Obstructive Uropathy
Obstruction caused by an anatomic or functional defect.
Causes of Upper Urinary Tract Obstruction
Stricture, urethral blockage from stone, abdominal inflammation or swelling,
Hydroureter
Dilation of ureter caused by upper urinary tract obstruction.
What happens to urine in hydroureter?
Urine accumulates in the ureter.
Hydronephrosis
Dilation of renal pelvis and calyces caused by proximal obstruction.
Which part of the kidneys are effected first by a urinary tract obstruction?
the Distal/proximal nephron parts.
Which part of the kidneys are effected second by a urinary tract obstruction?
Glomeruli.
What happens to the renal cortex and medulla because of urinary tract obstruction?
Renal cortex and medulla are reduced in size
Kidney Stone
Mass of crystals, protein, that form within and may obstruct urinary tract.
What are risk factors for kidney stone?
Gender, race, geographic location, seasonal factors, fluid intake, diet, and occupation.
Crystallization
The process by which crystals grow from small to larger stones.
Renal Colic
Moderate to severe pain often originating on the flank and radiating to the groin.
What does Renal Colic pain indicate?
Obstruction of renal pelvis or proximal ureter.
What is the goal of kidney stone treatment?
Reduce size of stones formed and prevent new stone formation.
Lithotripsy
Ultrasonic or laser treatment used to fragment stones for excretion of the urine (make stones small enough to pass).
Neurogenic Bladder
General term for Bladder dysfunction
Dyssynergia
Loss of coordinated neuromuscular contraction.
Urge incontinence
Involuntary loss of urine, but there is overwhelming sensation of I have to urinate now. involuntary contractions of detrusor and urination happens.
Stress Incontinence
Loss of urine due to increase in abdominal pressure.
Overflow incontinence
Bladder is overdistended and urination occurs.
Overactive Bladder Syndrome
Detrusor is too weak to empty bladder, resulting in urinary retention with overflow ro stress incontinence.
Underactive Bladder
May result in stress and overflow incontinence.
Obstruction
Resistance to urine flow.
Urethral stricture
Narrowing of the lumen.
One cause of underactive bladder in males?
Enlarged prostate.
Clinical Manifestation of lower urinary tract obstruction.
Frequent day time voiding. Nocturia. Poor force of stream, intermittent stream, urgency, feeling of incomplete bladder emptying.
Postvoid Urine measurement
Evaluation tool for obstruction. Catheterize patient 5-15 minutes after urination to determine if they can completely empty bladder.
Bladder Scanner
Evaluation tool. Can determine height and width of bladder to determine approximation of urine amount.
Uroflowmetry
Evaluation tool. Calculate force of urine stream (milliliters voided per second).
Methods for treating lower urinary tract obstruction
Pharmacotherapy, surgery, urethral dilation, intermittent catheterization (condom catheter for men), urinary diversion.
Renal Adenomas
Benign, encapsulated tumors that are able to be removed through surgery. They can become malignant.
Renal Cell Carcinoma
Adenocarconoma. 5 year survival rate is less than 50%. It is the most common renal tumor.
Adenocarcinoma
Tumor that arises from ductal or glomerular or glandular tissue.
What percent of all renal neoplasms are renal cell carcinoma?
85%
Risk factors for RCC (renal cell carcinoma)
Black races, cigarette smoking, obesity and hypertension. (They are investigating a link between it and estrogen administration).
RCC symptoms
Hematuria, flank pain, palpable mass, weight loss, metastasis (to lungs, lymph nodes, liver, bone, thyroid, CNS).
What percentage of RCC patients have signs and symptoms?
fewer than 10%
Bladder Cancer Risk factors
Dyes, smoking, genetic alterations.
Symptoms of bladder cancer.
Gross painless hematuria, frequency, nocturia, urgency.
Evaluation for bladder cancer.
Urine Cytology (Cells in urine), cytoscopy or tissue biopsy.
Where is bladder cancer known to metastasise to?
Liver, bones and lungs.
Urinary Tract Infection
Inflammation of the urinary epithelium.
What is the cause if a UTI?
bacteria that has been displaced from gut flora.
Where do UTIs occur?
Urethra, prostate, bladder, ureter, kidney.
UTI risk factors
Diabetes, indwelling catheter, urinary tract obstruction, women have higher risk due to shorter urethra and location of the urethra.
Types of UTIs
Acute cystitis, interstitial cystitis, acute pyeelonephritis, and chronic pyelonephritis.
Most common pathogen that causes UTIs
E. coli.
Ureterovesical junction
Closes during bladder contraction to prevent urine reflux.
Acute cystitis
Inflammation of the bladder.
Manifestation of acute cystitis
Frequency, dysurea, urgency and lower suprapubic pain.
Evaluation and treatment of Acute Cystitis
Urine culture and sensitivity. and antimicrobial therapy. Increasing fluid intake and administering urinary analgesics.
When are follow up urine cultures performed?
1 week after antibiotic treatment, and every month for three months
Interstitial Cystitis Manifestations
Negative urine cultures, most common in women 20-30 yo. Causes bladder fullness, frequency, small urine volume, chronic pain.
Pyelonephritis
Infection of renal pelvis. Spread might occur to blood.
Bacteria that can cause pyelonephritis
E. coli, proteus, pseudomonas.
Signs of acute pyelonephritis
Renal Edema and purulent urine.
S&S of acute pyelonephritis
fever, chills and flank pain.
Chronic pyelonephritis
Recurring infection of the kidney that leads to scarring.
Clinical manifestations of chronic pyelonephritis
Hypertension, frequency, dysuria, flank pain, hypercholesterolemia, proteinuria, leads to renal failure.
Glomerulopathies
Disorders that directly affect glomerulus.
Signs and Symptoms of glomerulopathies
Hypertension, edema, and elevated blood urea nitrogen (BUN).