Urinary Pathologies Flashcards
What are the two types of UTI
Lower UTI - •urethritis, cystitis
Upper UTI - •= pyelonephritis
Define UTI?
•Presence of more than 100,000 organisms per ml (105/ml) in a Mid-Stream Urine (MSU)specimen.
What is the incidence for UTI?
Woman
pregnancy
What is the organism responsible fr UTI?
E.Coli
What are the risks for UTI?
Sexual intercorse
pregnancy
changes in the balance of the commensal organism
neonates
diabetes melileus
immunosuppressors
bladder instrumentation
lower urinary tract obstruction
What are the clinical features of Lower UTI?
Urethritis
- dysuria
- Pain during urination
Cystitis
- pain during voiding
- The sensation of a full bladder
Foul smell urine
Hematuria
Fever
In elder: fatigue confusion
WHat is an upper UTI?
•An infection can ascend and cause an acute pyelonephritis if the vesico-ureteric valves are incompetent and/or the bacteria can climb
What is the pathophysiology of upper UTI?
•Spread of the infection further into the kidney an occur via two routes:
- •Directly through the lumen of the collecting tubules
- •Passing from the submucosa of the inflamed calyces into the interstitial tissue
- Organism proliferation incites an acute inflammatory reaction
- Abscess formation is possible and associated with renal damage
Clinical features of Upper UTI?
- Sudden onset of unilateral or bilateral loin pain +/- radiations occurs to the iliac fossa and groin
- Tenderness/guarding are usually present in the renal angle and lumbar region
- Fever, rigors, nausea, vomiting can occur
- Symptoms of the initial cystitis:urinary frequency, dysuria, cloudy, offensive–smelling urine
What is the management for UTI?
Urine test
Antibiotic therapy
PTE education
Address risk factors
What is Nephrolithiasis?
Kidney stones
masses of minerals that cause urinary obstruction
What are the types of renal calculi?
- •75-85% of calculi are composed of calcium oxalate and phosphate
- 5-10% are uric acid stones
- 5% are composed of struvite
- 1% are cystinestones
What are the risk factors for renal calculi?
- Hot weather
- increase sweating
- decrease fluid intake
- Diseases with increase stone forming minerals
- Increased dietary intake of stone forming minerals
- correlation with chronic disease (HBP, obesity, diabetes,)
What is the pathophys for kidney stones?
- deposit of calcium phosphate (rnadal’s plaques)
- plaques move into urinary lumen acting as nuclei for growth
- aggregation of mineral leads to stone
Clinical features of kidney stones?
dull flank pain
pain may radiate to the groin
pain exacerbated by urination
hematuria or stony fragments in urine
renal distention
asymptomatic
What are the complications of renal calculi?
Ureteric impaction: renal colic
- pallor
- sweating
- vomiting
- crying agony
Neoplasia: •Large stones can Irritate the renal epithelium causing metaplasia, and eventually squamous cell carcinoma
What is the ureteric referred pain pattern?
What is the management of kidney stones?
Pain management
reduce the concentration of stone-forming substances
removal of stone
- ureteroscopy
- lithotripsy - laser
What is chronic kidney disease?
The decline in kidney function
69-80 mild
<15 = kidney failure
Aetiology of kidney failure?
- Systemic disease: diabetes HBP
- renal disease: kidney stones/ chronic pyelonephritis
Pathophys of kidney disease?
Intact nephron hypothesis
- •Surviving nephrons compensate for damaged nephrons until the advanced stages of CKD
- •These nephrons undergo expansion and are capable of hyperfiltration
Trade off hypothesis
- •The continued loss of functioning nephrons and adaptive hyperfiltration likely results in further nephron injury and ultimately end-stage disease
Pathological processes of CKD
- •Progressive glomerular hypertension, hyperfiltration and hypertrophy
- •Glomerulosclerosis
- •Tubulointersitial inflammation and fibrosis
Clinical features of kidney failure?
MUSCULOSKELETALCHANGES
- •Bone pain,
- increased # risk,
- m. weakness,
- myalgia,
- arthralgia
NEUROLOGICAL CHANGES
- •Peripheral neuropathies (esp. sensory in lower limb)
- •Cognitive or behavioural effects
- Neuromuscular irritation: muscle cramps, twitching
MAnagement for kidney failure?
DIetary management
medication
KIDNEY FAILURE
- dialysis
- renal transplant
What is AKI?
- Sudden decline in kidney function occurring over hours to days
- Results in reduced fluid & electrolyte regulation, waste elimination and acid-base balance
What are the classifications of AKI?
- prerenal: impaired renal blood flow
- intrarenal: nephron damage (infection) - least likely for osteos
- postrenal: urinary tract obstruction
What is Bladder cancer?
Primary cancer that starts in the bladder.
- Transitional cell carcinoma
Risk factors for bladder cancer?
- smoking
- chemicals
- family Hx
What are the clinical features for bladder cancer?
Hematuria
Urinary symptoms
pain
abdominal mass
systemic features
hepatomegaly
What is the most common type of kidney cancer?
renal cell carcinoma
Risk factors for renal cancer?
- male
- smoking
- chronic disease
- chemicals
- Family Hx
Clinical features of kidney cancer?
- haematuria
- flank pain
- abdominal mass
- systemic features
- metastatic disease
