Urinary System Disorders 3 · PDF filenephritis and polycystic kidney disease ... The lecture...

Urinary System Disorders 3

Lecture 18

Pathology and Clinical

Science 1 (BIOC211)

Department of BioscienceText Reference:

Porth’s Pathophysiology: Concepts of Altered Health States

Sheila C. Grossman & Carol Mattson Porth.

Ninth Edition.

Copyright © 2014 Lippincott, Williams & Wilkins Publishers, Inc.

© endeavour.edu.au

© Endeavour College of Natural Health endeavour.edu.au 2

Session Learning Objectives

The aim of this session is to :

o Comprehend the causes, clinical features and

management of acute and chronic tubulo interstitial

nephritis and polycystic kidney disease

o Explain the pathogenesis , clinical features ,

investigations and management of chronic pyelonephritis

o Discuss the aetiology, presentations, clinical assessment

and management of renal calculi.

o Understand the clinical features, investigations,

management and prognosis of tumours in the kidneys.


INTERSTITIAL NEPHRITIS

A group of inflammatory, inherited and other

diseases affecting renal tubules and the

surrounding tissues

Clinical presentations:

• Often renal failure

• Electrolyte abnormalities (hyperkalaemia &

acidosis)

• Proteinuria

• Haematuria

• Pyuria


ACUTE INTERSTITIAL

NEPHRITIS (AIN)Acute inflammation in the tubulo-

interstitium.

Sometimes associated with uveitis

Aetiology

• Allergic – penicillins, NSAIDs, allopurinol

• Immune – autoimmune nephritis

• Infections – acute bacterial pyelonephritis,

TB

• Toxic – myeloma, mushrooms


ACUTE INTERSTITIAL

NEPHRITIS (AIN)

Investigations

• Blood tests

• Renal biopsy

Management

• Withdrawal of drug in drug-induced

• Corticosteroids

• Dialysis

• Treatment of cause


ACUTE INTERSTITIAL

NEPHRITIS (AIN)

http://www.nature.com/ajg/journal/v96/n12/images/ajg2001858f1.gif

http://www.nature.com/ajg/journal/v96/n12/images/ajg2001858f1.gif


CHRONIC INTERSTITIAL

NEPHRITIS (CIN)

Caused by heterogeneous group of disease

• Persistent causes of AIN

• GN

• Immune/ inflammatory

• Toxic

• Drugs

• Infection

• Congenital

• Metabolic and systemic diseases



NEPHRITIS (CIN)

Clinical features

• Chronic Renal

Failure,

hypertension

and small

kidneys in adult

life

• Electrolyte

abnormalities

http://www.health-writings.com/img/ql/chronic-tubular-interstitial-nephritis/238062-243597-2458.jpg




NEPHRITIS (CIN)

http://www.humpath.com/IMG/jpg/chronic_interstitial_nephritis.jpg

Extensive deposition of fibrous tissue



NEPHRITIS (CIN)Lymphocytes and fibrous tissue

present


Normal Glomerulus


POLYCYSTIC KIDNEY DISEASE

(PKD)

o Prevalence of adult PKD 1: 1000

o Inherited as an autosomal dominant trait

Pathology

• Small cysts developed from infancy/childhood

and enlarge slowly and irregularly →

surrounding normal kidney tissue is

attenuated → renal failure with grossly

enlarged kidneys

• Non-pathological cysts are normal, especially

with increasing age



(PKD)

Clinical features

• Discomfort in loin or abdomen

• Acute loin pain/renal colic

• Hypertension

• Haematuria

• UTI

• Renal failure

• Berry aneurysms of cerebral vessels (associated feature)



(PKD)

Diagnosis

• Family history

• Clinical findings

• Ultrasound

Management

• Good control of Blood Pressure

• Dialysis

• Renal transplant



Large Polycystic Kidneys

http://radpod.org/wp-content/uploads/2007/02/apkd.JPG



http://www.charonboat.com/item/295/page8.htm



http://upload.wikimedia.org/wikipedia/commons/6/68/Polycystic_kidneys%2C_gross_pathology_20G0027_lores.jpg


REFLUX NEPHROPATHY

(CHRONIC PYELONEPHRITIS)

Chronic interstitial nephritis associated with

vesico-ureteric reflux (VUR) in early life with

appearance of scars in the kidneys

Pathogenesis

• VUR is associated with recurrent UTI in

childhood → renal scars

• VUR – unilateral or bilateral and of any

grade or severity


REFLUX NEPHROPATHY


o Clinical features

• Usually asymptomatic

• Hypertension at any age

• Proteinuria

• Features of Chronic Renal Failure

• Features of UTI

o Investigations

• Radionucleide scan

• Ultrasound

• CT, MRI


REFLUX NEPHROPATHY


o Management

• Treat infection

• Prophylactic therapy for UTI

• Nephrectomy (unilateral)

o Prognosis

• Good prognosis with small or unilateral

renal scars


CHRONIC PYELONEPHRITIS

http://1.bp.blogspot.com/-c0aqbGIgcO4/TX7pPs9eLRI/AAAAAAAAA4o/0xDg_StGFmQ/s1600/chronic_pyelonephritis.jpg


URINARY TRACT CALCULI &

NEPHROCALCINOSISAetiology

o Formation is poorly understood

Types of stones

o Urinary calculi consist of aggregates of crystals containing small amounts of protein and glycoprotein

- calcium oxalate

- calcium phosphate

- magnesium phosphate

- uric acid stones

- cysteine stones

o Vary in size, particles like sand to very large staghorn stone

o Deposits of calcium may be present throughout renal parenchyma ( nephrocalcinosis )


URINARY TRACT CALCULI

From Porth’s Pathophysiology: Concepts of Altered Health States. (9th ed., p. 1091),

by Sheila C. Grossman & Carol Mattson Porth.

Philadelphia, U.S.A. Walters Kluwer Health - Lippincott, Williams & Wilkins


STAGHORN

CALCULI

From Porth’s Pathophysiology: Concepts of Altered Health

States. (9th ed., p. 1092), by Sheila C. Grossman & Carol

Mattson Porth. Philadelphia, U.S.A. Walters Kluwer Health -

Lippincott, Williams & Wilkins



NEPHROCALCINOSIS

Conditions associated with stone formation

o Infection of urinary tract

o Climate or occupation giving rise to low urine

volume

o High protein, high salt diet and high calcium

o Hypercalciuria

o Hyperoxaluria

o Some inherited disorders



NEPHROCALCINOSISClinical features

o Depend on size, shape and position of the stone

o Nephrocalcinosis - usually no symptom

o Pain, recurrent urinary infection or clinical features of urinary tract obstruction

o Stone impacted in the ureter renal colic (loin to groin)

o Hematuria

o Frequency



NEPHROCALCINOSISo Investigation

• Examination of urine – RBCs

• Plain X ray abdomen

• IVU

• CT

• Ultrasound

• Chemical analysis of stone

o Management

• Bed rest, analgesics

• Adequate fluid intake

• Lithotripsy

• Endoscopic surgery


NEPHROCALCINOSIS

Calculi occupying the Medullahttp://radpod.org/wp-content/uploads/2007/01/bartter.jpg


NEPHROCALCINOSIS

http://www.softmedicus.net/blog/wp-content/uploads/2008/07/11f1.gif


NEPHROCALCINOSIS

http://www.hiv-infected.com/wp-content/uploads/2011/07/nephrolithiasis-300x238.gif


KIDNEY STONES

http://curezone.com/upload/Kidney_Stones/kidney_stone_agony_pain_misery.jpg


TUMOURS OF THE KIDNEY

o3% of malignancies

oBenign, malignant and secondary

tumours can occur


RENAL ADENOCARCINOMAo Most common malignant tumour of the

kidney in adults

o More common in males

o Peak incidence between 65-75 years of age

o Tumour arises from renal tubules

o Direct invasion of perinephric tissues is common

o Lymphatic spread to para-aortic nodes

o Blood-borne metastasis to anywhere in the body


RENAL ADENOCARCINOMA

Clinical features

• Haematuria 60%

• Loin pain 40%

• Mass

• Systemic effects

Investigations

• Ultrasound

• CT

Management

• Radical nephrectomy

• Immunotherapy

Prognosis

• If confined to kidney – 75% 5-yr survival


RENAL CARCINOMA

Porth’s Pathophysiology: Concepts of Altered Health States

Poorly differentiated adenocarcinoma

http://www.microscopyu.com/staticgallery/pathology/images/adenocarcinomaofkidney20x04.jpg


CHRONIC KIDNEY DISEASE

SUMMARY

From Porth’s Pathophysiology: Concepts of Altered Health States. (9th ed., p. 1119),

by Sheila C. Grossman & Carol Mattson Porth. Philadelphia, U.S.A. Walters Kluwer

Health - Lippincott, Williams & Wilkins


Readings and ResourcesResources:

o Set Textbooks:

Colledge, N.R., Walker, B.R. & Ralston S.H. (2014). Davidson’s Principles and Practice of Medicine, (22nd ed.). Edinburgh.

Churchill Livingstone.

Grossman, S.C. & Porth, C.M. (2014). Porth’s Pathophysiology: concepts of altered health states, (9th ed.). Philadelphia,

U.S.A. Walters Kluwer Health - Lippincott, Williams & Wilkins.

o Additional textbooks:

Davies, A. & Moores, C. (2010). The respiratory system: basic science and clinical conditions, (2nd ed.). Edinburgh. Churchill,

Livingstone, Elsevier.

Field, M., Pollock, C., Harris, D. (2010). Systems of the Body: The Renal System; Basic Science and Clinical Conditions. (2nd

ed.). United Kingdom: Churchill Livingstone.

Jamison, J.R. (2006) Differential Diagnosis for Primary Care: a handbook for health care practitioners. (2nd ed.). Edinburgh.

Churchill Livingstone.

Lee, G. & Bishop, P. (2013). Microbiology and Infection Control for Health Professionals, (5th ed.). Frenchs Forest, NSW.

Pearson Education.

McCance, K.L. & Huether, S.E. (2014). Pathophysiology: the biological basis for disease in adults and children, (7th ed.). St.

Louis, MO. Elsevier.

Murphy, K. (2011). Janeway’s immunobiology, (8th ed.). New York. Garland Science.

Noble, A., Johnson, R. & Bass, P. (2010). The cardiovascular system: basic science and clinical conditions, (2nd ed.).

Edinburgh. Churchill, Livingstone, Elsevier.

Pagana, K.D. & Pagana, T.J. (2013). Mosby’s diagnostic and laboratory test reference, (11th ed.). St. Louis, MO. Elsevier.

Smith, M.E. & Morton, D.G. (2010). The digestive system: basic science and clinical conditions, (2nd ed.). Edinburgh.

Churchill, Livingstone, Elsevier.

VanMeter, K.C. & Hubert, R. (2014). Gould’s pathophysiology for health professions, (5th ed.). St. Louis, MO. Elsevier.


COMMONWEALTH OF AUSTRALIA

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The material in this communication may

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