DISEASE
DEFINITION
KIDNEY Diseases
(start)
an inherited disorder characterized
by many bilateral cysts that cause
enlargement of the kidneys but
reduce the functioning renal tissue
- discovered in adulthood
inflammatory disease of the
glomeruli
Polycystic
Kidney Disease
Glomerulonephritis
Primary – only glomerular
abnormality is present
Secondary – glomerular
abnormality results from other
diseases such as diabetes, SLE
(systemic lupus erythematosus)
Acute
Glomerulonephritis
common in children + young adults
-start 2 weeks after infection
Chronic
Glomerulonephritis
prolonged + progressive
inflammation or degeneration of the
kidneys leading to scarring +
chronic renal failure
CAUSE
Signs/Symptoms
Dg
Tx
flank pain, hematuria, urinary tract
infections, hypertension, progressive
renal failure with uremia
ultrasound,
CT scan
renal dialysis,
transplantation
hematuria, proteinuria, RBC casts,
oliguria (small amt of urine), edema,
hypertension, aazotemia (elevated
urea nitrogen + creatinine in the
blood)
asymptomatic in early stages, fatigue,
edema, hypertension, anemia,
hematuria, RBC casts, brown-tinted
urine, proteinuria, hyperlipidemia,
kidney failure
evaluation of the urine
+ blood, kidney
biopsy
antibiotics, protein
restriction, diuretics
proteinuria, lipiduria,
hypoalbuminemia, generalized
edema, hyperlipidemia, kidney failure
evaluation of urine +
blood, renal biopsy
normal protein, low fat
diet, salt restriction,
diuretics, steroids,
albumin replacement,
dialysis, kidney
transplants
triggered by allergic reaction:
1) injury resulting from
antibodies reacting with fixed
glomerular antigens
2) injury resulting from
circulating antigen-antibody
complexes that become
trapped within the glomerular
membrane
Antigens:
endogenous (DNA)
exogenous (streptococcal membrane
antigen, drugs, toxins, varicella virus
(chicken pox), hep B
(Pathogenesis): antigen-antibody
complexes are responsible for
development of allergic inflammation
of the basement membrane
characterized by small kidneys w/
sclerosed glomeruli
-develops insidiously
Nephrotic
Syndrome
clinical symptoms which can
develop in patients suffering from
primary or secondary glomerular
disease
Pyelonephritis
an inflammation of renal pelvis,
tubules and interstitium
E. coli, Proteus, Pseudomonas
-bacteria enter kidneys: from the
bladders + ureters; via the blood
Predisposing factors: kidney stones,
vesicoureteral reflux, pregnancy,
neurogenic bladder, instrumentation,
female sexual trauma
1
DISEASE
DEFINITION
Acute
Pyelonephritis
an acute pyogenic infection of
kidneys
Chronic
Pyelonephritis
chronic pyogenic infection of
kidneys causing atrophy + scarring
of the kidneys
patient has a history of recurrent
acute pyelonephritis, kidney stones,
strictures, or reflux
Chronic
Interstitial
Nephritis
Kidney Stones
aka Renal
Calculi,
Nephrolithiasis, Urolithiasis
chronic inflammation + fibrosis of
the interstitial spaces between the
tubules
masses of crystals + protein
-anywhere in urinary tract
-cause obstruction + pain;
secondary infection
CAUSE
(Pathophysiology):
-chronic obstruction prevents
elimination of bacteria
-progressive inflammation causes
fibrosis + scarring
-renal pelvis becomes dilated
-renal parenchyma atrophies
-concentrating ability of kidneys lost
-chronic renal failure develops
drug toxicity (aspirin, acetaminophen),
phenacetin, antibiotics, ischemia,
irradiation, immune complex diseases
Causes of Development:
-high urine concentration
-chronic urinary tract infection
-hyperparathyroidism
-gout, cystinosis
-unknown causes
composition of kidney stone: Ca,
oxalates, urales, cystine
Renal Cell
Carcinoma
(Adult Kidney
Cancer)
Urethritis
Balanoposthitis
Cystitis
Signs/Symptoms
Dg
Tx
fever, chills, malaise, flank pain,
costovertebral angle tenderness,
nausea, vomiting, frequency, urgency,
leukocytosis,
-urine has: protein, WBC, RBC,
bacteria (pus, casts)
-none
-fatigue, anemia, hypertension
-frequency, dysuria (pain during
urination), flank pain
-renal failure
clinical picture +
urine evaluation
antibiotics,
antipyretics,
removal of
obstruction
urine evaluation
(WBC, casts,
bacteria); renal
function tests;
ultrasound; IVU
(intravenous
urography)
elimination of
obstruction,
eradication of
bacteria
-many calculi are silent
-back or suprapubic pain
-renal colic: sudden excruciating pain
originating in kidney area, radiating
across the abdomen into the genitalia
or thighs
-nausea, vomiting, fever
-abdominal distention
-hematuria, frequency of urination
hematuria, flank pain, fatigue,
palpable mass, wt. loss, fever of
unknown origin, hypertension,
metastases in lungs, liver, lymph
nodes, bone
urinalysis, IVU
eradication of
infection,
cystoscopic
extraction of
calculus, ultrasound
or laser disruption
(lithotripsy),
chemical
dissolution, surgery
surgery
-adenocarcinoma
-more common in males, 50-60
years old
-kidneys may be invaded by
malignant cells in leukemia +
lymphoblastoma
acute or chronic infection of the
urethra
inflammation of the glans penis and
foreskin
tobacco
E. coli, Proteus, Neisseria gonorrhoeae,
chlamydia trachomatis
burning pain on urination, urgency + freq.,
urethral discharge, urine: pyuria, bacteriuria
inflammation of the urinary bladder
-more common in females
-diabetes, pregnancy, neurogenic
bladder (need to pee often), poor
hygiene
-results from ascending infection
from the urethra or prostate, or
occurs secondary to urethral
instrumentation (catheterization)
E. coli, Klebsiella, Proteus,
Pseudomonas, Staphylococcus
dysuria, urinary urgency + frequency,
suprapubic + low back pain, nocturia,
meaturia, cloudy urine (not enough
water in body, calcium salts)
Types of Cystitis
hyperemic (red bladder), hemorrhagic,
suppurative, ulcerative, gangrenous
clinical symptoms,
urine evaluation, IVU,
MRI, arteriography
antibiotics
urine evaluation
(bacteriology)
antibiotics
2
DISEASE
DEFINITION
Nonbacterial
Cystitis
(urethral
syndrome)
= symptoms of cystitis with negative
urine cultures
-could be an infection of the
paraurethral glands or interstitial cystitis
(autoimmune disease)
Carcinoma of
Bladder
-common, affects both sexes
-present in ppl older than 60
(Transitional Cell
Carcinoma)
Chronic Renal
Failure
CAUSE
Signs/Symptoms
Dg
Tx
-cigarette smoking
-carcinogens present in chemical,
rubber + textile industries
-asymptomatic
-hematuria (painless)
-dysuria, freq., pyuria
-pelvic pain
-metastases in lymph nodes, liver,
bones, lungs
azotemia (in the blood) = retention of
nitrogenous wastes
-cytology of urine
-cystoscopy + biopsy
-laser, vaccination
-transurethral
resection
-partial or total
cystectomy
-usually insidious
-result of: chronic
glomerulonephritis, severe
pyelonephritis, long standing
obstruction of urinary tract,
atherosclerosis of kidney’s arteria
dialysis,
transplantation
Clinical Symptoms: mm. weakness,
anemia, slowed mental activity
I. Bacterial Diseases
(start)
Pyogenic
Bacterial
Infections
a) Staphylococcal infections
aa) Staphylococcal food poisoning
b) Group A Streptococcal Infections
c) Pneumococcal Infections
d) Streptococcus Viridans Infection
e) Meningococcal Meningitis
f) Hemophilus Influenzae Infection
Staphylococcal
Infections
-bacteria normally carried on the
skin + in nose of 25% of ppl
cardinal signs of inflammation
(redness, swelling, heat, pain, loss of
function), fever, leukocytosis,
purulent drainage from an abscess
examples: furuncles+carbuncles
-breast abscesses (nursing moms)
-postoperative infections – stitch
abscesses
Staphylococcal
Food Poisoning
= vomiting + diarrhea caused by
eating food contaminated by
staphylococcal enterotoxin
Group A
Streptococcal
Infections
examples of diseases: Pharyngitis
(Strep throat), Tonsillitis, Scarlet
fever, Impetigo, Erysipelas
(Cellulitis)
examples of diseases: Pneumonia,
acute otitis media (mid ear
infection), acute sinusitis,
meningitis
Pneumococcal
Infections
food handlers with skin infections
contaminate food left at room
temperature
pain, fever + other signs of
inflammation
Streptococcus Pneumoniae (normal
member of throat flora)
Prophylaxis: a
vaccine for a person
with chronic heart
disease, chronic
bronchitis, diabetes
+ elderly in chronic
care facilities
3
DISEASE
DEFINITION
Streptococcus
Viridans
Infection
-part of normal flora of mouth
-most common cause of Bacterial
Endocarditis – previously damaged
heart valves (by rheumatic fever)
are inflamed + destroyed
-epidemic meningitis caused by
meningococcus
-occurs in early spring, transmitted
via the oral route
-an bacterial infection that starts as
mid ear infection
-meningitis in small children
-pneumonia in adults
Meningococcal
Meningitis
Hemophilus
Influenzae
Infection
Enteric
Bacterial
Infections
a) Salmonella Infections
aa) Typhoid Fever
ab) Other Salmonella Infections
(Salmonelloses)
b) Shigellosis (Bacillary Dysentery)
c) Cholera
Salmonella
Infections
Typhoid Fever
major bacterial diarrheal illnesses
worldwide
caused by Salmonella Typhi,
common in developing countries
Sources: poultry, unpasturized milk,
raw eggs, raw egg products
Other
Salmonella
Infections
(Salmonelloses)
Shigellosis
(Bacillary
Dysentery)
Cholera
acute infection of the bowel common in overcrowded
populations with inadequate
sanitation
an acute infection involving the
entire small bowel, characterized by
profuse watery diarrhea, vomiting,
muscular cramps, dehydration,
oliguria (small amt of pee) +
collapse
CAUSE
Signs/Symptoms
Dg
Tx
confirmed by
isolation of bacteria in
cultures from direct
rectal swabs
Therapy: fluids, diet
Prevention: proper
cooking, handling +
storage of food;
preventing
contamination of food
by infected animals +
humans
Treatment of carriers
is important: Typhoid
Mary
fever, leukocytosis, heart murmur,
positive blood culture
pharyngitis, fever, meningeal
symptoms
nausea, crampy abdominal pain,
diarrhea (watery), fever
Sources of infection: excreta of infected
ppl or convalescent carriers
fever, anorexia, abdominal pain,
diarrhea (with blood, mucus, pus),
dehydration (from up to 20 or more
stools per day)
Spread: by ingestion of water or foods
contaminated by the excrement of persons
with a symptomatic or an asymptomatic
infection
-persons living in endemic areas (Asia,
Middle East, Africa) gradually acquire a
natural immunity
-dangerous for travelers!
-some patients become chronic biliary
carriers
-E. coli causes travelers diarrhea
4
DISEASE
DEFINITION
Other Bacterial
Infections
a) Tetanus (Lockjaw)
b) Botulism
c) Lyme disease
Tetanus
(Lockjaw)
an acute infectious disease
characterized by an intermittent
tonic spasm of voluntary mm.
CAUSE
Signs/Symptoms
an exotoxin produced by the
clostridium tetany (sporulating bacillus)
– spores remain viable for years in soil
+ animal feces
stiffness of the jaw, headache,
irritability, restlessness, stiff neck,
trismus, risus, sardonicus (fixed smile
+ elevated eyebrows), opisthotonus,
generalized spasm, respiration
problems, cyanosis, asphyxia
Prophylaxis:
immunization with
a toxoid; wound
care: prompt
cleaning of dead
tissue and dirt
from GI tract: nausea, vomiting,
diarrhea, abdominal cramps
Prophylaxis: proper
canning, use of
preservatives,
adequate heating of
canned food before
serving
may follow after trivial (needle) or
major contaminated wounds where
there is no oxygen in the injured tissues
*anaerobic bacteria
Botulism
neuromuscular poisoning from the
Clostridium Botulinum (anaerobic
bacillus) toxin
the toxin affects nerve-muscle
junctions, causes painful contractions
Clostridium Botulinum spores are in the
soil and are highly heat resistant
Sources: home-canned foods
(vegetables, fruits, fish, pork, poultry),
honey
Lyme Disease
a multisystem inflammatory disease
caused by spirochete Borvelia
Burgdorferi
Lyme Disease
cont’d
Viral Diseases
Infection
(start)
Routes of viral invasion:
1. nasal and respiratory
2. oral and gastrointestinal
3. through blood (needles, bites)
Body responses to viral infections:
inflammatory response – vascular
congestion + leakage of exudates;
immune response – collection of
lymphocytes in infected tissue
-transmitted by tick bites
-common children
neurological: dry mouth, dilopia,
blepharoptosis, loss of
accommodation, paralysis respiratory
failure
occurs in stages:
1. localized infection of the skin
(erythema migrans)
-with or without flu-like illness
-appears soon after the bite at the site
of the bite
2. disseminated skin infection
(erythema chronicum migrans)
arthralgias, meningitis, neuritis,
carditis
-occurs 9 mos. after onset of illness
-can continue for years
Dg
Tx
history, clinical
symptoms, serologic
tests
viral diseases do not
respond to antibiotic
therapy
treatment is
supportive only
prevention: by
immunization
5
DISEASE
DEFINITION
CAUSE
Chicken Pox
(Varicella)
an acute viral disease characterized
by headache, moderate fever,
malaise, followed by an eruption of
macules, papules, vesicles +
crusting
an acute CNS infection involving
primarily the dorsal root ganglia +
characterized by a vesicular
eruption + neuralgic pain in the
cutaneous areas supplied by
peripheral sensory nerves arising in
the affected root ganglia
a) influenza
b) flu (common cold)
c) intestinal flu (viral enteritis,
gastroenteritis), Norwalk,
stomach flu
d) Herpes simplex infections
aka Asian flu
-occurs every 2-3 years in small or
large epidemic
-causes respiratory disease with
high mortality rate among the
elderly
-caused by Varicella-Zoster virus
-usually a mild disease in children
Herpes Zoster
(Shingles)
Common Viral
Infections
Influenza
Flu (common
cold)
Signs/Symptoms
Dg
Tx
Complication: secondary streptococcal
infection of the scratched vesicles
-caused by the same virus that causes
chicken pox
-the virus remains dormant in the nerve
ganglia for many years
-activated usually by stress
-caused by several strains of influenza
viruses
runny nose, malaise, severe muscular
aches + pains, pneumonia
SARS: similar to influenza, more
severe, cause is different
Herpes simplex
infections Type I
can be caused by influenza viruses or
many other viruses (adenoviruses,
rhinoviruses)
-precipitated by stress or febrile illness
-virus lives dormant in nerves
-is transmitted by direct contact
Herpes simplex
infections Type II
Complication: can cause fatal
encephalitis (inflammation of the brain)
-may be transmitted during childbirth +
produce a fatal disseminated neonatal
infection
-usually mild
-nausea, vomiting, diarrhea, malaise
diet, fluids
oral and skin lesions on or near the
lips called “cold sores” or “fever
blisters”
Complication: causes genital infections
6