Urinary System Pathologies Flashcards
What does UTI’s stand for?
Urinary tract infections
What part of the urinary tract do UTI’s affect?
Any part, but most commonly the bladder.
What are UTI’s?
Urinary tract infections. Infection and inflammation of the urinary tract.
Which gender are more likely to get UTI’s and why?
Women, because they have a shorter urethra.
Which bacteria is most commonly associated with UTI’s?
E.Coli (about 75% of cases)
What are the main signs/symptoms of a UTI?
- Painful urination (dysuria)
- More frequent urination
- Nocturia
- Dark/cloudy urine
- Suprapubic pain
- Loin pain
- Nausea
- Haematuria
- Confusion (very common)
- Nitrates. leukocytes & erythrocytes on dipstick test
Which UTI is often indicated by suprapubic pain?
Cystitis
Which UTI is often indicated by loin pain?
Kidney infection
What is cystitis?
Infection of the bladder
What causes cystitis?
Bacteria being pushed into the urethra Wiping back to front Catheterisation More likely in diabetes mellitus (sugar feeds bacteria) Sexual activity Post-menopausal
Why does an enlarged prostate often cause chronic cystitis in older men?
An enlarged prostate can obstruct urine flow, causing bladder urine stasis.
List 3 signs / symptoms of cystitis.
- Pain in lower back / abdomen
- Dysuria - stinging pain
- Urgency to urinate
- Only passing small amounts of urine
- Smelly / cloudy urine
- Systemic symptoms - malaise, nausea, fever
- Suprapubic pain
How would you diagnose cystitis?
- Dipstick test - nitrates, leukocytes & erythrocytes
2. Urine microscopy - significant bacteriuria
How is cystitis treated allopathically?
Antibiotics
What is pyelonephritis?
The medical term for a kidney infection (microbial infection of the renal pelvis and medulla).
What can chronic pyelonephritis (kidney infection) lead to?
Necrosis and scarring of renal tissue and kidney disease.
List 3 causes of pyelonephritis
- Infection (bacterial) spreading up from the bladder
- Diabetes Mellitus
- Immunocompromised patients
- Obstructed flow of urine (enlarged prostate, kidney stones)
- More common in pregnancy
- More common in gout
List 3 signs/symptoms of pyelonephritis
- Dysuria
- Loin pain
- Fever, malaise, fatigue
Are you likely to see proteins in the urine of someone with pyelonephritis?
Yes. As soon as we see proteins in urine, we know that the problem is coming from the kidney(s).
What might you see in a blood test, if pyelonephritis is diagnosed?
Inflammatory markers (raised CRP, ESR, white blood cells)
List some possible complications of pyelonephritis.
- Septicaemia
- Renal access
- Secondary hypertension (increased renin release)
- Chronic kidney disease and renal failure
What is the allopathic treatment for pyelonephritis?
Broad spectrum antibiotics (IV in severe cases)
Strict bed rest and fluids
What is glomerulonephritis?
An autoimmune disease causing glomerular inflammation and increased leakiness of glomerular capillaries. This allows proteins and erythrocytes to escape into the urine.
Name the 2 types of glomerulonephritis
Primary (no associated cause other than AI) and Secondary (part of / as a result of another disease, i.e, lupus)
Which type of bacteria is involved in a throat infection that may precede glomerulonephritis in children?
Streptococcus (Post-streptococcal glomerulonephritis)
List 3 ways in which glomerulonephritis may present in the patient.
- Often asymptomatic
- Haematuria and/or proteinuria (red/frothy urine)
- Back pain
- Oedema
- Hypertension
- Nausea, fever, fatigue
What would urinalysis of a patient with glomerulonephritis reveal?
Erythrocytes and protein in the urine
What would you see in a blood test of a patient with glomerulonephritis?
Raised CRP, ESR
Low GFR (glomerular filtration rate)
Low albumin levels in the blood
High urea and creatinine levels in the blood
Name a kidney pathology where the cause is autoimmune.
Glomerulonephritis
What is the allopathic treatment for glomerulonephritis?
Corticosteroids, antibiotics, diuretics
What is nephrotic syndrome?
A group of conditions / collection of signs and symptoms associated with damaged capillaries in the glomerulus (glomerular permeability), causing them to be very leaky and causing proteinuria.
List 3 symptoms associated with nephrotic syndrome
Glomerular damage
Proteinuria (leaking of proteins)
Hypoalbumiaemia (lack of blood albumin)
Oedema (swelling in tissues due to loss of plasma proteins from blood)
List 3 causes of nephrotic syndrome.
- Glomerulonephritis
- Lupus
- Infections (i.e, HIV, malaria)
- Drugs (i.e, NSAIDs)
- Diabetic nephropathy
What is Nephropathy?
Diabetic kidney disease
What percentage of diabetics will develop diabetic nephropathy?
40%
What is the cause of death in 10% of diabetics?
Renal failure
Why are people with diabetes mellitus more susceptible to nephropathy / kidney diseases?
Because hyperglycaemia elevates blood pressure and damages blood vessels of all sizes, including glomerular capillaries.
Explain what happens (the pathophysiology) in diabetic nephropathy.
- Diabetes Mellitus elevates blood pressure.
- This causes increased intra-glomerular pressure.
- Glomerularsclerosis results, which causes scarring in the capillaries and therefore further increased blood pressure.
- Damaged glomerular capillaries leak proteins out of the blood and into the urine (proteinuria -> Nephrotic syndrome)
- The kidneys are often enlarged
What are the signs and symptoms of diabetic nephropathy?
Initially asymptomatic
Fatigue, nausea, vomitting, pallor, oedema
What is another name for renal calculi?
Kidney stones
What percentage of the population have kidney stones?
2%
What are renal calculi (kidney stones) most commonly made up of?
Calcium minerals
(calcium oxalate or calcium phosphate)
Other kidney stones can involve uric acid and magnesium.
Which gender is more commonly affected by renal calculi?
Males (3:1)
What causes kidney stones?
An imbalance between water and minerals in the blood.
Dehydration, hypercalceamia, low blood volume
Also gout (hyperuricaemia), hyperparathyroidism, kidney structure abnormalities
List 3 signs / symptoms of renal calculi
Often asymptomatic, but:
- Severe loin pain, radiating to the groin when passing down the ureter (ureteric colic)
- Traces of blood in urine (dipstick test)
- Nausea, vomitting and fever
What is the allopathic treatment for renal calculi?
NSAID's Avoid oxalate foods (rhubarb, spinach, cacao, etc) Increased fluid intake Shockwave therapy Surgery
What are diuretics?
Drugs that act on the kidney tubules, to increase the loss of sodium and water.
What conditions might diuretics be prescribed for?
High blood pressure (hypertension), oedema
What is renal dialysis also known as?
Renal replacement therapy
What does renal dialysis do?
Filters the blood and removes waste (renal dialysis takes the place of the kidneys for patients in renal failure, waiting for a kidney transplant)
Name the 2 types of kidney/renal dialysis
Haemodialysis and Peritoneal Dialysis
Why are renal dialysis patients often given long term antibiotics?
Because renal dialysis carries an increased risk of infection
What does peritoneal dialysis involve?
The extraction of waste products through the peritoneum
List 2 benefits and 2 disadvantages of peritoneal dialysis, versus haemodialysis.
Benefit = it can be done at home and is more comfortable Disadvantages = it takes longer than haemodialysis and also has to be done every day.
How often does renal dialysis have to be carried out?
Haemodialysis = 3-4 times per week
Peritoneal dialysis = every day
Peritoneal dialysis carries a risk of which pathology/infection?
Peritonitis
How long does a session of Haemodialysis take and how often does it have to be carried out.
1 session takes 3-4 hours. It usually has to be done 3 times per week.
What is used/administered to prevent blood clotting during haemodialysis?
Anticoagulant drugs
List 1 side effect of haemodialysis
Hypotension (removal of too much water)
What can cause ureteric colic if it passes into the ureter?
A kidney stone / renal calculi
What is the term used to describe an infection of the bladder?
Cystitis
Name a renal disease characterised by antigen-antibody complexes being deposited in the glomerulus
Glomerulonephritis
Name the part of the nephron that absorbs most water.
Proximal convoluted tubule
Name the hormone released by the kidneys that stimulates red blood cell production.
Erythropoietin
Name the group of medications that cause loss of water from the urinary tract.
Diuretics
Which form of renal dialysis uses the abdomen to allow for substance exchange across a semi-permeable membrane?
Peritoneal dialysis
Which substance has a renal threshold of 9 mmol/L, after which it is excreted?
Glucose
What is the functional unit of the kidney?
The nephron
How many nephrons are there per kidney
More than 1 million per kidney
What size are the kidneys?
Each kidney is about the size of a computer mouse
