Renal Therapeutics 4: Kidney disorders Flashcards
What is a urinary tract obstruction and how is it split?
- One of the tubes being blocked
- Split into upper UTO (ureteric stones)
and lower UTO (prostatic hypertrophy)
Describe the process of acute urinary tract obstruction?
- Obstruction in ureter or above (stone)
- Fluid accumulation in renal pelvis
- Leads to a raise in hydrostatic pressure
- Reduced GFR
- Filteration is continuous
- Increased intra renal pressure
- Dilatation and stasis
What can acute urinary tract absorption lead to and how can provide relief of it?
- Can lead to infections and in addition stone formation
- Getting rid of obstruction prompts relief and complete restoration may be followed by massive diuresis
- Doing it quickly protects nephrons
What diagnostic tool can you use to see what the kidney looks like?
IVU scan to see what the kidney system looks like
Describe the process of chronic partial urinary tract obstruction? And how it is caused?
- Incompetence of valve between bladder and ureter
- Chronic renal inflammation and infection
- Lower UTO caused by bladder cancer, bladder neck obstruction or benign (gradual increase) or malignant prostatic hypertrophy
- Reflux nephropathy progresses to chronic kidney disease in adulthood
What are the most common causes of UTO?
- Renal calculi leads to calcium oxalate build up which can lead to a build up of kidney stones due to problems with ureter
- Neuromuscular can cause obstruction and blockages which lead to build up of liquid
- Structural can result in abnormal shape
- Abnormal mass of child can put pressure on system surrounding the child
What are some of the symptoms of UTO that occur below the bladder?
Hesitancy, frequency, nocturia (pissing at night), terminal dribbling or bladder discomfort occur (voiding and storage problems)
What are some of the symptoms of UTO that occur above the bladder (stones)?
- Renal colic- liquid backing up into the kidneys causing damage
- this is associated with ureteric obstruction
What is chronic reflux nephropathy and how is it caused?
- When urine flows back into the kidney due to valve defect which lead to ureters swelling
- Can cause hypertension and renal infection
How do you manage reflux nephropathy?
- Surgery
- Conservative treatment that’s non invasive
- Such as Electrohydraulic shock wave and laser shattering of stones
What is renal calculi and how is it based on diet?
- Renal stone disease
- Rich in animal proteins, intake of refined sugar, salt, oxalate rich food
- Low intake of fluid, high ambient temperatures enhance risk of renal stone formation
What are the types of stones that can be produced and how?
- Calcium oxalate stone
- formed from hypercalciuria or excessive GI absorption of oxalate + alkaline urine - Cystine stones
- Metabolic disorder with reduced tubular reabsorption of cystine - Infection stones
- Calcium oxalate or calcium phosphate
What are the causes of the formation of stones?
- The stones are insoluble in urine (calcium oxalate)
- The stones form in different urine environments:
- Cystine and uric acid stones are soluble in alkali
- Calcium phosphate & Magnesium Ammonium Phosphate soluble in acids - Low urine volume forms uric acid stones and calcium stones
- Infections cause Magnesium Ammonium Phospate
- Drugs or metabolites sometimes create stones
What are the symptoms and signs of having kidney stones?
- Sudden or gradual renal colic
- Inability to lie down as there’s a lot of pain
- Nausea and vomiting
How do you investigate kidney stones?
- Urinanalysis test (presence of blood?)
- Imaging: Kidney ureter bladder X ray
- Ultrasound
- Intravenous urogram (IVU)
- Computed tomography