renal calculi

Neurogenic bladder

tumors

prostatic hypertrophy

strictures of ureters or urethra

1. calcium

2 types: calcium oxalate & calcium phosphate

smallest of kidney stones; most common

seen more frequently in middle-aged men

2. struvite

most common in women because of their
      increased risk for UTI

are called infection stones

display staghorn formation

3. uric acid-- gout

4. cystine-- cystinuria is a genetic disease characterized by excessive urinary cystine extretion

hallmark: sudden-onset renal colic pain

gross or microscopic hematuria

Nausea, vomiting, urgency, dysuria

1. high solute concentration

2. low urine volume

3. altered urine pH

-alkaline --struvite and Ca.phosphate stone formation

-acidic- Ca.oxalate, uric acid, and cystine stone formation

any type of urinary incontinece caused by CNS lesions or lesions of the nerves supplying the bladder

is a functional obstruction; depending on the type of damage, it will either cause incontinence or retention with overflow leakage

most common type of renal neoplasm (90%)

manifests with classic triad:

hematuria

flank pain

palable flank or abdominal mass

lungs

liver

lymph nodes

bone

most bladder cancers arise from transitional epithelium lining the urinary tract;

predisposing factors:

occupational exposure to carcinogenic chemicals

chronic UTI, and cigarrette smoking

primary manifestation= hematuria

also- frequency, urgency, dysuria

Uncomplicated UTI- infection in an individual who is otherwise perfectly healthy and has a normal urinary system

Complicated UTI- infection in somone who has an abnormal immune system or another condition that compromises their immune system and responsiveness to treatment

Inflammation of the bladder; a lower UTI
bladder is the most common site for UTI

most cases result from bacterial invasion from the urethra; Diagnosis is based on urinalysis (w/ E.Coli being most common causative agent)

Triad: frequency, urgency, dysuria(painful discharge/burning upon urination)

suprapubic pain

Urethral syndrome: acute form of nonbact. cystitis; UTI symptoms without evidence of bacterial infection

Symptoms= frequency, urgency, dysuria, dyspareunia; occurs mostly in women

Interstitial Cystitis: chronic; S&S= frequency, urgency, pain on bladder filling; occurs mostly in women; Antiproliferative Factor is in the urine of people w/ IC; APF blocks the growth of cells lining the bladder wall

Inflammation of the renal pelvis and interstitium;

usually d/t ascending UTI; women > men

most common causative agents: pseudomonas, E. Coli, Proteus

risk factors: vasicourethral reflux; urinary obstruction

renal tubules are the primary renal tissue affected; glomeruli are not affected; does not usually lead to renal failure

hallmark= costovertebral angle tenderness on palpation

sudden onset of fever and chills

flank/groin pain

common triad: frequency, urgency, dysuria

need a urine culture to distinguish from bladder infection

presence of WBC casts in urine indicate upper bladder infection as upposed to bladder infection

chronic/recurrent kidney infection with scarring and inflammation of the kidney; 2nd leading cause of chronic renal disease

ongoing inflammation -->fibrosis and scarring with loss of functional nephrons

ultrasonography/IVP shows a small kidney with characteristic clubbing of affected calyces

result from alterations in the structure and function of the glomerular circulation; damage is mediated by the immune process but is not r/t infection; involve inflammatory processes

basement membrane damage causes:

hematuria

proteinuria

RBC casts

Decreased GFR

Glomerular damage causes a decrease in GFR d/t

-Decreased glomerular membrane surface area

-Decreased glomerular capillary BF and

-Decreased glomerular capillary hydrostatic pressure

inflammation of the glomerulus

three types:

1. acute: postinfectious disease

2. rapidly progressive: cause is often unknown; may be secondar to other diseases

3. chronic: autoimmune processes

hypoalbuminemia

hyperlipidemia

hypercoagulability

lipiduria

altered immunity

edema

A collection of symptoms caused by glomerular disease

involves increased glomerular permeability and protein leakage in urine of 3.5 g/day

Sudden loss of renal function; usually reversible

may be intrarenal, prerenal, or postrenal

anuria= urine output <50 mL/ day

oliguria= urine output <400 mL/day or <30 mL/hr

Azotemia= usually caused by renal failure or insufficiency and is the buildup of nitrogenous wastes in the blood  (specifically BUN)

Uremia= the clinical manifestations associated with azotemia; usually associated with renal failure; is known as the syndrome of renal failure

Renal insufficiency

vs.

Renal failure

renal insufficiency is a decline in renal function to about 25% of normal or to a GFR of 25-30 mL/min; levels of creatinine and urea are slightly elevated

renal failure is a significant loss of renal function; When less that 10% of renal functioning remains, disease is considered as end-stage renal failure

most common cause of acute renal failure;

all causes of prerenal failure involve a decrease in renal perfusion

1. Hypovolemia

    a. water and electrolyte loss

    b. hemorrhage

2. Hypotension

    a. septic shock

    b. cardiac failure

    c. pulmonary embolism

    d. interruption of renal artery flow

causes most severe deviation from normal renal function; ATN is most common cause

other causes:

prolonged renal ischemia

glomerulopathies

nephrotoxins (pesticides, heavy metals, solvents)

malignant HTN

coagulation defects

disease is rare because obstruction must be bilateral in order to produce renal failure; caused by:

urethral obstruction- edema, tumors, stones, clots

ureteral obstruction- prostatic hypertrophy

bladder obstruction

(urethral strictures)

1. decreased renal reserve: <75% of nephrons have been lost; findings: no signs or symptoms, BUN and creatinine levels are normal

2. renal insufficiency: 75-90% of nephrons have been lost; findings: polyuria, nocturia, slight elevation of BUN and creatinine, may be controlled by diet and meds

3. end-stage renal disease: >90% of nephrons have been lost; findings: azotemia, uremia, fluid and electolyte abnormalities, renal osteodystrophy; dialysis or transplantation needed

urinary tract obstruction

UTI

glomerular disorders

renal failure

kidney stones (most common obstructive disorder in adults)

tumors

prostatic hypertrophy

neurogenic bladder