Urinary system pathologies Flashcards
Urinary Tract infections
(UTI)
- Infection and inflammation of the urinary tract. UTI’s can affect any part of the urinary tract.
(Most common location of UTI is the bladder=cystitis, & also the kidneys))
Causes:
* Microbial infection (often bacterial)
* Increases with age
* More common in women
Signs and symptoms:
* Dysuria
* Frequent urination
* Nocturia
* Cloudy and smelly urine
* Suprapubic pain (cystitis)
* Loin pain (kidney infection)
* Hematuria
* Nausea
* Confusion
Diagnosis:
* Urine dipstick; Nitrates, Leukocytes & erythrocytes
Cystitis
(UTI)
- Infection of bladder (a type of UTI)
Can be divided into acute or chronic causes.
Cyst – bladder, itis – inflammation)
Causes: * More common in women (urethra shorter & closer to anus)
* E.coli – 75% of cystitis (bacteria from the intestinal flora)
* Bacteria being pushed into the urethra; sexual activity - ‘Honeymoon cystitis’, wiping back to front, catheterisation
* Post-menopausal (thinned lining)
* Diabetes mellitus (extra glucose in bladder will feed any E-coli & allow to grow / colonise)
* Chronic cystitis is common in older men with an enlarged prostate – it obstructs urine flow causing bladder urine stasis
Signs and symptoms:
* Pain in lower back / abdomen
* Dysuria & frequent / urgent need to urinate but only passing small amounts (oliguria)
* Dark smelly / cloudy urine
* Systemic signs – malaise, nausea, fever
Diagnosis:
* Dipstick; Nitrates, leucocytes & erythrocytes
* Urine microscopy; significant bacteriuria
Allopathic treatment: * Antibiotics (adverse effects)
Pyelonephritis
(Kidney infection)
A microbial infection of the renal pelvis & medulla
- Renal pelvis & calyces fill with purulent exudate
Causes:
* Infection spreading up from the bladder (i.e. E.coli) or (more rarely) through the blood
* Diabetes mellitus
* Immunocompromised patients
* Obstructed flow of urine (enlarged prostate, kidney stones)
* Pregnancy
* Gout
Signs and symptoms:
* Loin pain & tenderness (often unilateral)
* Dysuria & increased frequent urgency
* Haematuria & cloudy / foul smelling urine
* Fever, nausea, vomiting, malaise, fatigue
Diagnosis:
* Dipstick urinalysis; Nitrates, erythrocytes, leukocytes, protein
* Urine microscopy; Bacteria, urinary casts (of blood or epithelial cells), blood cells & protein
* Blood; increased inflammatory markers (ESR) & WBCs
* Imaging; ultrasound
Complications:
* Repeated episodes of ‘acute pyelonephritis’ are common and can lead to ‘chronic pyelonephritis’
Glomerulonephritis
An immune-mediated disease that causes glomerular inflammation
Pathophysiology:
* Autoimmune reaction (type III hypersensitivity) – whereby antigen-antibody immune complexes are formed in response to infection
* These immune complexes are deposited in the glomeruli where they trigger an immune response, which leads to leaky capillaries and leukocyte proliferation, allowing proteins and erythrocytes to escape into urine
Causes:
* Divided into primary (when no associated disease elsewhere) or secondary (when glomerular involvement is part of a systemic disease; e.g. SLE)
* Autoimmune; immune-mediated injury to the glomeruli. Often occurs one to three weeks after a bacterial infection (often from upper respiratory tract)
* In children, post-streptococcal glomerulonephritis is common
Signs and symptoms:
* Asymptomatic haematuria and / or proteinuria causing cloudy / frothy urine
* Back pain due to glomerular inflammation
* Fluid retention; peripheral and facial oedema
* Oliguria
* Hypertension (due to ‘glomerulosclerosis’: scarring & fibrosis of glomerular capillaries reduces renal blood flow and GFR resulting in an increase in renin)
* Fatigue, headaches, fever, nausea
Diagnosis:
* Urinalysis: Erythrocytes & protein
* Blood; Elevated ESR & CRP, GFR (low), Serum albumin low, Elevated serum urea, Antibodies
Allopathic treatment:
* Corticosteroids, Antibiotics, Diuretics
Other:
* The kidneys are involved symmetrically, but there may be minimal, focal or diffuse involvement.
Nephrotic syndrome
A collection of signs and symptoms associated with increased glomerular permeability (leaking) & heavy proteinuria
Causes:
* Glomerulonephritis
* Diabetic glomerulosclerosis
* Systemic Lupus Erythematosus
* Infections (HIV, malaria, hepatitis, etc.)
* Drugs (NSAIDs)
Signs and symptoms:
* Characterised by;
* Proteinuria
* Hypoalbuminemia
* Oedema (the loss of plasma proteins leads to low plasma osmotic pressure, so fluid moves out of capillaries into tissues)
Diabetic Kidney
(Nephropathy)
Kidney damage caused by Diabetes
Pathophysiology:
* Diabetes mellitus elevates BP
* Glomerulosclerosis occurs as a result of the increased intra-glomerular pressure. The kidneys are often enlarged (different to other pathologies)
* Glomeruli become damaged and proteins leak (microalbuminuria) = nephrotic syndrome
Causes:
* Diabetes (type 1 & 2) - 40% of diabetes develop diabetic nephropathy
* Hyperglycemia
Signs and symptoms:
* Initially none
* Fatigue
* Nausea
* Vomiting
* Pallor
* Oedema
Complications:
* Renal failure is the cause of death in 10% of diabetes
Renal Calculi
(Kidney stones)
Hard deposits made of mineral and salts that form inside your kidneys
(most commonly made of calcium oxalate & phosphate (80%), other types include uric acid & magnesium stones)
Causes:
* Dehydration (increased solute concentration)
* Hypercalcaemia (e.g. hyperparathyroidism)
* Gout (hyperuricaemia)
* Renal anatomical anomalies
Signs and symptoms:
* Often asymptomatic
* Severe loin pain, radiating to the groin (ureteric colic)
* Trace of blood in the urine (on dipstick test)
* Nausea, vomiting, fever
Allopathic treatment:
* NSAIDs.
* Drink lots of fluids
* Shockwave therapy or Surgery (>6mm only 1% can pass)
* Avoid oxalate-rich food (rhubarb, spinach, cocoa)
* Avoid calcium
Other:
* 2% of the population have kidney stones
* Men are commonly affected (3:1)
* Stones may stay in position (can obstruct urine outflow) or migrate down the urinary tract, producing symptoms en route
