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BioMed S2 R > 11. Urinary System - Pathologies > Flashcards

11. Urinary System - Pathologies Flashcards

1
Q

Urinary Tract Infection (UTI): definition

A

Infection and inflammation of the urinary tract
UTIs can affect any part of the urinary tract.

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2
Q

Who’s more likely to suffer with a UTI?

A

More common in women

Increases with age

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3
Q

Urinary Tract Infection (UTI): signs and symptoms

A 
Dysuria
Frequent urination
Nocturia
Cloudy, smelly urine
Suprapubic pain
Haematuria
Nausea
Confusion
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4
Q

Urinary Tract Infection (UTI): diagnostics

A

Dipstick: nitrites, leukocytes, erythrocytes

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5
Q

Cystitis: definition

A

Infection of the bladder

Can be acute or chronic

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6
Q

Who’s more likely to suffer from cystitis?

A

More common in women

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7
Q

Cystitis: aetiology

A

Bacteria pushed into urethra
75%+ caused by bacteria (E. coli) from intestinal flora

‘Honeymoon cystitis’ (high sexual activity)
Wiping back to front
Catheterisation
Post-menopausal (thinned lining)
Diabetes mellitus
Enlarged prostrate (causes urine stasis, chronic cystitis common in older men)

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8
Q

Cystitis: signs and symptoms

A

Pain in lower back/abdomen
Dysuria
Oliguria
Dark, smelly, cloudy urine
Malaise, nausea, fever (systemic)

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9
Q

Cystitis: diagnostics

A

Dipstick: nitrites, leukocytes, erythrocytes
Urine microscopy: significant bacteriuria

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10
Q

Cystitis: allopathic treatment

A

Antibiotics

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11
Q

Pyelonephritis: definition

A

A microbial infection of the renal pelvis & medulla, often a result of ascending bacterial infection from bladder (i.e. E.coli) or (more rarely) through the blood.

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12
Q

Pyelonephritis: pathophysiology

A
  • Bacteria spreading from bladder to kidneys (in rare occasions spread from the blood)
  • Renal pelvis and calyces fill with purulent exudate
  • Repeated episodes of ‘acute pyelonephritis’ are common and can lead to ‘chronic pyelonephritis’
  • Chronic pyelonephritis can lead to destruction (necrosis) and scarring of renal tissue.
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13
Q

Pyelonephritis: aetiology

A 
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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14
Q

Pyelonephritis: signs and symptoms

A

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

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15
Q

Pyelonephritis: diagnostics

A

Dipstick: nitrites, leukocytes, erythrocytes, proteins

Urine microscopy: bacteria, casts, blood cells, protein

Blood test: ↑Inflammatory markers (ESR) & WBCs.

Imaging: Ultrasound

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16
Q

Pyelonephritis: complications

A

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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17
Q

Pyelonephritis: allopathic treatment

A

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

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18
Q

Glomerulonephritis: definition

A

Autoimmune disease that causes glomerular inflammation

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19
Q

Glomerulonephritis: pathophysiology

A

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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20
Q

Glomerulonephritis: aetiology

A
  • 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)
  • In children, post-streptococcal glomerulonephritis is common
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21
Q

Glomerulonephritis: signs and symptoms

A
  • Asymptomatic haematuria and/or proteinuria
  • Cloudy/frothy urine
  • Back pain (due to glomerular inflammation)
  • Fluid retention - peripheral and facial oedema
  • Oliguria
  • Hypertension
  • Fatigue, headaches, fever, nausea
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22
Q

Why is hypertension a symptom in glomerulonephritis ?

A

Glomerulosclerosis: scarring and fibrosis reduces renal flow and GFR resulting in an increase in renin which stimulates the RAAS

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23
Q

Glomerulonephritis: diagnostics

A

Urinalysis: erythrocytes, proteins

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

24
Q

Glomerulonephritis: allopathic treatment

A

Corticosteroids
Antibiotics
Diuretics

25
Q

Nephrotic Syndrome: definition

A

Collection of signs and symptoms associated with increased glomerular permeability (leaking), characterised by proteinuria and hypoalbuminaemia

26
Q

Nephrotic Syndrome: pathophysiology

A

Loss of plasma proteins leads to low plasma osmotic pressure (hypoalbuminaemia), so fluid moves out of capillaries into tissues = oedema

27
Q

Nephrotic Syndrome: aetiology

A

Glomerulonephritis, diabetic glomerulosclerosis
Systemic Lupus Erythematosus (SLE)
Infections - HIV, malaria, hepatitis
Drugs - NSAIDs

28
Q

Diabetic Kidney (Nephropathy): definition

A

Deterioration of kidney function related to diabetes mellitus

29
Q

What percentage of diabetics are likely to develop nephropathy?

A

40%

30
Q

Diabetic Kidney (Nephropathy): pathophysiology

A

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 (microalbuminuria) -> nephrotic syndrome.

31
Q

Diabetic Kidney (Nephropathy): signs and symptoms

A

Initially none
Fatigue, nausea, vomiting
Pallor
Oedema

32
Q

Renal calculi: definition

A

Also known as Kidney stones; hard mineral and salt deposits that form in the kidneys.

33
Q

Renal calculi: pathophysiology

A
  • Most commonly made of calcium oxalate and phosphate (80%). Other types include uric acid stones and magnesium stones.
  • 2% of the population have kidney stones.
  • Men more commonly affected (3:1).
  • Stones may stay in position (can obstruct urine outflow) or migrate down the urinary tract, producing symptoms on route.
34
Q

Renal calculi: aetiology

A

Dehydration (increased solute concentration)
Hypercalcaemia e.g. hyperparathyroidism
Gout (hyperuricaemia)
Renal anatomical anomalies

35
Q

Renal calculi: signs and symptoms

A

Often asymptomatic
Severe loin pain radiating to the groin (ureteric colic)
Trace of blood in urine (dipstick test)
Nausea, vomiting, fever

36
Q

Renal calculi: allopathic treatment

A 
NSAIDs
Increase fluid intake
Shockwave therapy
Surgery (if bigger than 6mm)
Avoid intake of oxalate rich food - rhubarb, spinach, cocoa
Avoid calcium
37
Q

What are diuretics?

A

Medications which increase loss of sodium and water from the kidneys

38
Q

What are diuretics used to treat?

A

Oedema
Hypertension

39
Q

What are the types of diuretics?

A

Thiazide diuretics
Loop diuretics
Potassium sparing diuretics

40
Q

What do thiazide diuretics do?

A

Act on the DCT

41
Q

What do loop diuretics do?

A

Act on the Loop of Henle

42
Q

What do potassium sparing diuretics do?

A

Act on the collecting ducts

43
Q

What do diuretics cause excess secretion of?

A

Sodium
Potassium
Magnesium
Chloride

*Need to be replaced to maintain muscle/nervous system function

44
Q

Which foods act as diuretics?

A

Celery
Dandelion

45
Q

What does renal dialysis do?

A

Also known as ‘renal replacement therapy’

Mimics the excretory function of kidneys to :
- remove wastes
- balance electrolytes

46
Q

Who needs renal dialysis?

A

Patients in renal failure

47
Q

Types of renal dialysis

A

Haemodialysis
Peritoneal dialysis

48
Q

What does renal dialysis increase the risk of?

A

Infection so often antibiotics are given

49
Q

What is haemodialysis?

A

Removing waste products (urea, creatinine) and water from blood

50
Q

Where is haemodialysis used?

A

Usually in hospital but can be out-patient

51
Q

How often is haemodialysis used?

A

Usually 3 times a week

3-4 hours each session

52
Q

What is peritoneal dialysis?

A

Uses the peritoneum’s structure as a highly semi-permeable membrane to allow for the diffusion of fluids and dissolved substances

53
Q

How does peritoneal dialysis work?

A

A tube is inserted into the abdomen which administers dialysis fluid.
Filtration of waste occurs using the lining of the abdominal cavity (peritoneum) as a filter.
Removal occurs via a shunt

54
Q

Where is peritoneal dialysis used?

A

Often administered at home

55
Q

How long does peritoneal dialysis take?

A

Longer than haemodialysis but often more comfortable

56
Q

What does peritoneal dialysis increase risk of?

A

Peritonitis at site of tube exit

57
Q

How do diuretics work ?

A

Diuretics reduce water and sodium re-absorption from the kidney tubules.

BioMed S2 R (34 decks)

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