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Lecture 37 March 2nd-Renal

Lecture 37 March 2nd-Renal

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Published by: api-26938624 on Oct 19, 2008
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1DDX: LECTURE 37 \u2013 MARCH 2ND, 2007
\u201cpolycystic\u201d anything is a congenital abnormality. Blind tubules form and fill with fluid, forming cysts.
Autosomal dominant PKD: enlarged kidneys, they keep growing. Cysts will appear in other organs too.
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
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.

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.

CVA=costo-vertebral angle
Pathognomonic: KI pain doesn\u2019t change with stretching, temperature changes (ddx from muscular pain)
Uretal colic: Passing stone: colic-y pain. Not constant.
(covered in hydronephrosis).
Can also have asymptomatic obstruction. Over time, their kidney function is compromised.
Oligurea: little urination
Polyurea: they are urinating a lot but not getting rid of wastes. Filtrate is not concentrated.
Megaureter: plugged ureter will enlarge. Usually occurs in chronic state. Body will deposit calcium in ureter to
prevent it from rupturing.
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.
Pain can be confused with cramping from diarrhea.
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.
There are normally compounds in urine that prevent formation of salts.
Dehydration may be a factor increasing supersaturation.
Pre-formed nuclei. Areas of inflammation may cause deposit of salts. Inflammation may disappear, but nucleus
Hypertension seems to play a role too.
Pain will depend on where the stone lodges.
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.
Stones will keep growing: they are nuclei themselves.
Magnesium will help calcium-based stones.
Things that cause breakdown: prolonged fasting, starvation
DDX LECTURE 37, MARCH 2ND, 2007 \u2013 PAGE 1

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