pathologies Flashcards
3 things to check urine for
cloudy/clear
sweet/pungent
colour - dark/light
secondary indicators that urinary tract pathology is likely
oedema headaches - (dehydration) exhaustion nausea vomiting - confusion in elderly
7 physical secondary signs of kidney problems
pale (rbcs) puffy face bags under eyes vertical wrinkles bulging veins on temples (renal pressure) swollen hands/fet swellings worse at night (protein loss)
bladder camera op
cytoscopy
typical clinical findings with kidney problems (4)
Anaemia
low K, Na, Ca
High urea
High creatinine
painful, burning urination
dysuria
large quantity of urine
polyuria
little urine
oliguria
no urine
anuria
protein in urine
proteinuria
bacteria in urine
bacteriuria
waking in the night to urinate
nocturia
blood in urine
haematuria
Albumin in urine may indicate
kidney disease - gloerulonephritis
glucose in urine may indicate
diabetes
RBCs in urine may indicate
inflammatory urinary patholgy - eg - nephritis
ketones in urine may indicate
using large amounts fat/protein for energy
bilirubin in urine may indicate
liver pathology
urobilinogen in urine may indicate
liver pathology
haemolytic disease
casts - solid materials in urine may indicate
nephron disease/pyelonephritis
microbes in urine may indicate
infection
1 upper urinary tract pathology
pyelonephritis
3 lower UT pathologies
prostitis
cystitis
urethritis
why UTIs more common in women
shorter urethra, closer to anus
what is urinary tract infection
infection/inflammation of urinary tract - usually urethra
Dysuria frequent urge to urinate day/night cloudy smelly urine suprabubic pain haematuria
Urinary tract infection
cause Urinary tract infection (3)
microbial infection (often from GIT bacteria) urine flow obstruction catheter use
diagnosis UTI
urine dip-stick - nitrates,
blood - RBC, WBC
bladder infection
Cystitis
cystitis more common in older rather than younger men why
enlarged prostste
pain lower back/abdomen
dysuria
frequent urge to urinate but only tiny amount - Oliguria
dark, smelly, cloudy urine
systemic signs - fever, malaise, nausea, fever
acute Cystitis
causes acute cystitis
not emptying bladder fully bacteria in urethra - honeymoon cystitis (pee after sex) wiping back to front urine flow obstruction catheter/diaphragm use enlarged prostate thinned lining (post menopausal) diabetes
diagnosis cystitis
dipstick - bacteria, WBCs, maybe blood
mostly in older men when enlarged prostste obstructs urine flow causing residual urine
chronic Cystitis
collective term for inflammatory disorders of glomeruli
glomerulonephritis
most common disease of the kidneys
glomerulonephritis
back pain - kidneys swell dark cloudy urine - oliguria facial/periorbital oedema - increased blood pressure systemic signs - tiredness, headaches, fever, nausea
acute glomerulonephritis
dark cloudy urine could indicate
proteins & RBCs
facial & perorbital oedema why
Na & water retenyion
diagnosis glomerulonephritis
urine - RBCs, protein
blood - elevated serum urea, creatinine
allopathic treatment glomerulonephritis
strict bed rest few weeks
antibiotics & glucocorticoids
restricted sodium, water, protein consumption
10% of cases become chronic
2-5% fatal - renal failure
complications for -
Glomerulonephritis
chronic glomerulonephritis is
glomerulonephritis not healed after 2-3 weeks
may present with glomerular scarring
nephrotic syndrome
nephritic syndrome
what type of reaction is glomerulonephritis
autoimmune
what does the body form in response to prior infection that can lead to gflomerulonephritis
antigen-antibody immune complexes
where are antigen-antibody immune complexes deposited in lead up to glomerulonephritis
glomeruli - cause damaging immune reaction
leads to leaky capillaries, excessive cell proliferation
glomerulonephritis - 1 kidney involved or symmetrical
symmetrical
in glomerulonephritis damaged kidneys allow what to leak into urine
protein & RBCs
in glomerulonephritis what causes congestion in glomeruli, interfering with filtration process
fibrin deposits, WBC & platelet aggregation
cause glomerulonephritis
auto-immune-mediated injury to glomeruli -
often 1/2 weeks after bacterial infection
often tonsils, sinuses, teeth, respiratory tract
glomerular sclerosis definition
scarring/fibrosis glomerular capillaries
nephrotic syndrome definaition
leaky glomeruli
2 causes glomerular sclerosis
glomerulonephritis
end stage diabetes
causes nephrotic syndrome 5
glomerulonephritis diabetic glomerulsclerosis systemic lupus infections (malaria, hepatitis) drugs traetment
GFR
Glomerular Filration Rate
congestion of glomerular capillaries INHIBITS blood flow, leads to high blood pressure as kidneys produce more renin to increase blood flow and restore proper GFR
gloerular sclerosis
protein(albumin) seeps through leaky glomeruli - albuminaria
loss of plasma proteins = low plasma osmotic pressure & hypotonic capillaries, so fluid leaks into tissues = oedema
also, weight gain, pallor, normal BP, normal blood urea/creatinine
nephrotic sydrome
diabetic microangiopathy
progressive glomerulosclerosis - scarring
diabetic macroangiopathy
atheroma of renal arteries
cause of death in 10% of all diabetics
renal failure
diagnosis diabetuc kidney
albuminaria
initially none, fatigue, nausea, vomiting, itchy skin, metal taste in mouth, heartburn, oedema in limbs/eyelids
diabetic kidney
allopathic traetment diabetic kidney 4
normalise blood sugar levels
ACE inhibitors or angiotensin 2 to reduce blood pressure
low protein diet if kidney function reduced
severe cases dialysis/kidney transplant
Describe acute pyelonephritis 3
Acute microbial infection of renal pelvis & medulla which has usually spread up from bladder
Renal pelvis & calyces fill with purulent exudate
Medulla is inflamed and abscesses/necrosis may be present
Cause acute pyelonephritis
Infection spreading up from bladder Obstructed flow of urine Pregnancy Diabetes Medication abuse Gout
Dysuria & other signs of cystitis
Pain in lower back
Sensitivity to touch in kidney area - often 1 sided
Fever fatigue nausea
Acute pyelonephritis
Diagnosis acute pyelonephritis
Urine - bacteriauria pus heamaturia
Urinary casts consisting if WBCs or renal epithelial cells, maybe protein
Blood - elevated WBCs & ESR
Allopathic treatment acute pyelonephritis
Antibiotics
Strict bed rest
Fluids
Warm packs
Severe cases pus compresses renal artery & vein or obstruct ureter
Recurrent/chronic infections = fibrosis, loss of tubule function
Reoccurrence is common
Infection often remains asymptomaticly in bladder - important to check
Acute pyelonephritis
Prophylactic
Preventative measure
Why can cranberry juice be a useful prophylactic for a UTI
Reduces ability of E Coli to adhere to bladder mucosa
Incompletely healed acute pyelonephritis or recurrent pyelonephritis
Chronic pyelonephritis
Can be undiagnosed for long time,
Headache, tiredness, fever,, mild anaemia, high ESR
Chronic pyelonephritis
Chronic pyelonephritis diagnosis 3
Pus in urine
Bacteria in urine
High ESR
What are renal calculi
Kidney stones
How does arteriosclerosis, associated with hypertension, cause more hypertension
Arteriosclerosis causes decreased blood flow in glomeruli,
which reduces GFR,
Increases renin secretion
Causes further increase in BP
What is renal hypertension
Secondary hypertension, caused by chronic kidney disease
Renal calculi primarily affect
Men
Where can renal calculi occur
In whole urinary tract
What affect do renal calculi have on urine outflow
Can obstruct it
Renal calculi can consist of 4
Utica acid
Calcium
Struvite
Oxalates
Cause struvite renal calculi
Alkaline urine
Cause Uric acid stones in urine
Acid urine
Cause Uric acid crystals in urine
Gout
Cause calcium phosphate stones in urine
Hyperparathyroidism
Other causes kidney stones 3
Dehydration
Infection
Urine obstruction
Asymptomatic often early, maybe blood trace in urine
Later when stone moves, colic pain in kidney area radiating to groin
Nausea, vomiting, rapid pulse
Renal calculi
Lithotripsy
Shockwave or laser therapy for kidney stones
Preventative steps to take if family history of renal calculi
Adjust urine pH through diet
Reduce oxalates & Uric acid
Balance calcium levels
Increase fluid intake
What do diuretic drugs remove from body
Excess sodium & water
How do diuretics work
Lower rate of re absorption of filtrate from kidney tubules so more water and Na is excreted
Complications diuretics
Loss of electrolytes
Muscle weakness/palpitations caused by excessive loss of K & Mg
What is dialysis
Artificial kidney used for acute renal failure
Two types dialysis
Haemodialysis
Peritoneal dialysis
Why is prophylactic use of antibiotics v common with both forms of dialysis
Both carry risk of infection