CLINICAL MEDICINE
EXCRETORY SYSTEM
Diseases & Disorders
RENAL DISORDERS
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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
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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
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 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.
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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.
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Symptoms
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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
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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
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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
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 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
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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
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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
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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
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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
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► 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