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Lecture 37 March 2nd-Renal

Lecture 37 March 2nd-Renal

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1DDX: LECTURE 37 \u2013 MARCH 2ND, 2007
CONDITIONS OF THE RENAL SYSTEM
CONGENITAL ABNORMALITIES
\u2022
\u201cpolycystic\u201d anything is a congenital abnormality. Blind tubules form and fill with fluid, forming cysts.
\u2022
Autosomal dominant PKD: enlarged kidneys, they keep growing. Cysts will appear in other organs too.
\u2022
Tubes can be obstructed in a number of ways: can clog it, can pinch it, can put stuff in the tube that will block it over
time.
HYDRONEPHROSIS
\u2022
Distal obstruction: will be backup pressure. Kidney has no capsule (unlike prostate, spleen). Pressure from blood,
net oncotic pressure. Can enlarge to 4x regular size.
\u2022

Kidney formed of pyramidal structures. Increase in pressure, the tissue of the KI is pushed to the sides, the kidney is mostly water. Pressure atrophy of tissue. This is usually a chronic condition that develops over time. If the tissue is damaged, it can regenerate to a certain degree.

ACUTE OBSTRUCTION
\u2022
CVA=costo-vertebral angle
\u2022
Pathognomonic: KI pain doesn\u2019t change with stretching, temperature changes (ddx from muscular pain)
\u2022
Uretal colic: Passing stone: colic-y pain. Not constant.
CHRONIC OBSTRUCTION
\u2022
(covered in hydronephrosis).
\u2022
Can also have asymptomatic obstruction. Over time, their kidney function is compromised.
\u2022
Oligurea: little urination
\u2022
Polyurea: they are urinating a lot but not getting rid of wastes. Filtrate is not concentrated.
\u2022
Megaureter: plugged ureter will enlarge. Usually occurs in chronic state. Body will deposit calcium in ureter to
prevent it from rupturing.
\u2022
In chronic condition, don\u2019t have pain because the body has adapted to it. Have pain in acute. Not perceived in the
same way by the body.
UROLITHIASIS
\u2022
Pain can be confused with cramping from diarrhea.
\u2022
Not quite sure what causes KI stones. Has something to do with calcium? Not due to high calcium intake. Uric acid
stones can be linked to gout, purine-containing foods. Stone-forming salts in urine.
\u2022
There are normally compounds in urine that prevent formation of salts.
\u2022
Dehydration may be a factor increasing supersaturation.
\u2022
Pre-formed nuclei. Areas of inflammation may cause deposit of salts. Inflammation may disappear, but nucleus
remains.
\u2022
Hypertension seems to play a role too.
\u2022
Pain will depend on where the stone lodges.
\u2022
Staghorn calculi (see picture below) : can be huge: 2/3 the size of kidney! Forms with point, following the shape of the
interior of kidney.
\u2022
Stones will keep growing: they are nuclei themselves.
\u2022
Magnesium will help calcium-based stones.
\u2022
Things that cause breakdown: prolonged fasting, starvation
DDX LECTURE 37, MARCH 2ND, 2007 \u2013 PAGE 1

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