Flashcards in Renal Therapeutics 4: Kidney disorders Deck (31):
What is a urinary tract obstruction and how is it split?
1. One of the tubes being blocked
2. Split into upper UTO (ureteric stones)
and lower UTO (prostatic hypertrophy)
Describe the process of acute urinary tract obstruction?
1. Obstruction in ureter or above (stone)
2. Fluid accumulation in renal pelvis
3. Leads to a raise in hydrostatic pressure
4. Reduced GFR
5. Filteration is continuous
6. Increased intra renal pressure
7. Dilatation and stasis
What can acute urinary tract absorption lead to and how can provide relief of it?
1. Can lead to infections and in addition stone formation
2. Getting rid of obstruction prompts relief and complete restoration may be followed by massive diuresis
3. Doing it quickly protects nephrons
What diagnostic tool can you use to see what the kidney looks like?
IVU scan to see what the kidney system looks like
Describe the process of chronic partial urinary tract obstruction? And how it is caused?
1. Incompetence of valve between bladder and ureter
2. Chronic renal inflammation and infection
3. Lower UTO caused by bladder cancer, bladder neck obstruction or benign (gradual increase) or malignant prostatic hypertrophy
4. Reflux nephropathy progresses to chronic kidney disease in adulthood
What are the most common causes of UTO?
1. Renal calculi leads to calcium oxalate build up which can lead to a build up of kidney stones due to problems with ureter
2. Neuromuscular can cause obstruction and blockages which lead to build up of liquid
3. Structural can result in abnormal shape
4. Abnormal mass of child can put pressure on system surrounding the child
What are some of the symptoms of UTO that occur below the bladder?
Hesitancy, frequency, nocturia (pissing at night), terminal dribbling or bladder discomfort occur (voiding and storage problems)
What are some of the symptoms of UTO that occur above the bladder (stones)?
1. Renal colic- liquid backing up into the kidneys causing damage
- this is associated with ureteric obstruction
What is chronic reflux nephropathy and how is it caused?
1. When urine flows back into the kidney due to valve defect which lead to ureters swelling
2. Can cause hypertension and renal infection
How do you manage reflux nephropathy?
2. Conservative treatment that's non invasive
3. Such as Electrohydraulic shock wave and laser shattering of stones
What is renal calculi and how is it based on diet?
1. Renal stone disease
2. Rich in animal proteins, intake of refined sugar, salt, oxalate rich food
3. Low intake of fluid, high ambient temperatures enhance risk of renal stone formation
What are the types of stones that can be produced and how?
1. Calcium oxalate stone
- formed from hypercalciuria or excessive GI absorption of oxalate + alkaline urine
2. Cystine stones
- Metabolic disorder with reduced tubular reabsorption of cystine
3. Infection stones
- Calcium oxalate or calcium phosphate
What are the causes of the formation of stones?
1. The stones are insoluble in urine (calcium oxalate)
2. The stones form in different urine environments:
- Cystine and uric acid stones are soluble in alkali
- Calcium phosphate & Magnesium Ammonium Phosphate soluble in acids
3. Low urine volume forms uric acid stones and calcium stones
4. Infections cause Magnesium Ammonium Phospate
5. Drugs or metabolites sometimes create stones
What are the symptoms and signs of having kidney stones?
1. Sudden or gradual renal colic
2. Inability to lie down as there's a lot of pain
3. Nausea and vomiting
How do you investigate kidney stones?
1. Urinanalysis test (presence of blood?)
2. Imaging: Kidney ureter bladder X ray
4. Intravenous urogram (IVU)
5. Computed tomography
How do you treat the pain symptoms of kidney stones?
Pain: NSAID (diclofenac 100mg suppository)
- Opiates before hand
- Can cause worsening of any pre-exisiting renal impairment
How do you treat and manage the treatment of kidney stones without surgery?
1. Small stones: Ample fluid intake (flush it out)
2. Penicillamine: dissolve cystine stones
3. Oxalate stones: Dietary calcium restricted, thiazides used (reduce urinary calcium and increase urine flow)
4. Ultrasonic disruption of bigger stones- break it and flood it out with water
How do you treat and manage the treatment of kidney stones with surgery?
1. A scope is placed up the ureta and it mechanically breaks up the proximal ureteric stones by a process called ureterorenoscopy
2. Distal ureteric stones usually pass spontaneously
3. calcium channel antagonist and α-rezeptor blocker to relax smooth muscle of distal ureter
4. ESWL (extracorporeal shock wave lithotripsy)
How are urinary tract infection normally caused?
1. Bacterial UTI is caused by infection of the bladder (cystitis)
2. More common in women as the urethra is shorter
3. Escherichia Coli (E.Coli) is responsible for most of the bacteria
4. Bacteria enters mostly via the urethra which then enters the blood stream
(organisms from flora are involved)
How do we investigate UTI and what are the symptoms?
1. Microbial tests
2. Sometimes elderly have no symptoms
3. Inflammation and injury are determined by the host response
4. Clinical features and course: acute urethritis/cystitis (burning on urination)
What are the clinical syndromes of UTI?
1. Recurrent UTI due to genetic factors
2. Acute cystitis: increased frequency, urgency, dysuria, microscopic haematuria
3. Acute urethritis: dysuria, sexual transmitted
4. Prostatitis (acute and chronic): fever, malaise, perennial pain, urgency, frequency, dysuria
5. Complicated UTI: renal stones, catheter-associated UTI bacteriuria in pregnancy
How do you manage UTI?
1. General increased fluid intake, oral treatment (potassium citrate solution), cranberry juice
2. This can render the risk of renal damage, symptomatic relief, render urine sterile, prophylactic therapy
How do you manage acute cystitis?
Acute cystitis: 3 day regimens of antibiotics (trimethoprim, oral cephalosporin)
How do you manage prostatitis (inflammation of prostate)?
Lipid soluble antibiotics (like trimethoprim, doxycycline, quinolones) (course of 2-4 weeks)
What are the clinical features of acute pyelonephritis and how do you manage it?
1. Clinical features:
Both kidneys affected it may be caused by intrarenal obstruction with post renal failure
Oral antimicrobial therapy
What is chronic pyelonephritis, how is it caused, and what are the clinical features?
1. Recurrent infections (acute pyelonephritis) that's caused by chronic infection and sterile reflux unclear
2. Renal pelvis may not have natural defence against bacteria
3. Clinical features: Proteinuria, hypertension or UTI
How do you manage chronic pyelonephritis?
Regular monitoring is sufficient in the absence of renal impairment
What is glomerular disease?
Affects both kidneys as glomeruli are sensitive to inflammatory immune damage
What is asymptomatic proteinuria and how is it detected?
1. When protein is too large for filtration
- 500mg protein in 24 hours
- Albumin loss in urine
- Detection by urine
What is polycystic disease and what does it look like?
1. The most common inherited renal disease that's caused via a mutation in the PKD1 gene on chromosome 16
2. Both kidneys are 2 to 3 times enlarged and many fluid fill up the inert cysts (crushes adjacent renal structure)