HOSA PATHO: Urinary system

6%

Acute glomerulonephritis

• Description: inflammation and swelling of the glomeruli. It can be secondary or systemic. Usually follows a streptococcal infection of the throat or skin.

• characteristic signs/symptoms: bloody urine, protein in urine, edema, headache, flank, pelvic pain, malaise, low-grade fever,, and streptococcal infection.

• etiology: beta-hempolytic streptococcus

• diagnosis: urine analysis, elevated WBC, presence of beta-hemolytic streptococcus, enlargement of the kidneys

• treatment: NSAIDs, restricted sodium intake, diuretics, and antibiotic therapy

Chronic glomerulonephritis

• Description: slowly progressive noninfectious disease that can lead to irreversible renal damage and renal failure. Progressive destruction results in glomerular filtration rate decreasing, resulting in the retention of uremic poisons.

• characteristic signs/symptoms: could present as asymptomatic, azotemia, edema, oliguiria, fatigue, malaise, vomiting, pruritis, and dyspnea. Uremic frost; azotemia, body excretes urea via sweat glands to compensate (crystals or urea appear on the skin)

• etiology: antigen-antibody complex lodge in the glomerular capsular membrane (triggering an antiinflammatory response)

• diagnosis: urine analysis, renal biopsy, elevated creatinine and BUN levels, ultrasonography.

• treatment: antihypertensives, diuretics, and antibiotics if UTI occurs.

Nephrotic Syndrome (nephrosis)

• Description: excessive amount of protein in the urine. Disease of the basement membrane. Protein-losing kidney.

• characteristic signs/symptoms: bloody urine, edema, headache, flank or pelvic pain, and lethargy.

• etiology: increased permeability of the glomerulus

• diagnosis: presence of gross proteinuria and lipiduria

• treatment: ACE inhibitors and diuretics

Acute Renal Failure

• Description: sudden onset where there is a severe reduction in renal function. Nitrogenous products could accumulate in blood, resulting in acute uremic episode.

• characteristic signs/symptoms: olguria, gastrointenstinal disturbances, and drowsiness.

• etiology: diminished blood flow to the kidneys and exposure to nephrotoxins

• diagnosis: urine analysis and blood tests reveal elevated BUN and creatinine levels

• treatment: diuretics/drug IV therapy

Chronic kidney disease

• Description: gradual and progressive loss of nephrons, resulting in reduced renal function that results in uremia. It is systemic.

• characteristic signs/symptoms: weak, tired, and lethargic

• etiology: disease and infections of the kidney (pyelnephritis)

• diagnosis: blood studies show elevated BUN and creatinine as well as decreased hemoglobin and hematocrit levels.

• treatment: Diuretics and diet and nutritional changes to help control protein and sodium intake (reduce work of diseased kidneys)

pyelonephritis

• Description: MOST common type of renal disease. Inflammation of the renal pelvis and connective tissues of one or both kidneys.

• characteristic signs/symptoms: bloody foul-smelling urine, accompanied by fever, chills, nausea,vomiting, and pelvic and flank (lumbar) pain.

• etiology: bacteria from previous infections (E.coli), UTI, inflammation or trauma of mucousa in the bladder

• diagnosis: kidneys are swollen and enlarged on radiographic studies, elevated WBC and RBC, and clinical findings

• treatment: Iv or oral antibitoics (penicillin)

Hydronephrosis

• Description: abnormal diltaton of the renal pelvis caused by pressure from urine that cannot flow past an obstruction in the urinary tract

• characteristic signs/symptoms: vaugue backache, diminished urine output, asymptomatic

• etiology: dilation caused by built up pressure in the kidneys renal calculi, prostatic hyperplasia (enlargement)

• diagnosis: retrograde pyelography

• treatment: necessary antibitoics and potential surgery

Renal calculi

• Description: stones in the kidneys or anywhere in the urinary tract caused by concentrated mineral salts

• characteristic signs/symptoms: passing of stones, severe flank pain, and pelvic pressure and pain that is accompanied by nausea and vomiting.

• etiology: unknown, hereditary. Men are more prone than women. 30-50 age range.

• diagnosis: clinical findings, stones, labratory analysis, CT, ultrasonography, and CT.

• treatment: hydration and lithotripsy (destruction of the kidney stones)

Infectous cystitis and urethritis

• Description: cystitis is inflammation of the urinary bladder, and urethritis is inflammation of the urethia. Two common forms of lower urinary tract infections.

• characteristic signs/symptoms: frequency, urinary urgency, pelvic and lower back pain, fever, and chills

• etiology: E. coli, Klebsiella, enterobacter, protes, and psudomonas.

• diagnosis: Urinanalysis shows dark yellow, piml. or red urine/ Abnormal urinary sediment and pus. Custoscopy shows reddened and inflammed bladder.

• treatment: amoxicillin. Antibitoic and antiseptic therapy.

Diabetic nephropathy

• Description: renal change from diabetes mellitus; expected in all patients with type 1; changes are glomerulosclerosis (Carrington of the glomerulus, resulting in reduced filtration, more buildup waste in the blood)

• characteristic signs/symptoms: urinary retention, protein in urine, hypertension, nausea. UTI and nephropathy are common complications.

• etiology: Hyperglycemia (High Blood Sugar): Chronic high blood sugar damages the blood vessels and nephrons (filtering units) of the kidney.

• Hemodynamic Changes: Increased intraglomerular pressure (hyper-filtration) causes damage.

• Risk Factors: Poorly managed diabetes (Type 1 or 2), smoking, high cholesterol, and obesity.

Diagnosis for diabetic nephropathy

• Urine Test: Albumin-to-creatinine ratio (UACR) check for albuminuria.

• Blood Test: Estimated glomerular filtration rate (eGFR) to evaluate kidney function.

• Blood Pressure Monitoring: Frequently high.

• Imaging/Biopsy: Renal ultrasound or kidney biopsy if diagnosis is unclear

Treatment for diabetic nephropathy

• Blood Pressure Medication: ACE inhibitors (e.g., Lisinopril) or ARBs (e.g., Losartan) are standard to protect kidneys.

• Blood Sugar Control: Tight glycemic control with medication (e.g., SGLT2 inhibitors).

• Lipid Management: Statin therapy.

• Lifestyle Changes: Low-salt/low-protein diet, weight loss, exercise, and smoking cessation.

• Advanced Disease: Dialysis or kidney transplantation if kidneys fail.

Polycystic kidney disease

• a genetic disorder characterized by numerous fluid-filled cysts forming in the kidneys, causing organ enlargement and progressive loss of kidney function

autosomal dominant + PKD1/PKD2/PKHD and RARELY—DZIP1L

dominant form (commonly expressed in adults) accounts for 85%-90% of poly cystic kidney disease(s).

recessive form: more commonly expressed amongst younger children, and issue of ARPKD—fibrocystin (impairs normal fluid sensing and cell signaling, which leads to uncontrolled proliferation, fluid accumulation, and CYST FORMATION)

Type 1 polycystic kidney disease: more sever, more cysts, faster cyst groeth, larger cysts, flank pain, hematuria, hypertension, and progression of ESRD (end-stage renal disease is around 54 years). makes up around 85% of cases

Type 2 polycystic kidney disease: less severe, PC2 makes up less of the cell matrix adhesion, so it is less significant when it comes to cell proliferation in the kidneys in PKD in comparison to type 1 PKD/PC1/polycystin-1 PKD. Progressio to ESRD is around 69 years old. PKD2 makes up around %15 of cases.

characteristic signs/symptoms pkd

• High blood pressure (Hypertension): Often the earliest sign.

• Back/Side/Abdominal Pain: Caused by cyst growth.

• Hematuria: Blood in the urine.

• Kidney Failure: Gradual loss of renal function.

Etiology for PKD

• Autosomal Dominant PKD (ADPKD): The most common form (85-90% of cases), typically diagnosed in adults (30-50s). It is inherited from one affected parent.

• Autosomal Recessive PKD (ARPKD): A rare, severe form that begins in utero or childhood.

• Cause: Faulty genes (

  ,

  for ADPKD) cause cysts to grow, compressing healthy nephrons

diagnosis pkd

• Imaging Tests: Ultrasound is the most common method to detect cysts, though CT scans or MRIs are also used for higher sensitivity.

• Genetic Testing: Identifies the specific mutation, useful for family screening.

• Family History Analysis: Reviewing parent/relative history of kidney disease.

treatment pkd

• No cure exists, but management includes:

• Blood Pressure Management: ACE inhibitors or ARBs are often used.

• Pain/Infection Management: Painkillers (avoiding NSAIDs if possible) and antibiotics for UTIs.

• Lifestyle Changes: Low-salt diet, increasing fluid intake, avoiding caffeine, and smoking cessation.

• Progression Management: Medications like Tolvaptan to slow cyst growth.

• End-Stage Treatment: Dialysis or kidney transplantation.

Neurogenic bladder

• dysfunction of the bladder (either overactive or underactive) caused by nervous system damage, leading to symptoms like incontinence, retention, frequency, and urgent needs

SS for neurogenic bladder

• Overactive (Spastic) Bladder: Sudden, frequent, or uncontrollable urges to urinate; leakage (incontinence).

• Underactive (Flaccid) Bladder: Inability to empty the bladder (retention), dribbling, and loss of sensation that the bladder is full.

• General Symptoms: Recurrent urinary tract infections (UTIs), painful urination, and nocturia (waking at night)

Etiology for neurogenic bladder

• Spinal Cord Injury/Conditions: Trauma, tumors, spina bifida, or herniated discs.

• Neurological Diseases: Multiple sclerosis (MS), Parkinson's disease, or stroke.

• Nerve Damage: Diabetic neuropathy, heavy metal poisoning, or nerve damage from pelvic surgery.

• Infections: Infections that damage nervous system pathways

diagnosis for neurogenic bladder

• Urodynamic Testing: Assesses bladder capacity, pressure, and function during filling and emptying.

• Imaging: Ultrasound, CT scan, or MRI of the brain, spine, or bladder.

• Cystoscopy: Visualization of the bladder and urethra with a camera.

• Post-Void Residual (PVR): Measurement of urine remaining in the bladder after urination

treatment for neurogenic bladder

• Catheterization: Intermittent catheterization is preferred to empty the bladder regularly.

• Medications: Anticholinergics to relax an overactive bladder or cholinergic drugs to stimulate an underactive one.

• Lifestyle Changes: Fluid management and timed voiding.

• Neuromodulation: Nerve stimulation therapies to manage nerve signals.

• Surgery: In severe cases, to remove obstructions or widen the bladder.

Stress incontinence

• involuntary leakage of urine caused by increased abdominal pressure on a weakened bladder sphincter or pelvic floor muscles, typically during coughing, sneezing, laughing, or exercising

SS for stress incontinence

• Involuntary urine leakage: Usually small-to-moderate amounts occurring during, not before, physical exertion.

• Trigger activities: Sneezing, coughing, laughing, lifting, walking, or changing positions.

• Associated issues: Potential embarrassment, anxiety, or restriction of physical activities/sports.

• Mixed symptoms: Sometimes occurs alongside urge incontinence.

etiology stress incontincence

• Childbirth: Vaginal delivery can weaken pelvic support.

• Aging: Muscles naturally weaken with age.

• Chronic strain: Chronic coughing (e.g., from smoking or asthma), persistent constipation, or heavy lifting.

• Previous pelvic surgery: Including hysterectomy or prostate surgery.

• Obesity: Excess weight increases pressure on the bladder

diagnosis stress incontinence

• Medical History & Physical Exam: Evaluation of symptoms, medical history, and a pelvic exam in women or rectal exam.

• Cough Stress Test: A doctor observes leakage while the patient coughs or bears down with a full bladder.

• Voiding Diary: Recording fluid intake and leakage incidents.

• Urinalysis: Checking for infection or blood.

• Urodynamic Testing: Specialized tests to measure bladder pressure and capacity (if needed)

treatment stress incontinence

• Behavioral/Lifestyle Changes: Weight loss, reducing caffeine/alcohol, smoking cessation, and managing constipation.

• Pelvic Floor Muscle Training (Kegels): Exercises to strengthen supporting muscles, often with physical therapy.

• Vaginal Devices: Pessaries or inserts to support the bladder neck.

• Urethral Bulking Agents: Injections to help the urethra close more tightly.

• Surgery: Sling procedures (the most common) or artificial urinary sphincters to support the urethra.

Renal cell carcinoma

• most common adult kidney cancer, arising from the tubular epithelium

SS renal cell carcinoma

• Classic Triad (Rarely all together): Blood in urine (hematuria), flank pain, and a palpable mass.

• General Symptoms: Unexplained weight loss, fever, fatigue, and loss of appetite.

• Advanced Symptoms: Varicocele (swelling of veins around a testicle) and signs of metastasis (e.g., bone pain, breathing issues).

• Paraneoplastic Syndromes: High blood pressure, high calcium (hypercalcemia), or abnormal liver function tests (Stauffer syndrome)

etiology renal cell carcinoma

• Lifestyle: Tobacco smoking is a significant risk factor.

• Physical Health: Obesity (especially in women) and high blood pressure.

• Medical History: Long-term dialysis or chronic renal failure.

• Environmental/Genetics: Exposure to trichloroethylene/asbestos, and genetic conditions like von Hippel-Lindau disease.

diagnosis renal cell carcinoman

• Imaging: Contrast-enhanced, triple-phase helical CT scan is the standard, followed by MRI or ultrasound.

• Laboratory Tests: Urinalysis (to check for blood), blood tests for kidney function (creatinine), and blood count (anemia).

• Biopsy: Usually not necessary for diagnosis unless the tumor is small or uncertain

treatment renal cell carcinoma

• Localized Disease (Early Stage): Surgery is the primary treatment, including Radical Nephrectomy (removing the whole kidney) or Partial Nephrectomy (removing only the tumor).

• Ablation: Cryotherapy or radiofrequency ablation for small tumors in patients unable to have surgery.

• Advanced/Metastatic Disease: Targeted therapies (e.g., tyrosine kinase inhibitors), immunotherapy, or systemic treatment, rather than traditional chemotherapy

Bladder tumors

• abnormal tissue growths in the bladder lining, primarily causing hematuria (blood in urine) and urinary frequency, often driven by smoking or carcinogen exposure.

SS bladder tumors

• Hematuria (Most common): Visible (rusty/bright red) or microscopic blood in urine.

• Voiding Symptoms: Increased frequency, urgent need to urinate, or pain/burning (dysuria) during urination.

• Physical Changes: Feeling the need to urinate without results, weak stream, or inability to empty the bladder.

• Advanced Symptoms: Lower back/pelvic pain, unintended weight loss, or inability to urinate.

etiology bladder tumors

• Smoking: The leading cause, accounting for about half of all cases.

• Chemical/Carcinogen Exposure: Industrial toxins (aromatic amines, dyes, rubber, leather).

• Chronic Bladder Irritation: Long-term infections, kidney stones, or long-term catheter use.

• Age/Gender: More common in older adults and men.

diagnosis bladder tumors

• Cystoscopy: Using a camera to inspect the bladder lining for tumors.

• Biopsy: Tissue sample removal during cystoscopy to check for cancer cells.

• Urine Tests: Urinalysis for microscopic blood and urine cytology/tumor markers to detect cancer cells.

• Imaging: CT urogram or retrograde pyelograms to visualize the upper urinary tract and detect metastasis

treatment of bladder tumors

• Transurethral Resection of Bladder Tumor (TURBT): Primary surgical treatment for non-muscle-invasive bladder cancer to remove the tumor, explain Urologic Surgeons of Washington and American Academy of Family Physicians | AAFP.

• Intravesical Therapy: Liquid drugs (immunotherapy like BCG or chemotherapy) directly introduced into the bladder.

• Radical Cystectomy: Surgical removal of the entire bladder for invasive cancer.

• Systemic Chemotherapy & Radiation: Used for advanced, muscle-invasive, or metastatic tumors.