Urinary Pathologies Flashcards
What are some urinary pathologies?
Duplex /horseshoe (normal variants)
Renal calculus
Hydronephrosis
Neoplasms (renal cell and bladder carcinoma)
Renal failure
Cysts
Polycystic
Urethral stricture/ fistula
Urinary tract infection (UTI)
Bladder function
What is a duplex?
Duplex or double ureters are existing from either one or both (uni or bilateral) kidney(s) and extending to the bladder that has been opened
What is the prevalence of duplex?
A partial or complete duplication of one or both ureters occurs in about 1 in 150 persons
Most are asymptomatic
What are the potential problems associated with a duplex of the ureters?
There is a potential for obstructive, infective problems due to the abnormal flow of urine and the entrance of 2 ureters into the bladder in close proximity, but most of the time this is an incidental finding
What is a horseshoe kidney pathology?
It is a congenital abnormality, the Horseshoe kidney refers to the appearance of the fused kidney which results from fusion at 1 pole
What is the prevalence of a horseshoe kidney?
In more than 90% of cases, fusion occurs along the lower pole approximately 1/3 asymptomatic (unless pathology presents)
What is the incidence of a horseshoe kidney?
1 in 400- 800 live births more likely in men than women
For up to 66% can lead to higher rates of hydronephrosis, kidney stones, and UTIs
What is a renal calculi (nephrolithiasis)
Kidney stones are usually formed following a buildup of a substance in the body such as: calcium, ammonia, uric acid (a waste product that is produced when the body breaks down food to use as energy), cystine (an amino acid that helps build protein)
What is the clinical presentation of a renal calculi?
Blood in the urine (frank or microscopic)
Renal colic (severe pain and flank)
Pain or difficulty in urination
Patients may be pale, vomiting, or have a fever
What other medical conditions can increase the risk of developing kidney stones?
Cancer or kidney disease, this is usually due to the treatments from these conditions and can have a higher risk with Crohn’s disease can cause obstruction and lead to hydronephrosis
What is the radiographic appearances of a renal calculi?
80% are radiopaque on X-ray
5-10% (uric acid) are radiolucent on x-ray but visible on CT/ US
What do most of the stones consist of?
Calcium oxalate
What is the main cause of 80% of the calcium salts?
Dehydration
Where does most caculi originate from?
The kidney and then travel down the ureter, can grow further
What does the level of pain depend on?
It depends on a degree and level of obstruction
What is the incidence and prevalence of a renal calculi?
More common in male than female (approximately 3 times more)
Most common age range is 20 to 49 years
Family member history increases risks
80-85% approximately will pass spontaneously
What is a staghorn calculus?
Upper urinary tract stone which include renal pelvis and at least 2 calyces
75% are sttuvite-carbonate-apatite
What is struvite caused by?
Infection (bacterial/ fungal) with alkaline urine and presence of ammonia
Most a relatively asymptomatic blocks flow of urine and normally associated with chronic UTIs
What is hydronephrosis?
Dilation of the renal pelvis due to the build up of urine
How does hydronephrosis occur?
The urine collection system of the kidney becomes stretched and distended because of an obstruction to the free outflow of urine from the kidney down the ureter to the bladder
What is the result of hydronephrosis?
Secondary changes can occur in the kidney including a deterioration in renal function
The obstruction may be at any level, but is most common at the pelvis of the kidney
What are the symptoms and causes of hydronephrosis?
It is more common during pregnancy and usually due to the blockage of the urinary system
Symptoms: renal colic, renal stones, infection in urinary system, malignancy in urinary system
What is a treatment option for hydronephrosis?
Removal of stone /swelling and /or stent for treatment
What can stagnation lead to?
Infection
Scarring
Sepsis
Stone formation
For women it can also cause gynecologic cancer
For men obstruction can be due to an enlarged prostate gland and /or prostrate cancer
What is the prevalence of hydronephrosis?
Men over 60 have higher rates of hydronephrosis than women
What is a neoplasm?
A renal cell carcinoma (RCC) and its the most common type of renal cancer
What are the symptoms of neoplasms?
Fever
Weight loss
Hypertension
Night sweats
Hypoglycemia
Malaise
What is the incidence of neoplasms?
Can be sporadic or hereditary and 90% are symptom free
What are the risk factors of the neoplasms?
Male
Smoking
Increased age
Obesity
Hypertension
How is neoplasm staged?
With the use of TNM (tumour nodes metastases)
What is the most common type of neoplasm in the bladder?
Transactional cell carcinoma (TCC)
What are the clinical signs of a neoplasm?
Painless haematuria
Dysuria, urgency, frequency of micturition
With progression can experience bony/ pelvic pain, oedema in lower extremities, flank pain
What is the second and most common neoplasm of the bladder?
Squamous cell carcinoma (SCC) of the bladder infiltrating through the bladder wall into the vagina wall
What are some risk factors of a bladder carcinoma?
Exposure to substances such as smoking, some dyes and solvents
What is the prevalence of a bladder carcinoma?
It is most common in 50 to 60 and over years of age and rare under 40
What are the two types of renal failure?
Acute and Chronic
What is meant by acute renal failure?
Sudeb onset
Usually reversible with treatments and has numerous numerous causes
What are some of the causes of acute renal failure?
Reduction in renal arterial supply (shock, trauma)
Urine outflow obstruction (mechanical)
Acute tubular necrosis (ischemia through severe shock or dehydration, medication (NSAIDs), excess paracetamol)
What does acute tubular necrosis lead to?
It can lead to reduced urine production and can solved by:
Oligura (<400ml per day -adults)
Severe oligura (<100ml)
Anuria (none)
Result and systemic effects such as pulmonary oedema
What is meant by chronic renal failure?
Irreversible damage usually slow onset (progresses over years)
Asymptomatic
Affect filtration function and increases urine output
What is the aetiology of chronic renal failure?
Includes diabetes meilitus and hypertension
What what is polycystic kidney disease?
It means multiple cysts in on both kidneys, these cysts grow and multiply over time, also causing the mass of the kidneys to increase
What is the process of polycystic kidney disease?
The diseased kidney shuts down causing end-stage renal disease for which dialysis and transplantation are the only forms of treatment
Is polycystic kidney disease hereditary?
Yes
What are the causes of urethral stricture?
Infection /inflammation
Ischemia
Trauma can result in voiding problems, UTIs, pain
Some can be asymptomatic
Urinary retension can also occur
What are some risk factors of urethral fistula?
Endometriosis
Inflammatory bowel disease
Vesicovaginal
Serious complication from pelvic diseases or surgery
