What is urinary tract obstruction?
an interference w/ the flow of urine at any site along the urinary tract.
What can cause urinary tract obstruction?
anatomic or functional defect
obstructive uropathy most common (anatomic)
Severity of urinary tract obstruction is based on...
-location
-completeness
-involvement of one or both upper urinary tracts
-duration
-cause: stricture/congenital; compression from tumor or inflammation; stone
hydroureter
the distention of the ureter with urine that cannot flow because the ureter is blocked
-proximal to obstruction
hydronephrosis
enlargement of renal pelvis & calyces
obstruction sequelae
7 days: fibrosis of distal nephron
14 days: both proximal & distal nephron
28 days: damage to glomerulus (inability to concentrate urine & conserve Na+ & bicarb ? dehydration ? metabolic acidosis)
60 days: partial kidney recovery
compensatory hypertrophy
other kidney ? in size of glomeruli
-obligatory growth (due to growth hormone)
postobstructive diuresis
A period of brisk urine production when urinary tract obstruction is relieved. 10 liters of urine is excreted within a 24 hr period.
kidney stones
calculi (urinary stones)
-massess of crystals, protein, or other substances that form w/in & may obstruct the urinary tract
-classified accroding to teh minerals comprising the stones (Ca+, Ph+, oxalate, uric acid)
-prevalence: 5% women; 12% men
80% betwe
risk factors for kidney stones
-FLUID INTAKE, gender [male], race [white], geographic location [south], seasonal factors, diet (? protein, ? Ca, ? oxalate [tea], & occupation
kidney stone formation
*supersaturation of one or more salts
-presence of a salt in a higher concntration than the volume able to dissolve the salt 0example: pouring salt in a bucket of water, it will eventualluy accumulate at the bottom)
-stones: calcium oxalate or calcium pho
manifestations of kidney stones
-renal colic: hematuria, flank pain ? groin (obstruction in pelvis/prox ureter)
-lower abdominal pain (mid ureter)
-dysuria (lower ureter)
evaluation of kidney stones
-stone & urine analysis
-intravenous pyelogram (IVP) or kidney, ureter, bladder x-ray (KUB)
-spiral abdominal CT
**
most common - MRI
**
treatment for kidney stones
-high fluid intake, decreasing dietary intake of stone-forming substances
or
-stone removal: endoscopy; laser lithotripsy
What is functional obstruction of lower urinary tract obstruction?
neurogenic bladder (bladder dysfunction to nerve dysfunction) or atonic [flaccid-can't contract] bladder
detrusor hyperreflexia
increased contractile activity of the detrusor muscle of the bladder, resulting in urinary incontinence
-bladder empties automatically when full
-due to stroke, brain tumors, dementia: causes urinary leakage & incontinence (CNS lesion)
detrusor areflexia
-neurogenic bladder
-atonic, flaccid bladder due to distension of bladder (BPH) or peripheral nerve lesion
renal adenomas
-benign tumor, can become malignant
renal cell carcinoma
-RCC: 80% of all Ca's
-cancerous tumor of the kidney in adulthood
-2X more prevalent in men
-? smokers, African-americans
5 YR. SURVIVAL 50% (2% w/ metastasis)
Treatment for renal cell carcinoma
-surgical removal
- +/- chemo/XRT
Bladder tumors
bladder lining made up of transitional cells
transitional cell Ca:
-gross, painless hematuria
-males > 60 year old
-1% of all cancers
What is a Urinary Tract Infection?
-an inflammation of the urinary epithelium caused by bacteria
-most common pathogen of UTI: E. Coli
-virulence of uropathogens: host defense mechanisms important
What is acute cystitis?
-inflammation of the bladder
manifestations of acute cystits
-often assymptomatic
-frequency, dysuria, urgency, & lower abdominal &/or suprapubic pain , hematuria
diagnosis of acute cystits
-urinalysis, culture & sensitivity
treatment for acute cystitis
antimicrobial therapy (3-7 days), increased fluid intake, avoidance of bladder irritants, & urinary analgesics (pyridium) = orange urine
what is interstitial cystits?
nonbacterial cystitis
manifestations of interstitial cystits
-most common in women 20-30 years old
-bladder fullness, frequency, small urine volume, chronic pelvic pain
treatment for interstitial cystits
-no single treatment effective (? steroids); symptoms relief
What is pyelonephritis?
inflammation of the kidney and its pelvis caused by bacterial infection
Acute pyelonephritis
-can occur after instrumentation
-acute infection of the renal pelvis interstitium
-vesicoureteral reflux & urinary obstruction most common underlying factors
-E. coli, proteus, pseudomonas typical organisms
chronic pyelonephritis
-persistant or recurring episodes of acute pyelobephritis that leads to scarring
-risk of chronic pyelonephritis increases in individuals w/ renal infections & some type of obstructive pathologic condition (prostatic hypertrophy)
what is nephrotic sediment?
massive amounts of PROTEIN [& lipids] in the urine
glomerulopathies
disorders that directly affect the glomerulus
What is nephritic sediment?
-blood, WBC's, & CASTS [cylindrical aggregates of particulate matter]
-sediment of chronic glomerular disease has less stuff in the sediment
What is glomerulonephritis?
inflammation of the glomeruli of the kidney
-***immunologic abnormalities (most common)
-drugs & toxins
-vascular disorders
-systemic diseases
-viral causes
-**
most common cause of end-stage renal failure
**
Where is glomerulonephritis?
-diffuse
-local
-segmental (skip-lesions)
How to diagnose glomerulonephritis?
presentation:
-membranous=thickening of wall w/ immune depostis
-sclerotic= glomerular scarring from previous glomerular injury
glomerular disorders
demonstrates a sudden or gradual insidious onset of hypertension, edema, & an elevated blood urea nitrogen (BUN) & plasma creatinine
-decreased glomerular filtration rate: elevated plasma creatinine (reduced creatinine clearance, i.e. not as much filtrate
What does glomerular damage cause?
-a decreased glomerular basement membrane surface area
-decreased glomerular blood flow leading to:
-decreased glomerular hydrostatic pressure
*
ALL OF THE ABOVE CAUSES A DECREASE IN THE GFR (decreased filtrate)
*
2 major ways to have immune related injury to glomerulus...
*mecahnisms of injury (immune related)
1.) deposition of circulating soluble antigen-antibody complexes, often w/ complement fragments
or
2.) formation of antibodies against the glomerular basement membrane
also
3.) streptococcal release of neuramidase wi
What is acute poststreptoccal glomerulonephritis?
inflammation of the glomerli 10 days after strep infection
-commonly affect kids
What is Goodpasture syndrome?
Autoantibodies against alveolar and glomerular basement membrane proteins
-rapidly progressing glomerulonephritis
Chronic glomerulonephrits
-autoimmune: Ag/Ab complexes or anti-GBM antibodies damage capillary wall
-diabetes & lupus are secondary causes
Diagnosis of chronic glomerulonephritis
-hypertension
-edema
-urinalysis w/ protein
-WBC's
-RNC's
-casts
treatment for glomerulonephritis
-antibiotics (due to strep)
-steroids (autoimmune disease)
-anticoagulants
nephrotic syndrome
a condition in which very high levels of protein are lost in the urine and abnormally low levels of protein are present in the blood
-excretion of 3.5g or more of protein in the urine per day
-the protein excretion is caused by glomerular injury: ? capill
Prerenal acute renal failure
-before the kidney
-most common cause of ARF
What causes prerenal acute renal failure?
-impaired renal blood flow
by:
-massive dehydration
-low blood pressure
-massive bleeding
-massive heart attack
-GFR declines because of the decrease in filtration pressure/rate (DETERMINANTS OF FILTRATION PRESSURE: 25% of cardiac output goes to the kidne
intrarenal acute renal failure
renal failure in the kidney due to tubular necrosis
acute tubular necrosis
Name the most common type or cause. � Acute renal failure in the United States
what causes....?
-ischemia of tubules due to bleeding, sepsis, burns. nephrontoxins (x-ray dye, aminoglycoside antibiotics like gentamycin)
-Dx: oliguria/ ? BUN, ? creatinine
postrenal acute renal failure
-post kidney
-develops due to obstruction
-occurs w/ urinary tract obstruction that affect the kidneys bilaterally (? prostate, bilateral ureteral obstruction, bladder neck obstruction)
phases of acute renal failure
-oliguria phase (1-3 weeks): don't make much urine
-diuretic phase (variable): make way too much urine (worry about dehydration)
-recovery phase (3-12 months)
treatment for acute renal failure
-correct fluid & electrolyte imbalances
-treat infections
-maintain nutrition
- ? dialysis (temporary)
mortality rate: 30%
what is chronic renal failure?
-the irreversible loss of renal function that affects nearly all organ systems (months ? years)
-proteinuria & uremia (the syndrome caused by accumulation of nitrogenous waste products from protein metabolism)
-? creatinine & urea clearance (elevation in
stages of chronic renal failure
-chronic renal insufficiency- no symptoms, 25% renal function remains
-chronic renal failure- systemic manifestations
-end-stage renal failure- < 10% renal function left
What can chronic renal failure be a complication of?
-hypertension
-diabetes mellitus
-renal diseases:
1.) chronic glomerulonephritis (most common cause)
2.) chronic pyelonephritis (kidney infection)
3.) obstructive uropathies (prostatic hypertrophy)
What is Uremia?
accumulation in the blood of nitrogen-bearing waste products (urea) that are usually excreted in the urine
-systemic manifestations caused by decline in renal function
What are the alterations of chronic renal failure?
-musculoskeletal
-cardiovascular & pulmonary
-hematologic
-immune
-neurologic
-gastrointestinal (alteration in protein, carbohydrate, & lipid metabolism)
-endocrine & reproduction
-integumentary