renal disorders & its management

8/9/2019 Renal Disorders & Its Management

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WELCOME


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RENAL DISORDERS &RENAL DISORDERS &ITS MANAGEMENTITS MANAGEMENTRENAL DISORDERS &RENAL DISORDERS &ITS MANAGEMENTITS MANAGEMENT

1.1. UTI [Urinary tract infections]UTI [Urinary tract infections]

2.2. NephrolithiasisNephrolithiasis


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URINARY SYSTEMS Consist of 2 kidneys, 2 Ureters, 1 Urinary Bladder

& 1 Uretra Organs work together in removing waste from the

body Kiidneys filter the bloodplasma & return most ofthe water & solutes to the bloodstream.

The remaining water & solutes constitute theurine.

Passes through the ureters to the bladder whereurine is stored until its excrete from the bodytrough the urethra.


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Infections Disease of kidneys & urinary tract

are often Silent. Urinary tract

infections & nephrolithiasis are twodiseases of urinary tract.


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Urinary tract infections

[UTI] Types of urinary infections are Lower

uti [affecting the bladder & uretra &

upper uti affecting the kidneys &uretra.


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LUTI PATHOGENSIS The most common cause is bacteria from the

bowel i.e. E.coli that lives on the skin near the

rectum or in the vagina, which can spread & enterthe urinary tract through urethra. Rest of the infections due to Proteus,

Pseudomonas species, Streptococci orStaphylococcus epidermis.

In hospital other organisms Klebsiella orstreptococci are prevalent.


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The first stage is colonization of theperiurethral zone with pathogenic,usually faecal organisms.

This infection travels upwards in theurinary tract.

Multiplication depends on a numberof factors, including the size of theinoculums & virulence of bacteria.


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RISK FACTORS Reduced water intake: Being female 1. The female urethra is shorter than the males. 2. Antibacterial actions of some secretions of the male

prostate glands. 3.Female urethra proximity to the vagina, STDs, such as

herpes simplex virus & chlamydia. Unhygienic conditions: in Infants. Abnormal structure of the bladder: misallignment of the

ureters can cause the values between the bladder &

ureters to remain open when the bladder is emptying. Dueto the urine is forced back into the ureters that can causerenal damage.


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Foreign body in the urinary tract [Catheter,

nephrostomy tubes, ureteric stents] Conditions cause incomplete bladder emptying. 1. Wating to much time to urinate. 2.Urethral stricture [meatal stenosis], bladder

diverticulam.

3.Neurogenic bladder dysfunction. Diabetes Mellitus. Bladder outlet obstructions. 1.Calculi in the urinary tract. 2.Benign hypertrophy of prostrate [BHP]. Due to diseases or medications [Cortisone] lower

the immunity.


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SIGNS & SYMPTOMS Growth of bacterial colonies of 100,000 per ml or more in a

freshly voided mid stream urine sample [Asymtomaticbacteriuria].

Urethirities. 1. Burning with urination. 2. Increased

frequency. 3. Strangury. 4. Pus in urine. 5. In men, peniledischarge. Cystitis. 1. Pressure in the pelvis. 2. Suprapubic pain. 3.

Strong smelling urine. Proststitis. 1.Dysuria. 2. Urgency. 3. Frequency. 4. Pain in

the lower abdomen.

Additional symptoms. 1. Nausea & vomitting. 2. Fever. 3.Fatigue. 4. Chil. 5. Mental changes or confusion.


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Diagnosis Charecterstic clinical features like frequency,

dysuria, haematuria, urgency & strangury. Demonstration of a significant growth of

organisms. Counts of >10 10 organisms per ml. The presence of neutrophils in the urine. An abdominal ultrasound [USG-KUB]may be

needed to evaluate the status of Renal system.


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Chronic or Recurrent

[UTI] Symptoms return 2 or more times in

6 months.

Symptoms of a single episode lastlonger than weeks. Symptoms last longer than 48 hours

after the treatment has begun. Pyleonephritis [Kidney infection].


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Prognosis Complicated may result in permanent

renal damage.

Wheras uncomplicated rarely do so.


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Uncomplicated UTI Anatomically & phsiologically normal.

Nomal renal function.

No associated disorder which impairs

defence mechanism.


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Complicated UTI Abnormal urinary tract. Eg; obstruction,

calculi, vesico-ureteric reflux, neurological

abnormality, in-dewelling catheter, chronicprostatitis, cystic kidney, analgesicnephropathy, renal scanning.

Associated disorder or treatment that

predisposes to UTI. [Diabetes mellitus].


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Complications Treated promptly & properly avoide UTI. The UTI rarely leads to complications. Recurrent

attacks casued by bacteria such as Ureaplasma

urealyticum & proteus [common]. Staphyloccus, Klebsiella, Providencia &

Pseudomonas leads to hydrolysis of urea intoammonium & hydroxyl ions which leads toformation ofStones..

Untreated UTI lead to acute or chronicinfections.


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Prevention Generals. Drinking plenty of liquids.

To urinate frequently.

For females. To wipe from front toback.

Avoid potentially irritating feminine

products.


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Management Advice to the patients.

Maintain good personal hygiene.

Empty the bladder before & afterintercourse.

In children emptying the bladder beforegoing to sleep.

Medicinal treatment based on symptoms.


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Upper UTI Over 50% of patients who have

cystitis or bacteriuria, will infection

travelled upwards & thus infect theKidneys.


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PATHOGENESIS BI of the renal parenchymacan happen in

two ways, 1. Ascent of the organisms via;

The ureter. 2. Blood borne. Organisms: 75% of the infections are dueto E. Coli, The reminder due to Proteusspecies, Klebsiella, Staphylococci or

Streptococci.


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RISK FACTORS One or more of complicating factors

of renal disease.

More common in infants & womens. Stasis within the UT compromises its

defences. Renal cysts or scars facilitate

infections.


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NEPHROLITHIASISNEPHROLITHIASIS

[Kidney stones,R

enal[Kidney stones,R

enalcalculi, Stones]calculi, Stones]

NEPHROLITHIASISNEPHROLITHIASIS

[Kidney stones,R

enal[Kidney stones,R

enalcalculi, Stones]calculi, Stones]Definition.Definition.

Kidney stones are hardened mineral deposits thatKidney stones are hardened mineral deposits thatform in kidney. They are microscopic particles &form in kidney. They are microscopic particles &

develop into stones. They can be one or many presentdevelop into stones. They can be one or many presentin calyces or pelvis of the kidney or in the ureter.in calyces or pelvis of the kidney or in the ureter.


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PATHOPHYSIOLOGY The kidneys filter waste products from

the blood & add them to the urine. When

the waste materials not completelydissolve in the urine, it produces crystals& kidney stones.

INCIDENCE.

Stones affect about 2 out of every 1000peoples. Recurrence is common & its makerisk. A family or personal history of stonesmay leads to high risk.


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Super Saturation The dehydration may cause the

imbalance in the liquids & disolved

solids in the urine. The urine must beoverladed of harmful substances,chemicals, & trace of elementscombine that to form crystals whichslowly devlops layer upon layer toform a stone. Studies suggest thatdrinking plenty of water may prevent

kidney stones.


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RISK FACTORS Inadequate fluid intake. Dehydration.

Reduced urinary flow & volume. Certain chemical levels is high or too

low. High levels. Calcium [hypercalciuria], Crystine [caused by agenetic disorder], Oxlate[hyperoxaluria], Uric acid [hyperuricosuria], Sodium [hypernatremia].

Low level of citrate is a risk factor.


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Several medical conditions.

Congenital kidney defect. [Medullary spongekidney, Renal tubular acidosis].

Hyperparathyroidism.

Gout. Hypertension. Colitis. Crohns disease.

Arthritis. UTI. Obustruction in passage. Diets.


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Matrix Another chemical component of

urine, a noncrystalline protein called

matrix. It may cause to formation ofstones.


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TYPES OF STONES The chemical components of stones

must be different. There are 5 main

types. 4 types must be common. Calcium

Uric acid

Sturvite Crystine

Xanthine stones [rare]


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CALCIUM OXALATE

STONES Roughly Four out of Five [71%] are calciumstones. It is most common. The mostcommon cause of calcium stone production

is excess calcium in the urine. It combineswith other substances like Oxalate,Phosphate or Carbonate. Oxalate is foundin some foods such as fruits & vegetables.Disease of the small intestine, certain

genetic factors & intestinal byepasssurgery may cause excess amount ofOxalate. Excess calcium may result fromingesting large amount of Vit. D, treatmentwith thyroid hormones or certain

diuretics, some cancers & kidney


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Also calcium high levels can bepresent in parathyroid glands are

overactive [hyperparathyroidism].Excess calcium is removed from theblood by the kidneys & excreted inthe urine. In hypercalciuria it

combines with other waste productsto form stones. Low level of citrate,high level of oxalate & uric acid,

Inadequate urinary volume may alsocause stones.


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Increased intestinal absorption of Cal[absorptive hypercalciuria], excessive

hormones level [hyperparathyroidism] &renal Cal leak [kidney defect], prolongedinactivity also increases urinary Cal & maycause stones.

Renal tubular acidosis [inherited conditioncondition which the kidneys fail to excreteacid] significantly reduces citrate & total

acid levels can form stones usually calciumphosphates.


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URIC ACID STONES Uric acid is the end product of purine

metabolism & excreated through thekidneys. An overproduction of uric acidsoccurs when there is excessive breakdownof cells, which contain purines or inabilityof the kidneys to excrete uric acid. They

are associated with gout orchemotherapy. These is most likely seen inmens. Normal uric acid level are 2.4 to6.0mg/dl in females & 3.4 to 7.0mg/dl in

males.


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Cystine stones Cystine is an ammino acid in protein thatdoes not dissolve well. Some people inherita rare, congenital condition that results in

large amounts crystine in the urine iscalled crystine. It can affect both men &women. The kidneys do not adequ ately re-absorb certain amino acids during thefiltering process thus resulting in excess

excretion & thus percipitate & formcrystals or stones in the kidneys, ureters,or bladder. Crystaline stones are difficultto treat & needs long term. This is usuallyseen after an episode of stones.


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Struvite stones &

staghorn calculi This is usually a result of UTI. These

stones are more common in women.

They can grow large & may obstructkidneys, ureters or bladder. Thepresence of urease producingbacteria including Ureaplasma

urealyticum & proteus [mostcommon], Staphlococcus, Kelbsiella,Providencia & Pseudomonas species,leads to the hydrol syis of urea into

ammonium & hydroxylions.


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Xanthine stones [rare] These stones are small & usually round oroval. This stones may usually occur due to agentic disorder in patients who have an

enzyme disorder. Enzyme xanthineoxidase, which results in the production ofxanthine & hypoxanthine rather than uricacid as an end product of purinemetabolism. These calculai may also

develop in patients taking allopurinol anxanthine-oxidase inhibitor. Pure xanthinestones are radiolucent, but withxanthinuria there may be calcium saltmixture to render these stones slightly

radio-opaqie.


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SIGNS & SYMPTOMS The most common symptom is an intense,

colicky pain that may fluctuate 5 to 15minutes. The pain usually starts in the

back or the side just under or below theedge of the ribs. As the stone moves downthe ureter toward the bladder, the mayradiate to the lower abdomen, groin &

genital structures on that side. If thestone stops moving, the pain may stop too.


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Patient Complaints Flank pain or back pain, a. On one or both sides b. Progressive

c. Severe d. Colicky e. Move or radiate to lower in flank, pelvis,

groin, genitals

Nasuea, vomitting

Urinary frequency/ urgency increased


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Urinary frequency/ urgency increased Blood in urine Abdominal pain

Painful urination Excessive urination at night Urinary hesitation

Testicle pain Groin pain Fever Chills

Abnormal urine colour


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DIAGNOSIS & TESTS

Straining the urine may capture the stones


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Straining the urine may capture the stoneswhen excreted, Analysis the stone &showsthe type of stones.

Urine analysis crystals & RBC Blood test Uric acid elevates in uric acid

stones. High levels of calcium in Calsiumstones [75%].

Other investigations: Abominal X-ray canhelps visualization of most kidney stones &judge changes & size of stones.

USG KUB region Safe, Painless, but it

may miss small stones located especially inureter or bladder.


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Retrograde pyelogram.

IVP [Intravenous pyelogram] - This

study can define location of stones,degree of blockage caused by stone.

Abdominal CT scan This imaging

test can identify stones regardlessof composition & doesnt require theuse of contrast dye.


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complications Recurrence of stones UTI

Obstruction of the ureter, acuteunilateral obstructive uropathy Kidney damage, scarring

Decrease or loss of function of theaffected kidney.


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Management In many cases, making a few lifestyle canprevent kidney stones. An overall diet lowin salt & animal protein may reduce the

chances of developing stones. Liberal fluid intake. Dietary advise. Supplements advised Taking 50 mga day

Vit. B6 with 200 to 400 mg a day ofmagnesium.


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Homoeopathic Medicines Some mother tinctures are toxic

effect if given in macro doses &

could have side effects for aprolonged period.

The selection of an individualized

indicated remedy according to thesymptoms.


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BERBERIS VULG Botanical name: Berberis vulgaris linn Family: Berberidaccae Common name: Barberry, Kashmal Habitat: India, Europe &North of Asia

Parts used: Bark of root Alcohol percentage: 47 51%v/v Active constituents: Berberine, Oxyacanthine Action: Anti bacterial, Anti inflammatory, Antioxidant,

Stimulates immune cells Clinical: Renal calculi, Renal colic, Inflamation of kidneys,

Haematuria


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INDICATIONS Left side kidneys stones with bubbling sensation. 1 Inflammation of kidney, Haematuria. 1 Pain in kidney region radiating from abdomen to hips groins

& down to urethra. 1

Frequent recurring, crampy, aching pain in the bladder whileits empty or full. 2 Renal gravel, renal calculi. 4 Urine with mucus & bright red meaty sediment. Pain in

thighs & lions. 1 Frequent urination. Urethra burns when not urinating. 1

Dose: 5 to 10 drops 3 to 4 times daily.


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CHIMAPHILA

UMBELLATA Botanical name: Chimaphila umbellata [Linn] Borton. Family: Ericaceae. Common name: Pipsissewa. Habitat: Temperate asia, North america, Canada, Mexico,

Japan, Siberia & Europe. Parts used: Whole plant. Alcohol %: 66 70%v/v. Constituents: Chimaphillin, arbutin, ericalin, ursone, tannin,

sugar, gum, resin. Action: Diuretic, removes irritation of kidneys & urinary

tract, astringent, tonic. Clinical: Cystitis-acute & chronic, bladder stone, nephritis.


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Indications Acute & chronic catarrh of the bladder. 1 Urine: Scanty & loaded with ropy, muco-purlent sediment. 4 Inability to pass urine without standing with the feet wide

apart. 1

Frequent urine at night with increasing the debility fromstone in bladder. 4 Vesical tenesmus from prolapse or retroversion. 4 Must strain before the urine. 1 Prostatic enlargement. 1 Without pain or uneasiness sensation of something

fluttering the kidney region. 3


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COCCUS CACTI Botanical name: Dactylopus coccus cocosa. Family: Coccidae. Common name: Cochineal beetle, Kerm dara. Natural order: Hemiptera.

Habitat: Mexico, Peru, Central america, Spain & WestIndies. Parts used: Dried female insect. Alcohol %: 48 52%v/v. Constituents: Caraminic acid. Action: Anodyne, antispasmodic.

Clinical: Urinary calculi, urethritis, haematuria, dysuria,nephritis, ascitis.


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Indications Haematuria, brick red sediment. 1 Drawing pain extending to the ureter to the bladder at 5 pm

walking from sleep. 3 Urination with burning pain in the urethra. 2 Urine hot, yellow, turbid or red scanty & thinner than usual. 3

Burning dysuria & urine acidic. 3 Haematuria, urates & uric acid: lancinating pains from kidney to

bladder. 1 Thick urine, deep coloured. 1 Dull pressive pain & soreness in region of kidneys. 2 Frequent & copious urination, urine clear as water, soon becomes

turbid & cloudy. 2 Dose: 5 10.


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ERIGERON CANADENSE Botonical name: Erigeroncanadensis linn.

Family: Compositae.Common name: Canada fleabane.

Habitat: Western himalayas, punjab, & uppergangetic plains.

Parts used: Whole plant.Alcohol %: 47 51%v/v.Active constituents: Tannin, gallic & volatile oil.Action: Arteries & capillaries contrlling hemorrhage &

increases mucous discharge.Clinical: Haematuria, dysuria.


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Indications Profuse bright red blood in urine, painful micturation. 1 Sharp, stinging pain in left renal region, complete

suppression of urine or urging to urinate. 2 Urination painful or suppressed, dysuria of teething

children, frequent desire. 2 Crying when urinating. 2 Urine profuse, of very strong order & palate colour. 3 External parts inflamed or irritated, with considerable

mucous discharge. 2 Dose: 5 10.


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HYDRANGEA

ARBORESCENS Botaonical name: Hydrangea arborescens linn. Family: Saxifragaceace. Common name: Seven barks. Habitat: United states.

Parts used: Rhizome & roots. Alcohol %: 57 61%v/v. Active constituents: Glycosides, saponins, resins, rutin,

essential oils & flavanoids. Action: Diuretic, anti-lithic, sedative to cystic & urethral

irritation.

Clinical: Bladder catarrh, renal calculi, urethritis.


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Indications Urine white amorphos salts deposit profuse,gravel. 1

Calculus, renal colic, bloody urine. 1 Relives distress from renal calculus, with soreness

over region of kidneys & bloody urine. 1 Acts on ureter, sharp pain in the loins- especially

left. 1 Spasmodic stricture. 1 Burning in the urethra & frequent desire. 1 Dose: 5 10.


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OCIMUM CANUM Botanical name: Ocimum canum sins. Family: Labiatae. Common name: Brazillian alfavaca, Kalatulsi. Habitat: India, sri lanka, java, west asia, tropical africa,

madagascar, cultivated in america. Parts used: Leaf. Alcohol %: 79 81%v/v. Active constituents: Terpenoids, eugenol, thymol, &

estragole. Actions: Mild diuretic, smooth muscle relaxant,

immunomodulator & nerve tonic. Clinical: Renal colic, albuminuria, renal calculi.


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Indications Uric acid diathesis. 1 Urine: red sand, high acidity, odur of musk with crystals of

uric acid. 1 Renal colic [right or left]. 2

Intollerable smell with turbid, purulent, depositing whitealbuminous sediment.2 Vomiiting every 15 minutes with renal colic [rt or lt].2 Saffron yellow urine. 3 Red urine with brickdust sediment after the attack. 3 Dose: 5 10.


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PAREIRA BRAVA Botanical name: Chondrodendron tomentosum ruiz & pavon. Family: Menispermaceae. Common name: Virgin vine, velvet leaf. Habitat: Brazil, peru, west indies, & central america.

Parts used: Root. Alcohol %: 66 70%v/v. Active principle: Bisbenzlisoquinoline alkaloids such as

chondrodendrine & isochondrodendrine, berberine,deyamitine, cissampareine.

Action: Antibacterial, antiseptic, wondhealer, anti-

inflammatory, reduces fever, antilithic. Clinical: Renal colic, oedema, urethritis, cystitis, dysuria.


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Indications Black, bloody urine red sediment with a strong ammoniacalsmell. 1

Catarrh of the bladder, constant urging, great straining,pain during efforts to urinate. 4

Sensation as if bladder was distended with going pain downthe thighs, & extending down the feet. 4

Strangury with paroxysm of violent pains; urine can only bevoided while pt is on his knees with head pressing againstthe floor. 4

Excruciating pain in the left lumbar region radiating fromleft kidney to groin, following the course of ureter. 2

Bruised pains in the region of kidney. 2 Dose: 5 -10


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Indications Tenesmus with pressure on bladder & discharge of a whiteturbid matter mixed with mucous, severe pain at conclusionof urination with passage of blood. 2

Child screams before & passing urine & passes largequantity of sand. 2

While sitting urine dribbles & passes freely when stands. 4 Offensive smell of urine & genitals. 4 Burning & thread like elongated flakes while urinating. 2 Pus & charged with gravel or small pebbles in urine. 4 Pain & cramps in the bladder with urging & burning, frequent

urging, scanty & painless discharge. 4

Urine pale, copious, sandy, bloody. 2 Frequent discharge of pale copious urine, growing turbid onstanding like clay water. 3

Severe strangury as in case of stone, when discharging ofwhite turbid matter, with mucous. 3

Dose: 5 10.


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SENEICO AUREUS Botanical name: Senecio aureus linn. Family: Compositae. Common name: Golden ragwort, life root.

Habitat: United states, north & west, found inswamps. Parts used: Whole plant. Alcohol %: 47 51%v/v.

Constituents: Pyrrolizidine alkaloids, florosenine,otosenine, floridanine, eremophilane,sesquiterpenes.

Action: Diuretic, anti inflammatory, emmenagogue. Clinical: Haematuria,pyelitis, renal colic ,nephritis,

dysuria.


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G


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STIGMATA MAYDIS -

ZEA Botanical Name: Zea mays linn. Family: Graminae. Common name: Maize, Indian corn. Habitat: India [wildly cultivated].

Parts used: Corn silk. Alcohol %: 37 41%v/v. Active principle: Flavonoids[maysin], allantion, alkaloids,

saponins, volatile oil, mucilage, vit. C, & K, pottassium. Action: Cholagogue, demulcent, diuretic lithotripic,

vasodilator, anti inflammtory.

Clinical: Cystitis, pyelitis, renal lithiasis, renal colic, oedema.


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TEREB NTH N E


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TEREBINTHINAE

OLEUM Botanical name: Terebinthinae oleum. Common name: Turpentine oil. Specific gravity: 0.854 0.868.

Refractive index: 1.467 1.477. Alcohol %; 84 88%v/v. Action: Rubiefacient, antiseptic, anesthetic. Clinical: Urethritis, glomerulonephritis, cystits,

albuminaria, irritable bladder, oedema,haematuria.


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Indications Starngury with bloody urine. 1 Urine: scanty, suppressed, with odour of violets & mucousdeposit. 1

Urethritis, with painful erections. 1 Inflamed kidneys following any acute disease. 1

Constant tenesmus. 1 Burning pain in the region of kidneys. 1 Violent burning & drawing in the bladder & urethra. 3 Stragury, dysuria,dragging & cutting pain in bladder, urine

scanty, cloudy & bloody urine, difficult micturation. 4 Heaviness &pains in the region of kidneys in the morning

while sitting, disappearing on motion. 3 Urine rich in albumin & blood, but few casts; < living in damp

dwellings. 3 Dose: 5 10.

THLASPI BURSA


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THLASPI BURSA -

PASTORIS Botanical name: Capsella bursa pastoris medic. Family: Cruciferac. Common name: Shepherds purse. Habitat: India, [more in north & western himalayas.

Parts used: Whole plant. Alcohol %: 52 56%v/v. Constituents: Resin & volatile oil, seeds yield proteid

substances. Action: Anti haemorrhagic & anti uric acid remedy. Clinical: Albuminuria, renal & vesical irritation, oedema,

renal calculi, dysuria, haematuria.


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Indications Haematuria with burning, frequently passingstrong odour of urine. 2

Increased flow of urine with copious discharge of

sand. 2 Oedema. Renal calculus with brick red sediment. 2 Strangury after accouhement; dribbling of urine.2 Dysuria of old persons, with dribbling. 2 Dose: 5 10.


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UVA UR

SI Botanical name: Arctostaphylos uva ursi spreng. Family: Ericaceae. Common name: Bearberry. Habitat: Europe, US, mexico & N asia.

Parts used: Leaf. Alcohol %: 57 61%v/v. Constituents: Ursolic acid, volatile oil, arbutin, quercetin,

ericolin, methylarbutin, iron, manganese myricetin, tannin.Ursolic, galic &malic acids.

Action: Diuretic, strong antibacterial properties.

Clinical: Pyelitis, cystitis, urethritis, dysuria, haematuria.


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