Patho week 12
Severity of a urinary tract obstruction depends on (5)
-Cause of the lesion -Duration of blockage -Location of blockage -Degree of completeness -Whether it involves one or both urinary tract systems
In a spermatocele, Ducts of epididymis become_______and form collections of________.
-Dilated -Collections of sperm containing fluid
Treatment for Cryptorchidism
-GnRH hormone therapy may trigger descent -If hormone therapy is unsuccessful, patient may need surgery
Problems of inadequate spermatogenesis (3)
-Impaired sperm quantity -Impaired sperm quality -Impaired sperm motility
2 specific signs of epididymitis
-Positive Prehn's sign (relief of symptoms with scrotal elevation) -May pyuria (WBC in urine)
AKI clinicaly measures by (4)
-decreased GFR -Increased blood urea nitrogen -increased serum creatinine -reduced urine output
a UTI is diagnosed by a urine culture of specific microorganisms with counts of
10,000/mL or more
Precocious puberty is very rare in males
1:50,000
Clinical manifestations of CKD are similar to AKI however they do not typically appear until after______ of renal function is lost
25%
Erections lasting longer than_________are medical emergencies.
4 hours
Most people with kidney stones will develop their first stones before the age of
50
Uncircumcised men have a ______increased risk of developing penile cancer
50
If torsion cannot be reduced manually, then surgery must be performed within_______ after the onset of symptoms to preserve normal testicular function
6 hours
Metabolic acidosis Decreased GFR Elevated BUN and creatinine
AKI
A specific clinical manifestation of a testicular torsion
Absent cremaster reflex (stroking inner part of thigh leads to contraction of cremaster muscle which pulls up the testes; absent in testicular torsion)
Inflammation of the glomerulus
Acute Glomerulonephritis
Leads to decreased glomerular filtration rate (GFR) due to decreased blood flow and scarring
Acute Glomerulonephritis
-Ascending infections of urinary tract; tends to occur in men 30-50 years of age -Symptoms are similar to UTI or pyelonephritis (fever, back pain, dysuria, incomplete bladder emptying, etc)
Acute bacterial inflammation
4 main categories of prostatitis
Acute bacterial inflammation Chronic bacterial inflammation Chronic pelvic pain syndrome Asymptomatic inflammatory prostatitis
May be caused by immunological responses, ischemic injury, free radicals, drugs, toxins, infections, or as a consequence of chronic diseases such as diabetes or lupus
Acute glomerulonephritis
classic triad of HUS
Anemia Thrombocytopenia AKI
promotes glomeruli hypertension which may progress to tubulointerstitial fibrosis and scarring
Angiotensin II
Severely reduced urine output of less than 10 mL/hr or complete absence of urine production
Anuria
Discovered incidentally but completely asymptomatic and no indication of infection
Asymptomatic inflammatory prostatitis
Symptoms are associated with urethral compression Urge to urinate often Some delay in starting urination Decreased force of the urinary stream
BPH
-Also known as benign prostatic hypertrophy -Enlargement of the prostate gland via hyperplasia and hypertrophy, which are continuous processes throughout life
Benign Prostatic Hyperplasia (BPH)
Most common cause in men; enlargement of prostate leads to obstruction of bladder outlet
Benign prostate hypertrophy
its important to check for______ when a patient comes in with delayed puberty.
Brain tumors
Hypertension, glucose intolerance, inflammation, potassium abnormalities can all lead to increased risk of cardiovascular disease
CKD
Loss of plasma proteins including complement cascade' patients will be more likely to develop infections
CKD
Loss of protein leads to loss of plasma proteins including coagulation cascade; patients will be more prone to bleeding
CKD
Similar to AKI, can be clinically measured by decreased GFR, increased serum creatinine, increased blood urea nitrogen (BUN), degree of albuminuria, and reduced urine output
CKD
-HPG axis is working normally but prematurely -Need surveillance for possible brain tumor
Central precocious puberty
Recurrent urinary tract symptoms and presence of bacteria in urine or prostatic fluid
Chronic bacterial inflammation
Progressive loss of renal function; typically caused by underlying systemic diseases such as uncontrolled hypertension, diabetes, systemic lupus erythematous or intrinsic kidney disease
Chronic kidney disease
No pathogenic bacteria can be found Symptoms are similar to bacterial prostatitis but typically more mild
Chronic pelvic pain syndrome
-Hematuria (blood in urine) -dull and aching flank pain -palpable flank mass in thinner individuals
Clinical Manifestations
Edema, erythema, and tenderness of the prepuce with purulent discharge.
Clinical Manifestations of Phimosis
-Typically begins as small ulcerative or papillary lesion on penis that grows over shaft -Another early sign is leukoplakia (thick white plaque over meatus) -Later signs include penile pain and bleeding, weight loss, fever, general malaiseoCan metastasize
Clinical manifestations of penile cancer
Painless testicular enlargement• Associated with gynecomastia and epididymitis Need to differentiate between hydrocele and spermatocele (misdiagnosis is common)
Clinical manifestations of testicular cancer
Urethral tingling, itching, or burning sensation on urination (dysuria), urinary frequency and urgency; purulent or clear mucus-like discharge from the urethra
Clinical manifestations of urethritis
Gross (visible to the eye) hematuria which may be episodic and accompanied by other nonspecific urinary tract symptoms such as dysuria (pain while urinating), urgency, incontinence
Clinical manifestations of urothelial carcinoma
frequency, urgency, dysuria (pain while urinating), hematuria and/or cloudy foul-smelling urine, flank pain
Clinical manifestations of uti
Sudden onset varicocele in older man
Consider Renal tumors
Failure of one or more of the testes to descend from the abdominal cavity into the scrotum
Cryptorchidism
increased risk of testicular cancer, infertility, and pain
Cryptorchidism
what is used to screen for prostate cancer (2)
Direct Rectal examination Transcretal Ultrasound
intrarenal AKI
Direct injury of renal parenchyma or interstitial cells
Two most common pathogens for UTI
E.coli Staph saprophyticus
kidneys fail to ascend into abdomen from the pelvis
Ectopic kidney
3 other affects of CKD
Edema and fluid overload Decreased urinary excretion of potassium and phosphorous lead to electrolyte disturbances Patients develop altered protein, carbohydrate and fat metabolism
-Inflammation of the epididymis -Common in sexually active young men
Epididymitis
Urethral opening on the dorsal side of the penis
Epispadias
2 things that cause prostate cancer
Excess androgens may increase the risk of developing prostate cancer BRCA2 genetic mutations are also associated with prostate cancer
GnRH stimulates the release of_______ and______ which stimulates the maturation of the testes.
FSH LH (Bio 202 lab be like)
Nephrotic Syndrome
Glomeruli injury to the basement membrane leads to escape of proteins
Arterioles of the glomerulus become swollen and occluded with fibrin clots. This leads to further destruction of RBCs as they pass through the swollen glomeruli blood vessels
HUS
2 ways to preform dialysis
Hemodialysis Peritoneal Dialysis
Acute disorder characterized by hemolytic anemia, thrombocytopenia, and renal impairment
Hemolytic Uremic Syndrome (HUS)
Most common community-acquired cause of acute renal failure in children Associated with bacterial and viral endotoxin agents (especially E. coli O157:H7)
Hemolytic Uremic Syndrome (HUS)
5 risk factors of testicular cancer
High androgen levels genetic predisposition History of cryptorchidism Trauma infection
May occur in adults if there is an imbalance between fluid secretion and reabsorption in scrotal tissues
Hydrocele
Scrotal swelling caused by the collection of fluid in the tunica vaginalis (serous membrane that covers testes)
Hydrocele
AKI can cause electrolyte disorders such as
Hyperkalemia and hyperphosphatemia
3 clinical manifestations of nephrotic syndrome
Hypoalbuminemia, edema, and hyperlipidemia
urethral opening on the ventral side or under surface of the penis
Hypospadias
pre-renal AKI
Inadequate renal perfusion leads to eventual decrease in glomerular filtration pressure
Obstructions in the upper urinary tract lead to
Increased hydrostatic pressure Dilation of the ureter, renal pelvis, calyces, renal parenchyma, glomerulus
The bladder has a non voluntary_________ and a voluntary________.
Internal urethral sphincter External urethral sphincter
Most common cause of upper urinary tract obstruction is
Kidney stones
Delayed puberty is defined as
Lack of secondary sex characteristics by the age of 14 years old
The newly transplanted kidney may come from either a living or deceased donor and is placed in the
Lower abdomen near the pelvis
Immune complexes and inflammation at the glomeruli leads to increased permeability of glomerular filtration membrane
Nephritic Syndrome
Mild proteinuria (<3.5 g) with hematuria
Nephritic Syndrome
The functional unit of the kidney is referred to as the
Nephron
Urinary protein excretion of 3.5 g or more
Nephrotic Syndrome
Can be caused by lesions in the brain or spinal cord that lead to loss of coordinated neuromuscular contraction
Neurogenic bladder
3 common causes or a lower urinary tract obstruction
Neurogenic bladder Urethral stricture Benign prostate Hypertrophy
BPH is more common with
Older age
-Acute inflammation of the testes -Uncommon except as a complication of systemic infections (mumps) or as an extension to epididymis
Orchitis
Foreskin is retracted and cannot be moved forward (reduced) to cover the glans penis
Paraphimosis
Often diagnosed in men older than 55 years of age
Penile Cancer
Sex hormones are produced by some mechanism other than stimulation by the gonadotropins (gonadal tumors, exogenous steroids)
Peripheral precocious puberty
Penile foreskin (prepuce) is "too tight" and cannot be retracted back over the glans penis
Phimosis
Abnormal phimosis may occur due to (2)
Poor hygine chronic infections
The supersaturation of one or more salts leads to_______ and then________ or________ into a________.
Precipitation Crystallization Aggregation stone
Development of secondary sex characteristics before the age of 9 years old.
Precocious Puberty
Maintenance of fluid volume before and after surgery/diagnostic procedures when nephrotoxic drugs or contrast agents are used.
Prevention of AKI
Associated with spinal cord trauma, sickle cell disease, leukemia, pelvic tumors or infections, penile trauma, and cocaine use
Priapism
Condition of persistent and prolonged penile erection lasting longer than 4 hours
Priapism
Treatment includes needle aspiration of blood from corpus or creation of vascular shunts
Priapism
Most commonly diagnosed non-skin cancer in men (lifetime risk estimated to be 15.9%)
Prostate Cancer
First appearing symptoms are caused by bladder outlet obstruction Slow urinary stream, urinary hesitancy, incomplete bladder emptying, increased urinary frequency, nocturia, dysuria Need to differentiate between benign prostatic hypertrophy
Prostate cancer
Risk factors include older age (very rare in men less than 50 years of age), family history, and race (increased rates in African Americans)
Prostate cancer
One of the most widely used methods but recently controversial Elevated PSA levels may occur in prostate cancer, BPH, prostatitis, or other conditions
Prostate specific antigen (PSA) Used to screen for prostate cancer
Inflammation of the prostate
Prostatitis
contributes to tubulointerstitial injury by promoting inflammation and progressive fibrosis
Proteinuria
Factors that contribute to advancing disease progression of chronic kidney disease include (2)
Proteinuria Angiotensin II
In Nephritic syndrome, urinary RBC and WBC cast with_________, and patients also develop_______.
Proteinuria Hypertension
Infection of upper urinary tract system (ureters, renal pelvis, kidneys)
Pyelonephritis
2 specific treatments for renal cell carcinoma
Radical nephrectomy: surgical removal of the affected kidney Partial nephron-sparing nephrectomy: for smaller tumors
The dilations in an upper urinary tract obstruction leads to (2)
Reduced glomerulus filtration rate (GFR) and reflexive dilation of structures (hydroureter,Hydronephrosis).
benign solid tumors of the renal cortex which can transform into malignant tumors
Renal adenomas
absence of one or both kidneys; remining kidney is typically normal but becomes hypertrophic and prone to developing CKD due to increased stress on organ
Renal agenesis
Adenocarcinomas from tubular epithelial cells Most common malignant renal cancer
Renal cell carcinoma
renal function reduced significantly
Renal failure
typically measured by certain factors such as serum creatinine levels, glomerular filtration rate (GFR), and albuminuria
Renal failure
renal function reduced by 25%
Renal insufficiency
consider inferior vena cava obstruction
Right sided varicocele
premature newborns sexually active and pregnant women women who are on certain antibiotics patients with indwelling urinary catheters patients with diabetes mellitus
Risk factors for UTI
smoking aromatic amines arsenic in drinking water
Risk factors for Urothelial Carcinoma
Tumors kidney stones neurogenic bladder
Risk factors of Post renal AKI
acute tubular necrosis exposure to nephrotoxic contrast dye acute glomerulonephritis graft rejection
Risk factors of intrarenal AKI
hypotension of any cause hypovolemia from acute blood loss/hemorrhage renal vasoconstriction caused by NSAIDs (ibuprofen)
Risk factors of pre renal AKI
female gender kidney stones vesicoureteral reflex pregnancy neurogenic bladder instrumentation and sexual trauma
Risk factors of pyelonephritis
male gender smoking obesity hypertension renal failure
Risk factors of renal cell carcinoma
-Benign cystic collection of epididymis fluid located between the head of the epididymis and the testis - Also known as epididymal cyst
Spermatocele
Clinical manifestations are similar to hydrocele (swelling of testes) however aspiration demonstrates a milky fluid
Spermatocele
the production of male gametes or sperm
Spermatogenesis
Diploid germ cells that divide to form spermatocytes and then haploid spermatids
Spermatogonia
Treatment for Varicocele
Surgical treatment includes ligation of the spermatic vein or occlusion of the vein by percutaneous methods (balloon catheter or sclerosing fluids)
2012 review by USPSTF demonstrated regular PSA screening had little to no reduction in prostate cancer-related mortality but increased harmful consequences due to further evaluations and treatments Some more recent evidence point in the other direction Now recommended not to screen in men >70 years of age and selective screening based on patient history and shared decision-making in men 55-69
TRUE
In renal transplants, the old kidneys are typically left in place (except in cases of renal carcinoma)
TRUE
Severe paraphimosis is a medical emergency
TRUE
Among the most curable cancers Common in men between 15 and 35 years of age
Testicular Cancer
Rotation of a testis causing twisting of the blood vessels in the spermatic cord which leads to vascular engorgement and reduced circulation of the testes
Testicular Torsion
Spermatids require_______ to mature into sperm
Testosterone
three surgical treatments for prostate cancer
Total prostatectomy, transurethral resection of the prostate (TURP), cryotherapy
Bed rest, scrotal support, elevation of the scrotum, hot or cold compresses, analgesic agents for relief of pain
Treatment for orchitis
Obstructions can be further classified as
Upper urinary tract Lower urinary tract
Infection, surgery, or injury leads to narrowing of urethra
Urethral stricture
-Inflammation of the urethra -Can also have nonsexual origins (urologic procedures, insertion of foreign objects, anatomic abnormalities, or trauma)
Urethritis
the interference with the flow of urine at any site along the urinary tract
Urinary tract obstruction
Post renal AKI
Urinary tract obstruction leads to increased intratubular pressure and decreased GFR
cancer of uroepithelial cells of the inner lining of the ureters, bladder, and urethra
Urothelial carcinoma
-Typically occurs on left scrotum and often described as a "bag of worms" -Can cause infertility due to decreased blood flow to testes
Varicocele
Inflammation and dilation of the veins in the spermatic cord caused by inadequate or absent valves in the spermatic veins
Varicocele
in epididymitis, pathogenic microorganism reaches the epididymis by ascending via the________ from an already infected______ or______.
Vas deferens Bladder Urethra
malfunctioning valve allows backwards flow of urine; common presenting symptoms are frequent UTIs
Vesicoureteral reflux:
2 things the kidneys produce
Vitamin D Eythropoietein
Malignant embryonal tumor of the kidney also known as nephroblastoma Most common solid tumor of childhood Peak incidence is around 2-3 years of age Can develop sporadically or from genetic inheritance
Wilms Tumor
As mass grows, child may experience vague abdominal pain, hematuria, fever, and hypertension
Wilms tumor
The two hit hypothesis states that
Wilms tumor-suppressor genes WT1 and WT 2 are located on chromosome 11 Children who inherit a mutation in one allele of a tumor-suppression gene require just one more somatic mutation for a tumor to form
Lower urinary tract obstruction relates to the
ability of the bladder to empty into the bladder outlet
Sudden decline in kidney function
acute kidney injury
2 main clinical manifestations of pyelonephritis
acute onset of systemic symptoms (fever and chills) may have costovertebral angle tenderness
Treatment for uncomplicated hydrocele
aspiration of the fluid and injection of a sclerosing agent into the scrotal sac
This urine is then collected in the______ and_______ to be transported to the_______.
calyces renal pelvis ureter
If left untreated, acute glomerulonephritis can become chronic and eventually lead to
chronic kidney disease
Frothy brown-tinged urine ("cola-colored") from hematuria and proteinuria Low serum albumin due to loss in urine Edema caused by decreased intravascular oncotic pressure Severe or progressive glomerular disease can lead to eventual oliguria (urine output <30 mL/hour)
clinical manifestations of Acute Glomerulonephritis
Kidney stones are masses of (3)
crystals proteins mineral salts that form in the urinary tract
The most common type of UTI is
cystitis, or inflammation/infection of the bladder
Tends to be familial or associated with other chronic illnesses (cystic fibrosis, chronic kidney disease) or poor nutrition
delayed puberty
Most commonly chronic glomerulonephritis is due to secondary causes such as
diabetes or lupus
Most common clinical manifestation of wilms tumor is
enlarging asymptomatic upper abdominal mass in a healthy, thriving child
UTI are typically caused by
genitourinary bacterial flora which overgrow or travel backwards into the host's body (retrograde movement)
The nephron produces urine by filtering plasma through the
glomerulus
Toxic build up of end-products of metabolism leading to hypertension, anorexia, nausea/vomiting, diarrhea, constipation, malnutrition, weight loss, seizures, cardiovascular disease, etc
hyperuremic syndrome
Immunological responses regarding acute glomerulonephritis are most often
immune complex mediated (type III hypersensitivity) but may also be type II or IV
Patient who receive solid-organ transplants will need to be on life-long_____________ to prevent allograft rejection from occurring
immunosuppressant therapy
Clinical manifestations include renal pain and signs/symptoms of urinary tract obstruction
kidney stones
End stage renal disease
less than 10% of renal function remains
CKD can develop into
life-threatening hyperuremic syndrome
large kindey stones may have to be treated via
lithotripsy: shockwaves or laser to externally break down stone into smaller pieces
Renal cell carcinoma is a
localized disease
Increase in filtration pore size leads to
loss of proteins, WBC, and RBCs in the urine
Some kidney stones may travel to the bladder and cause a
lower urinary tract obstruction
In HUS, bacterial toxin causes
lysis of RBCs and activation of coagulation cascade and platelets
In HUS toxins also travel to the kidneys were it causes
lysis of endothelial basement membrane cells of the glomeruli
The primary function of the kidneys are to
maintain optimal internal environments for tissue and cell metabolism
SRY gene on the Y chromosome codes for
male characteristics
Injury to the glomeruli can also lead to
nephritic and nephrotic syndromes
he study of kidneys and kidney-related diseases is referred as
nephrology renal
another way to treat/prevent AKI is to avoid
nephrotoxic medications
Causes of acute kidney injury can be divided into 3 main categories
pre-renal intrarenal Postrenal
Classic manifestation of HUS
prodromal gastrointestinal illness with diarrhea followed by sudden onset of severe HUS symptoms 1-2 weeks later
Chronic renal failure
progressive renal failure typically caused systemic disease process
Oliguria
reduced urine output of less than 30ml/hour
Some substances may be reabsorbed or filtered through the
renal tubules
Kidneys regulate blood pressure via
renin-angiotensin-aldosterone system
movement of testes out of scrotum in response to cold temperature or physical activity; typically self-limited and does not require treatment
retractile testes
-male gender -inadequate fluid intake -geographic location (high temperature/humidity -dietary patterns
risk factors for developing a kidney stone
human papillomavirus (HPV), smoking some treatments for psoriasis (UV light)
risk factors for penile cancer
Sperm are produced in the
seminiferous tubules
most penile cancers are a form of
squamous cell carcinomas
Acute renal failure
sudden onset; may be temporary or irreversible depending on underlying cause
Chronic dilation in an upper urinary tract obstruction leads to
tubulointerstitial fibrosis and apoptosis, which further affect kidney function
The study of the bladder and bladder-related diseases is referred to
urology
allograft rejection
when a recipients body rejects a donors kidney
