RENAL PART 4 glomerulonephritis-urinary bladder conditions

What is this?

• Tuft of capillaries connecting afferent and Efferent arterioles of the nephron; capillaries are supported by mesangial cells and basement membrane where the circulating blood is filtered with the urine filtrate being the end produc

GLOMERULUS

What condition is this?

Group of conditions that damages the kidney’s filtering units

● Most common cause of ESRD worldwide

● 3 rd leading cause of ESRD in the US

● Damage to glomerulus

Under GLOMERULONEPHRITIS, what condition is this?

■ Principally associated with hematuria

■ Lupus nephritis

■ Ig A nephropathy

Nephritic Syndrome

Under GLOMERULONEPHRITIS, what condition is this?

■ Principally associated with proteinuria

■ Diabetes, membranous glomerulopathy

○ Nephrotic Syndrome

ETIOLOGIC FACTORS OF GLOMERULONEPHRITIS

● Immune origin

● Result of deposition of a circulating antigen-antibody complex into some portion of the glomerulus (basement membrane and mesangium) followed by an inflammatory response and damage

● __ (post-streptococcal GN)

● __ (lupus nephritis)

ETIOLOGIC FACTORS OF GLOMERULONEPHRITIS

● Immune origin

● Result of deposition of a circulating antigen-antibody complex into some portion of the glomerulus (basement membrane and mesangium) followed by an inflammatory response and damage

● Exogenous antigens (post-streptococcal GN)

● Endogenous antigens (lupus nephritis)

In Glomerulonephritis, this is for African american

Focal segmental glomerulosclerosis – African american

PATHOGENESIS OF GLOMERULONEPHRITIS (FILL IN THE BLANKS)

● Antigen-antibody complex deposits in the membrane and are not being filtered and causes inflammatory response accompanied by release of cytokines causing glomerular scarring

● __– results form a rupture of the capillary wall or proliferation of mesangial cells

● __– results from altered permeability of the glomerular filtration barrier for protein

PATHOGENESIS OF GLOMERULONEPHRITIS (FILL IN THE BLANKS)

● Antigen-antibody complex deposits in the membrane and are not being filtered and causes inflammatory response accompanied by release of cytokines causing glomerular scarring

● Hematuria – results form a rupture of the capillary wall or proliferation of mesangial cells

● proteinuria – results from altered permeability of the glomerular filtration barrier for protein

● __– results form a rupture of the capillary wall or proliferation of mesangial cells

hematuria

● __– results from altered permeability of the glomerular filtration barrier for protein

proteinuria

In GLOMERULONEPHRITIS, what condition has these clinical manifestations?

• Proteinuria (>3g in 24hrs)

• Hypoalbuminemia

  • Significant loss of protein in the kidney

• Hyperlipidemia

  • Loss of protein stimulates liver to produce cholesterol

  • Cholesterol (as high as 300-400 mg/dl)

• Edema

  • Fluid flows to areas of greater protein concentration which is outside the blood vessel

  • Principal symptom that will lead to consult

• Hypercoagulability

  • Can cause spontaneous thrombosis (renal vein thrombosis)

  • Sudden onset of flank pain or abdominal pain

  • Gross hematuria

NEPHROTIC SYNDROME

In GLOMERULONEPHRITIS, what condition has these clinical manifestations?

• Hematuria

  • Abnormal shape erythrocyte (“Mickey mouse cells”)

• Oliguria

  • Less than 400ml of urine/day

• Hypertension

  • Enhanced tubular reabsorption of salt and water

• Renal insufficiency

  • Decrease in renal blood flow

  • Decrease in GFR

NEPHRITIC SYNDROME

What are the Urinary Bladder Conditions?

● URINARY INCONTINENCE

● NEUROGENIC BLADDER

In URINARY BLADDER CONDITIONS, what condition is this?

● Complaint of involuntary urine loss

● Two most common categories

URINARY INCONTINENCE

What are the 2 most common categories of URINARY INCONTINENCE?

STRESS URINARY INCONTINENCE

URGENCY URINARY INCONTINENCE

What category of Urinary Incontinence is this?

• Complaint of involuntary loss of urine on effort or physical exertion

• Sneezing coughing

• Occurs during activities that increases intraabdominal pressure

STRESS URINARY INCONTINENCE

What category of Urinary Incontinence is this?

• Involuntary loss of urine associated with urgency (sudden compelling desire to urinate that is difficult to defer)

• Detrusor instability (bladder contracts at small volume

• Overactive bladder syndrome (hyperreflexive bladder)

  • Urinary urgency usually accompanied by frequency and nocturia in the absence of UTI

• Common in adults

URGENCY URINARY INCONTINENCE

In diagnosing Urinary Incontinence, this is used by filling the bladder with water and then recording changes in intravesicular and abdominal pressure

cystometry

TREATMENT OF URINARY INCONTINENCE

___ – first line of treatment

• Education : lifestyle changes, fluid modification, weight loss

• Bladder training

• Exercises : __

• Modalities : __

• Pessaries : devices inserted in the vagina designed to support the bladder and bladder neck reducing pelvic organ prolapse and compressing the urethra

• Pharmacologic

  • Used in conjunction with behavioral modifications

  • __

    • Inhibits involuntary detrusor contractions

    • Atropine, ipratropium, diphenhydramine

    • __  – most common side-effect

TREATMENT OF URINARY INCONTINENCE

Conservative tx – first line of treatment

• Education : lifestyle changes, fluid modification, weight loss

• Bladder training

• Exercises : pelvic stability exercises

• Modalities : pelvic floor electrical stimulation

• Pessaries : devices inserted in the vagina designed to support the bladder and bladder neck reducing pelvic organ prolapse and compressing the urethra

• Pharmacologic

  • Used in conjunction with behavioral modifications

  • Anticholinergics or muscarinic antagonist

    • Inhibits involuntary detrusor contractions

    • Atropine, ipratropium, diphenhydramine

    • Dry mouth and constipation – most common side-effect

In URINARY BLADDER CONDITIONS, what condition is this?

● Voiding dysfunction associated with neurologic pathology

● Interferes with normal urine storage and coordinated voluntary release

NEUROGENIC BLADDER

In treating neurogenic bladder, this is clean, intermittent to avoid bladder distention in cases of urinary retention. Every 4 hours interval

Catheterization