Obstructive Uropathy & End Stage Renal Disease Flashcards

Flashcards covering urinary tract obstruction, renal stones, hydronephrosis, and end-stage renal disease based on lecture notes.

What is Urinary Tract Obstruction (UTO)?

A condition where urine flow is blocked at any level of the urinary tract, potentially leading to hydronephrosis and kidney damage.

What is hydronephrosis?

Dilation of the renal pelvis and calyces with progressive renal atrophy, often caused by urinary tract obstruction.

What are some congenital causes of urinary tract obstruction?

Urethral valves/strictures, meatal stenosis, bladder neck obstruction, ureteropelvic junction obstruction, severe vesicoureteral reflux.

What are some acquired causes of urinary tract obstruction?

Urinary calculi, prostatic hypertrophy, tumors, inflammation, sloughed papillae, normal pregnancy, neurogenic bladder.

What is Urolithiasis?

Calculus formation at any level in the urinary collecting system, most often in the kidney.

What factors contribute to the pathogenesis of renal stones?

Abnormal urine composition, changes in urine pH, bacterial infections, and supersaturation of urine.

What are the main types of renal stones?

Calcium stones, struvite stones, uric acid stones, and cystine stones.

What are the typical characteristics of renal stones morphology?

Often multiple, small (2-3 mm), smooth or jagged, sometimes forming staghorn calculi.

What metabolic and environmental factors are associated with calcium stones?

Hypercalciuria (idiopathic, absorptive, renal, hypercalcemia), hyperoxaluria, hyperuricosuria, hypocitraturia, low urine volume.

How do struvite stones form?

Urinary tract infections with urea-splitting bacteria leading to alkaline urine and struvite crystal formation.

What conditions are associated with uric acid stones?

Gout, leukemias, rapid cell turnover, or a persistent tendency to excrete acidic urine.

What causes cystine stones?

A genetically determined defect in renal tubular transport leading to impaired reabsorption of cystine, ornithine, lysine, and arginine.

What are the clinical features of renal stones?

Renal colic, hematuria, dysuria, urgency, frequency, nausea, vomiting.

What are potential complications of renal stones?

Urinary tract obstruction, recurrent UTIs, chronic kidney disease, nephrocalcinosis, impaired renal function.

What are some immediate consequences of urinary tract obstruction?

Dilation of renal pelvis and calyces, UTIs, pain, hematuria, bladder dysfunction (overdistension, hypertrophy).

What are some long-term complications of urinary tract obstruction?

Renal impairment/failure, urolithiasis, hypertension, post-obstructive diuresis, sepsis, infertility/sexual dysfunction.

What are some causes of hydronephrosis?

Congenital abnormalities, foreign bodies, proliferative conditions (BPH, tumors), inflammatory conditions, neurogenic bladder, physiological causes (pregnancy).

What is the pathogenesis of hydronephrosis?

Glomerular filtration continues despite obstruction, filtrate diffuses into interstitium, leading to dilation and compression.

What are the gross features of hydronephrosis?

Kidney may be enlarged with distended pelvicalyceal system, compressed and atrophied parenchyma, obliterated papillae.

What are the microscopic features of hydronephrosis?

Tubular dilation and atrophy, followed by fibrosis and glomerular atrophy.

What are the clinical features of hydronephrosis?

Flank pain, abdominal mass, hematuria, recurrent UTIs, fever, lower urinary tract symptoms, oliguria/anuria, renal failure, uremia.

What is End-Stage Renal Disease (ESRD)?

Final, irreversible stage of chronic kidney disease where kidneys can no longer maintain homeostasis.

What are the key features of ESRD?

GFR <15 mL/min/1.73 m², extensive fibrosis, atrophy, and loss of function; requires dialysis or kidney transplantation.

What are the main etiologies of ESRD?

Diabetic nephropathy, hypertensive nephrosclerosis, glomerular diseases, tubulointerstitial diseases, hereditary disorders, obstructive uropathy.

What is the pathogenesis of ESRD?

Progressive renal damage leads to glomerulosclerosis, tubulointerstitial fibrosis, and capillary rarefaction.

What are the gross morphological features of chronic kidney damage?

Pale, shrunken kidney with irregular scars, cortical thinning, and blurring of corticomedullary junction.

What are the gross features of ESRD kidneys?

Kidneys symmetrically shrunken, granular surface, thinned cortex and medulla, blurring of corticomedullary junction.

What are the microscopic features of ESRD?

Hyalinosed glomeruli, hyaline casts, thickened vessels, interstitial fibrosis and inflammatory infiltrate.

What are the systemic manifestations of ESRD?

Anemia, bleeding tendency, fatigue, neuropathy, renal osteodystrophy, edema, hypertension, anorexia, hyperphosphatemia.