THER2030 Renal System Pathologies

Congenital and inherited renal disorders

ectopic and horseshoe kidney, decrease in renal mass, renal dysplasia / dysgenesis

How is ectopic kidney positioned

outside normal position

What is a horseshoe kidney

two kidneys fused together

Cystic kidney disease is

fluid filled cysts occur within tubular structures of kidney

Two forms of polycystic kidney disease

autosomal dominant (most common, onsets in adulthood), autosomal recessive (rare, onsets in infancy)

Medullary spine kidney / medullary cystic disease is

autosomal recessive disease with shrunken kidneys with cysts onset in childhood

End stage of medullary cystic disease

renal disease by adulthood

In what population is simple / acquired renal cyst most common

older adults

Cause of simple cystic kidney disease

idiopathic, associated with aging

Cause of acquired cystic kidney disease

end stage renal disease or dialysis treatment, tubular obstruction

Cause of polycystic kidney disease

changes in basement membrane / epithelium of renal tubule predisposing to cystic dilation and inciting inflammation

Cause of medullary cystic kidney disease

progressive basement membrane disruptions leading to chronic kidney disease and failure

Symptoms of simple and acquired cystic kidney disease

hematuria, infection, hypertension, secondary tumours in the walls of cyst

Where does autosomal dominant cystic kidney disease present and initial symptoms

present in every segment in the thousands; asymptomatic initially

Structure and symptoms of autosomal recessive cysts in kidney

elongated cysts; cause severe renal dysfunction, liver fibrosis, portal hypertension, and death in the first year of life

Manifestations of medullary cysts in kidney

inability to concentrate urine leading to polyuria polydipsia enuresis (bed weeting)

How is cystic kidney disease diagnosed

lab tests, urinalysis

Treatment for cystic kidney disease

less severe - supportive treatment, control secondary complications; more severe - above continued plus kidney dialysis or transplant

Massage contraindications in renal cystic conditions

fluid management likely impaired - use ADLs to measure tolerance, mod for meds

Renal / urinary obstruction is

not a pathology but a common complication of many renal and urinary issues including calculi, pregnancy, prostatic hyperplasia, scar tissue from infection / trauma, neurological disorders

Complications of renal / urinary obstruction

promotes stasis of urine, back pressure, increased risk of infection and calculi (kidney stones), hydronephrosis, damage and impaired function

What is hydronephrosis

urine filled dilation of the renal pelvis and calices

Renal calculi is

crystalline structures that form from urine components, also known as kidney stones and nephrolithiasis

What does renal calculi begin as

nidus / nucleus that continues to crystalize

What type of calculi is associated with increased blood calcium

calcium type

What is calcium type renal calculi secondary to

bone resorption due to immobility / disease, hyperparathyroidism, renal tubular acidosis

What type of renal calculi is associated with UTI in alkaline urine

magnesium ammonium phosphate type

What type of renal calculi is associated with cystinuria and most often manifests from autosomal recessive genetic disorder

cystine type

Contributing factors to renal calculi

high calculi causing components in blood and urine, issues with metabolism, endocrine system, and intestinal absorption, UTI

Types of pain manifesting with renal calculi

renal colic, ureteral colic, noncolicky pain

Renal colic pain is caused by

stretching of ureter and collecting system from stones moving into ureter

Causes of noncolicky pain

stones that produce general distention of the renal calices / pelvis

What does urinalysis detect for in renal calculi

hematuria

How is renal calculi diagnosed

urinalysis, or analysis of stone once passed

Treatment for renal calculi that are too large to pass

uteroscope, nephrolithotomy, ultrasonic lithotripter / extracorporeal shock wave lithotripsy

Treatment for renal calculi

dietary modification, change of urine pH, treat UTI, diuretics, increased water intake

Massage contraindications with renal calculi

avoid treatment when stones are being passed, risk of infection, no CIs after recovery but may need to modify for residual damage

Urinary tract infection is

bacterial infection within the urinary system

Most common UTI is caused by what bacteria

E.Coli

Cystitis is

bladder infection

Pyelonephritis is

kidney infection

What factors stop regular infection from bacteria with UTI

washout phenomenon and immune activity

What increases the risk of introducing bacteria in UTI

catheterization and sexual activity

Bacteria can enter the urinary system via the blood, most often in what populations

neonates and immunocompromised

Lower urinary tract infection is more common in what sex

females > males

Why are UTIs more common in females

shorter urethra, pregnancy due to obstruction, smooth muscle relaxation promoting stasis and increased urine capacity

Is upper or lower UTI more serious

upper

Why is upper UTI more serious

invades the kidney leading to an acute inflammatory response

What factors increase risk of upper UTI

children, obstruction, predisposing conditions such as diabetes

Lower - minimal / non systemic UTI symptoms

irritative voiding, foul or cloudy urine, symptoms overlap with urethritis caused by chlamydia, gonorrhea, and herpes simplex

Upper - systemic UTI major symptom

acute - constant ache in loin area of back (low ribs/back/pelvis)

What population often present atypically with UTI

babies and young children

Why do UTIs often get overlooked in older adults

frequency, urgency, and incontinence are common in older populations so typical symptoms are overlooked

Diagnosis of UTI

urinalysis, culture, imaging

UTI treatment

antibiotics, increased fluids, preventative measures with recurrent infection

Massage contraindications with UTI

avoid massage until resolved

Five categories of glomerular disease

nephritic syndromes, rapidly progressing glomerulonephritis, nephrotic syndrome, urinary sediment, chronic glomerulonephritis

Key factor of proliferative glomerular disease

increased inflammatory or glomerular cells

Key factor of membranous glomerular disease

thickening of basement membrane

Key factor of membranous glomerular disease

thickening of basement membrane

Key factor of sclerotic glomerular disease

scarring

Nephritic syndrome is

proliferative inflammatory disease that reduces permeability of glomerular membrane

What causes post-infective nephritic syndromes

bacteria - most commonly group A streptococci, parasites, virus - measles, mumps, chicken pox

Causes of rapidly progressive nephritic syndromes

idiopathic, vasculitis, Goodpasture syndrome

What is Goodpasture Syndrome

uncommon aggressive form of nephritic glomerular disease thought to relate to solvent or drug exposure, influenza, or cancer

Clinical manifestations post-infective nephritic glomerular syndrome

impaired renal function due to occlusion, oliguria, edema, hypertension

What is oliguria

decreased urine output

Treatment of nephritic glomerular syndrome

antibiotics, immunosuppressive therapy

Nephrotic syndrome is

increased permeability of glomerular membrane

What is minimal change disease in primary nephrotic syndrome

fusion of foot processes in children

Clinical manifestations of nephrotic syndrome

edema, atherosclerosis, decreased immunity

Common medication for nephrotic syndrome

corticosteroids

Hypertensive glomerular disease is

mild to moderate hypertension causing sclerotic changes in renal arterioles and small arteries

What is the leading cause of end stage renal disease

hypertensive glomerular disease

Massage considerations and contraindications with glomerular disease

often a complication of another kidney or systemic pathology, if the kidney is compromised avoid techniques which heavily affect circulation

Malignant renal tumour in adults

renal cell carcinoma

Malignant renal tumour in children

Wilms tumour

Clinical manifestations of Wilms tumour

large symptomatic mass, hypertension, other congenital anomalies, possible rupture

Clinical manifestations of renal cell carcinoma

asymptomatic, hematuria, renal mass, inferior vena cava may be affected

How is Wilms tumour diagnosed

palpation then imaging

How is renal cell carcinoma diagnosed

ultrasound, CT, MRI

How are Wilms and renal cell carcinoma tumors treated

surgery, chemo, radiation

Massage contraindications with malignant renal tumour

drug treatment can change tissue health, avoid taxing kidney

Renal failure is

kidneys fail to remove metabolic end products from blood, regulate fluid, electrolyte and pH balance of the extracellular fluid

Acute kidney failure is

rapid decline in kidney function within a few hours

Acute kidney failure can be reversible under what condition

precipitating factor is reversed before damage occurs

What is the mortality rate of acute kidney failure

40-75%

What is the key problem in prerenal acute kidney failure/infarction (AKI)

decreased blood flow to kidneys leading to reduced perfusion

What does hypovolemia mean

low blood volume

What are the major causes of hypovolemia leading to prerenal AKI

hemorrhage, dehydration, GI fluid loss, burn-related fluid loss

What conditions cause decreased vascular filling in acute kidney failure

anaphylactic shock and septic shock

How does heart failure cause prerenal AKI

the heart can’t pump enough blood causing decreased renal perfusion

What is the core problem in intrinsic acute kidney failure

direct damage to kidney tissue

What is the most common cause of intrinsic AKI

acute tubular necrosis (ATN)

What causes ischemic ATN

prolonged renal ischemia

What dioxins can cause nephrotoxic ATN

drugs, heavy metals, organic solvents

What is intra-tubular obstruction

blockage of tubules by crystals, debris, or proteins

What acute renal diseases can cause intrinsic AKI

acute nephritis and pyelonephritis

What what is the core problem in postrenal acute kidney failure

obstruction of urine outflow

What type of obstruction must occur to cause postrenal AKI

bilateral ureteral obstruction