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Urinary System Diseases

Urinary System Diseases. Introduction to Human Diseases: Chapter 8. Review of Urinary System Anatomy. Kidney Cortex & medulla Glomeruli Calyx & renal pelvis Ureters Urinary bladder Urethra. Polycystic Kidney Disease. Inherited defect of the collecting tubules in renal cortex

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Urinary System Diseases

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  1. Urinary System Diseases Introduction to Human Diseases: Chapter 8

  2. Review of Urinary System Anatomy • Kidney • Cortex & medulla • Glomeruli • Calyx & renal pelvis • Ureters • Urinary bladder • Urethra

  3. Polycystic Kidney Disease • Inherited defect of the collecting tubules in renal cortex • Autosomal dominant (adults) • Autosomal recessive (children) • Leads to bilateral progressive dilation of renal tubules and cyst formation • Slow onset in adulthood (most commonly) • Renal colic & pain, hematuria, HTN, renal failure & dialysis (6-10% all ESRD in US have this disease)

  4. Acute Pyelonephritis • Infection in kidney & renal pelvis • Etiology: • Bacterial most commonly • Usually E. coli • More common in females • Due to shorter urethra • In males, often associated with enlarged prostate

  5. Acute Pyelonephritis • S/S: • Dysuria, urinary frequency, urgency & voiding in small amounts • Abnormal Urinanalysis: • Hematuria, pyuria, bacteria present • Treatment: antibiotics, fluids • Complications: renal scarring, renal failure, sepsis

  6. Acute Glomerulonephritis • Allergic inflammation of glomeruli • Post-streptococcal GN • After strep pharyngitis or other strep URI • Lupus, etc. diseases • Etiology: Ag-Ab complexes become trapped in capillaries of glomeruli (1-2 weeks after original infection)

  7. Acute Glomerulonephritis • S/S • Hematuria, HTN, peripheral edema, oligouria • Urine: • Hematuria, proteinuria • Treatment: • Diuretics, salt restriction, HTN treatment • Usually good prognosis

  8. Nephrotic Syndrome • Massive renal (urinary) protein loss (severe proteinuria) • A glomerular disease due to damage to basement membrane • Etiologies: glomerulonephritis (70-75%), DM, SLE, neoplasms, drugs, toxins, or idiopathic

  9. Nephrotic Syndrome • 70% are less than 5 YOA • Overall mortality is 2-5% • Down from 50% • Due to steroid treatment • S/S: • edema is first sign in 95% of patients • Proteinuria, hyperlidipemia, hypoalbuminemia

  10. End-Stage Renal Disease (ESRD) • Also referred to as: • CRF (chronic renal failure) • CKD (chronic kidney disease) • Progressive loss of ability to excrete urea, creatinine, & other nitrogenous compounds which then accumulate in the blood • ESRD affects virtually every other organ system in some way

  11. ESRD • Increasing incidence since 1989 • Causes: • Vascular diseases • Glomerular diseases, obstructing uropathies • DM, RA, SLE • Drugs, infections • Blood tests begin to show abnormalities after loss of approximately 50% of GFR (glomeruli)

  12. ESRD • Graded as 1 (mildest) to 5 (most severe) • S/S: variable • Early: abnormal labs only • Late: oligouria or anuria, azotemia, peripheral edema, pulmonary edema, weakness, skin changes, anemia, HTN, hyperkalemia • Treatment: HTN treatment, dialysis, transplantation, treatment of anemia, potassium lowering meds

  13. Treatment of ESRD • Peritoneal dialysis • Hemodialysis • Renal transplantation

  14. Acute Tubular Necrosis • Sudden deterioration of renal function due to destruction of tubular segments of kidneys • Usually due to an acute ischemic or toxic event • Trauma, nephrotoxic antibiotics, heavy metals, myoglobinuria, amphotericin, x-ray contrast dye, aminoglycosides, multiple myeloma

  15. Acute Tubular Necrosis (ATN) • S/S: four phases • Onset • Oliguric or anuric phase (longest, 10-14 days) • Diuretic phase • Recovery phase • Treatment: same as for ESRD • Prognosis: variable

  16. Nephrolithiasis • Renal stones, renal calculi, uroliths • 10% lifetime prevalence in US • Males: females 3:1 • Age 20-49 YOA first onset • Associated with hypercalcemia • Most stones are calcium salts • Also uric acid, cystine, struvite

  17. Kidney Stones • S/S: • Sudden onset severe flank or lower quadrant pain, nausea, vomiting, visible hematuria • Pain location changes as stone moves • Once in bladder, stone is asymptomatic • Most pass within 24 hrs spontaneously • Treatment: pain relief, fluids • Complications: obstruction

  18. Hydronephrosis • Distention of renal pelvis and calyces due to urine accumulation • Etiology: physical obstruction of urine outflow • S/S: asymptomatic to flank pain, anuria • Testing: blood testing, UA, CT • Treatment: relief of the obstruction, often surgical

  19. Cystitis & Urethritis • Common lower urinary tract inflammations due to infection (UTI) • Etiology: most commonly E. Coli • Females most commonly affected • S/S: same as kidney infection except no flank pain • Testing and treatment: same as pyelonephritis

  20. Neurogenic Bladder • Malfunction of bladder due to neurological dysfunction • CNS or PNS or ANS • S/S: loss of voluntary control of micturition or altered sensation of bladder fullness • Ranges from bladder overactivity to underactivity

  21. Neurogenic Bladder • Etiologies: • Spinal cord injury, alcoholism, heavy-metal poisonings, DM, hypothyroidism, SLE, MS, dementia, Parkinson’s, etc • Treatment: self catheterization, Crede’s method to empty bladder, treatment of UTI’s

  22. Bladder Tumors • Usually from epithelial layer • Almost always malignant • Severity varies with depth • Etiology: unknown • Mostly males affected • Associated with: • Smoking, chemicals (aniline dyes, etc), chronic cystitis

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