RENAL DISEASE: RENAL STONES AND UT OBSTRUCTION Pathophysiology of Disease: Chapter 16 (401-404) - PowerPoint PPT Presentation

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RENAL DISEASE: RENAL STONES AND UT OBSTRUCTION Pathophysiology of Disease: Chapter 16 (401-404)

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RENAL DISEASE: RENAL STONES AND UT OBSTRUCTION Pathophysiology of Disease: Chapter 16 (401-404) Jack DeRuiter, PhD Dept of Pharmacal Sciences April, 2000 – PowerPoint PPT presentation

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Title: RENAL DISEASE: RENAL STONES AND UT OBSTRUCTION Pathophysiology of Disease: Chapter 16 (401-404)


1
RENAL DISEASE RENAL STONES AND UT OBSTRUCTION
Pathophysiology of Disease Chapter 16 (401-404)
  • Jack DeRuiter, PhD
  • Dept of Pharmacal Sciences
  • April, 2000

2
Urinary Tract ObstructionCommon 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

3
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

4
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

5
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

6
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?

7
Treatment and ComplicationsPages 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
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