Syspath Urinary gekkii

Pathologies of the Urinary System

• Lecture outline includes Kidney Pathologies, Lower Urinary Tract Pathologies, and Neoplasms of the Urinary System.

Kidney Pathologies

• Pyelonephritis:

  • Kidney infection, primarily caused by ascending bacterial urinary tract infection.
  • Symptoms include fever, flank/back pain, nausea/vomiting, urgency, and frequency.
  • Diagnosis involves urinalysis, blood tests, and imaging (MRI, CT, ultrasound).
  • Treatment is with antibiotics.
  • Etiology: Ascending UTI (Escherichia coli bacteria) is the main cause. Urinary tract blockage (e.g., pregnancy, kidney stones, benign prostatic hyperplasia), and instrumentation (catheters) can also contribute.
  • Symptoms: Sudden onset fever, nausea/vomiting, flank/back pain, painful urination, enlarged kidney(s), costovertebral angle tenderness, and Murphy's punch sign.
  • Diagnosis: Urinalysis, blood tests, imaging (MRI, CT, ultrasound).
  • Treatment: Antibiotics.

• Renal Calculi (Kidney Stones):

  • Hard masses in the urinary tract.
  • Common in middle-aged men. They occur 1/1000 people yearly.
  • Composition: Primarily calcium oxalate (80%), uric acid, struvite, cystine.
  • Epidemiology: Occurs in 1/1000 people annually. Most common in middle-aged men.
  • Etiology:
    • Diet high in protein, vitamin C, and calcium
    • Diet low in water and calcium
    • Genetics
    • Hyperparathyroidism
    • Gout
    • UTIs
  • Symptoms: No symptoms until blockage. Commonly severe flank pain (renal colic), hematuria, urinary urgency/frequency, nausea/vomiting, chills/fever (if infection present), and lower abdominal pain (bladder stones).
  • Diagnosis: Based on pain patterns, urinalysis (RBC, WBC, crystals), imaging (US, CT).
  • Treatment: Increasing fluids. Alpha-adrenergic blockers (Tamsulosin). Analgesics. Shockwave lithotripsy or endoscopic techniques.
  • Prevention: Increase fluids, control calcium intake, manage underlying medical conditions (e.g., hyperparathyroidism), modify diet (low protein/purines for uric acid stones, low oxalate for oxalate stones).

• Glomerulonephritis:

  • A disorder affecting the glomeruli (kidney's filtering units), causing damage and impacting filtration.

  • Overview: Disorder of the glomeruli, causing damage resulting in nephritic or nephrotic syndrome (or a mix).

  • Etiology for acute: Strep infections (post-streptococcal glomerulonephritis), Type III hypersensitivity reaction.

  • Chronic Etiology: Infections (e.g. strep), systemic autoimmune diseases, viral infections (e.g., Hepatitis B, C, HIV), and systemic diseases (e.g., diabetes mellitus, hypertension, SLE).

  • Acute Glomerulonephritis (AGN):

    • Inflammation of glomeruli
    • Usually presents as nephritic syndrome
    • Most commonly caused by strep throat or skin infection (post-streptococcal glomerulonephritis (PSGN))

  • Chronic Glomerulonephritis: Chronic inflammation causing slow-progressive damage and scarring of glomeruli; more prone to nephrotic syndrome

    • More likely than AGN to result in nephrotic syndrome

  • Nephrotic Symptoms Massive proteinuria (protein in urine), hypoalbuminemia (low blood albumin), edema, hyperlipidemia, and sometimes clotting issues.

  • Nephritic Symptoms: Mild proteinuria, hematuria (blood in urine), azotemia, RBC casts in urine, oliguria (low urine output), high blood pressure (HTN), antistreptolysin O (ASO) titers often elevated.

  • Signs and Symptoms for AGN: Half of patients may not have initial symptoms; edema, reduced urine output (oliguria), pink/cola-colored urine (foamy), mild to severe high blood pressure (HTN) may present, may have weakness, fever, tiredness.

  • Signs and Symptoms for Chronic GN: Mild and subtle symptoms often overlooked; edema (facial and extremity), high blood pressure (HTN), potential for headache/visual problems, seizures, and coma.

  • Diagnosis: Blood tests (check for elevated waste products, WBC, anemia), urinalysis, imaging (US, CT, MRI)

  • Treatment:

    • Acute GN: Low sodium, low protein diet. Diuretics (e.g., furosemide) to remove excess sodium and water. Blood pressure medication (if needed). Antibiotics- if infection is still present Corticosteroids if rapidly progressive disease. dialysis or transplantation if kidney failure.
    • Chronic GN: Treatment of underlying conditions (if present). Support therapy (e.g., low-sodium/low-protein diet, diuretics, blood pressure medications)

• Neoplasms of the Urinary System: (Cancer)

• Overall, males are more likely to have cancers of the urinary tract than females

• In the urinary tract, the majority of neoplasms are malignant.

• Primary urinary tract tumors are more common than secondary tumors.

Lower Urinary Tract Pathologies (UTIs)

• Urinary Tract Infections (UTIs):
  • Overview: Infections in the bladder, urethra, or kidneys (upper/lower) (ascending infections more common in females- shorter urethra).
  • Etiology: Bacteria (Escherichia coli, other bacteria/fungi/viruses) which travel up the urethra to the bladder). Can also arise from the bloodstream.
  • Cystitis: (bladder infection): Ascending route of infection via urethra is most common/ lower UTI.
    • Risk factors (females): Shorter urethra, proximity of urethra to vagina & anus, sexual activity, pregnancy, postpartum, decreased urethra acidity (etc).
    • Risk factors (males): Urinary tract abnormalities, enlarged prostate.
    • Symptoms: Frequent/painful urination, urgency, suprapubic pain, low back pain, cloudy/bloody urine, fever (lower UTIs generally don't have fever).
    • Diagnosis: Urinalysis (looking for WBCs & bacteria), dipstick test (looking for nitrites & leukocyte esterase).
• Treatment*: Antibiotics, Increased fluid intake.
  • Prostatitis: (prostate infection) occurs more commonly in males.
    • Infections start in urethra, spread to the prostate, then the bladder.
    • Treatment: Antibiotics, some may require a longer course & a stronger antibiotic if there are complicating factors
    • Urethritis (urethra infection): Can result from bacterial/viral infections or chemical irritation from spermicides/soaps.
    • Symptoms: Frequent/painful urination, urethral discharge (possibly different colors/consistency depending on the causative organism).
    • Diagnosis: Swab or culture to identify the causative agent
    • Treatment: Effective treatment depends on the causative organism, possibly stronger, longer courses of antibiotics will be needed for some infections.

Neoplasms of the Urinary System (Cancer)

• Bladder Cancer:
  • Overview: Malignancy of the bladder.
  • Etiology: Primarily linked to smoking and chronic bladder infections (such as cystitis).
  • Symptoms: Painless hematuria (blood in the urine) (70-80% of diagnosed cases), and possible irritative voiding issues (pain, urgency).
  • Diagnosis: Urinalysis. Cystoscopy (important diagnostic tool). Further imaging if suspected metastasis.
  • Prognosis: Survival rates vary widely depending on stage & depth of tumor
  • Treatments: Removal, Radiation, and chemotherapy.
• RCC (Renal Cell Carcinoma):
  • Overview: Malignancy of the renal (kidney) cortex
  • Etiology: Smoking, age (50-70), exposure to toxins (cadmium, asbestos), obesity.
  • Symptoms: Hematuria, flank pain, fever, possible weight loss.
  • Diagnosis: Elevated imaging tests, CT & MRI.
  • Prognosis: Varies widely.
    • Dependent on if contained within the kidney, regional (local) spread, or distant metastasis.
    • Treatment: Surgical removal. Chemotherapy sometimes may also be used.
• Malignancies of the Renal Pelvis and Ureters: - Overview: - Less common than other types of kidney cancer. - Usually transitional cell carcinomas - Etiology & Risk factors: Similar to RCC (smoking, age) - Symptoms - Often includes hematuria - Diagnosis: Urinalysis, ureteroscope (to further visually assess for abnormalities) and CT scan, biopsies are important - Treatment: Surgical resection is common treatment choice
• Urethral Cancer: - Overview: Malignancy in the urethra - Causes: Certain strains of HPV, and frequent UTIs, age, and gender - Symptoms: Blood in the urine, weak urinate stream, interrupted urination, possible pain - Diagnosis: Cystoscopy, urinalysis, biopsy, CT scan - Prognosis: Dependent on stage and precise location of tumor - Treatment: Surgical resection, radiation therapy, possibly chemotherapy