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Transcript
RENAL DISEASE: RENAL STONES AND UT OBSTRUCTION Pathophysiology of Disease: Chapter 16 (401-404) Jack DeRuiter, PhD Dept of Pharmacal Sciences April, 2000 Urinary Tract Obstruction: Common Causes (page 402) Obstructions of Ureter, Bladder Outlet or Urethra caused by: • • • • • • • Structural malformations (Table 16-16) Inflammation and Trauma Tumor/Cancer of renal and neighboring structures Blood clots Pregnancy Neuropathy/Spinal Cord Disease Renal stones Clinical Presentation: (pages 401-404) • Flank Pain (+/-): – Distention of ureter, renal pelvis or capsule – Severity: proportional to distention • Hematuria • Azotemia: Bilateral Obstruction • Decreased urine production – Anuria: Bilateral obstruction Etiology (page 402) • Hypercalciuria (75%): Calcium oxalate stone – Heredity (Idiopathic; most common), Neoplasm, Bowel surgery • Struvite Stones (10-15%): Magnesium, Ammonium, Phosphate – UT Infections: Urease-Producing microbes (Proteus) • Hyperusicosuria (5-8%): Uric acid stones – Gout, Heredity, Malignancy, Lesch-Nyhan Syndrome • Cystinuria (1%): Defective amino acid transport Pathology and Pathogenesis (page 402) • Cause: Nucleation and precipitation of salts in renal structures • Contributing Factors – – – – Dehydration: Less salt “dissolved” High protein diets: Acidosis and Inc GFR: Ca High sodium diet: Calcium oxalate Essential Hypertension: Hypercalciuria • Dietary calcium and oxalate does not enhance likelihood of stone formation in most patients Preventative/Protective Measures (page 402) • Fluids: Enhanced dissolution of salts • Citrate: chelates Ca to form soluble complex which is excreted • Magnesium: Salt replacement? • Dietary fiber: Indirect Effect? Treatment and Complications: Pages 403-404 • Stone passage: Fluids, bed rest and analgesia • Treatments (Table 16-17): – Diuretics, urine alkalinization, allopurinol, etc • Complications: – – – – Hydronephrosis/Complete obstruction Infection or abscess behind obstruction Renal damage due to repeated stone formation Hypertension: increased renin production
