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RENAL DISEASE: RENAL STONES AND UT OBSTRUCTION Pathophysiology of Disease: Chapter 16 (401-404)

RENAL DISEASE: RENAL STONES AND UT OBSTRUCTION Pathophysiology of Disease: Chapter 16 (401-404). Jack DeRuiter, PhD Dept of Pharmacal Sciences April, 2000. Urinary Tract Obstruction: Common Causes (page 402). Obstructions of Ureter, Bladder Outlet or Urethra caused by:

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RENAL DISEASE: RENAL STONES AND UT OBSTRUCTION Pathophysiology of Disease: Chapter 16 (401-404)

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  1. RENAL DISEASE:RENAL STONES AND UT OBSTRUCTIONPathophysiology of Disease: Chapter 16 (401-404) Jack DeRuiter, PhD Dept of Pharmacal Sciences April, 2000

  2. Urinary Tract Obstruction:Common Causes (page 402) Obstructions of Ureter, Bladder Outlet or Urethra caused by: • Structural malformations (Table 16-16) • Inflammation and Trauma • Tumor/Cancer of renal and neighboring structures • Blood clots • Pregnancy • Neuropathy/Spinal Cord Disease • Renal stones

  3. Clinical Presentation: (pages 401-404) • Flank Pain (+/-): • Distention of ureter, renal pelvis or capsule • Severity: proportional to distention • Hematuria • Azotemia: Bilateral Obstruction • Decreased urine production • Anuria: Bilateral obstruction

  4. Etiology (page 402) • Hypercalciuria (75%): Calcium oxalate stone • Heredity (Idiopathic; most common), Neoplasm, Bowel surgery • Struvite Stones (10-15%): Magnesium, Ammonium, Phosphate • UT Infections: Urease-Producing microbes (Proteus) • Hyperusicosuria (5-8%): Uric acid stones • Gout, Heredity, Malignancy, Lesch-Nyhan Syndrome • Cystinuria (1%): Defective amino acid transport

  5. Pathology and Pathogenesis (page 402) • Cause: Nucleation and precipitation of salts in renal structures • Contributing Factors • Dehydration: Less salt “dissolved” • High protein diets: Acidosis and Inc GFR: Ca • High sodium diet: Calcium oxalate • Essential Hypertension: Hypercalciuria • Dietary calcium and oxalate does not enhance likelihood of stone formation in most patients

  6. Preventative/Protective Measures (page 402) • Fluids: Enhanced dissolution of salts • Citrate: chelates Ca to form soluble complex which is excreted • Magnesium: Salt replacement? • Dietary fiber: Indirect Effect?

  7. Treatment and Complications:Pages 403-404 • Stone passage: Fluids, bed rest and analgesia • Treatments (Table 16-17): • Diuretics, urine alkalinization, allopurinol, etc • Complications: • Hydronephrosis/Complete obstruction • Infection or abscess behind obstruction • Renal damage due to repeated stone formation • Hypertension: increased renin production

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