Kidney part 2

• - Inflamation of the renal pelvis, the outher basin-like portion of the kidney at the attachment of the ureter
•  -Common in young childern escpecially girls due to the shorter urethra that in boys
•  - untreated, infection may spread to kidney tissue leading to  pyelonephritis

• - Caused by pyogenic (pus forming) Bacteria
•     - bacteria may orginate from a unrinary bladder infection or blood
•     - or from fecal contamination and travel up the urethra to urinary bladder then up the uretea or to the renal pelvis

Dysuria

Antibotics

Bacterial infection of the kidney and the renal pelvis

• Caused by pyrogenic (pus forming) bacteria
• leads to the obstruction of the unrinary tract slows urine flow which increased risk of infection

• 1 - cogenital defect
• 2- kidney stone
• 3-Enlarged prostate gland

• 1- abscesses from and rupture, draining pus into the renal pelvis and urine
• 2 - Abscesses can fuse and fill the entire kidney with pus
• 3-left untreated, may lead to renal failure and uremia
• 4-Kidneys shrink, describeed as granular contracted kidney

• Bacterial infection of the kidney and renal pelvis
•  - Leads to obstruction of the unrinary tract slows urine flow which increase risk of infecton

Caused by Pyogenic (pus-forming) bacteria

• Causes of obstruction include 
• - Congential defect
• -kidney stone
• -enlarged prostate gland

• 1- abscesses form and rupture draining pus into the renal pelvis and wrine
• 2-abscesses can fuse and fille the entire kidney and wremia
• 3-kidneys shrink, descibed as granular contracted kidney

• [1] Urinalysis
•     [a] Urine turbid or cloudy in appearance
• [2] Microscopy
•     [a] Cells and bacteria

• Chills
• high fever
• sudden back pain
• dysuria

Antibotics

(1) A solid mass made up of tiny crystal

(2) One or more stones can be in kidneys or ureter at the same time

• [1] Calcium stones- most frequent (~80%)
• [2] Uric acid stones (~10%)
• [3] Struvite stones (~10%)
• [4] Cystine stones- least frequent (~1%)

• [a] Occurs 4X more often in men that in women
• [b] Likely to reoccur
• [c] Causes include
•    {1} Unexplained hypercalciuria (causes elevated urinary Ca2+)
•    {2} Hyperparathyroidism (causes excess serum Ca2+)
•    {3}Sarcoidosis (raises serum Ca2+ levels due to overproduction of vitamin D by sarcoid granuloma)
•    {4} Cancers

• [a] More common in men than in women
• [b] Associated with gout, chemotherapy, or high protein diet
• [c] Causes urine to become more acidic leading to excess uric acid levels and stone formation
• [d] Conditions producing acidic urine include dehydration, colon surgery, or high protein diet

• [a] Found in women who have a urinary tract
• infection
• [b] Grow very large blocking the kidney, ureter, or
• urinary bladder
• [c] Bacterial enzymes increase ammonia urinary
• concentrations so urine becomes more alkaline triggering stone precipitation

• [a] Least common
• [b] Inherited disorder involving the amino acid
• cystine (the least soluble of naturally occurring amino acids)
• [c] Formed in people who have cystinuria
• [d] Kidneys fail to reabsorb cystine which then
• crystallizes and precipitates anywhere in the urinary tract

Primary symptom

[1] Severe pain that begins and ends abruptly- Pain in abdomen or side of the back, may move to groin or testicles

• (c)Other symptoms
• [1]Abnormal urine color
• [2] Hematuria
• [3]Chills
• [4]Fever
• [5]Nausea (Pete class)
• [6] Vomiting

• [1] Dehydration
• [2] Urinary tract infection by blocking urinary flow permitting bacterial growth in urinary tract
• [3] Urinary stasis caused by some type of obstruction such as tumors, strictures, or anatomical abnormalities

• [1]Computed tomography (CT) scans
• [2]Intravenous pyelogram (IVP)
• [3]Renal ultrasound/scan
• [4]KUB (x-ray for examining kidneys-ureters-bladder)

• 1- Hydration
• 2-Medications
•    [a]Allopurinol (for uric acid stones)
•    [b]Antibiotics (for struvite stones)
•    [c]Diuretics
•        {1}Thiazide diuretics plus potassium citrate
•         {2}Potassium-sparing diuretics
•      [d]Phosphate solutions (reduces Ca2+
• release into the bloodstream)

• [e]
• Sodium bicarbonate or sodium citrate (makes
• urine more alkaline)

• [a] Extracorporeal shockwave lithiotripsy (ESWL)
• [b] Laser lithotripsy
• [c] Percutaneous nephrolithotomy (PNL)
• [d] Ureteroscopic stone removal
• [e] Open (incisional) surgery

Swelling of one (unilateral hydronephrosis) or both (bilateral hydronephrosis) kidneys due to a backup of urine

• (2) Considered a condition, not a disease
• (a) May result from anatomic or functional processes
• interrupting the flow of urine
• (b) Increased ureteral pressure leads to decreased
• glomerular filtration rate, tubular function, and renal blood flow
• (c) Brief disruptions in urine flow are limited and
• reversible
• (d) Chronic disruptions in urine flow can lead to
• tubular atrophy and nephron loss

• [1] Birth defects
• [2] Ureterocele (swelling at the base of one of the
• ureters)
• [3] Ureter prolapse
• [4] Kidney stones or blood clots in the renal pelvis
• [5] Compression of the ureter due to fibrous bands,
• an abnormally located artery or vein, or tumor

• Kidney cyst that is a dilated renal tubule that does not
• open into the renal pelvis

Cysts enlarge, fuse together, and may become infected

• [1] Congenital defects
• [2] Autosomal dominant hereditary disease
•      [a] Symptoms usually begin in middle age
• [3] Autosomal recessive hereditary disease
•      [a] Symptoms appear in infancy or early childhood

• [1] Physical examination
• [2] Renal ultrasound
• [3] Computed tomography (CT) scan
• [4] Intravenous pyelogram (IVP)

• [1] Antihypertensive medications
• [2] Diuretics
• [3] Low-salt diet
• [4] Antibiotics
• [5] Drainage of cysts
• [6] Surgical removal of affected kidney
• [7] Kidney transplantation

Inflamation of the urinary bladder casue by bacterial infection

More common in women then men due tothe women shorter urthea

• [1] In women, E. coli from colon could enter urethra
• [2] Sexual intercourse
• [3] Coughing or exertion squeezes urinary bladder pushing some urine into the urethra then urine reenters urinary bladder

• (c) Diagnosis
• [1] Microscopic examination reveals
•     [a] Bacteria
•     [b] Pus
•     [c] Casts
•     [d] Leukocytes
•  (d) Treatment - Antibiotics

• Loss of urinary bladder control or the involuntary
• release of urine

• 1 -Temporary urinary incontinence
• 2- Persistent urinary incontinence

• [a] Alcohol
• [b] Overhydration
• [c] Dehydration
• [d] Caffeine
• [e] Urinary bladder irritation
• [f] Medications
• [g] Urinary tract infection
• [h] Constipation

• [a] Pregnancy
• [b] Changes with aging
• [c] Hysterectomy
• [d] Painful urinary bladder syndrome (interstitial
• cystitis)
• [e] Prostatitis
• [f] Enlarged prostate
• [g] Prostate cancer
• [h] Urinary bladder cancer or urinary bladder stones
• [i] Neurological disorders
• [j] Obstruction

• 1- Overflow incontinence - urinary bladder overfills and urine leask from the urethra
• 2-Stress incontinence - urethral sphincter is either weakend or damaged allowing leakage of urine following increased abdominal preasure
• 3-Urge incontinence - Strong sudden need to urinate due to urinary bladder spasms or contractions

• 1- Behavioral techniques
• 2- Physical Therapy
• 3-Medical devices
• 4-Inerventional therapies
• 5-Surgery
• 6-Miscellaneous

[1] Urinary bladder training

[2] Scheduled toilet trips

[3] Fluid and diet management

[1] Pelvic floor muscle exercises

[2] Electrical stimulation

[1] Anticholinergics

[2] Topical estrogen

[3] Antidepressant

[1] Urethral inserts

[2] Pessary

[1] Radiofrequency therapy

[2] Botulinum toxin type A

[3] Bulking material injections

[4] Sacral nerve stimulator

[1] Artificial urinary sphincter

[2] Sling procedures

[3] Urinary bladder neck suspension

[1] Absorbent pads and protective garments

[2] Catheters