Other renal disorders
Nephrocalcinosis/urinary or renal stones/calculi/urolithiasis/nephrolithiasis:
Common – 1/1000 adults.
Types – calcium, struvite, uric acid, cystine
Aetiology –
Clinical features –
Management – bed rest and analgesia for pain; lithotripsy (shock waves to fragment stones)
Renal artery stenosis:
Most commonly due to atherosclerosis. Rare <50yrs.
Results in hypertension and renal failure.
If untreated complete arterial occlusion; collateral vessels may develop if progression is slow.
Treatment – lipid lowering drugs; antihypertensives; low-dose aspirin; angioplasty; bypass
Acute Tubular Necrosis (acute tubulointestinal nephritis):
Common cause of acute renal failure in those that are critically ill; mortality can be as high as 70%; due to ischaemia from disrupted blood supply (eg hypotension, trauma, septic shock) or toxins (eg radiographic contrast agents);
Treatment – initially diuretics and infusion of large volume of fluids;
Renal tubular acidosis (RTA):
Failure of tubules to create and acid urine
Interstitial nephritis:
i) Acute:
• acute inflammation of the tubulo-interstitium
• due to drugs (30%) (eg penicillin, NSAID’s, allopurinol); systemic diseases (eg sarcoidosis, Sjogren’s syndrome); infections (eg leptospirosis, tuberculosis)
ii) Chronic:
• group of diseases causing a chronic inflammation of the tubulo-interstitium
• due to chronic glomerular disease; inflammatory diseases (eg SLE, sarcoidosis, amyloidosis); tumours; drugs (eg NSAID’s); metabolic diseases (eg Wilson’s disease, hypokalaemia)
Chronic Pyelonephritis/Reflux Nephropathy:
Interstitial nephritis due to urinary tract infection
Polycystic Kidney Disease:
Autosomal dominant trait affecting about 80/100 000 adults (rare infantile form is autosomal recessive) – genes on chromosome 16 and 4.
Grape-like cysts develop in kidney decline in renal function.
Initially asymptomatic until later in life until cysts in tubular epithelium are large enough to cause symptoms – vague abdominal discomfort, hypertension, haematouria, renal failure
Treatment – no cure; dialysis; transplant
Urinary tract obstruction:
Fanconi’s syndrome:
Malformation of proximal renal tubules, often leading to end-stage renal disease. Onset is usually in first six months of life or adult (depends on type).
Treatment – symptomatic
Bladder cancer:
Second most common urologic cancer. 90% are transitional cell tumours from epithelial lining.
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