Beruflich Dokumente
Kultur Dokumente
6th Edition
2007 Lippincott Williams & Wilkins
Urogenital Tract
Differential Diagnosis of Urogenital Disorders
Renal failure
= clinical condition associated with rapid steadily increasing azotemia oliguria (<500
mL urine per day) over days / weeks
Etiology:
A. PRERENAL
= renal hypoperfusion secondary to systemic illness
1. Fluid + electrolyte depletion
2. Hemorrhage
3. Hepatic failure + hepatorenal syndrome
abnormally elevated resistive
index
4. Cardiac failure
5. Sepsis
resistive index <0.75 in 80% of
kidneys
B. RENAL (most common)
1. Acute tubular necrosis:
ischemia, nephrotoxins, radiographic contrast, hemoglobulinuria,
myoglobulinuria, myocardial infarction, burns
resistive index 0.75 in 91% of
kidneys
2. Acute glomerulonephritis + small vessel disease:
acute poststrep glomerulonephritis, rapidly progressive
glomerulonephritis, lupus, polyarteritis nodosa, Schnlein-Henoch
purpura, subacute bacterial endocarditis, serum sickness,
Goodpasture syndrome, malignant hypertension, hemolytic uremic
syndrome, drug-related vasculitis, abruptio placentae
normal resistive index <0.70
3. Acute
tubulointerstitial nephritis:
lack of
osteosclerosis
less evidence of subperiosteal resorption
3. Amyloid deposition
o Path: amyloid consists of 2-microglobulin
o Organs: bone, tenosynovium (carpal tunnel syndrome), vertebral disk, articular
cartilage + capsule, ligament, muscle
4. Destructive spondyloarthropathy (15%)
o diskovertebral junction erosion + sclerosis
o
formation
lack of osteophytosis
Schmorl node
o facet involvement
with subluxation
5. Tendon rupture
6. Crystal deposition disease
o Type: calcium hydroxyapatite, CPPD, calcium oxalate, monosodium urate
7. Osteomyelitis + septic arthritis
8. Avascular necrosis (in up to 40%)
Diabetes insipidus
= characterized by daily production of very large volume of dilute urine (specific gravity
<1.005, <200 mOsm/L)
in
adulthood:
a. congenital
1. Rare X-linked recessive genetic disorder with unresponsiveness of tubules
+ collecting system to vasopressin (in infants + young males) with
variable expression
2. Autosomal dominant form (rare)
b. acquired = nephrogenic DI syndrome
= disorders affecting the medulla / distal nephrons:
medullary + polycystic disease, sickle cell nephropathy,
postobstructive uropathy, reflux nephropathy, chronic uremic
nephropathy, unilateral renal artery stenosis, acute tubular necrosis,
drug toxicity, analgesic nephropathy, hypokalemic +
hypercalcemic nephropathy, amyloidosis, sarcoidosis
symptoms in infancy:
vomiting secondary to hypernatremic dehydration
mental retardation
caloric growth failure (water favored over formula)
symptoms after infancy:
increased fluid intake
avoiding urination
bilateral hydroureteronephrosis
Rx: thiazide diuretics, low-salt diet, encouragement of frequent
micturition, indomethacin
Hypercalcemia
Polycythemia
P.879
Arterial hypertension
A. PRIMARY / ESSENTIAL HYPERTENSION (8590%)
B. SECONDARY HYPERTENSION
a. Renal parenchymal disease (510%)
b. Potentially curable secondary hypertension (12%)
vascular
1. Renovascular disease
0.184.4%
2. Coarctation
0.6%
hormonal
1. Pheochromocytoma
0.040.2%
2. Cushing syndrome
0.3%
3. Primary aldosteronism
0.010.4%
4. Hyperthyroidism
5. Myxedema
renal
1. Unilateral renal disease
Renovascular Hypertension
11.
Middle aortic syndrome, aortic dissection, dissecting
aortic aneurysm
12.
Posttraumatic renovascular hypertension
. occlusion of main renal artery
a. significant stenosis by intimal flap
b. severe renal contusion
c. segmental renal artery branch injury
Renal artery stenosis is present in 77% of hypertensive
patients!
Renal artery stenosis is present in 32 49% of
normotensive patients!
1520% of patients remain hypertensive after
restoration of normal renal blood flow!
Clinical findings that suggest renovascular disease:
1.
2.
3.
4.