Transcript RENAL DISEASE - Auburn University

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:
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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
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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:
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Hydronephrosis/Complete obstruction
Infection or abscess behind obstruction
Renal damage due to repeated stone formation
Hypertension: increased renin production