of flash pulmonary oedema.