module 8 Flashcards
presence or formation of stones in an organ or in a duct of a body
Lithiasis
formation of kidney stones in the kidney
nephrolithiasis
presence of stones in the urinary tract which can include kidneys,urethers or bladder(urethera)
urolithiasis
uremia forms?
urine stones
it is condition characterized by the swelling or dilation of both of the kidneys due to the accumulation of urine as there will be a blockage of urine.
hydronephrosis
Small, hard Stones (1-3mm);
- Stones have sharp edges
- Radio-Opaque
calcium stones( 80% )
Large Stones (Molds to Renal
Pelvis/Calyces) ʹ Hence Staghorn
Chronic Irritation of Epithelium surrounding
Stone > Squamous Metaplasia
Triple Phosphate/Struvite/ “Staghorn” Stones
15%
may cause flank discomfort, recurrent
infection or persistent hematuria
- may remain asymptomatic for years and
not require treatment
calyx
- tend to cause UPJ obstruction renal pelvis
and one or more calyces
pelvis
- often associated with infection
- infection will not resolve until stone
cleared - may obstruct renal drainage
staghorn calculi
- 5 mm diameter will pass spontaneously in
75% of patients the three narrowest
passage points for upper tract stones
include: UPJ, pelvic brim, UVJ
ureter
Factors promoting stone formation
- stasis (hydronephrosis, congenital
abnormality) - medullary sponge kidney * infection
(struvite stones) - hypercalciuria
- increased oxalate
- increased uric acid
Loss of inhibitory factors
- magnesium (forms soluble complex with
oxalate) - citrate (forms soluble complex with
calcium) - pyrophosphate
- glycoprotein
- Account for 80 - 85% of all stones
- Ca2+ oxalate most common, followed by
Ca2+ phosphate description - grey or brown due to hemosiderin from
bleeding - radiopaque
calcium stones
- Female patients affected twice as often as
male patients - Etiology and pathogenesis
o account for 10% of all stones
o contribute to formation of staghorn
calculi
o consist of triple phosphate (calcium,
magnesium, ammonium)
o due to infection with urea splitting
organisms NH2CONH2 + H2O ––>
2NH3 + CO2
o NH4 alkalinizes urine, thus
decreasing solubility
struvite stones
- Account for 10% of all stones
- Description and diagnosis
o orange colored gravel, needle
shaped crystals
o radiolucent on x-ray
o filling defect on IVP
o Radiopaque on CT scan
o Visualized with ultrasound
Uric Acid Stones
- Autosomal recessive defect in small bowel
mucosal absorption and renal tubular
absorption of dibasic amino acids - Seen in children and young adults
- Aggressive stone disease
- Description
o hexagonal on urinalysis
o yellow, hard
o radiopaque (ground glass)
o staghorn or multiple
o decreased reabsorption of “COLA”
o cystine (insoluble in urine);
ornithine, lysine, arginine (soluble in
urine)
Cystine Stones
- Infection of the renal parenchyma with local
and systemic manifestations of infection - may be classified as uncomplicated or
complicated
Acute Pyelonephritis
in the absence of
conditions predisposing to anatomic
or functional impairment of urine
flow
Uncomplicated Acute Pyelonephritis
occurring in the setting
of renal or ureteric stones,
strictures, prostatic obstruction
(hypertrophy or malignancy),
vesicoureteric reflux, neurogenic
bladder, catheters, DM, sickle-cell
hemoglobinopathies, polycystic
kidney disease, immunosuppression,
and post-renal transplant
Complicated Acute Pyelonephritis
- A form of chronic tubulointerstitial nephritis
of bacterial origin - Cortical scarring, tubulointerstitial damage,
and calyceal deformities seen - May be active (persistent infection) or
inactive (persistent focal sterile scars post-
infection) - Histologically indistinguishable from many
other forms of TIN (severe vesicoureteral
reflux, hypertensive disease, analgesic
nephropathy) - Active chronic pyelonephritis may respond
to antibiotics - Need to rule out TB
Chronic Pyelonephritis
Is patient more than mildly symptomatic or
complicated pyelonephritis in the setting of
stone obstruction a urologic emergency?
true
Another name for Incomplete Glomerular-Membrane Damage
NEPHROTIC SYNDROMES
Another name for complete Glomerular-Membrane Damage
Nephritic Syndromes
- Normal GFR
- +++Polyuria
- ++++ Proteinuria (>3000mg/day: Nephrotic)
o > Granular (Protein) Casts.
o > Edema (Especially Periorbital)
o > Hypercoagulability (Loss of
Antithrombin-III in Urine)
o > Immunocompromise state (Loss of
Ig in Urine)
o Hyperlipidemia (Attempted Hepatic
Compensation for dec. Plasma
Osmolarity) - Serum Creatinine Mildly Elevated
o (Dehydrated due to Polyuria; But
Edematous due to Proteinuria)
NEPHROTIC SYNDROMES
THE Childhood cause of Nephrotic
Syndrome (1-8yrs)
MCD (Minimal Change Disease) / Foot Process
Disease
> 50% of Adult Nephrotic Syndrome
MGN (Membranous Glomerulonephrosis)
- <35% of Adult Nephrotic Syndrome
- Vey similar to MCD but in adults
FSGS (Focal Segmental Glomerulosclerosis)
- Dec GFR
- Oliguria
o > Renal Hypertension
(Hypoperfusion of JG Cells due to
dec GFR)
NEPHRITIC SYNDROMES
THE Childhood cause of Nephritic
Syndrome (3-15yrs)
PSGN (Post-Strep Glomerulonephritis)
THE Adult (15-30yrs)
Cause of Nephritic Syndrome
IgA Nephropathy (Berger’s Disease)
NOT a Separate Disease; ANY
Glomerulonephritis can > RPGN
RPGN (Rapidly Progressive Glomerulonephritis)
Acute Renal Failure
Rapid loss of kidney function͟
Before the Blood Reaches the Kidney
Pre-Renal Renal Failure
The kidney itself is
damaged
- Acute glomerular nephritis
- Tubular diseases e.g., acute tubular necrosis
- Interstitial diseases e.g., auto immune
disorders such as SLE
- Vascular diseases e.g., polyarteritis nodosa
Intra-Renal Renal Failure
Due to outflow obstruction from the
kidneys
Post-Renal Renal Failure
4 Stages of Chronic Renal Failure
Stage 1 = > 90 ml/min GFR (Normal) plus
other signs of renal disease
Stage 2 = 90-60 ml/min GFR
Stage 3 = 60-30 ml/min GFR
Stage 4 = 30-15 ml/min GFR
Stage 5 = <15 ml/min GFR
General Effects/Problems Encountered in
Renal Failure:
o Acid Base Balance
o Electrolyte Balance
o Fluid Balance
o Dec Erythropoiesis
o Renin Angiotensin System > Renal
Hypertension
o Calcium Metabolism
o Uremia
o Dec Urine Output
o Dec Toxin Excretion
Dec U:C
Intra Renal
(Infection/toxin/Ischemia/Hypoxia/)
PATHOLOGIC KIDNEY
Inc U:Cr
EITHER Pre Renal
OR
Post Renal
inc P: CR = Inc Protein in Urine
Proteinuria therefore Daily Creatinine Excretion is Constant
30-300mg Urine Protein:Creatinine Ratio
Microalbuminuria
> 300mg Urine Protein:Creatinine Ratio
Macroalbuminuria/Proteinuria͘͟
> 3000mg Protein:Creatinine Ratio
Nephrotic Syndrome
continuum of progressive
nephron loss and declining renal function
Chronic Renal Failure
a gradual decrease in the functioning of the kidneys
dwindles
