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Biomedicine II > 11. Urinary System Pathologies > Flashcards

11. Urinary System Pathologies Flashcards

1
Q

Urinary Tract Infections (UTIs)

A
  • Infection & inflammation of the urinary tract. UTI’s can affect any part of the urinary tract.
  • More common in women.
  • Increases with age.
  • Microbial infection (often bacterial)
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2
Q

Urinary Tract Infections (UTIs): Signs and Symptoms

A
  • Dysuria, frequent urination, nocturia, cloudy & smelly urine, suprapubic pain.
  • Haematuria, nausea, confusion.
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3
Q

Urinary Tract Infections (UTIs): Diagnosis

A

•Urine dipsticks: Nitrates, leukocytes and erythrocytes

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4
Q

Cystitis

A
  • Infection of the bladder(a type of UTI).
  • Can be divided into acute and chronic causes.
  • More common in women(urethra shorter and closer to anus).
  • 75%+ of cystitis caused by E.coli(bacteria from the intestinal flora).
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5
Q

Cystitis: Causes

A
  • Bacteria being pushed into urethra: ‘Honeymoon cystitis’, wiping back to front, catheterisation.
  • Post-menopausal (thinned lining) & Diabetes mellitus.
  • Chronic cystitis is common in older men with an enlarged prostate. It obstructs urine flow causing bladder urine stasis.
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6
Q

Cystitis: Signs and Symptoms

A
  • Pain in lower back/abdomen.
  • Dysuria& frequent/urgent need to urinate but only passing small amounts (oliguria).
  • Dark, smelly/cloudy urine.
  • Systemic signs -malaise, nausea, fever.
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7
Q

Cystitis: Diagnosis

A
  • Dipstick: Nitrates, leucocytes & erythrocytes.

* Urine microscopy: Significant Bacteriuria.

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8
Q

Cystitis: Allopathic Treatment

A

Antibiotics

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9
Q

Pyelonephritis: Kidney infection

A
  • A microbial infection of the renal pelvis & medulla.
  • Often a result of ascending bacterialspread from bladder (i.e. E.coli) or (more rarely) through the blood.
  • Renal pelvis & 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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10
Q

Pyelonephritis: Causes

A
  • Infection spreading up from the bladder.
  • Diabetes Mellitus.
  • Immunocompromised patients.
  • Obstructed flow of urine (enlarged prostate, kidney stones).
  • Pregnancy.
  • Gout.
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11
Q

Pyelonephritis: Signs and Symptoms

A
  • Loin pain and tenderness (often unilateral).
  • Dysuriaand increased frequent urgency.
  • Haematuria & cloudy/foul smelling urine.
  • Fever, nausea, vomiting, malaise, fatigue.
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12
Q

Pyelonephritis: Diagnosis

A
  • Dipstick urinalysis: Nitrates, erythrocytes, leukocytes, protein.
  • Urine microscopy: Bacteria, urinary casts (of blood or epithelial cells), blood cells and protein.
  • Blood: ↑Inflammatory markers (ESR) & WBCs.
  • Imaging: Ultrasound.
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13
Q

Pyelonephritis: Complications

A
  • Septicaemiaand renal abscess.
  • Secondary hypertension.
  • Chronic pyelonephritiscan lead to chronic kidney disease and renal failure.
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14
Q

Pyelonephritis: Allopathic Treatment

A
  • Strict bed rest, fluids (>2L), warm packs.

* Antibiotics (broad spectrum).

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15
Q

Glomerulonephritis

A

• An immune mediated disease that causes glomerular inflammation.

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16
Q

Glomerulonephritis: Pathophysiology

A
  • Autoimmune reaction (type III hypersensitivity) -whereby antigen–antibody immune complexes are formed in response to infection.
  • These immune complexes are deposited in the glomeruli where they trigger an immune response, which leads to leaky capillaries & leukocyte proliferation, allowing proteins and erythrocytesto escape into urine.
17
Q

Glomerulonephritis: Causes

A

• Divided into Primary (when no associated disease
elsewhere) or Secondary (when glomerular
involvement is part of a systemic disease e.g. SLE).
• Autoimmune: Immune-mediated injury to the
glomeruli. Often occurs 1-3 weeks after a bacterial
infection (often from upper respiratory tract).
• In children, post-streptococcal glomerulonephritis is
common.

18
Q

Glomerulonephritis: Clinical Presentation

A
  • Asymptomatic haematuria and/or proteinuria causing cloudy/frothy urine.
  • Back pain due to glomerular inflammation.
  • Fluid retention: peripheral & facial oedema.
  • Oliguria.
  • Hypertension (Due to ‘Glomerulosclerosis’: Scarring & fibrosis of glomerular capillaries reduces renal blood flow & GFR resulting in an increase in renin).
  • Fatigue, headaches, fever, nausea.
19
Q

Glomerulonephritis: Diagnosis

A
  • Urinalysis: Erythrocytes & protein.

* Blood: Elevated ESR & CRP, GFR (low), serum albumin low. Elevated serum urea, creatinine, antibodies.

20
Q

Glomerulonephritis: Treatment

A

Corticosteroids
Antibiotics
Diuretics

21
Q

Nephrotic Syndrome

A

• A collection of signs and symptoms associated
with increased glomerular permeability (leaky)
and heavy proteinuria.
• Characterised by proteinuria & hypoalbuminaemia.
• The loss of plasma proteins leads to low plasma
osmotic pressure, so fluid moves out of capillaries
into tissues = oedema.

22
Q

Nephrotic Syndrome: Causes

A
  • Glomerulonephritis & Diabetic glomerulosclerosis.
  • Systemic Lupus Erythematosus.
  • Infections (HIV, malaria, hepatitis etc.)
  • Drugs (NSAIDs).
23
Q

Diabetic Kidney (Nephropathy)

A

• 40% of diabetics develop diabetic nephropathy.
• Renal failure is the cause of death in 10% of diabetics.
• Pathogenesis:
Diabetes mellitus elevates blood pressure. Glomerulosclerosisoccurs as a result of the increased intra-glomerular pressure. The kidneys are often enlarged (different to other pathologies).
•Glomeruli become damaged and proteins leak (microalbuminuria) -> nephrotic syndrome.

24
Q

Diabetic Kidney: Signs and Symptoms

A 
Initially none
Fatigue
Nausea
Vomiting
Pallor
Oedema
25
Q

Renal calculi: Kidney Stones

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 migratedown the urinary tract, producing symptoms on route.
26
Q

Kidney Stones: Causes

A

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

27
Q

Kidney Stones: Signs and Symptoms

A
  • Often asymptomatic.
  • Severe loin pain, radiating to the groin (‘ureteric colic’).
  • Trace of blood in the urine(on dipstick test).
  • Nausea, vomiting and fever.
28
Q

Kidney Stones: Treatment

A
  • NSAIDs. Drink lots of fluids, shockwave therapy or surgery.(>6mm only 1% can pass).
  • Avoid intake of oxalate rich food e.g. Rhubarb, spinach, cocoa. Avoid calcium.
29
Q

Diuretics

A

• Medications which Increase loss of sodium and water from the kidneys.
• Diuretics reduce water and sodium re-absorption from the kidney tubules.
• Used for oedema and hypertension.
• Three groups:
Thiazide diuretics (act on DCT)
Loop diuretics (act on loop of Henle)
Potassium sparing diuretics (act on collecting ducts).
• Diuretics cause excessive excretion of potassium, sodium, chloride & magnesium.
• It is essential to replace lost electrolytes. Foods such as celery act as a diuretic.

30
Q

Renal Dialysis

A
  • Renal dialysis is also known as “renal replacement therapy”.
  • Used for patient in renal failure, whereby it mimics excretory function of kidneys to remove wastes/balance electrolytes etc.
  • Two types: Haemodialysis& Peritoneal Dialysis.
  • Both carry increased risk of infection, so often given antibiotics (consider side effects).
31
Q

Peritoneal Dialysis

A
  • Peritoneal dialysis utilises the peritoneum’s structure as a highly vascular semi-permeable membrane, to allow for diffusion of fluids & dissolved substances.
  • A tube is inserted into the abdomen which administers dialysis fluid, through which waste products diffuse into. Removal occurs via a shunt.
  • Often administered at home. Takes longer than haemodialysis but is often more comfortable.
  • Excess water can be removed by changing dialysis solution.
  • Significant risk of peritonitis at site of tube exit.
32
Q

Haemodialysis

A
  • Removing waste products (e.g. urea, creatinine) and water from blood.
  • Usually in hospital but can be outpatient. Usually require 3 times a week, 3-4 hours each.
  • Anticoagulants are used to prevent blood clotting.
  • Side effects include hypotension (removal of too much fluid).

Biomedicine II (16 decks)

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