- purulent or chronic infection can lead to scar tissue formation over a calyx- loss of tubule funcction, hydronephrosis- obstruction, dilated area filled with urine- necrosis, eventual chronic renal failure if untreated
- signs are simialr to those of cystitis
What are some UT inflammatory disorders?
- nephrotic syndrome (nephrosis)
What is glomerulonephritis?
- UT inflam
- can be acute post streptococcal glomerulonephritis (APSGN)
- develop 2-10 days after initial infection
-inflammatory response in the glomerulus- increase cap permeability, cell proliferation, swelling - congestion- decrease GFR and retention of waste and fluid
What is the development of APSGN?
Changes in the nephron
What is nephrotic syndrome (nephrosis)?
- UT inflam disorder
- nonspecific disorders in which the kidneys are damaged ( abnormality in the glomerular capillaries)
- maybe secondary to a number of renal diseases, as well as systemic disorders: systemic lupus erythematosus (SLE), exposure to nephrotoxins, drugs
- pathophysiology is not well established but follows a sequence
What is the pathophysiology of nephrotic syndrome?
- increased glomerular permeability- leakage of large amounts of protein from the blodd into the urine- serum hypoalbuminemia, low plasma osmotic pressure, generalised edema
- blood pressure remains low (hypovolemia) or normal- may be elevated depending on angiotensin 2 levels
- low blood volume increases aldosterone secretion- more severe edema, high blood cholesterol, lipoprotein in urine
What are the signs of nephrotic syndrome?
Massive edema throughout body (anasarca)
ascites, pleural effusion, pitting edma on legs
What is a urinary tract obstruction?
- obstruction in the urinary tract reduces the urinary flow and impair the renal function
- frequent effect of a partial or complete obstructionisa dilation of the renal pelvis- hydronephrosis
- obstructions of the urinary tract are painful and need immediate treatment due to the effect on renal function- reduced GFR
What are the types and location of urinary tract obstruction?
Calculi- in the ureter
Cancer- ovary, cervix, uterus
Congenital pelviuretic junction obstruction- top ureter
Functional: vesicourteruc refulx and neurogenic bladder- between ureter and bladder
Prostatic hypertrophy/ cancer
What are the extrinsic obstructions?
What are intrmural obstructions (in the wall of the ureter)?
- transitional cell cancer
WHat are the intraluminal (in lumen) obstructions of the urteter?
- blood clot
- renal papilla
What is Uroithiasis (calculi)? (formation of stones)
- can develop anywhere in urinary tract
- stones may be small or very large
- tend to form with excessive amounts of solutes in filtrate, insufficient fluid intake- major factor for calculi formation
- urinary tract infection
What is the calculi of the stone composed of?
- calcium salts
- high urine calcium levels (hypercalcemia)
- form readily with highly alkaline urine
What are uric acid stones?
- type of stones
- hyperuricemia (abnormally high levels of urine in the blood)
- gout, high- purine diets, cancer chemotherapy
- especially with acidic urine
Different types of stones
stone formation depends on predisposing factors
What is the composition of the different types of renal calculi?
What is the secondary problem is caused by calculi being located in the kidney or ureter?
- dialation of calyces and atrophy of renal tissue
What is renal colic caused by?
obstruction of the ureter
- intense spasm of pain in flank area- radiates intogroin,lasts until stone passes or is removed
possible nausea and vomiting, cool moist skin, rapid pulse
- radiologic eaxmaination confirms location of calculi
Note stones in kidney or bladder are often asymptomatic
- frequent infections may lead to investigation
- flank pain possinle caused by distention of renal capsule
What are the consequences of a urinary tract obstruction?
- reduced glomerular filtration rate
- reduced renal blood flow (after initial rise)
- impaired renal concentrating ability
- imapired distal tubular function
* nephrogenic diabetes insipidus
* renal salt wasting
* renal tubular acidosis
* impaired potasium concentration
= Chronic renal failure
Where do priamry renal carcinomas arise from?
- tubule epithelium
- more often the renal
What occurs with the progression of renal carinomas?
- tends to symptomatic in early stages
- oftenhas metastasized to liver, lung, bone or central nervous systemattime of diagnosis
- occurs more frequently in males and smokers
- treatment is kidney removal
- immunotherapy may be used in some cases- tumor is radioresistnat and unresponsive to chemotherapy
What are the manifestations of renal cel carinomas like?
- painless initally-either gross or microscopic
- dull, aching flank pain
- palpable mass
- unexplained weight loss
- anemia or erythrocytosis (excessive RBCS)
- paraneoplatic synromes- crushing syndrome
Discuss bladder tumors
- most bladder tumours are malignant and are common form transitional epithelium of the bladder
- often develops as multiple tumours
- tumour is invasive through wall to adj structures- metastasizes to pelvic lymph nosed, liver and bone
- diagnosed by urine cytology and bipsy
What are the early signs of bladder cancer?
- hematuria- blood in urine
- dysuria- painful urination
- infection common
what are predisposing factors for bladder cancer?
- working with chemicals in lab/ industry- analine dyes, rubber, aluminium
- cigarette smoking (50% of cases)
- recurrent infections
- heavy intake of analgesics
Blader cancer and treatment
- surgical resection of tumour
- chemo and radiation
- photoradiation successful in some early cases
What is a Wilms Tumour?
- most common tumour in children
- defects in tumour- supressor genes on chromosome 11- may occur in conjunction with other congenital disorders
- usually unilateral- large encapsulated mass
- pulmonary metastases may be present at diagnosis
What is nephrosclerosis?
- vascular disorders
- involves vascular changes in the kidney- some occur normally with aging
- thickening and hardening of the walls of the arterioles and small arteries
- narrowing of the blood vessel lumen- reduction of blood supply to kidney (ischemia, atrophy), stimulation of renin (increase BP), continued ischemia (destruction of renal tissue and CHRONIC RENAL FAILURE)
How do you treat nephrosclerosis?
-can be primary lesion (developed in kidney) or secondary to essential hypertension
- antihypertensive agents
- beta- blockers
- sodium intake should be reduced
Hypertension and the kidney
What are some congenital disorders?
- vesicoureteral reflux
- ectopic kidney
- horseshoe kidney
What is vesicoureteral reflux?
- defective valve in the bladder
What is agenesis?
- failure of one kidney to develop
What is hypoplasia?
- congenital disorder
- failure to develop to normal size
What is ectopic kidney?
- kidney and ureter displaced out of normal position
- congenital disorder
Whta is horseshoe kidney?
- congenital disorders
- fusion of the two kidneys
What is adult polycystic kidney?
- autosonal dominant gene on chromosome 16
- no indications in child and young adults
- first manifestations usually around age 40
- multiple cysts develop in both kidneys: enlargement of kidneys, compression and destruction of kdney tissue, CHRONIC RENAL FAILURE
- diagnosis by CT
What is acute renal failure due to?
- acute bilateral kidney diseases
- severe, prolonged circulatrory shock or heart failure