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Renal pathology, kidney stone, tumors, urinary incontinence, urinary tract…
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kidney stone
calcium
calcium phosphate
x-ray and CT radiopaque; wedge-shaped prism; treat with low sodium-diet, thiazides
calcium oxalate
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most common; ↓urine pH; from ethylene glycol ingestion, vitamin C abuse, hypocitraturia, malabsorption; treat with thiazides, citrate, low sodium diet
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uric acid
↓pH; x-ray radiolucent, CT minimally visible; rhomboid or rosettes; 5%; associated with hyperuricemia
treat with alkalinization, allopurinol
cystine
treat with low sodium diet, alkalinization, chelating agent
↓pH; x-ray faintly radiopaque, moderately radiopaque; hexagonal; PCT transporter defect; staghorn calculi
lead to hydronephrosis, pyelonephritis; flank tenderness, colicky painradiating to groin(鼠径部), hematuria
tumors
renal cell carcinoma
treatment: surgery/ablation, immunotherapy, rarely curative; resistant to chemotherapy and radiaton therapy
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hematuria, palpable mass, polycythemia, flank pain, fever, weight loss
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renal oncocytoma
painless hematouria, flank pain, abdominal pain
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benign epithelial cell tumor; from collecting duct; well-circumscribed mass with central scar; large eosinophilic cell
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urinary incontinence
urgency incontinence
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treat with training, antimuscarinics
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overflow incontinence
associated with polyuria, bladde outlet obstruction, neurologic bladder
treat with catheterization, relieve obstruction
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stress incontinence
risk: obesity, vaginal delivery, prostate surgery
treat with exercise, weight loss, pessaries
urethral hypermobility or intrinsic sphincteric deficiency→leak with ↑intra-abdominal pressure; + bladder stress test
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hydronephrosis
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caused by urinary tract obstruction(most common), retroperitoneal fibrosis, vesicoureteral reflux
acute kidney injury
intrinsic renal failure
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due to acute tubular necrosis(common), acute glomerulonephritis; patchy necrosis→debris obstructing tubule and fluid backflow across necrotic tubule→↓GFR
prerenal azotemia
↓ RBP→GFR; ↑BUN/creatinine ratio, ↓FEna (urine osmolality>500; urine Na+<20; FEna<1%; BUN/Cr>20)
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necrosis
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renal papillary necrosis
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associated with sickle cell disease, acute pyelonephritis, NSAIDs, DM
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basic
cast in urine
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WBC casts: tubulointerstitial inflammation, acute pyelonephritis(腎盂腎炎), transplant rejection
waxy casts: end-stage renal disease, chronic renal failure
RBC casts: glomerulonephritis, hypertensive emergency
hyaline casts: non specific, normal finding
indicate that hematuria/pyuria is of glomerular or renal tubular origin; bladder cancer, kidney stone→hematouria, no cast; acute cystitis→pyuria, no casts
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glomerular disease
nephritic syndrome
due to GBM disruption; hypertension, ↑BUN and creatinine, oliguria, hematuria, RBC cast; proteinuria (<3.5g/day); inflammatory
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Alport syndrome
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mutation in type 4 collagen→thining and splitting of glomerular basement membrane; XD; eye problem, glomerulonephritis, sensorineural deafness
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nephrotic syndrome
podocyte disruption→charge barrier impaired; massive proteinuria (>3.5g/day); hypoalbuminemia, edema, hyperlipidemia, frothy(泡立つ) urine with fatty casts; may +nephritic syndrome(GBM disruption); associated with hypercoagulable state and infection
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membranous nephropathy
LM-diffuse capillary and GBM thickening; IF-granular due to IC deposition; EM-spike and dome appearance of subepithelial deposits
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1° or 2° to drug, infection, SLE, solid tumors
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Pyelonephritis
acute pyelonephritis
by ascending UTI, CT show striated parenchymal enhancement
risk factors: indwelling urinary catheter, urinary tract obstruction, vesicoureteral reflux, diabetes mellitus, pregnancy
fever, flank pain, chill, nausea/vomiting
complications: chronic pyelonephritis, renal papillary necrosis, perinephric abscess, urosepsis
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chronic pyelonephritis
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urinary tract obstruction, vesicoureteral reflux
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