Other renal disorders
Nephrocalcinosis/urinary or renal stones/calculi/urolithiasis/nephrolithiasis:
Common – 1/1000 adults.
Types – calcium, struvite, uric acid, cystine
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; bypassAcute 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 urineInterstitial 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 infectionPolycystic 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 failureTreatment – no cure; dialysis; transplantUrinary 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 – symptomaticBladder cancer: Second most common urologic cancer. 90% are transitional cell tumours from epithelial lining.