Week 8: Renal Disorders (part two)

Types of urinary tract infections

-Asymptomatic bacteriuria

-Symptomatic infections

-Lower UTIs (Cystitis)

-Upper UTIs (Pyelonephritis)

Causes of UTIs

- most common: Escherichia coli

- enters through the: urethra

Causes of UTIs associated with stasis or urine flow (#1): Anatomic obstructions:

Anatomic obstructions:

- urinary tract stones

- pregnancy

- prostatic hyperplasia

- increased pressure resulting in reflux

Causes of UTIs associated with stasis or urine flow (#2): Functional obstructions

- neurogenic bladder

- infrequent voiding

- bladder muscle instability

- constipation

Protective mechcanisms of the urinary tract:

- wash out phenomen

- muscin layer

- local immune responses

- normal flora of the periurethral area in the women

- prostate secretions in men

Characteristics of acute episode of cystitis

(symptoms are sudden and have a short duration)

- Cystitis: inflammation of the bladder

1. Frequency of urination: often as 20 minutes

2. Lower abdominal/back pain

3. Burning + pain on urination "dysuria"

4. Cloudy/foul smelling urine

Special considerations of UTI

Patients:

- sexually active women

- pregnant women

- age-related effects: infants/toddlers/adults/elderlys

characteristics of glomerulonephritis

- glomerulonephritis: inflammation of the glomeruli- tiny filitering units in the kidneys

Immune mechcanisms:

- glomerular antibodies

- circulating antigen-antibody complexes

characteristics:

- hematuria with red cell casts

- decreased GFR

- "Azotemia": presence of nitrogenous waste in the blood

- oliguria

- hypertension

Causes of glomerulonephritis

diseases that provoke a proliferative inflammatory response of the endothelial, mesangial, or epithelial cells of the glomeruli

Inflammatory process of glomerulonephritis

-Damages the capillary wall-->

-Permits RBC to escape into the urine -->

-Produces hemodynamic changes that decrease the GFR

Structural changes in glomerulonephritis

1. Prolifterative:

- increase number of cells in glomerulus

- indicates: active inflammation

2. Endothelial:

- refers to: changes in endothelial cells lining the glomerulus

3. Mesangial:

- changes involving: mesangial cells (support cells in the glomeruli)

urinary changes in glomerulonephritis

- Proteinuria: excess protein in urine

- Hematuria: blood in urine

- Pyuria: (increased WBCs) pus in the urine

- Oliguria: decreased urine output

- Edema: swelling in tissues

- Hypertension

- Azotemia: increase nitrogenous wastes in blood

EX: BUN or creatinine

Tubulointerstitial Disorders

- Damage to the proximal, loop, or distal portion of the nephron

- Disorders: acute and renal tubular acidosis

Pyelonephritis

- type of kidney infection that involves inflammation of paranchyma (renal pelvis and kidney tissue)

Proximal and Distal Tubular Acidosis

- Renal tubular acidosis: proximal tubular disoders that affect bicarbonate reabsorption

- Distal tubular acidosis: affects the secretion of fixed metabolic acids