Editing Excretory system (section)

==Clinical significance==

=== Kidney stones ===
{{Main|Kidney stone disease}}

Scientifically, masses referred to as a renal calculus or nephrolith, or more commonly, "kidney stones", are solid masses of crystals that may be a variety of shapes, sizes, and textures, that can reside within one or both of the kidneys.<ref name=":1">{{Cite web | url=https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/definition-facts | title=Definition & Facts for Kidney Stones &#124; NIDDK}}</ref> Kidney stones form when the balance is off between the concentration of substances that pass through urine, and the substances that are supposed to dissolve them. When substances are not properly dissolved, they have the ability to build up, and form these kidney stones. These stones are most commonly made up of substances such as calcium, cystine, oxalate, and uric acid, as these are the substances that normally would dissolve within the urine. When they do not dissolve correctly and further build up, they will commonly lodge themselves in the urinary tract and in this case, are usually small enough to pass through urine. In extreme situations, however, these stones may lodge themselves within the tube that connects the kidney and the bladder, called the ureter. In this case, they become very large in size and will most likely cause great pain, bleeding, and possibly even block the flow of urine.<ref>{{Cite journal|doi=10.1001/jama.2012.6217|pmid=22797461|title=Kidney Stones|journal=JAMA|volume=307|issue=23|pages=2557|year=2012|last1=Punnoose|first1=Ann R.|last2=Golub|first2=Robert M.|last3=Lynm|first3=Cassio|doi-access=free}}</ref> These can occur in both men and women, and studies show that around 12% of men, and 8% of women in America will develop kidney stones within their lifetime.<ref>{{cite journal |last1=Coe |first1=F. L. |title=Kidney stone disease |journal=Journal of Clinical Investigation |date=October 2005 |volume=115 |issue=10 |pages=2598–2608 |doi=10.1172/JCI26662 |pmc=1236703 |pmid=16200192 }}</ref>

==== Treatment ====
In those extreme situations, in which kidney stones are too large to pass on their own, patients may seek removal. Most of these treatments involving kidney stone removal are done by a urologist; a physician who specializes in the organs of the [[urinary system]].<ref>{{Cite news|url=http://www.medicinenet.com/script/main/art.asp?articlekey=5916|title=Medical Definition of Urologist|work=MedicineNet|access-date=2017-04-23|language=en}}</ref> A common way of removal is shock wave lithotripsy, in which the urologist will shock the kidney stone into smaller pieces via laser, allowing these pieces to further pass through the urine on their own, as a normal case of kidney stones. Larger, more serious cases may demand Cystoscopy, Ureteroscopy, or Percutaneous Nephrolithotomy, in which the doctor will use a viewing tool or camera to locate the stone, and based on the size or situation, may either chose to continue with surgical removal, or use the shock wave lithotripsy treatment. Once the kidney stone(s) are successfully eliminated, the urologist will commonly suggest medication to prevent future recurrences.<ref name=":1" />

=== Pyelonephritis ===
{{Main|Pyelonephritis}}

[[Pyelonephritis]] is a type of [[urinary tract infection]] that occurs when bacteria enters the body through the urinary tract. It causes an inflammation of the renal parenchyma, calyces, and pelvis.<ref>{{Cite web|url=http://www.medilexicon.com/dictionary/74282|title=mediLexicon|website=mediLexicon}}</ref> There are three main classifications of pyelonephritis: acute, chronic and [[Xanthogranulomatous inflammation|xanthogranulomatous]].

==== Acute pyelonephritis ====
In acute pyelonephritis, the patient experiences high fever, abdominal pain and pain while passing urine. Treatment for acute pyelonephritis is provided via antibiotics and an extensive urological investigation is conducted to find any abnormalities and prevent recurrence.<ref>{{Cite book|title=Concise Medical Dictionary (9 ed.)|last=Martin|first=Elizabeth|publisher=Oxford University Press|year=2015|isbn=978-0-19-968781-7}}</ref>

==== Chronic pyelonephritis ====
In chronic pyelonephritis, patients experience persistent abdominal and flank pain, high fever, decreased appetite, weight loss, urinary tract symptoms and blood in the urine. Chronic pyelonephritis can also lead to scarring of the renal parenchyma caused by recurrent kidney infections.<ref name=":0">{{cite journal |last1=Korkes |first1=Fernando |last2=Favoretto |first2=Ricardo L. |last3=Bróglio |first3=Marcos |last4=Silva |first4=Carlos A. |last5=Castro |first5=Marilia G. |last6=Perez |first6=Marjo D.C. |title=Xanthogranulomatous Pyelonephritis: Clinical Experience with 41 Cases |journal=Urology |date=February 2008 |volume=71 |issue=2 |pages=178–180 |doi=10.1016/j.urology.2007.09.026 |pmid=18308077 }}</ref>

==== Xanthogranulomatous pyelonephritis ====
Xanthogranulomatous pyelonephritis is an unusual form of chronic pyelonephritis. It results in severe destruction of the kidney and causes granulomatous abscess formation. Patients infected with Xanthogranulomatous pyelonephritis experience recurrent fevers, [[anemia]], kidney stones and loss of function in the affected kidney.<ref name=":0" />

==== Treatment ====
A urine culture and antibiotics sensitivity test is issued for patients who are believed to have pyelonephritis. Since most cases of pyelonephritis are caused from bacterial infections, antibiotics are a common treatment option. Depending on the species of the infecting organism and the antibiotics sensitivity profile of the organism, treatments may include [[Quinolone antibiotic|fluoroquinolones]], [[cephalosporin]]s, [[aminoglycoside]]s, or [[trimethoprim]] individually or in combination.<ref>{{cite journal |last1=Gupta |first1=Kalpana |last2=Hooton |first2=Thomas M. |last3=Naber |first3=Kurt G. |last4=Wullt |first4=Björn |last5=Colgan |first5=Richard |last6=Miller |first6=Loren G. |last7=Moran |first7=Gregory J. |last8=Nicolle |first8=Lindsay E. |last9=Raz |first9=Raul |last10=Schaeffer |first10=Anthony J. |last11=Soper |first11=David E. |last12=Infectious Diseases Society of |first12=America |last13=European Society for Microbiology and Infectious |first13=Diseases |title=International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases |journal=Clinical Infectious Diseases |date=1 March 2011 |volume=52 |issue=5 |pages=e103–e120 |doi=10.1093/cid/ciq257 |pmid=21292654 |doi-access=free }}</ref> For patients with xanthogranulomatous pyelonephritis, treatment might include antibiotics as well as surgery. [[Nephrectomy]] is the most common surgical treatment for a majority of cases involving xanthogranulomatous pyelonephritis.<ref name=":0"/>

==== Epidemiology ====
In men, roughly 2-3 cases per 10,000 are treated as outpatients and 1 in 10,000 cases require admission to the hospital. In women, approximately 12–13 in 10,000 cases are treated as outpatients and 3-4 cases are admitted to a hospital.<ref>{{cite journal |last1=Czaja |first1=C. A. |last2=Scholes |first2=D. |last3=Hooton |first3=T. M. |last4=Stamm |first4=W. E. |title=Population-Based Epidemiologic Analysis of Acute Pyelonephritis |journal=Clinical Infectious Diseases |date=August 2007 |volume=45 |issue=3 |pages=273–280 |doi=10.1086/519268 |pmid=17599303 |doi-access=free }}</ref> The most common age group affected by Xanthogranulomatous pyelonephritis is middle-aged women.<ref>{{cite journal |last1=Malek |first1=Reza S. |last2=Elder |first2=Jack S. |title=Xanthogranulomatous Pyelonephritis: A Critical Analysis of 26 Cases and of the Literature |journal=Journal of Urology |date=May 1978 |volume=119 |issue=5 |pages=589–593 |doi=10.1016/s0022-5347(17)57559-x |pmid=660725 }}</ref> Infants and elderly are also at an increased risk because of hormonal and anatomical changes.<ref>{{cite journal |last1=Goodman |first1=Tr |last2=McHugh |first2=K |last3=Lindsell |first3=M |title=Paediatric xanthogranulomatous pyelonephritis |journal=International Journal of Clinical Practice |date=January 1998 |volume=52 |issue=1 |pages=43–45 |doi=10.1111/j.1742-1241.1998.tb11558.x |pmid=9536568 }}</ref>