Urinary System Pathologies PDF

Pathologies of the Urinary System Lecture Outline: Kidney Pathologies Lower Urinary Tract Pathologies Neoplasms of the Urinary System Dr. Kevin Tipper, ND PATHOLOGIES OF THE KIDNEY Py...

Pathologies of the Urinary System Lecture Outline: Kidney Pathologies Lower Urinary Tract Pathologies Neoplasms of the Urinary System Dr. Kevin Tipper, ND PATHOLOGIES OF THE KIDNEY Pyelonephritis Overview Kidney infection MC cause = ascending bacterial urinary tract infection SSx: fever, back and flank pain, N/V, urgency, frequency Dx: urinalysis, blood analysis, imaging (MRI, CT, U/S) Tx: antibiotics Pyelonephritis Etiology MC cause is ascending UTI (Escherichia coli bacteria) We will discuss UTIs in the upcoming slides Urinary tract blockage can also cause pyelonephritis Pregnancy Renal calculi (kidney stones) Benign prostatic hyperplasia Instrumentation (eg. catheter) Pyelonephritis Symptoms Sudden onset of fever, N/V, and flank or mid-low back pain Painful, enlarged kidney(s) w/ costovertebral tenderness Murphy’s punch sign Polyuria, frequent urination, hematuria Possible ureter spasm d/t irritation from infection or kidney stone Renal colic may occur with ureter spasm Pyelonephritis Symptoms Children experience subtle sx that can be difficult to recognize Elderly may have no sx of urinary tract problem Delirium is common sx of infection in elderly May have no sx until sepsis occurs Can be acute or chronic Chronic pyelonephritis presents with vague sx and intermittent fever Pyelonephritis Diagnosis Urinalysis Check the urine for presence of WBCs and other changes Urine culture (Petri dish) To identify the causative organism for more precise, better treatment CBC to check for elevated WBC or bacteria in blood Ultrasound of CT used to check for kidney stones, structural abnormalities, obstruction Pyelonephritis Treatment Antibiotics Broad spectrum antibiotics started ASAP Choice of drug and dosage may be modified based on urine culture Outpatient, PO (by mouth) antibiotics are usually successful if: No N/V or dehydration No signs of severe infection (low BP, confusion) If any of the above exist, pt is hospitalized for tx IV antibiotics for two days, then given PO Pyelonephritis Complications Pus accumulation of kidney (pyonephrosis) Sepsis Kidney failure Becauseof the above, kidney infections require prompt medical attention Pyelonephritis Massage and Pyelopnephritis CONTRAINDICATION Medical attention is needed, massage treatment is postponed until resolved Renal Calculi Definition aka kidney stones Hard masses that form anywhere in the urinary tract Epidemiology Occurs in 1/1000 people yearly Most common in middle-aged men Renal Calculi What are kidney stones made of? Can be composed of: Calcium (calcium oxalate stones) - 80% are composed of calcium oxalate Uric acid Struvite Cystine Vary in shape and size and therefore vary in SSx Formation may be prevented with dietary changes Renal Calculi Etiology Diets high in protein, vitamin C, calcium Diets low in water, calcium Genetics (family Hx) Hyperparathyroidism Gout UTIs Struvite stones aka “infection stones” Renal Calculi Signs and Symptoms Stones may cause no symptoms until urinary blockage occurs, usually in the ureters Severe and intermittent back and flank pain, renal colic Hematuria, frequency, urgency, dysuria, urinary retention N/V, sweating, chills, fever (if infection present) Bladder stones: lower abdominal pain, possible interruption of urine flow, LUTS (lower urinary tract symptoms) Renal Calculi Diagnosis Suspected based on pain pattern Urinalysis RBC, WBC, and crystals Imagingis done to visualize size and location of stone US, CT Renal Calculi Treatment Small stones pass without intervention Increasing fluids may help passage alpha-adrenergic blockers (Tamsulosin, dilates urethra) analgesics Stones too large to pass on their own may require shockwave lithotripsy or an endoscopic technique Renal Calculi Prevention Depends on composition of stone Increased fluids may help prevent all types Calcium stones diet low in sodium, high in potassium calcium intake should remain normal (1,000-1,500mg/day) Uric acid stones diet low in protein/purines Oxalate stones diet low in rhubarb, spinach, cocoa, nuts, pepper, tea Renal Calculi Massage and Renal Calculi CONTRAINDICATION Medical attention is needed, massage treatment is postponed until resolved Onceresolved, there are no contraindications Glomerulonephritis Overview Glomerulonephritis = disorder of the glomeruli (clusters of vessels in the kidney that filer blood) causing damage and affecting filtration Can show up as nephritic syndrome or nephrotic syndrome (or a combination of both) May be acute or chronic Glomerulonephritis Etiology Most causes of acute glomerulonephritis are due to strep infections (poststreptococcal glomerulonephritis) Type III hypersensitivity reaction Chronic acute glomerulitis may be caused by infection or systemic autoimmune diseases Bacterial infection (streptococcal) Viral infections (Hepatitis B, hepatitis C, HIV) Systemic diseases (diabetes mellitus, hypertension, SLE) Glomerulonephritis Common Signs and Symptoms Full picture depends on degree of nephrotic or nephritic syndrome present Common signs and symptoms include Edema H/A visual disturbances seizures Glomerulonephritis Nephrotic Syndrome Inflammation of the glomerulus causing damage to the membrane Pores created in glomerulus are large enough to allow protein to cross, but not large enough for RBC to cross the membrane Characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, edema (“PALE”) Without albumin protein in blood, edema occurs With less antithrombin protein, clotting can occur Hyperlipidemia occurs as liver tries to synthesize protein to compensate for loss Glomerulonephritis Nephritic Syndrome Inflammation of the glomerulus Larger pores created vs nephrotic syndrome Significant destruction of glomerulus results in RBC crossing the membrane Characterized by mild proteinuria, hematuria, azotemia, RBC casts in urine, oliguria, antistreptolyin O titers, hypertension (“PHAROAH”) Glomerulonephritis Nephritic vs. Nephrotic Syndrome Nephritic Nephrotic P – proteinuria P - proteinuria H – hematuria A – hypoalbuminemia A – azotemia L – Hyperlipidemia R – RBC casts E – edema O – oliguria females (general urinary tract neoplasms) Most are malignant Primary tumors are more common Bladder Cancer Overview 12,300 new cases each year in Canada the MC malignancy involving GU system 3x more common in males Smoking: single greatest risk factor Other risk factors: second-hand smoke, chronic or recurrent cystitis Most occur > 50 yo MC type: transitional cell CA Bladder Cancer Signs and Symptoms MC early symptom: PAINLESS hematuria Can lead to anemia w/ fatigue and pallor About 1/3 of patients can have irritative voiding symptoms such as pain and burning during urination, urgency or frequency If there is pain, usually related to local advanced or metastatic tumours: Back pain Suprapubic pain Abdominal pain Bladder Cancer Diagnosis Suspected when there is blood in urine Routine microscopic exam of urinalysis Urine may be visibly red Suspected when SSx linked to cystitis do not resolve with treatment for infection MC diagnostic tool: cystoscopy Accidental dx during CT or US DDX May mimic sx of cystitis, prostatitis r/o UTI or infection Bladder Cancer Bladder Cancer Bladder Cancer Bladder Cancer Bladder Cancer Bladder Cancer Prognosis Slow growing tumors and superficial tumors of the inner lining have 95% 5 year survival rate Deeper tumors of the muscle layer have 45-60% 5 year survival rate Metastatic bladder cancer has a much poor prognosis Treatment Superficial tumors may be removed completely during cystoscopy Deeper tumors require partial or total cystectomy Radiation and/or chemotherapy may be necessary Bladder Cancer Massage and Bladder Cancer No contraindications Renal Cell Carcinoma (RCC) Definition RCC is the most common type (80-85%) of renal cancer (involves renal cortex) The 2nd MC type is transitional cell carcinomas of the renal pelvis 2x more common in males 2x more likely in smokers Other risk factors: age 50-70 exposure to toxic substances – cadmium, asbestos obesity Renal Cell Carcinoma (RCC) Signs and Symptoms Hematuria, flank pain, fever, weight loss MC first sx: blood in the urine May be microscopic Abdominal exam may reveal palpable lump or enlarged kidney Potential polycythemia paraneoplastic syndrome d/t increased EPO release Pruritis, H/A, fatigue, dizziness, visual disturbances Potential anemia Fatigue, dizziness, pallor, cold extremities Renal Cell Carcinoma (RCC) Diagnosis Advanced imaging: CT or MRI Often incidental finding If dx is confirmed, further studies are required to r/o metastasis CXR, CT of head and/or chest, and bone scan Prognosis Dependent on many factors If contained in the kidney, 5 year survival rate is 85% Local spread to renal vein or IVC only, 5 year survival rate is 35-60% Distant metastasis has 5 year survival rate of 10% May be limited to palliative care Renal Cell Carcinoma (RCC) Treatment Surgicalremoval may be curative when there is no metastasis or only local metastasis to vasculature Total kidney Tumor and locally adjacent tissue only Early spread, especially to lungs, is common Chemo/radiation Palliative care Renal Cell Carcinoma (RCC) Massage and Renal Cell Carcinoma (RCC) No contraindications Malignancies of Renal Pelvis & Ureters Definition The MC type of malignancy affecting renal PELVIS and the URETERS is transitional cell CA ~17% of patients with transitional cell CA of renal pelvis or ureters will have concurrent bladder cancer at presentation Renal pelvis and ureters much less common than cancer of the rest of the kidney and bladder Fewer than 6,000 people/year in US Signs and Symptoms MC first SSx: hematuria (70-80% of patients present at diagnosis) Other SSx: crampy flank pain, lower abdominal pain, obstruction of urine flow Malignancies of Renal Pelvis & Ureters Diagnosis Urinalysis and microscopic exam may reveal cancer cells Ureteroscope may be used for both diagnosis and treatment Confirmative dx: CT scan Can DDx neoplasms from stones and/or blood clots Prognosis Local, non-metastatic tumors are often cured by surgical resection If metastasis occurs, outlook is poor Malignancies of Renal Pelvis & Ureters Treatment Nephroureterectomy and partial bladder removal for cases where there is no evidence of metastasis If pt only has one functioning kidney, it is usually not removed Avoid dialysis dependence Certain cancers may be treated with laser therapy or minimally invasive resections Non-cancerous portion of ureter and bladder remain Metastatic cancer requires chemo and/or radiation Urethral Cancer Overview Rare May be r/t certain strains of HPV and frequent UTIs Most commonly affects Caucasian females Usually age 50+ Signs and Symptoms MC first sign: blood in the urine Microscopic or visual Weak, interrupted flow of urine (“stop and go”) Frequent urge to urinate/feeling of incomplete emptying Discharge from urethra Enlarged lymph nodes in the groin Friable tissue surrounding urethral meatus Urethral Cancer Diagnosis Cystoscopy Urinalysis Confirmed with biopsy Prognosis Dependent on precise location and staging Treatment Surgical resection Chemo and/or radiation Malignancies of Renal Pelvis, Ureters, Urethral Cancers Massage and Malignancies of Renal Pelvis, Ureters, Urethral Cancers No contraindications