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Kidneys and Urinary Tract Premed 2 Pathophysiology • The kidneys are paired organs, which have the production of urine as their primary function.They are an essential part of the urinary system, but have several secondary functions concerned with homeostatic functions. These include the regulation of electrolytes, acid-base balance, and blood pressure. • In producing urine, the kidneys excrete wastes such as urea and ammonium; the kidneys also are responsible for the reabsorption of glucose and amino acids. Finally, the kidneys are important in the production of hormones including calcitriol, renin and erythropoietin. • Located behind the abdominal cavity in the retroperitoneum, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder. Endocrine Function • The kidneys secrete the following hormones to initiate processes that occur in other parts of the body: • 1. Erythropoietin • 2. The active form of Vitamin D, 1,25dihydroxyvitamin D3, • 3. Renin Urinary tract Infection • More common in women, pregnancy • Most common organism: Escherichia coli • Predisposing factors: obstruction surgery catheters gyne abnormalities • Urinary frequency • Dysuria, pyuria, hematuria, bacteriuria UTI • Acute cystitis pyuria hematuria no white cell casts • Acute pyelonephritis fever, flank pains white cell casts Urolithiasis • Calculi or stones in the urinary tract; men • Most common type: calcium stones calcium oxalate, calcium phosphate radiopaque • Hypercalcemia, hypercalciuria • Causes: hyperparathyroidism malignancy vitamin D intoxication Urolithiasis • MAP stones: magnesium ammonium phosphate • Second most common type • Radioluscent • Staghorn (struvite) calculi • Infections with Proteus and Staphylococcus Urolithiasis • Uric acid stones hyperuricemia gout leukemia myeloproliferative diseases • Cystine stones cystinuria Adult polycystic disease • Most common inherited disease of the kidney • Shows clinically at 15 to 30 years old • Large kidneys, bilateral • Numerous cysts in the parenchyma • Associated with berry aneurysms in the circle of willis Renal Failure • • • • May be acute or chronic Always presents with azotemia Late stages: uremia Others: acidosis hyperkalemia abnormal fluid control hypocalcemia anemia hypertension Glomerulus Glomerular diseases • • • • • Nephrotic syndrome Proteinuria Hypoalbuminemia Edema Hyperlipidemia, hypercholesterolemia • • • • • Nephritic syndrome Oliguria Azotemia Hematuria Hypertension Glomerular diseases • Minimal change disease • Focal segmental glomerulosclerosis • Membranous glomerulonephritis • Lupus nephropathy • Poststreptococcal glomerulonephritis • Rapidly progressive glomerulonephritis • Goodpasture syndrome • Alport syndrome Minimal change disease(lipoid nephrosis) • common in young children • fused or absent epithelial foot processes Membranous glomerulonephritis • primary cause of nephrotic syndrome • teens, young adults • Diffuse thickening of the glomerular capillary wall • immune complexes deposits • “spike and dome” appearance Nephrotic syndrome • Lupus nephropathy immune complexes : • “ wire loops” Nephritic syndrome: Poststreptococcal glomerulonephritis -immune complex deposits : “lumpybumpy” -follows/accompanies infection: group A beta-hemolytic streptococci -increased ASO titers ALPORT SYNDROME Is hereditary nephritis. • abnormal collagen (type IV) • deafness,various eye disorders, lens dislocation, cataracts, corneal dystrophy. Rapidly progressive glomerulonepritis • Renal failure in weeks • Fibrin deposits in the Bowmans spacecrescents • Caused by: poststreptococcal – 50% Goodpasture syndrome • antibodies against the glomerular membrane • Linear pattern • hemoptysis
