11. Urinary System - Pathologies Flashcards
Urinary Tract Infection (UTI): definition
Infection and inflammation of the urinary tract
UTIs can affect any part of the urinary tract.
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
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)
Cystitis: signs and symptoms
Pain in lower back/abdomen
Dysuria
Oliguria
Dark, smelly, cloudy urine
Malaise, nausea, fever (systemic)
Cystitis: diagnostics
Dipstick: nitrites, leukocytes, erythrocytes
Urine microscopy: significant bacteriuria
Cystitis: allopathic treatment
Antibiotics
Pyelonephritis: definition
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.
Pyelonephritis: pathophysiology
- 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.
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 (ESR) & WBCs.
Imaging: Ultrasound
Pyelonephritis: complications
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
Broad spectrum 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)
- In children, post-streptococcal glomerulonephritis is common
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
- Fatigue, headaches, fever, nausea
Why is hypertension a symptom in glomerulonephritis ?
Glomerulosclerosis: scarring and fibrosis reduces renal flow and GFR resulting in an increase in renin which stimulates the RAAS
Glomerulonephritis: diagnostics
Urinalysis: erythrocytes, proteins
Blood test: inflammatory markers, low GFR, low serum albumin, elevated urea/creatinine, antibodies
Glomerulonephritis: allopathic treatment
Corticosteroids
Antibiotics
Diuretics
Nephrotic Syndrome: definition
Collection of signs and symptoms associated with increased glomerular permeability (leaking), characterised by proteinuria and hypoalbuminaemia
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 related to diabetes mellitus
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 (microalbuminuria) -> nephrotic syndrome.
Diabetic Kidney (Nephropathy): signs and symptoms
Initially none
Fatigue, nausea, vomiting
Pallor
Oedema
Renal calculi: definition
Also known as Kidney stones; hard mineral and salt deposits that form in the kidneys.
Renal calculi: pathophysiology
- 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.
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?
Sodium
Potassium
Magnesium
Chloride
*Need to be replaced to maintain muscle/nervous system function
Which foods act as diuretics?
Celery
Dandelion
What does renal dialysis do?
Also known as ‘renal replacement therapy’
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.
Filtration of waste occurs using the lining of the abdominal cavity (peritoneum) as a filter.
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
How do diuretics work ?
Diuretics reduce water and sodium re-absorption from the kidney tubules.
