Pyelonephritis and Kidney Stones Quiz

Pathologies of the Urinary System

• The lecture outline covers Kidney Pathologies, Lower Urinary Tract Pathologies, and Neoplasms of the Urinary System.

Kidney Pathologies

• Pyelonephritis:

  • A kidney infection.
  • Often caused by ascending bacterial urinary tract infections.
  • Symptoms include: fever, back/flank pain, nausea/vomiting, urgency, and frequency.
  • Diagnosis involves: urinalysis, blood tests, imaging (MRI, CT, ultrasound).
  • Treatment is with antibiotics.
  • Potential complications include pus accumulation in the kidney (pyonephrosis), sepsis, and kidney failure.
  • Important to note that medical attention is frequently required.
  • Massage treatment is contraindicated while the person is suffering from pyelonephritis

• Etiology (Causes):

  • Ascending UTI (Escherichia coli bacteria)
  • Urinary tract blockage (pregnancy, kidney stones, benign prostatic hyperplasia, instrumentation)

• Symptoms:

  • Sudden fever, nausea/vomiting, flank or mid-low back pain
  • Painful, swollen kidney(s) with tenderness
  • Frequent urination, hematuria (blood in urine)
  • Possible ureter spasm due to infection or kidney stones.
  • Children may have subtle symptoms, elderly may present with delirium or no symptoms until sepsis occurs.

• Diagnosis:

  • Urinalysis to check for white blood cells and other abnormalities.
  • Urine culture (Petri dish) to identify the causative organism.
  • Complete blood count (CBC) to check for elevated white blood cell count or bacteria in the blood
  • Imaging (ultrasound or CT) to check for kidney stones, structural abnormalities, or obstruction.

• Treatment:

  • Broad-spectrum antibiotics, typically started immediately.
  • Modifications in antibiotic choice and dosage may be based on urine culture results.
  • Treatment plan is modified based on patient (outpatient/inpatient based on N/V, dehydration, signs of severe infection), adjusting to IV to PO antibiotics.

Neoplasms of the Urinary System

• Renal Calculi (Kidney Stones):

  • Hard masses forming anywhere in the urinary tract.
  • Epidemiology: occurs in about 1/1000 people yearly, most common in middle-aged men.
  • Composition: Primarily calcium oxalate (80%). Other types include uric acid, struvite, and cystine.
  • Etiology (causes): diets high in protein, vitamin C, calcium; low water and calcium intake, genetic predisposition, hyperparathyroidism, gout, UTIs.
  • Symptoms: vary depending on stone size/location, potential pain/discomfort, possible hematuria, urgency, dysuria.
    • Some cases may present with none (until urinary obstruction). Lower abdominal pain may be associated with bladder stones
  • Diagnosis: suspected based on pain pattern, urinalysis (RBC, WBC, crystals), imaging (US, CT) to visualize size/position.
  • Treatment: small stones may pass spontaneously with fluids; large stones may require shockwave lithotripsy or endoscopic procedure.
  • Prevention: increased fluids, diet adjustments, medical management.
    • Prevention depends on the stone composition (Calcium stones: low sodium, high potassium, normal calcium intake; Uric acid stones: low protein/purine intake; Oxalate stones: low intake of rhubarb, spinach, cocoa, nuts, and pepper)
  • Massage contraindication: needs medical attention, treatment postponed until resolved.

• Glomerulonephritis:

  • Disorder of glomeruli.
  • Types: Nephritic (inflammation causing RBCs in urine, mild proteinuria, azotemia) and nephrotic (inflammation causing proteinuria, edema).
  • Etiology: Often caused by streptococcal infection (PSGN, poststreptococcal glomerulonephritis). Can be caused by autoimmune diseases , bacterial infections (streptococcal), viral infections (hepatitis B, hepatitis C, HIV) and systemic diseases (diabetes mellitus, hypertension, SLE).
  • Symptoms include edema, headache, visual disturbances, seizures, Possible rapid progression with HTN. Half of patients with AGN have no symptoms or very mild.
  • Diagnosis: Blood tests and urinalysis for microscopic exam. Rapid progression = RBC casts.
  • Treatment: Low sodium and low protein diet, diuretics (Furosemide). Corticosteroids given Iv, then PO. Antibiotics if infection is present.
  • Massage indications: AGN requires medical attention, treatment postponed. Be careful when using chronic GN, minimal abdominal, and CVA pressure. Contraindicated for acute GN, medical attention necessary.

• Polycystic Kidney Disease (PKD): A genetic disorder causing fluid-filled cysts developing in the kidneys (bilaterally).

  • Types: Dominant (adult onset) and Recessive (childhood onset). Recessive PKD is more severe.
  • Symptoms may be range, from none (until obstruction), to severe flank pain, frequent infections and kidney stones; Abdominal distension frequent urination, can cause kidney failure or death.
  • Diagnosis: blood work (kidney function, BUN/Cr, GFR), imaging (US, CT)
  • Treatment: antibiotics for UTIs. Anti-hypertensives (HTN); lithotripsy for kidney stones; dialysis or transplantation for kidney failure. Massage contraindication: abdominal massage and massage over the CVA is contraindicated.

• Malignancies of the Renal Pelvis and Ureters/Urethral Cancer: Specific cancers of the urinary tract.

  • Can develop in either, ureters or urethra may have concurrent bladder cancer (at the time of presentation)
  • Symptoms include painless hematuria (70-80%), possible crampy flank pain, lower abdominal pain, obstruction of urine flow.
  • Diagnosis: Urinalysis (microscopic exam). Ureteroscopy for diagnosis and treatment). Confirmative dx: CT scan.
  • Treatment: Nephroureterectomy with partial bladder removal (if no metastasis is present). Laser therapy or minimally invasive resections common treatments for local or non-metastatic tumors. Chemo/radiation for metastatic cases.
  • Massage: No contraindications.

• Bladder Cancer: Cancer of the bladder.

  • Epidemiology: 3x more common in males, typically in persons aged 50+; Smoking is the leading risk factor. Second-hand smoke, chronic, or recurrentcystitis also relevant risk factors
  • Symptoms: Painless hematuria is the most common symptom. Other symptoms include irritative voiding symptoms such as pain and/or burning during urination and/or frequency. Back pain, suprapubic pain, and abdominal pain are potential symptoms, typically associated with local advanced or metastatic cancer
  • Diagnosis: Routine microscopic exam of urinalysis. Urine typically visible red. suspected if blood is present. Cystoscopy is the primary diagnostic tool. Ruling out UTI or other conditions is also crucial.
  • Treatment: surgery (removal), chemotherapy, and/or radiation therapy, typically dependant on cancer stage: Superficial tumors may be removed during cystoscopy, potentially only requiring cystoscopy; Deeper tumors may need partial or total cystectomy; Metastatic bladder cancer is typically associated with a poor prognosis.
  • Massage contraindication: is not typically a contraindication, but any patient that is experiencing pain or discomfort should receive necessary medical attention prior to receiving any treatment.

• Renal Cell Carcinoma (RCC): Kidney cancer.

  • Definition: The most common type of kidney cancer.
  • Symptoms: Hematuria is often the first symptom; flank pain, fever, and/or weight loss may also be present. Possible palpable lump or enlarged kidney is possible. Potential for polycythemia or paraneoplastic syndrome. Potential anemia.
  • Diagnosis: Advanced imaging (CT, MRI). Potential for metastasis checks (CXR, head/chest CT, bone scan)
  • Prognosis: Survival rates depend on the extent (stage). Local cases: 85% 5 year survival; Local spread to renal vein/IVC: 35-60 %; Distant metastasis: 10%
  • Treatment: Surgical removal, chemo/radiation, palliative care.
  • Massage: No contraindications.

• Lower Urinary Tract Pathologies (general):

  • Cover broader aspects of urinary tract infections/infections like cystitis, urethritis

• Neoplasms of Urinary Tract (general):

  • Covers the general specifics and overview of the different cancers that can affect the urinary tract (e.g., RCC, bladder cancer).