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Clinical features 1-Loin pain 2-Renal ureteric pain 3-Dysurea, oliguria, polyuria, anuria,Nocturia,Frequency,Urinary incontinence 4-Dribbing of urine 5-Hematuria 6-Retension of urine 7-Fever and rigor
Investigations 1-Urine analysis 2-Ultrasound 3-IVP 4-Renal arteriograph 5-MRI 6-Renal biopsy
Prerenal disease
Results from inadequate blood flow to the kidney
Decreased intravascular volume Lesions in the renal arteries Hypotension
Systemic disorders that decrease urine output Creatinine clearance? Plasma creatine? BUN?
Renal diseases
Result from direct damage to nephron Glomerular disorders Tubulointerstitial disorders disorders of the medullary tubules and interstitial cells
Postrenal diseases
Commonly due to urinary tract obstruction
Kidney stones Tumors of bladder, ureters or prostate gland
Obstructive Disorders
Interference with urine flow at any point Anatomic or functional Impedes flow proximal to blockage Dilates urinary system Increases risk for infection Compromises renal function Anatomic changes are called obstructive uropathy
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Causes of obstruction
Congenital malformations Stones Abdominal tumor Tumor of urinary system or prostate Severe pelvic organ prolapse in women
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Incidence
Young adult women 0.2/month Lifetime risk in women 50% Young adult men prevalence < 1% High risk groups:
Premature infants Sexually active women Women using a diaphragm or spermicide Diabetics HIV or immunosuppressive disorders Obstruction of lower urinary tract
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Treatment
Antibiotics Drink normal amounts of water, but avoid bladder irritants, such as caffeine
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Acute pyelonephritis
Inflammation is usually focal, affecting pelvis, calyces, and medulla but glomeruli not usually involved. Kidney is infiltrated with wbcs pyuria Healing involves scarring and atrophy of affected tubules
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Acute pyelonephritis
Clinical manifestations:
Acute onset Fever or chills Flank or groin pain Frequency and dysuria
May be difficult to distinguish from cystitis look for white cell casts Treatment:
Microorganism specific antibiotics
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Chronic Pyelonephritis
Manifestations are often minimal Hypertension Frequency and Dysuria Flank pain
Diagnosis
Urine analysis Intravenous pyelography, ultrasound
Treatment
Relieve obstruction antibiotics
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Glomerulonephritis
Caused by a number of factors, most commonly abnormal immune response
Infection Toxins Vascular diseases Systemic diseases (diabetes mellitus)
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Acute Glomerulonephritis
Symptoms occur 10-21 days after infection
Hematuria Proteinuria Decreased GFR, oliguria Hypertension Edema around eyes, feet and ankles Ascites or pleural effusion
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Nephrotic Syndrome
Defined as excretion of 3.5 or more grams of protein / day Also see hypoalbuminemia, edema, hyperlipidemia Decrease in vitamin D
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Nephrotic Syndrome
Treatment:
Diet normal protein, low-fat, salt restricted Diuretics Protein supplements
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Renal Failure
Acute renal failure abrupt decrease in renal function
Increase in BUN and creatinine Usually oliguria (output < 30 ml/hour or 400 ml/day) Most cases are reversible if diagnosed and treated early Prerenal most common cause failure to restore blood volume or pressure and oxygen can lead to acute tubular necrosis or acute cortical necrosis
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Stage 2 Diuresis: 3-4 L/day of urine Stage 3 Recovery May take 3-12 months for plasma creatinine to return to normal About 30 % never regain normal kidney function.
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