Urologic and Renal Disorders Flashcards
congenital urologic disorders
renal agenesis
duplications
malposition
renal agenesis
failure of one or both (rare) kidneys to develop
may be bilateral or unilateral
bilateral renal agenesis
both kidneys fail to develop
rare, associated with other congenital anomalies
incompatible with life, typically miscarried
unilateral renal agenesis
only have one kidney bc other failed to develop
common, asymptomatic
other kidney typically enlarges to compensate
duplications of urinary tract
can be complete (formation of extra ureter and renal pelvis) or incomplete (only upper part of excretory system)
malposition
kidney doesn’t migrate out in peritoneum, kidney fusion “horseshoe kidney”
urinary tract infections are typically caused by which organisms
caused by gram- negative bacteria
most common pathogen is E. coli (from lower digestive tract)
these organisms contaminate perianal and genital area and ascend urethra (also from blood, lamp, direct extension)
natural conditions protective against UTI
free urine flow (normal anatomy)
large urine volume (typically flushes it out)
complete bladder emptying (washes it out)
acid urine (so bacteria struggle to grow)
this area is normally sterile
predisposing factors to UTIs
impairing drainage of urine (kink, lrg prostate, stone)
stagnation of urine
injury to mucosa by kidney stones (allowing bacteria to go deeper)
introduction of catheter or instruments to bladder
cystitis and gender
only effects the bladder
women more likely than men to get it (shorter urethra)
sexual intercourse promotes transfer of bacteria
males are more likely to happen to older men nc large prostate interferes with complete bladder emptying
clinical manifestations of UTI/cystitis
during pain on urination
urinate frequently with low volume
no fever or leukocytosis on CBC
UA
urinalysis
compare number of epithelial cells to leukocytes
50-100 ??, 500+ UTI
pyelonephritis
infection of the upper urinary tract caused by
- ascending infection from bladder (ascending pyelo)
- cried to kidney from blood stream (hematogenous)
typically preceded by untreated UTI
main clinical indication of pyelonephritis
UA will show WBC casts
clinical manifestations of pyelonephritis
localized pain and tenderness over infected kidney (flank pain)
responds well to abx
can be chronic and lead to failure
prostatitis
inflammation of the prostate
two types:
- acute bacterial prostatitis
- chronic bacterial prostatitis
likelihood for infection increases with age bc more kinks in urethra
acute bacterial prostatitis
subset of UTI
caused by urethral organisms to invade prostatic duct
acute prostatitis symptoms
similar to UTI
fever, chills
systemic symptoms
perineal or rectal dull achy pain
treatment for acute prostatitis
4+ weeks of Abx (long course)
could result in prostatic abscess
chronic bacterial prostatitis
recurrent prostatitis (low grade, residual colonization)
no abscess here, systemic illness
abx therapy is challenging and long bc meds don’t get in here well
Benign Prostatic Hypertrophy
common, age related, non malignant nodular enlargement of central area of prostate
due to decreased cell death
prostate enlarges and pushes on bladder, applying pressure and causing difficulty voiding
classic symptoms of BPH
wak stream hesitancy frequency noctruia post-void dribbling
treatment of BPH
- alpha-2 blockers
- 5-alpha reductase inhibitors
- surgical
5 alpha reductase inhibitors
finasteride (Proscar)
gradual reduction in size of prostate
blocks affects of androgens on growth
causes atrophy of the prostate gland epithelial cells, reduces the volume by 20-30%
alpha-1 blockers
tamulosin (Flomax)
relax prostate smooth muscle, blocking alpha stimulation
facilitates urine flow acts rapidly
BPH surgical treatment
transurethral prostatectomy (TURP)
removes prostatic tissue
risks sexual dysfunction
renal calculi pre disposing factors
- high [salts] in urine – salts saturates urine causing salts to precipitate and form calculi
- urinary tract infections – reduce solubility of salts in urine
- urinary tract obstruction – causes urine stagnation, promotes stasis and infection
passing renal calculi
passes through ureters to bladder, causes renal colic and hematuria (microscopic or visible)
some become impacted in ureter and need to be removed
staghorn calculus
urinary stones that increase in size to form large branching structures that adopt to contour of pelvis and calyces
massive, grows and fills space, must be surgically removed
manifestations fo renal calculi
colic associated with passage of a stone
obstruction of urinary tract causes hydronephrosis-hydroureter proximal to obstruction
treatment of renal calculi
cystoscopy
shock wave lithotripsy
ureteral stents
cystoscopy
snares and removes stones that are lodged in distal ureter
grab and physically remove kidney stone
shock wave lithotripsy
stones lodge in proximal ureter are broken into fragments that are readily excreted
ureteral stents
increase the size of the ureter below to pass