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2 TYPES:
KIDNEY
Glomerular Extraglomerular
- Glomerulonephritis - Benign/malignant
- IgA nephropathy renal tumor
- Thin basement - Polycystic kidney
membrane dz dz
- Alport’s syndrome - Sickle cell dz
- Pyelonephritis
- Stones/Renal cyst
- Renal Ca
- Renal papillary
necrosis
- Trauma
URETER
- Tumor/Carcinoma
- Stones
- Urethral stricture
- Infection
- Trauma
BLADDER
- Benign/malignant tumor
- Carcinoma
- Stone
- Infection: Cystitis
- Chronic irritation
- Trauma
URETHRA
- Infection: urethritis
- Traumatic catheterization
- Stone
- Stricture
URINARY TRACT PROSTATE
- Benign prostatic hyperplasia (BPH)
- Body’s drainage system for removing wastes - Prostatitis
and extra fluid - Prostate Ca
- Urinary tract includes: 2 kidneys, 2 urethers, - Trauma
bladder, urethra NON-URINARY TRACT HEMATURIA
- Hepatitis
KIDNEYS - Sexual activity
- Menstruation
- Setiap hari nya kidney filter 120-150 quarts (1
- Endometriosis
quarts = 0.94 liter) produce 1-2 quarts of - Vigorous exercise
urine DRUGS CAUSE RED URINE
- Rifampicin
- Chloroquin
- Ibuprofen DIAGNOSTIC APPROACH TO MACROSCOPIC HEMATURIA
- Nitrofurantoin
- Phenytoin
HYALINE CAST
CELLULAR CAST
RBC CAST
BACTERIAL CAST
EPITHELIAL CAST
GRANULAR CAST
WAXY CAST
Travelling schistosomiasis
History of catheterization
DD RCC
- Acute pyelonephritis
- Bladder cancer
- Chronic pyelonephritis
TNM STAGING - Non-hodgkin lymphoma
- Wilms tumor
T Tx Pri tumor can’t be assessed
T0 No tumor DIAGNOSIS
T1 ≤ 7 cm, limited to kidney
T1a ≤ 4 cm LAB
T1b 4 – 7 cm
- Urinalysis (UA)
T2 >7 cm, limited to kidney
- Urine cytology
T2a 7 – 10 cm
- CBC with differential
T2b >10 cm
- Electrolyte
T3 Tumor extend to major
- Renal profile
veins/adrenal
gland/perinephric tissue (not - Liver function test (LFT: AST, ALT)
beyond Gerota fascia) - Serum calcium
T3a Invades adrenal
IMAGING
gland/perinephritic
tissue (not beyond - CT scan (Pelvic CT) - utk diagnosis + liat staging
Gerota fascia) - MRI (if venous involvement suspected/patient
T3b Tumor extends to ga bs terima contrast)
renal veins/vena cava
- USG (useful for cystic renal lesions)
below diaphram
- Chest CT/X-ray
- Bone scan (suspect bone metastasis/ALP↑)
- Brain CT (suspect brain metastasis)
- PET scan (for distant metastasis) MONITORING
Stage I >90%
Stage II 75-95%
- Immunotherapy
- Radiation therapy (for palliative)
- Chemotherapy
AKI, CKD, ACKD
Bladder Cancer (Transitional Cell Carcinoma) Etiology
Present as painless visible hematuria in older male IgA deposition in glomerular mesangium
smoker. Other symptoms dysuria, blood clots and No evidence of a role for any specific antigen
obstructive symptoms. 90% urothelial cancer.
IgA Nephropathy
Etiology Nephrolithiasis
Defect in type IV collagen Rapid onset of excrutiating back and flank pain radiate
to abdomen and groin. Increasing pain with movement,
associated with nausea, vomiting, dysuria and urinary
Diagnostic
frequency.
Renal biopsy if proteinuria 200-300 mg/ day
Etiology
Electron microscopy if no proteinuria, normal
renal function Stones because of supersaturation in urine
Immunohistochemical to distinguish TBMN precipitation and crystallization
with early Alport syndrome
Calcium oxalate 75% (hypercalcemic,
hyperPTH, excess sodium intake)
Therapy Calcium phosphate (sama kayak Ca oxalate)
Uric acid (excess dietary purines, MPD,
BP goal <130/80 mmHg
uricosuric agents, metabolic syndrome)
ACEi if proteinuria >1 g/ day
Proteus mirabillis struvite formation
Ureteral obstruction
Pyelonephritis
Infection related GN Sepsis
Renal failure
New onset of Nephritic syndrome (hematuria, Diagnostic
proteinuria, edema, hypertension), AKI and infection.
CT scan non contrast
Epidemiology US for pregnant woman
Hematuria
Post streptococcal GN occurs in children
Therapy
Immunocompromising comorbidities DM,
alcoholism. Pain control NSAID/ Opidoid
Etiology Hydration oral/ IV
Uncontrolled pain, nausea and vomiting, AKI
Mostly associated with Streptococcal
hospitalize
pharyngitis and impetigo
Sepsis : Broad spectrum Abx and drainage via
In children 1-2 wks after pharyngitis and 2-4
nephrostomy
wks after impetigo
Stone passage
Diagnostic
o Nifedipine and tamsulosine
ASTO for streptococcal infection o Lithotripsy
Hypocomplementemia C3 and C4 Prevention
Adult may have nephrotic range proteinuria, o Reducing phosphate containing soft
hematuria RBC cast, while older adult may drinks
o Stop thiazide, citrate
supplementation, allopurinol
BPH Ecoli, kleb, proteus, pseudomonas
STD chlamidya
Urgency frequency, nocturia, urge incontinence, stress Diagnostic
incontinence, hesitancy, poor flow, straining, dysuria
DRE, urinalysis and culture, PSA.
Diagnostic using DRE If abscess occur CT, MRI, TRUS.
Renal function
Therapy
Therapy
Diuretics
First line Fluoroquinolone, TMP SMX 3-4 wks
Moderate to severe : Alpha bloker (terasozin,
Supportive : pain reliever and stool softener
doxasozin) + 5alpha RI (finasteride), or
Abscess drainage
phosphodiesterase inhibitor (tadalafil)
Alport Syndrome
Prostatitis
Hematuria with strong family history of renal disease
Abdominal pain, recent UTI, fever, chills, urinary
and sensory neural hearing loss
retention, recent prostate biopsy
Diagnostic urinalysis with microscopy, SrCr, family
Ascending infection through reflux of urine to prostate
history and biopsy.
through ejaculatory/ prostate ducts.
Eti