20-7 (Obstructive Uropathy) Flashcards
Obstructive lesions of the urinary tract increase your risk for what 2 things?
Infection
Stones
If the obstructive lesion in the urinary tract is unrelieved, what will occur?
Permanent renal atrophy
Dilation of the renal pelvis and calyces
Hydronephrosis
With an acute obstruction, what is the likely symptom?
Pain due to distention
– other symptoms based on cause
With a unilateral or partial obstruction, what is the likely symptom?
SILENT
With a bilateral partial obstruction, what is the likely symptom?
Inability to concentrate urine
=> polyuria and nocturia
With a bilateral complete obstruction, what is the likely symptom?
Oliguria or Anuria
– incompatible with life
If the bilateral complete obstruction is removed, what is the post-op symptom?
Diuresis – excreting lots of urine
Oliguria or Anuria is what type of obstruction?
Bilateral complete
Inability to concentrate urine (polyuria and nocturia) is what type of obstruction?
Bilateral partial
Silent (asymptomatic) is what type of obstruction?
Unilateral or partial
What population is more often affected by urolithiasis (stones) and where do most stones arise?
Men 20-30
– Arise in kidney
What are the 4 types of calculi (stones)?
- Calcium oxalate/phosphate
- Magnesium Ammonium phosphate
- Uric acid
- Cystine
What are the 4 types of calculi (stones)?
- Calcium oxalate/phosphate
- Magnesium ammonium phosphate
- Uric acid
- Cystine
What is the main mechanism for how stones arise?
Increased urinary concentration of the stones’ constituents such that it exceeds their solubility
What is the main mechanism for how stones arise?
Increased urinary concentration of the stones’ constituents such that it exceeds their solubility
Besides supersaturation with stone contents, what are some other general causes of stones (4)?
- Changes in urine pH
- Decreased urine volume
- Bacteria present
- Decreased inhibitors of crystal formation in urine
Calcium stones can be due to what types of molecular changes?
Hypercalcemia diseases Hypercalciuria Increased uric acid secretion Hyperoxaluria Hypocitraturia
The main molecular cause of calcium stones is?
Hypercalciuria without hypercalcemia
– Increased intestinal absorption/renal tubular issue
If Hypocitraturia is causing the calcium stones, what are the 2 signs?
Acidosis + diarrhea
How do Magnesium Ammonium Phosphate stones form?
Formed after infections by urea splitting bacteria that convert urea –> ammonia
How do Magnesium Ammonium Phosphate stones form?
Formed after infections by urea splitting bacteria that convert urea –> ammonia
What bacteria are considered urea splitting bacteria?
Proteus
Pseudomonas
Klebsiella
Some Staphylococci
Once bacteria convert urea to ammonia with struvite stones, what does that do to the urine?
Alkaline urine
Describe the size of magnesium ammonium phosphate stones and what is a special kind?
LARGE
- Staghorn stones = occupy renal pelvis
Uric acid stones are common in people with hyperuricemia (gout/leukemia). Although, a majority of people with uric acid stones do not have?
Do NOT have hyperuricemia or increased uric acid secretions!!! (weird)
A majority of people with uric acid stones do NOT have?
Hyperuricemia or increased uric acid secretions
How do the stones look when made of uric acid?
Radiolucent
Defects in renal reabsorption of amino acids will cause what type of stones to form?
Cystine
Calculi can be asymptomatic or cause pain/colic. What will larger stones cause and what are patients with stones at risk for?
Larger stones = hematuria
– Increased risk for superimposed infections
