Inflammation of the bladder and/or urethra (lower UTI)
Symptoms: urgency, frequency, incontinence, pelvic pain and pressure, low back pain, bladder spasm, fever, chills, burning, dark yellow urine, or pink-to-red urine if blood is present (hematuria)
Bacteria may travel through the urinary tract up to the kidney and cause a kidney infection called pyelonephritis
Cause: usually bacteria (Enterobacteriaceae: E. coli, Klebsiella, Enterobacter, Proteus, Pseudomonas), STDs, yeast, viruses, parasites, chemotherapy or radiation, catheterization
Treatment: antibiotics, fluid, rest
Pyuria:
Urine contains white blood cells and/or pus (exudate), which is a combination of dead bacteria and dead white blood cells and cellular debris
Sign of inflammation
Rich in protein
Foul-smelling
Greenish-yellow
6-10 or more polymorphonuclear neutrophils/hpf (microscope) in mid-stream, clean catch, voided urine that has not been spun down
Typically a sign of a bacterial urinary tract infection (UTI)
May also occur with STD's, such as gonorrhea or viruses
Patients with sepsis may have pyuria
Patients with pneumonia may have pyuria
Patients with pyelonephritis, a bacterial kidney infection, may have pyuria, flank (side) pain, tenderness, fever, nausea, painful urination, frequency, loss of appetite, vomiting, malaise, weight loss, blood in the urine (hematuria)
Close watch must be kept on this condition, which can rapidly lead to a buildup of pus surrounding the kidney, sepsis, or even cause the kidneys to go into kidney failure if left untreated
Usually starts out as a bladder infection, cystitis, or prostatitis
Those over age 65 are at higher risk for complications, and the risk of death from pyelonephritis and sepsis is around 40%
The most common cause is the bacterium Escherichia coli
Occasionally associated with drugs such as acetaminophen
Risk factors: frequent UTI's, STD, sexual intercourse, diabetes, use of spermicide, other forms of birth control, structural anomalies of the urinary tract
Urinalysis and urine culture are laboratory tests which aid in the diagnosis and treatment of this condition
By BruceBlaus - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=44756534
Inflamed and irritated bladder due to cystitis
White blood cells and bacteria in the urine,By Steven Fruitsmaak (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
By Bobjgalindo (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 4.0-3.0-2.5-2.0-1.0 (https://creativecommons.org/licenses/by-sa/4.0-3.0-2.5-2.0-1.0)], via Wikimedia Commons
Parasite Schistosoma haematobium
Pyuria with pus in the urine,By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17978816
Parasite Schistosoma haematobium
Fungi such as the Candida spp, as in Candida albicans seen here, can be associated with UTI
Pyelonephritis (Kidney Infection)
Pyelonephritis is the most common type of renal disease
Nosocomial (hospital-acquired)
Usually caused by coliform bacteria or enterococci that enter the urinary tract
Often catheter-associated
E. coli most common cause
Klebsiella spp
Pseudomonas spp
Community-acquired
Usually caused by coliform bacteria that inadvertently enter the urinary tract:
E. coli (70-80%)
Enterococcus faecalis
Inflammation of the renal pelvis and connective tissue of the kidney or kidneys
Usually due to bacterial infection (UTI) where bacteria has traveled from the bladder to the kidney or kidneys and usually starts out as a bladder infection, cystitis, or prostatitis
Bacteria travels to the kidney and creates biofilms that may be antibiotic-resistant
Pregnancy may be a cause of this as well
Renal calculi (stones) may also cause it
Benign prostatic hypertrophy may also cause (enlarged prostate) in males
Structural anomalies may cause it or cause one to become more prone to developing it:
Reflux (urine flows back into the bladder)
Stones or strictures blocking the ureters or urethra
Urinary stents
Urinary catheters
Shortened or angled urethra
Drainages
Urogenic bladder
Pregnancy
Medications
MS
Spina bifida
Spinal injuries
Prostate diseases
Diabetes mellitus
Immunocompromisation
Sexual intercourse
STD
Spermicide use
Pus builds up in the renal pelvis, and sometimes includes abscesses
Symptoms: rapid onset of fever, aches, chills, nausea, vomiting, flank (side) and low back pain, often following a UTI (urinary frequency and urgency), foul odor to the urine, pyuria, hematuria, tenderness
If it progresses to septic shock, see symptoms under "urosepsis" above
Risk factors: underlying UTI, kidney stone, enlarged prostate, pregnancy, tumor, women affected more often, sexual activity, poor hygiene, catheterization
Diagnosis: clean-catch urine (urinalysis) with increased RBCs, WBCs, pus, protein, casts, and nitrite (bacteria)
Treatment: antibiotics, fluids, rest, correction of underlying causes, which may include surgery to remove an obstruction
Urine pyuria (pus: white blood cells, bacteria or fungi or parasite, dark urine, often nitrite + and leukocyte esterase +, higher specific gravity)
Flank pain associated with kidney infection (pyelonephritis)
Polyuria: Increase in Urinary Frequency
Polydipsia: Increase in Thirst, Associated With Diabetes
Glomerulonephritis (Kidney Infection: Autoimmune)
Acute Glomerulonephritis: inflammation and swelling of the glomeruli of the kidneys (1)
Primary Glomerulonephritis
May or may not have a specific cause
May result from an autoimmune disease that causes circulating antigen-antibody complexes (large) that get stuck in the capillaries of the glomeruli
Tumors can cause this
Cysts can cause this
Autoimmune diseases like lupus can cause this
Secondary Glomerulonephritis
Due to some other systemic disease, such as a bacterial infection such as streptococcal bacterial infection of the throat or skin that went unnoticed or untreated
Children, teens and young adults are affected more so than older adults, as it usually follows Strep Throat (bacterial infection) 1-2 weeks later
Streptococcus pyogenes (Group A strep) is usually the cause
Usually resolves in 2 weeks and results in recovery
Some cases may result in long-term disease/damage as seen above under primary glomerulonephritis
Results/consequences include:
Decrease in glomeruli filtration rate
Water and salt retention in the body
Signs and symptoms include the following:
Blood in the urine (may be obvious or subtle; urine may appear dark or coffee-colored)
Detected by urinalysis, and includes presence of RBCs, WBCs, renal tubular cells, casts
Protein in the urine
This is due to the increased permeability of the glomerular membrane, and protein in the urine is typically not normal
Elevated blood urea nitrogen (BUN)
Elevated erythrocyte sedimentation rate (ESR)
Hypoalbuminemia
Kidneys may be swollen/enlarged on radiographic film
Edema (swelling/puffiness)
Decrease in urine volume
Raised blood pressure
Headaches
Visual disturbances in some cases
Malaise
Loss of appetite
Low-grade fever
Low back and/or flank (side) pain
Treatment:
Unfortunately, there is currently no treatment for the poststreptococcal glomerulonephritis except antibiotic therapy for the infection if it is still present
Diuretics: these can be given to aid in controlling swelling and edema and high blood pressure
Restriction of sodium intake
Corticosteroids to prevent immune reaction are the only therapy available for autoimmune types of glomerulonephritis
Chronic Glomerulonephritis:
Slow and progressive
Noninfectious
May lead to irreversible renal damage and even renal failure
An advanced stage of kidney disorder
Inflammation and destruction of the glomeruli of the kidneys, leading to reduction in GFR
Gradually leads to high blood pressure, blood in the urine, protein in the urine, edema and swelling, oliguria (decreased urine production), excess urea in the blood (azotemia) resulting in crystals of urea on the skin (uremic frost), fatigue, malaise, nausea, vomiting, itching, shortness of breath
Treatment for chronic glomerulonephritis:
Diuretics, antihypertensives, antibiotics if UTI exists, restriction of protein and salt, ACE inhibitor, and dialysis, if required, possible kidney transplant
Glomeruli of the nephron of the kidney
Hematuria: One of the Symptoms of Acute Glomerulonephritis
Hematuria, or the presence of red blood cells in the urine, may be microscopic (unable to be seen by the unaided eye) or macroscopic (visible with the unaided eye). More than three red blood cells per high power field (hpf) under the microscope indicates hematuria. It may also be glomerular (arising from the kidneys) or non-glomerular (arising from somewhere else along the urinary tract).
Glomerular Hematuria:
Inflammation of the glomeruli
Injury to the glomeruli
Leaking of red blood cells into the urine
May also cause formation of red blood cell casts
Often seen along with proteinuria
Causes:
IgA nephropathy
Alport's disease (hereditary nephropathy)
Benign familial hematuria
Glomerulonephritis
Non-Glomerular Hematuria:
UTI
Benign prostatic hyperplasia
Kidney stones
Polyps
Vigorous exercise
Sickle cell disease
Sickle cell trait
Renal papillary necrosis
Polycystic kidney disease
Bladder cancer or tumor
Prostate cancer or tumor
Hypercalciuria
Hyperuricosuria
Medullary sponge kidney
Red blood cells in the urine (microscopic hematuria)
Macroscopic (gross) hematuria
Diabetes, Type I: Insulin-Dependent and Type II: Diabetes Mellitus
Diabetic nephropathy
Renal changes that occur due to diabetes mellitus (glomerulosclerosis) which are irreversible
Risk of increased morbidity and mortality
Symptoms: urinary retention, nausea, high blood pressure, protein in urine, UTI, pyelonephritis, decreased GFR, elevated BUN level, increased cholesterol, protein and pus in urine, microalbumin
Treatment: antihypertensives, diuretics, ACE inhibitor, fluids, low-protein/low-fat diet; long-term dialysis and eventual kidney transplant may be required
Glucoseuria: Symptom of Diabetes
A positive glucose urine dipstick test
Proteinuria: Symptom of Diabetes
Ketone Acidosis/Ketonuria: Symptom of Diabetes
Diabetes Insipidis: Increased thirst, including at night, is a big symptom, along with dilute, clear urine
Nephritis
Nephrotic Syndrome (Nephrosis): Sodium and Water Retention, Puffiness, Casts, Proteinuria, Hematuria
Nephrotic syndrome, also called nephrosis, is a disease affecting the basement membrane of the glomeruli of the kidneys
This is often secondary to other primary renal diseases and systemic disorders
Results in loss of huge amounts of protein (albumin) in the urine
Decreased GFR occurs, resulting in severe water and sodium retention, edema and hypertension, as seen in the image below
Also results in blood in the urine (hematuria), either microscopic or macroscopic
Lipids are elevated
Urinalysis shows fatty casts and sloughed off fat bodies as well
Results in higher risk of infections
Symptoms include lethargy, depression, loss of appetite, puffiness around the eyes, swelling of the ankles, pitting edema, weight gain, skin irritation, itching, headaches, side or pelvic pain
Causes include glomerulonephritis, exposure to toxins or drugs, pregnancy, kidney transplant, metabolic disorders, diabetes mellitus, allergic reactions, infections
Toxins:
Acetaminophen
Amphetamines
Heroin
Silicon
Cyclosporin
Certain antibiotics
Lead
Arsenic
Mercury
Pesticides
Carbon tetrachloride
Methanol
Ethylene glycol (antifreeze)
Ibuprofen and other nonsteroidal antiinflammatory drugs
Radiographic contrast media
Cleaning products
Insecticides
Organic solvents
Treatment: treat underlying cause if possible, lower sodium and protein intake, diuretics, ACE inhibitors, corticosteroids, avoid certain drugs or toxins, monitor pregnancy or diabetes mellitus, allergic reactions
May progress to end-stage renal disease
With nephrotic syndrome, the sodium and water retention often result in puffiness of the eyes, lips, cheeks, and extremities
Protein casts and proteinuria, as well as RBC casts, Waxy casts may be seen in this syndrome
Patients with nephrotic syndrome may have to receive kidney dialysis
Polycystic Kidney Syndrome
This is a slowly progressive disease, often familial and genetic
Renal tissue is replaced with large cysts
Affects both kidneys
Kidneys become enlarged
Causes loss of renal function and renal failure
Symptoms: blood in urine, headache, edema, flank and pelvic pain
Treatment: there is no cure; dialysis and transplant may prolong life; manage high BP and any UTIs
Bladder Stones
Renal Calculi: Kidney Stones/Ureter Stones
Renal calculi: stones in the kidney or ureter or other areas of the urinary tract
Caused by concentration of mineral salts, and there are a variety of different kinds
Can occur on their own or in multiples and are various sizes and textures
Smaller stones usually pass on their own, some even unnoticed
Symptoms depend on size and type of stone and area of the urinary tract affected and if infection is also present, but do usually include renal colic (pain that comes and goes) on the side affected, urinary urgency, and sometimes blood in the urine; sometimes nausea and vomiting occurs, along with fever, chills and abdominal distension; sometimes hydronephrosis occurs
Staghorn calculi: larger stones shaped like the renal pelvis where they are formed
Causes: dehydration, excessive amount of calcium or uric acid present, immobilization, infection, urinary stasis, certain medications, gout, hyperparathyroidism, citric acid, foods containing oxalates, purines, or phosphorus
Treatment: fluids, treat pain and infection, analgesics, catch the stone in a special sterile cup for evaluation, lithotripsy, surgery for larger ones or meds to dissolve them, stent placement
Stenosis and Reflux:
Stricture or narrowing of the ureter or urethra, resulting in obstruction to flow of urine
Rhabdomyelitis
Muscle breakdown and damage, resulting in blood in the urine
Causes: congenital, medications, trauma, drug abuse, snake bites, electrical injury, heat stroke, heart attack, infections, lack of blood flow to a limb
Porphyriuria
Genetic disorder resulting in blood in urine
Hereditary Galactosemia
Genetic disorder that causes inability of sugars to be reduced and they spill over into the urine
Genetic mutation in the gene that makes the enzyme galactose-1 phosphate uridylyltransferase (single missense mutation at exon 6)
Inborn error of metabolism
Inability to metabolize galactose, causing it to build up in tissues, resulting in failure to thrive, liver problems, cataracts, developmental delay, poor growth, and sometimes mental retardation
Hereditary fructose intolerance is inability to metabolize fructose
Lactose intolerance
Glycogen storage diseases
Usually detected in infants by the Clinitest or Benedict's Test for Reducing Sugars
Kidney Cancer:
Renal cell carcinoma: the most common primary tumor of the kidney
Wilms' tumor: less common congenital tumor of childhood
Renal pelvic cancer: less common
One or more malignant tumors
Mostly sporadic but some are familial (genetic)
von Hippel-Lindau syndrome
Symptoms: hematuria, abdominal mass, flank (side) pain, weight loss, loss of appetite, fever, hypercalcemia, hepatic dysfunction
Risk factors: smoking, obesity, dialysis, acquired cystic kidney disease, exposure to chemicals or asbestos or cadmium
Treatment: surgical removal of kidney or partial nephrectomy and chemotherapy
Bladder Cancer:
Bladder neoplasms
Usually occur in the transitional epithelium that lines the bladder, but some involve the squamous cells
Symptoms: blood in urine, pain in flank or suprapubic region, dysuria, urgency, frequency, fatigue, weight loss, loss of appetite
Cause: environmental exposures to chemicals or carcinogens, aniline dyes, diesel exhaust, smoking, prior schistosomas infection (parasite)
Treatment: surgery, chemoradiotherapy if invasive
Bladder cancer
Prostate Cancer
Develops in the prostate
Most are slow-growing, but some are aggressive
If metastatic, may spread to the spinal vertebrae and lymph nodes
In later stages, leads to difficulty urinating, blood in the urine, and back and pelvic pain, fatigue, anemia
99% of cases occur >50 years of age
Genetics may have a link, as those with a sibling or parent with the disease or 2-3x more likely to get it themselves
Diets high in red meat, processed meat and milk products may be linked
Treatment: surgery, radiation, chemotherapy, drug therapy
By Cancer Research UK - Original email from CRUK, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34333596
By Cancer Research UK - Original email from CRUK, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34333915
By Cancer Research UK - Original email from CRUK, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34333601
By Cancer Research UK - Original email from CRUK, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34333601
Acute Renal Failure:
ARF is sudden and severe
Decreased renal function
Considered an emergency
Nitrogenous waste products build up in the blood very quickly, causing acute uremia
Symptoms: sudden oliguria, gastrointestinal symptoms, headache, lethargy, dizziness or loss of consciousness, muscle weakness, heart palpitations, shortness of breath, excess bruising
Very serious, affects other organs, can result in death
Treatment: treat underlying cause first; monitor all body systems, dialysis, fluid intake/output balance, high carb/low protein diet, control of sodium/potassium intake, antihypertensives, diuretics, antibiotics
Example of uremic frost, crystallization of urea in the sweat through the sweat pores; By Fythrion at English Wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=47569752
Chronic Renal Failure:
CRF is gradual, progressive destruction and loss of nephrons
Irreversible renal damage and loss of renal function
Gradual onset of uremia
Affects all body systems eventually
Results in weakness, fatigue, lethargy, fluid retention and puffiness, edema, hypertension, uremic syndrome, heart palpitations, muscle weakness, shortness of breath, metabolic acidosis, ulcers, dry, brittle hair with thinning and hair loss, itching and dryness of skin, uremic frost, malaise
Causes: glomerulonephritis, pyelonephritis, polycystic kidney disease, end stage of other renal diseases, chronic obstruction of urine due to tumors, cancers, or stones
Treatment: dialysis or kidney transplant, diet modifications to control sodium/potassium, protein, diuretics, antihypertensives, antibiotics, calcitriol
There is no cure
CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=517400; Hemodialysis machine
Hydronephrosis:
Occurs when there is an obstruction in the urinary tract
Causes dilation and swelling of the renal pelvis due to pressure from urine backup
If this occurs consistently, long-term or is severe, will result in scarring and fibrous changes of the involved nephrons, with ultimate loss of function as well
Usually chronic
Typically does not result in pain or symptoms other than a vague backache or decreased urine output
If infection occurs, patient will experience symptoms of pyelonephritis
Treatment: treat the underlying cause
Hydronephrosis of one kidney due to the presence of a kidney stone; By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15996866
By Source, Fair use, https://en.wikipedia.org/w/index.php?curid=18472498; Severe thinning and damage by chronic hydronephrosis of the kidney
Neurogenic Bladder:
Dysfunction of the bladder control
Involves the signals or signal pathways involved in voiding
Difficulty in emptying the bladder, as well as urinary incontinence
Symptoms: hesitancy, decreased volume of urinary stream, retention, sensation of full bladder but unable to empty, persistent incontinence, spontaneous voiding of spurts of urine (reflex neurogenic bladder)
Cause: often unknown; pregnancy; enlarged prostate; motor paralysis, damage to the brain, spinal cord, or nerves supplying the bladder due to trauma or disease, stroke (CVA), tumors, neuropathies, herniated lumbar disk, spinal cord trauma, polio, spinal cord lesion, myelomeningocele
Treatment: no cure; drug therapy possible
Stress Incontinence:
Uncontrollable leakage of urine (small amounts) during physical activity, exertion, exercise, laughing, sneezing, coughing, lifting, stretching, bending, running
Cause: weakening of the pelvic floor muscles and urethra; usually results from the trauma of childbirth and hormones
By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 404, Public Domain, https://commons.wikimedia.org/w/index.php?curid=158672
Overactive Bladder:
A common ailment in today's society
Urgency, incontinence, leakage of small amounts of urine, frequency, the need to urinate at night
Treatment: Kegel exercises, PT for pelvic muscles, behavior therapy, drug therapy, biofeedback training of the sphincter
Urinary Incontinence:
Reflex is overrun
Normal reflex: initiates voluntary urination (micturition) when the bladder is full (distended)
Sphincters of bladder and pelvic diaphragm relax
Bladder muscles contract
Bladder empties
Urinary incontinence is a partial or complete loss of voluntary bladder control
Inability to retain the urine
Elderly are most affected, as well as pregnant women and post-pregnancy (usually temporary)
Enuresis: bedwetting
By ColnKurtz - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=55886603
Medullary Sponge Kidney:
Also called Cacchi-Ricci disease
Congenital kidney disorder
Characterized by formation of cysts in the collecting tubules of one or both kidneys
At higher risk for kidney stones and urinary tract infections
Benign
May cause chronic renal (flank) pain in up to about 55% of patients