Persistent hesitancy and decreased force of stream suggest urethral stricture, which is often a result of urethral trauma following catheterization, endoscopy, or prostatic surgery. Rarely, a history of gonococcal urethritis is noted Direct visualization confirms the diagnosis, excludes urethral cancer, and avoids creating false channels by blind passage of a urethral sound. Repeated dilatation or [...]
Nocturia is reported in 2h of women and men > 65 yr of age who are not taking drugs; for those who take drugs or have more than three chronic diseases, the incidence is > 80%. Nocturia contributes to sleep disturbance, a problem for > 20% of elderly persons (see Ch. 11). Many older patients [...]
Thrombotic occlusive renal artery disease often complicates severe aortic and renal arterial atherosclerosis, especially when renal blood flow is reduced because of heart failure or volume depletion. Symptoms of renal artery occlusion may be notably absent. If renal function previously was good, the only manifestation of unilateral thrombosis may be an increase in BUN and [...]
Renal arterial emboli can occur in any clinical setting that is associated with peripheral embolization (eg, acute myocardial infarction, chronic atrial fibrillation, subacute bacterial endocarditis, and aortic surgery or aortography). The manifestations of renal embolism may vary from essentially no symptoms and signs to a full-blown syndrome of severe flank pain and tenderness, hematuria, hypertension, [...]
Acute glomerulonephritis has a clear age-related presentation and prognosis. In children and young adults, acute glomerulonephritis is often associated with recent streptococcal infection, producing hematuria, heavy proteinuria, edema, hypertension, and in many cases, the development of pulmonary congestion. The prognosis is generally good in poststreptococcal disease but variable in nonnoslslreptococcal cases. In elderly patients, Ihe [...]
Traditionally, age was thought to play an important role in the pathogenesis of nephrotic syndromes (eg, the likelihood of minimal-change disease decreases and that of amyloidosis increases with age). However, clinical und biopsy data from a large number of elderly nephrotic patients now indicate that, in general, age has no impact on the frequency of [...]
Renal blood flow: Blood flow through the kidneys progressively decreases from 1200 mL/min. in young adulthood to 600 mL/min by age 80 yr. The primary underlying factor is the decreased renovascular bed. However, the reduction in flow does not simply reflect decreased renal mass, since Row per gram of tissue falls progressively after the fourth [...]
Renal blood How: Blood flow through the kidneys progressively decreases from 1200 mL/min in young adulthood to 600 mL/min by age 80 yr. The primary underlying factor is the decreased renovascular bed. However, the reduction in flow does not simply reflect decreased renal mass, since flow per gram of tissue falls progressively after the fourth [...]
A substantial reduction in renal function accompanies normal aging, although the senescent kidney ordinarily functions sufficiently to remove wastes and adequately regulate the volume and composition of extracellular fluid. Nevertheless, changes in renal function reduce the older person’s capacity to respond to a variety of physiologic and pathologic stresses, with important clinical implications. Renal Anatomy [...]
Surgery is limited in the treatment of splenic disorders. Operative measures include splenectomy, repair of injuries by methods other than splenectomy, and drainage of abscesses. The main indications for splenectomy are trauma (either blunt, penetrating, or iatrogenic), disease of adjacent organs (such as the stomach, pancreas, or colon), idiopathic thrombocytopenic purpura, and advanced splenomegaly. Rarely [...]
