Day: May 26, 2024

This refers to a group of signs and symptoms secondary to glomerular disease. It reflects inflammatory damage to the glomerulus which increases the permeability to proteins and blood causing proteinuria and haematuria. Left untreated, it can progress to end-stage renal failure. Symptoms Haematuria Less proteinuria (< 3.5 g/24 h) Hypertension and blurred vision Oliguria – low urine output Azotemia – high urea/creatinine Can progress onto renal failure   Key tests Kidney biopsy    There are many specific conditions which give rise to nephritic syndrome, which have specific treatments:   IgA nephropathy This is most common cause of nephritic syndrome, called

This refers to a group of signs and symptoms secondary to glomerular disease. It encompasses damage to the glomerular capillary wall due to a podocyte pathology, leading to abnormal function or podocyte injury/death. It increases permeability to plasma proteins, resulting in albumin loss in the urine. Symptoms Frothy urine – due to loss of protein in urine (>3 g/24 h) Oedema (in ankles, periorbital and scrotum) – this occurs secondary to hypoalbuminemia resulting in decreased oncotic pressure High risk of thrombosis – this is due to loss of endogenous anticoagulants (e.g., antithrombin III) and can give rise to complications including

Acute Kidney Injury (AKI) This is a term which describes a rapid deterioration in renal function, which leads to increased serum urea and creatinine combined with a low urine output. It is very common, occurring in 50% of patients in intensive care units.   There are many different definitions of AKI but the widely used KDIGO criteria are: Rise in creatinine > 26 uM within 48 hours Rise in creatinine > 1.5 Å~ baseline value within 1 week Urine output < 0.5 ml/kg/h for more than 6 consecutive hours   Causes These can be divided into 3 categories: pre-renal, renal

We need to regulate potassium as it determines the resting membrane potential. – As the relative permeabilities of sodium and calcium are very low, K+ is the main determinant. – Normal extracellular [K+] = 4mM – Intracellular [K+] = 125mM – As the extracellular space much smaller than intracellular 16:24 litres, changes in [K+] extracellular affect Em greatly.   Why K+ changes The Potassium concentration can change for many reasons: – Changes in intake –> average of 100mM K+ eaten per day, but starvation may decrease this – Inability to absorb it –> inflammation of the bowel – Excessive loss –> 

We need to regulate pH as the function of enzymes and cell surface ion channels are affected by [H+]. – In addition, bone buffers [H+], so an increase in [H+] will demineralize bone – An acidosis also may lead to a potassium extracellular shift causing hyperkalaemia.   The main way body pH is controlled is by buffering [H+] ions by the bicarbonate buffer system. When [H+] ions are added, they are buffered by HCO3 ions and excreted by the lungs as CO2. However, this is not sustainable unless the kidneys also produce HCO3 ions to replace the ones that are lost.  

Testes These are the main male reproductive organs which are suspended in the scrotum on the pedicles of the spermatic cords. – These hang outside the body as the lower temperature is needed for effective spermatogenesis – They develop from the posterior abdominal wall and carry peritoneum as they migrate through the inguinal canal. – This peritoneum forms a double layer (tunica vaginalis) around the testes. – The residual connection to the peritoneal cavity is obliterated as the processus vaginalis. – Testes are also covered by outer fibrous tunica albuginea – At the head of the testis is the epididymis,

The kidneys lie with their hila at the level L1, with the right kidney being lower – Kidneys are retroperitoneal organs so access is often obtained from the back – The kidneys are enclosed in a fibrous capsule and embedded in perinephric fat.   The kidney is composed of an outer region called the cortex and a central medulla. – The medulla is formed of renal pyramids –> converge on calyces –> inner pelvis – The pelvis then continues on as the ureter carrying urine to the bladder.   Blood supply The kidney is perfused by the renal arteries, which

Hypospadias This is a developmental condition where the urethra opens on the under surface of the penis shaft, rather than the tip of the glans. It occurs when the urethral folds fail to close. Management Surgical correction is the definitive treatment   Epispadias This is a developmental condition where the urethra opens on the upper surface of the penis shaft, rather than tip of the glans. It can be due to wrong positioning of the genital tubercle.   Management Surgical correction   Balanitis This is acute inflammation of the foreskin and glans, usually due to infection Can also be due

Acute prostatitis This is acute inflammation of the prostate, which usually occurs in infection   Causes Young adults – Chlamydia trachomatis, Neisseria gonorrhoeae Older Adults – E. coli   Symptoms Dysuria, urinary frequency, and suprapubic pain Can cause urinary retention leading to pain and haematospermia Systemic symptoms, e.g., fevers   Key tests DRE gives tender prostate and secretions reveal bacteria   Management Antibiotics e.g. levofloxacin (Quinolone) or Trimethoprim   Benign prostatic hyperplasia (BPH) This refers to hyperplasia of the prostate which occurs with age and is common. It does not increase the risk of cancer, as it is the central