CLINICAL MEDICINE

EXCRETORY SYSTEM Diseases & Disorders

RENAL DISORDERS► Diabetic nephropathy► Glomerulonephritis► Hydronephrosis is the enlargement of one or both of the

kidneys caused by obstruction of the flow of urine.► Interstitial nephritis► Kidney stones are a relatively common and particularly painful

disorder.► Kidney tumours

Wilms tumour Renal cell carcinoma► Lupus nephritis► Minimal change disease► Nephrotic syndrome, ► Pyelonephritis is infection of the kidneys and is frequently

caused by complication of a urinary tract infection.► Renal failure Acute renal failure Chronic renal failure

Congenital Disorders

►Congenital hydronephrosis►Congenital obstruction of urinary tract►Duplicated ureter►Horseshoe kidney►Polycystic kidney disease►Renal dysplasia►Unilateral small kidney

Diabetic Nephropathy

Hydronephrosis

Renal Calculi

Nephrotic Syndrome

►Nephrotic syndrome is a group of symptoms including protein in the urine (exceeding 3.5 grams per day), low blood protein levels, high cholesterol levels, and swelling (oedema). The urine may also contain fat, which is visible under the microscope.

Nephrotic Syndrome

Causes & Risk►Nephrotic syndrome is caused by disorders

that damage the kidneys- the basement membrane of the glomerulus. This causes abnormal excretion of protein in the urine.

►The most common cause in children is minimal change disease, while membranous glomerulonephritis is the most common in adults.

►Others- infection, drug exposure, malignancy, hereditary disorders, immune disorders, diabetes, SLE, and amyloidosis.

►Nephrotic syndrome can affect all age groups. In children, it is most common from age 2 to 6. This disorder occurs slightly more often in males than females.

Symptoms

►Swelling (oedema ) • General or around the eyes• in the extremities, especially the feet and

ankles• abdomen • swelling ► Foamy appearance of the urine►Weight gain (unintentional) from fluid

retention►Poor appetite ►High blood pressure

Tests & Complications

► Urinalysis reveals large amounts of urine protein. Fats are often also present in the urine.

Tests to rule out various causes may include the following:► Glucose tolerance test ► Antinuclear antibody ► Rheumatoid factor ► Cryoglobulins ► Hepatitis B and C antibodies ► VDRL serology ► Serum protein electrophoresis ► Kidney biopsy

Atherosclerosis and related heart diseases

Renal vein thrombosis Acute renal failure Chronic renal failure Infections, including

pneumococcal pneumonia

Malnutrition Fluid overload,

congestive heart failure, pulmonary oedema

Hypertrophy of Prostate► BPH; Benign prostatic hypertrophy (hyperplasia);

Prostate – enlarged► The prostate is a male reproductive gland that

produces the fluid that carries sperm during ejaculation. It surrounds the urethra, the tube through which urine passes out of the body.

► An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. As the gland grows, it can press on the urethra and cause urination and bladder problems.

► An enlarged prostate is often called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. It is not cancer, and it does not raise your risk for prostate cancer.

Causes & Risk► The actual cause of prostate enlargement is

unknown. It is believed that factors linked to aging and the testicles themselves may play a role in the growth of the gland. Men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH.

► Similarly, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size.

► The likelihood of developing an enlarged prostate increases with age.

► BPH is so common that it has been said, "All men will have an enlarged prostate if they live long enough."

► A small amount of prostate enlargement is present in many men over age 40 and more than 90% of men over age 80.

► No risk factors have been identified other than having normally functioning testicles.

Symptoms

► Slowed or delayed start of the urinary stream ► Weak urine stream► Dribbling after urinating► Straining to urinate► Strong and sudden urge to urinate ► Incomplete emptying of your bladder► Needing to urinate two or more times per night ► Urinary retention (complete inability to urinate)► Incontinence ► Pain with urination or bloody urine (these may

indicate infection)

Tests & Complications After taking a complete medical

history, a digital rectal exam to feel the prostate gland, the following tests may also be performed:

Urine flow rate Post-void residual urine test to see

how much urine is left in your bladder after urination

Pressure flow studies to measure the pressure in the bladder as you urinate

An IVP (intravenous pyelography) to confirm BPH or look for blockage

Urinalysis to check for blood or infection

Urine culture to check for infection Voiding cystourethrogram   A prostate-specific antigen (PSA)

blood test to screen for prostate cancer

Cystoscopy

► Sudden inability to urinate

► Urinary tract infections ► Urinary stones ► Damage to the kidneys ► Blood in the urine► Even after surgical

treatment, a recurrence of BPH may develop over time.

Acute Renal Failure

►Kidney failure; Renal failure; Renal failure - acute; ARF - Acute (sudden) kidney failure is the sudden loss of the ability of the kidneys to remove waste and concentrate urine without losing electrolytes.

Causes & Risks► Decreased blood flow, which may occur with extremely low

blood pressure caused by trauma, surgery, serious illnesses, septic shock, haemorrhage, burns, or dehydration

► Acute tubular necrosis (ATN)► Infections that directly injury the kidney such as acute

pyelonephritis or septicaemia ► Urinary tract obstruction (obstructive uropathy)► Autoimmune kidney disease such as interstitial nephritis or

acute nephritic syndrome ► Disorders that cause clotting within the thin blood vessels of

the kidney ► Idiopathic thrombocytopenic thrombotic purpura (ITTP) ► Transfusion reaction ► Malignant hypertension ► Scleroderma, ► Haemolytic-uremic syndrome► Disorders of childbirth, such as bleeding placenta abruptio or

placenta previa

Symptoms Decrease in amount of urine

(oliguria) Urination stops (anuria) Excessive urination at night Ankle, feet, and leg swelling

Generalized swelling, fluid retention

Decreased sensation, especially in the hands or feet

Decreased appetite Metallic taste in mouth Persistent hiccups Changes in mental status or

mood ► Agitation ► Drowsiness /Lethargy ► Delirium or confusion or

Hallucination ► Coma ► Mood changes► Trouble paying attention

Slow, sluggish, movements Seizures / Hand tremor

(shaking) Nausea or vomiting, may

last for days Bruising easily Prolonged bleeding Nosebleeds Bloody stools Flank pain (between the

ribs and hips) Fatigue Breath odour High blood pressure

Tests & Complications► Urine tests (urinalysis) may

be abnormal.► Serum creatinine, BUN,

creatinine clearance, and serum potassium levels may increase.

► Arterial blood gas and blood chemistries may show metabolic acidosis.

► Kidney or abdominal ultrasound are preferred tests, but abdominal x-ray, CT scan, or MRI can tell if there is a blockage in the urinary tract.

► Blood tests may help reveal the underlying cause of kidney failure.

Loss of blood in the intestines

Chronic (ongoing) kidney failure

End-stage renal disease Damage to the heart or

nervous system Hypertension (high blood

pressure)

Chronic Renal Failure

►Also called Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency.

►Chronic renal failure is a gradual and progressive loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes.

Causes ► It most often results from any disease that causes

gradual loss of kidney function. It can range from mild dysfunction to severe kidney failure.

► Diabetes and hypertension (high blood pressure) are the two most common causes

► Glomerulonephritis of any type (one of the most common causes)

► Polycystic kidney disease ► Alport syndrome ► Reflux nephropathy ► Obstructive uropathy ► Kidney stones and infection► Analgesic nephropathy

Symptoms Initial symptoms may include the following:► Unintentional weight loss ► Nausea, vomiting ► General ill feeling, Fatigue, Headache ► Frequent hiccups ► Generalized itching (pruritus) Later symptoms may include the following:► Increased or decreased urine output ► Need to urinate at night ► Easy bruising or bleeding ► May have blood in the vomit or in stools► Decreased alertness

drowsiness, somnolence  lethargy, confusion  delirium coma ► Muscle twitching or cramps or Seizures ► Uremic frost -- deposits of white crystals in and on the skin► Decreased sensation in the hands, feet, or other areas

Tests ► Creatinine levels progressively increase► BUN is progressively increased► Creatinine clearance progressively decreases► Potassium test may show elevated levels► Arterial blood gas and blood chemistry analysis

may show metabolic acidosis Changes that indicate chronic renal failure, including

both kidneys being smaller than normal, may be seen on:

► Renal or abdominal x-ray ► Abdominal CT scan ► Abdominal MRI ► Abdominal ultrasound

Complications End-stage renal disease Pericarditis Cardiac tamponade

/Congestive heart failure Hypertension Platelet dysfunction Loss of blood from the

gastrointestinal tract Ulcers /Haemorrhage

/Anaemia Hepatitis B, Hepatitis C,

liver failure Decreased functioning of

white blood cells /Decreased immune response

Increased incidence of infection

Peripheral neuropathy Encephalopathy, nerve

damage, dementia Seizures

Weakening of the bones /Fractures /Joint disorders

Changes in glucose metabolism

Electrolyte abnormalities including hyperkalemia

Decreased libido, impotence

Miscarriage, menstrual irregularities, infertility

Skin dryness, itching/scratching with resultant skin infection

Urinary tract infections

Causes Dehydration Excessive salt/sugar

intake Poor hygiene Chemical

medication Catheterisation Post coital Psychosomatic

►Symptoms ►Burning► Itching► Increased frequency►Urging►Pain ►Change in colour

and odour► Fever / chills

Major Homeopathic remedies

►Berberis vulgaris

►Apis mel►Cantharis►Ars alb►Uva Ursi►Ferr phos

►Terebinth ►Nux vom►Bell ►Causticum ►Pulsatilla ►Acid Benz