11. Urinary System - Pathologies Flashcards by Andrea Hardy

Urinary Tract Infection (UTI): definition

Infection and inflammation of the urinary tract

Often bacterial

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Who’s more likely to suffer with a UTI?

More common in women

Increases with age

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Urinary Tract Infection (UTI): signs and symptoms

Dysuria
Frequent urination
Nocturia
Cloudy, smelly urine
Suprapubic pain
Haematuria
Nausea
Confusion

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Urinary Tract Infection (UTI): diagnostics

Dipstick: nitrites, leukocytes, erythrocytes

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Cystitis: definition

Infection of the bladder

Can be acute or chronic

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Who’s more likely to suffer from cystitis?

More common in women

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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)

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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

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Cystitis: diagnostics

Dipstick: nitrites, leukocytes, erythrocytes

Urine microscopy: significant bacteriuria

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Cystitis: allopathic treatment

Antibiotics

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Pyelonephritis: definition

Infection of the kidneys

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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

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Pyelonephritis: aetiology

Infection spreading up from bladder
Diabetes mellitus
Immunocompromised patients
Obstructed flow of urine (due to enlarged prostate, kidney stones)
Pregnancy
Gout

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Pyelonephritis: signs and symptoms

Loin pain and tenderness (often unilateral)
Dysuria
Frequent urination
Haematuria
Cloudy, smelly urine
Malaise, nausea, fever, vomiting, fatigue

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Pyelonephritis: diagnostics

Dipstick: nitrites, leukocytes, erythrocytes, proteins

Urine microscopy: bacteria, casts, blood cells, protein

Blood test: inflammatory markers and WBCs

Imaging: Ultrasound

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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

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Pyelonephritis: allopathic treatment

Large quantities of water/herbal teas (>2l/day)
Strict bed rest
Warm packs
Antibiotics

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Glomerulonephritis: definition

Autoimmune disease that causes glomerular inflammation

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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

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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

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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

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Glomerulonephritis: diagnostics

Urinalysis: erythrocytes, proteins

Blood test: inflammatory markers, low GFR, low serum albumin, elevated urea/antibodies

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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