Renal - Lecture 10 Flashcards
Glomerulonephritis
-Inflammation to Glomeruli (tiny filters). Results in Nephrotic (oedema, increase protein urine) or Nephritic (blood urine) syndromes.
Aet: Can results from other diseases
-Infections: Post Streptococcal Glomerulonephritis (most common), 1/52 after recovery of strep throat.
Bacterial endocarditis, Viral- HIV, Hep B, C
-Immune: Lupus
-Vasculitis: Polyarteritis
-Scarring: increased blood pressure, Diabetes
S+S: -Blood urine -Oedema -Increased blood pressure
-Foamy urine (excess protein urine)
-Abd. P -SOB -Fever -Fatigue -Blood vomit/stool
Renal Pathologies
Glomerulonephritis Renal Stones Renal Failure Acute vs. chronic Nephritic vs. Nephrotic Syndrome Urinary Tract Infection Pyelonephritis Cystitis
Kidney stones
Epi: 3;1 M;F, F.H, 35-45yrs
Aet: unknown but increased risk with F.H, Low fluid intake which lowers urine volume & increases urine concentration leading to formation stones, UTIs
path: calcium stones most common type forming when excess calcium in blood. Uric acid stones, people often have Gout with this excess urea. Struvite stones form from magnesium with repeated urinary tract infections.
S+S: Location block dependant
Ureteropelvic junction: mild/severe flank P, no radiation to groin, increase urine urgency, dysuria
In Ureter: Abrupt, severe P, colicky in flank & low abdm. Radiation to testes or vulva region. Nausea, vomit
Bladder: asymptomatic, urine retention
Signs: tachycardia, hypertension, freq positional change, min abd exam findings
Prog: 80-85% stones pass spontaneously, 20% hospitalised
prevention: good fluid intake, less salt & meat, treat underlying health condition
Common presenting complaints
Disorders of micturition Disorders of urine volume Alterations in urine composition Loin/flank pain Oedema Hypertension (due to impairment of the renin-angiotensin system)
Disorder of Micturation
-Frequency with increased volume and causes
Polyuria: increased urine Vol >3L day
Caused by:
-Polydipsia: increased flyuid intake, pathological hypothalamic dysfxn or psychological.
-Decreased ADH secretion or sensitivity (diabetes insipidus)
-Solute Diuresis (increased tubular solute load- glucose in diabetes mellitus)
Disorder of Micturation
-Frequency with poor flow & causes
Freq increase suggests: (poor flow norm accompanies)
- Inflammation (UTI)
- Tumor (Bladder, Prostate cancer)
- Urinary calculi
- Reduced bladder capacity
- from neuromuscular dysfxn of bladder or drugs (caffeine, alcohol)
Disorder of micturation
-Poor flow and causes
Weak flow or stream
Difficulty initiating (hesitancy) or stopping (dribbling)
Indicate: Prostate enlargement, M + W urethral stricture or detrusor M over activity
-can lead to obstructive nephropathy
Disorder of micturation
-Dysuria
P with urination from inflammation
Asooc. with Freq & Urgency
-suggests Cystitis or Urethritis (STD), Perineal or Rectal P = prostatitis
Dysuria Red Flags
Fever
Flank pain or tenderness
Immunocompromised patient
Recurrent episodes (including frequent childhood infections)
Known urinary tract abnormality
Male gender3 x Disorders of Urine Volume and causes
- Polyuria: increased urine Vol >3L day-Polydipsia (increased fluid intake), Decreased ADH secretion or sensitivity (diabetes insipidus), Solute Diuresis.
- Oliguria (urine prod. less than 500mL/Day = Increased urine concentration or urea & Creatinine)- Acute Kidney failure
- Anuria (less than 100ml D) - Renal tract obstruction, vascular catastrophe (renal A occlusion), cortical necrosis, Inflam. glomerulo D.
Haematuria character and causes
May arise from anywhere in urinary tract
-start of urination= Urethral bleeding
-end of urination= bladder or prostate bleeding
commonly caused by: UTI, Prostatitis or urinary calculi
(not all urine discolouration is bleeding= haemoglobin, foods, drugs)
Haematuria Red Flags
suggests significant path:
- Gross haematuria (i.e. significant amounts of blood)
- Persistent microscopic haematuria, especially in older patients
- Age > 50
- Hypertension and oedema
- Systemic symptoms (e.g., fever, night sweats, weight loss)
Renal Pain site & causes
Localised renal P= Acute pyelonephritis
Diaphragm or psoas M irritation= peri renal abscess
Sudden, sever, colicky, radiating to groin scrotum or labia= Acute renal obstruction (chronic obstruction= asymp)
Oedema cause & symptoms
- nephrotic syndrome or reduced excretory fxn = salt & H2o retention
- Fascial & Peri Orbital Oedema= nephrotic syndrome (nearly never occurs in Heart Failure, cirrhosis or advanced Renal Failure)
Uraemia cause and symptoms
Chronic Kidney D, accum nitrogenous wastes leads to uraemic syndrome Anorexia, vomiting, nausea, weight-loss Restless limbs Fatigue/weakness Reduced mental acuity Loss of concentration Pruritus Peripheral dysaesthesia (abnormal sense of touch) Headache Sleep disturbance Abnormal taste Sexual dysfunction
