11. Urinary System - Pathologies Flashcards
Urinary Tract Infection (UTI): definition
Infection and inflammation of the urinary tract
Often bacterial
Who’s more likely to suffer with a UTI?
More common in women
Increases with age
Urinary Tract Infection (UTI): signs and symptoms
Dysuria Frequent urination Nocturia Cloudy, smelly urine Suprapubic pain Haematuria Nausea Confusion
Urinary Tract Infection (UTI): diagnostics
Dipstick: nitrites, leukocytes, erythrocytes
Cystitis: definition
Infection of the bladder
Can be acute or chronic
Who’s more likely to suffer from cystitis?
More common in women
Cystitis: aetiology
75%+ caused by bacteria (E. coli) from intestinal flora
Wiping back to front
Catheterisation (repeated use)
Post-menopausal (thinned lining)
Diabetes mellitus
Enlarged prostrate (chronic cystitis common in older men)
Cystitis: signs and symptoms
Pain in loin (lower back/abdomen) Dysuria Frequent urination but only passing small amounts Dark, smelly, cloudy urine Malaise, nausea, fever
Cystitis: diagnostics
Dipstick: nitrites, leukocytes, erythrocytes
Urine microscopy: significant bacteriuria
Cystitis: allopathic treatment
Antibiotics
Pyelonephritis: definition
Infection of the kidneys
Pyelonephritis: pathophysiology
Bacteria spreading from bladder to kidneys
In rare occasions it can spread from the blood
Renal pelvis and calyces fill with purulent exudate
Pyelonephritis: aetiology
Infection spreading up from bladder Diabetes mellitus Immunocompromised patients Obstructed flow of urine (due to enlarged prostate, kidney stones) Pregnancy Gout
Pyelonephritis: signs and symptoms
Loin pain and tenderness (often unilateral)
Dysuria
Frequent urination
Haematuria
Cloudy, smelly urine
Malaise, nausea, fever, vomiting, fatigue
Pyelonephritis: diagnostics
Dipstick: nitrites, leukocytes, erythrocytes, proteins
Urine microscopy: bacteria, casts, blood cells, protein
Blood test: inflammatory markers and WBCs
Imaging: Ultrasound
Pyelonephritis: complications
Repeated episodes of acute pyelonephritis are common and can lead to chronic pyelonephritis
Chronic pyelonephritis can lead to the necrosis and scarring of renal tissue = kidney disease and renal failure
Septicaemia
Renal abscess
Secondary hypertension
Pyelonephritis: allopathic treatment
Large quantities of water/herbal teas (>2l/day)
Strict bed rest
Warm packs
Antibiotics
Glomerulonephritis: definition
Autoimmune disease that causes glomerular inflammation
Glomerulonephritis: pathophysiology
Autoimmune reaction (type III hypersensitivity)
Antigen-antibody immune complexes are formed in response to any infection
These immune complexes are deposited in the glomeruli where they trigger an immune response
This leads to leaky capillaries and leukocyte proliferation, allowing proteins and erythrocytes to escape into urine
Glomerulonephritis: aetiology
Primary - no associated disease elsewhere
Secondary - part of a systemic disease (e.g. SLE - lupus)
Autoimmune - often occurs 1-3 wks after a bacterial infection (often from upper respiratory tract). Common in children
Glomerulonephritis: signs and symptoms
Asymptomatic haematuria and/or proteinuria
Cloudy/frothy urine
Back pain (due to glomerular inflammation)
Fluid retention - peripheral and facial oedema
Oliguria
Hypertension (due to glomerulosclerosis. Scarring and fibrosis reduces renal flow and GFR resulting in an increase in renin)
Fatigue, headaches, fever, nausea
Glomerulonephritis: diagnostics
Urinalysis: erythrocytes, proteins
Blood test: inflammatory markers, low GFR, low serum albumin, elevated urea/antibodies
Glomerulonephritis: allopathic treatment
Corticosteroids
Antibiotics
Diuretics
Nephrotic Syndrome: definition
Collection of signs and symptoms associated with increased glomerular permeability (leaking) and heavy proteinuria
Nephrotic Syndrome: pathophysiology
Loss of plasma proteins leads to low plasma osmotic pressure (hypoalbuminaemia), so fluid moves out of capillaries into tissues = oedema
Nephrotic Syndrome: aetiology
Glomerulonephritis, diabetic glomerulosclerosis
Systemic Lupus Erythematosus (SLE)
Infections - HIV, malaria, hepatitis
Drugs - NSAIDs
Diabetic Kidney (Nephropathy): definition
Deterioration of kidney function
What percentage of diabetics are likely to develop nephropathy?
40%
Diabetic Kidney (Nephropathy): pathophysiology
Diabetes mellitus elevates blood pressure
Glomerulosclerosis occurs as a result of the increased glomerular pressure
The kidneys become enlarged (different to other pathologies)
Glomeruli become damaged and proteins leak
Diabetic Kidney (Nephropathy): signs and symptoms
Initially none
Fatigue, nausea, vomiting
Pallor
Oedema
Renal calculi: definition
Kidney stones
Most commonly made up of calcium oxalate and phosphate (80%)
2% of population have kidney stones
Men more commonly affected (3:1)
Renal calculi: pathophysiology
Stones may stay in position and obstruct urine flow
They may migrate down the urinary tract, producing symptoms en route
Renal calculi: aetiology
Dehydration (increased solute concentration)
Hypercalcaemia e.g. hyperparathyroidism
Gout (hyperuricaemia)
Renal anatomical anomalies
Renal calculi: signs and symptoms
Often asymptomatic
Severe loin pain radiating to the groin (ureteric colic)
Trace of blood in urine (dipstick test)
Nausea, vomiting, fever
Renal calculi: allopathic treatment
NSAIDs Increase fluid intake Shockwave therapy Surgery (if bigger than 6mm) Avoid intake of oxalate rich food - rhubarb, spinach, cocoa Avoid calcium
What are diuretics?
Medications which increase loss of sodium and water from the kidneys
What are diuretics used to treat?
Oedema
Hypertension
What are the types of diuretics?
Thiazide diuretics
Loop diuretics
Potassium sparing diuretics
What do thiazide diuretics do?
Act on the DCT
What do loop diuretics do?
Act on the Loop of Henle
What do potassium sparing diuretics do?
Act on the collecting ducts
What do diuretics cause excess secretion of?
Potassium
Magnesium
Sodium
Chloride
*Need to replace to keep muscle/nervous system function
Which foods act as diuretics?
Celery
Dandelion
What does renal dialysis do?
Mimics the excretory function of kidneys to remove wastes/balance electrolytes
Who needs renal dialysis?
Patients in renal failure
Types of renal dialysis
Haemodialysis
Peritoneal dialysis
What does renal dialysis increase the risk of?
Infection so often antibiotics are given
What is haemodialysis?
Removing waste products (urea, creatinine) and water from blood
Where is haemodialysis used?
Usually in hospital but can be out-patient
How often is haemodialysis used?
Usually 3 times a week
3-4 hours each session
What is peritoneal dialysis?
Uses the peritoneum’s structure as a highly semi-permeable membrane to allow for the diffusion of fluids and dissolved substances
How does peritoneal dialysis work?
A tube is inserted into the abdomen which administers dialysis fluid through which waste products diffuse into
Removal occurs via a shunt
Where is peritoneal dialysis used?
Often administered at home
How long does peritoneal dialysis take?
Longer than haemodialysis but often more comfortable
What does peritoneal dialysis increase risk of?
Peritonitis at site of tube exit
