Excretory Disorders
Excretory Disorders
Introduction
·
The excretory system (urinary system) is
essential for maintaining internal homeostasis by filtering blood, eliminating
nitrogenous wastes (urea, creatinine, uric acid), regulating fluid and
electrolyte balance, and maintaining acid–base equilibrium.
·
Kidneys are the primary organs of excretion,
supported by ureters, urinary bladder, and urethra.
·
When the excretory system is affected by disease
or dysfunction, it can lead to acute or chronic kidney impairment,
infections, stone formation, and problems of micturition.
·
These disorders can range from mild urinary
tract infections (UTIs) to life-threatening renal failure.
·
Major contributing factors include infections,
autoimmune conditions, metabolic disorders (like diabetes), obstruction,
hypertension, and genetic predispositions.
Definition
The involuntary leakage of urine due to loss of
bladder control.
Types
- Stress
Incontinence – leakage with sneezing, coughing,
or physical exertion (due to weak pelvic floor muscles).
- Urge
Incontinence – sudden urge to urinate, overactive
bladder.
- Overflow
Incontinence – bladder cannot empty fully; urine
dribbles.
- Functional
Incontinence – inability to reach toilet due to
mobility/cognitive problems.
- Mixed
Incontinence – combination of stress + urge.
Causes
- Pelvic
muscle weakness (post-pregnancy, aging, menopause).
- Neurological
disorders (stroke, spinal cord injury, Parkinson’s, multiple sclerosis).
- Prostate
enlargement in men.
- Urinary
tract infections.
- Medications
(diuretics, sedatives).
Symptoms
- Leakage
of urine, urgency, frequent urination, nocturia.
Diagnosis
- Clinical
history, bladder diary, urinalysis, urodynamic testing, ultrasound.
Treatment
- Conservative:
Pelvic floor exercises (Kegels), bladder training, lifestyle modifications
(weight loss, fluid management).
- Medications:
Anticholinergics (oxybutynin), β3 agonists, topical estrogen (in
post-menopausal women).
- Surgical:
Sling procedures, artificial sphincter, bulking agents.
Glomerulonephritis (GN)
Definition
Inflammation of the glomeruli, leading to
impaired filtration.
Causes
- Post-streptococcal
infection (Group A β-hemolytic streptococcus).
- Autoimmune
diseases (SLE, Goodpasture’s syndrome).
- IgA
nephropathy.
- Vasculitis.
Symptoms
- Hematuria
(cola-colored urine).
- Proteinuria.
- Edema
(face, periorbital, legs).
- Hypertension.
- Oliguria.
Diagnosis
- Urinalysis
(RBCs, casts, protein).
- Kidney
biopsy (confirms type).
- ASO
titers (post-streptococcal).
- Blood
urea nitrogen (BUN), creatinine elevated.
Treatment
- Treat
underlying infection.
- Immunosuppressants
(steroids, cyclophosphamide).
- Control
hypertension (ACE inhibitors).
- Dialysis
if severe.
Definition
A clinical condition caused by damage to the
glomerular basement membrane → massive protein loss.
Causes
- Primary:
Minimal change disease, focal segmental glomerulosclerosis, membranous
nephropathy.
- Secondary:
Diabetes, lupus, amyloidosis, infections (HIV, hepatitis B/C).
Features (Classic Triad)
- Massive
proteinuria (>3.5 g/day)
- Hypoalbuminemia
- Edema
(periorbital, pedal, ascites, pleural effusion)
Other: Hyperlipidemia, lipiduria.
Diagnosis
- Urine:
protein, lipid casts.
- Serum:
low albumin, high cholesterol.
- Biopsy:
identifies underlying cause.
Complications
- Thrombosis
(loss of antithrombin III).
- Infections
(loss of immunoglobulins).
- Malnutrition.
Treatment
- Salt
restriction, diuretics.
- Corticosteroids
(esp. in minimal change disease).
- Immunosuppressants
if resistant.
- Statins
for hyperlipidemia.
- Treat
underlying cause (e.g., diabetes, SLE).
Renal Stones
(Urolithiasis/Nephrolithiasis)
Definition
Hard crystalline deposits in kidneys or urinary tract.
Types
Risk Factors
- Dehydration,
high-protein diet, hyperparathyroidism.
- Gout,
urinary stasis, recurrent UTIs.
Symptoms
- Severe
flank pain (renal colic), radiates to groin.
- Hematuria.
- Nausea,
vomiting.
- Urinary
frequency/urgency if lower tract involved.
Diagnosis
- Ultrasound,
X-ray (KUB), CT scan (non-contrast).
- Urine
analysis (crystals, pH).
Treatment
- Small
stones (<5 mm): Hydration, pain relief,
α-blockers (tamsulosin).
- Large
stones: Lithotripsy, ureteroscopy,
percutaneous nephrolithotomy.
- Prevent
recurrence: hydration, diet modification, allopurinol (for uric acid
stones).
Acute Renal Failure (Acute Kidney Injury –
AKI)
Definition
Sudden, reversible loss of kidney function over
hours–days.
Causes
- Pre-renal:
Hypovolemia, shock, sepsis.
- Renal:
Acute tubular necrosis, glomerulonephritis, nephrotoxic drugs.
- Post-renal:
Obstruction (stones, prostate enlargement).
Symptoms
- Oliguria/anuria.
- Fluid
retention, edema, hypertension.
- Uremic
symptoms (nausea, confusion).
Diagnosis
- Rising
BUN and creatinine.
- Urinalysis
(casts).
- Ultrasound
(rule out obstruction).
Treatment
- Correct
underlying cause.
- Maintain
fluid and electrolyte balance.
- Avoid
nephrotoxic drugs.
- Dialysis
if severe.
Chronic Renal Failure (Chronic Kidney
Disease – CKD)
Definition
Progressive, irreversible loss of renal function
(>3 months).
Causes
- Diabetes
mellitus (leading cause).
- Hypertension.
- Glomerulonephritis,
polycystic kidney disease.
Stages (based on GFR)
- Stage
1: Kidney damage, normal GFR.
- Stage
2–3: Mild → moderate reduction.
- Stage
4: Severe reduction.
- Stage
5: ESRD (GFR <15) → dialysis/transplant.
Symptoms
- Uremia:
fatigue, anorexia, nausea, confusion.
- Anemia
(↓ erythropoietin).
- Bone
disease (renal osteodystrophy, secondary hyperparathyroidism).
- Fluid
overload → edema, hypertension.
Treatment
- Control
diabetes, hypertension.
- Dietary
protein, sodium, potassium restriction.
- Erythropoietin
for anemia.
- Phosphate
binders, vitamin D.
- Dialysis
or transplant in ESRD.
Urinary Tract Infection (UTI)
Definition
Infection of urinary tract (kidney, bladder, urethra).
Causes
- Bacteria
(E. coli most common).
- Risk
factors: female sex, poor hygiene, urinary catheterization, pregnancy,
obstruction.
Types
- Urethritis,
cystitis, pyelonephritis.
Symptoms
- Dysuria,
frequency, urgency.
- Suprapubic
pain (cystitis).
- Fever,
flank pain (pyelonephritis).
Diagnosis
- Urinalysis
(WBCs, nitrites).
- Urine
culture (gold standard).
Treatment
- Antibiotics
(trimethoprim-sulfamethoxazole, fluoroquinolones, nitrofurantoin).
- Hydration.
- Preventive
hygiene in recurrent cases.
Acute Tubular Necrosis (ATN)
Definition
Destruction of renal tubular epithelial cells → acute
renal failure.
Causes
- Ischemia
(prolonged hypotension, shock).
- Nephrotoxins
(aminoglycosides, radiocontrast dye, heavy metals).
Phases
- Initiation:
injury occurs.
- Maintenance:
oliguria, azotemia.
- Recovery:
diuresis, gradual improvement.
Symptoms
- Oliguria
→ edema, hypertension.
- Electrolyte
imbalance (hyperkalemia, metabolic acidosis).
Diagnosis
- Elevated
BUN, creatinine.
- Urine:
muddy brown granular casts.
Treatment
- Stop
nephrotoxic agents.
- Fluid
and electrolyte management.
- Dialysis
if needed.
Diabetes-Related Kidney Conditions
(Diabetic Nephropathy)
Definition
A chronic microvascular complication of diabetes
causing kidney damage.
Pathogenesis
- Persistent
hyperglycemia → glomerular hyperfiltration, basement membrane thickening,
mesangial expansion → glomerulosclerosis.
Risk Factors
- Poor
glycemic control.
- Long-standing
diabetes.
- Hypertension.
- Genetic
predisposition.
Symptoms
- Initially
asymptomatic.
- Microalbuminuria
(first sign).
- Progresses
to proteinuria, edema, hypertension.
- Can
lead to ESRD.
Diagnosis
- Urine:
microalbuminuria (>30 mg/day).
- Serum
creatinine, GFR monitoring.
- Kidney
biopsy (in atypical cases).
Treatment
- Strict
glycemic control.
- ACE
inhibitors/ARBs (reduce proteinuria, protect kidneys).
- Control
hypertension, lipids.
- Dialysis/transplant
in ESRD.
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