27 Intrarenal Disorders Flashcards
Intrarenal Disorders
occurs within kidney
-potential to result in renal insufficiency or failure
5 types of Intrarenal Disorders
1 Congenital 2 Neoplastic 3 Infectious 4 Obstructive 5 Glomerular
Nephralgia
kidney/renal pain
- generally felt at COSTOVERTEBRAL ANGLE
- –recorded as CVA tenderness or flank pain
nephralgia is due to…
distention/inflammation of renal capsule
dermatome
area of skin innervated by a specific spinal cord segment
nephralgia is transmitted to T10 + L1 via…
sympathetic afferent neurons
-mat be felt throughout dermatomes
Urinalysis
- DIPSTICK + MICROSCOPIC URINALYSIS
- –results provide clues to intrarenal pathologies
Abnormal Urinalysis Findings
dark, strong smell: DECR RENAL FUNCTN
cloudy, pungent: INFECTIOUS PROCESS
Diagnostic/Imaging Tests
1 KUB
2 Renogram/Renal Scan
3 Ultrasonography
4 CT/MRI
KUB
ID gross abnormalities related to size, position, + shape
-may show renal calculi
Renogram/Renal Scan
reveals renal vasculature + tumors
Ultrasonography
differentiates bw diff tissue characteristics
CT/MRI
detailed info about vasculature + tissue
Renal Agenesis
kidneys don’t dvlp in fetus
-either bilateral or unilateral
BILATERAL AGENESIS of kidney
NOT COMPATIBLE W LIFE
unilateral agenesis of kidney
compensatory hypertrophy of functional kidney
Renal Hypoplasia
some fetal kidney dvlpt
- can lead to pediatric end-stage renal failure
- SINGLE NORMAL KIDNEY CAN MAINTAIN NORMAL RENAL FUNCTION
- requires lifelong kidney monitoring
Cystic Kidney Disease
genetically transmitted renal disorder
- results in FLUID-FILLED CYSTS that can expand + disrupt urine formation + flow
- may be localized to one area or affect both
- can lead to renal failure
- may require dialysis or transplant in late stage
2 types of Cystic Kidney Disease
1 Autosomal RECESSIVE: at birth
2 Autosomal DOM: later in life
Renal Carcinoma
- metastatic disease
- ASYMPTOMATIC until advanced
Hematuria
- presence of blood in urine
- a sign of renal carcinoma, nephroblastoma (Wilms Tumor), or bladder cancer
- sometimes in chronic glomerulonephritis
Renal Carcinoma
S/S + staging
ASYMPTOMATIC until advanced
- CVA tenderness
- hematuria
- palpable mass
Staging: I-IV
Renal Carcinoma
treatment
- NEPHRECTOMY
- resistant to radiatoin, immunotherapy, + chemotherapy (p53 mutation)
Nephroblastoma
aka Wilms Tumor
-most common kidney cancer in children
Nephroblastoma
clinical manifestation
- palpable abdominal mass
- abdominal pain
- HYPERTENSION
- hematuria
Nephroblastoma
treatment
- nephrectomy
- radiatoin
- chemotherapy
- **excellent cure rate!
Pyelonephritis
infection of the kidney
most common Pyelonephritis
ascending infection fr lower urinary tract
-effective preventative measure is early removal of caterers
Acute Pyelonephritis
infection of renal pelvis or parenchyma
–usually fr ascending UTI
Renal Cell Carcinoma
risk factors
familial pattern:
smoking, obesity, hypertension
Acute Pyelonephritis
clinical manifestations
- CVA tenderness
- fever
- chills
- N/V
- anorexia
Acute Pyelonephritis
diagnosis
presence of WBC casts
–indicative of upper UTI
Acute Pyelonephritis
treatment
antimicrobials avoids decreased renal function
classic sign of Acute Pyelonephritis
CVA tenderness
anorexia in acute pyelonephritis will…
increase fever-induced hydration
Obstruction
conditions that interfere w the flow of urine
Urine Stasis
predisposes to infections + structural damage
-caused by renal obstruction
Obstruction
common causes
1 Stones
2 Tumors
3 Prostatic Hypertrophy
4 Strictures of the ureters or urethra
Stones
most common cause of renal obstruction
-composed of Ca crystals, uric acid, struvite, cystine
Complete renal obstruction results in
1 Hydronephrosis 2 Decreased GFR 3 Ischemic kidney damage 4 Acute Tubular Necrosis 5 Chronic Kidney Disease
how does complete renal obstruction cause ischemic kidney damage?
because of increased intraluminal pressure
Acute Tubular Necrosis
intrarenal acute renal failure
—self limiting disorder
Acute Glomerulonephritis
immune response to variety of potential triggers
-attraction of immune cells to area of inflammation results in LYSOSOMAL DEGRADATION OF THE BASEMENT MEMBRANE
In acute glomerulonephritis, why might GFR fail?
contraction of mesangial cells results in decreased surface area for filtration
what happens when immune cells come to an area of inflammation (acute glomerulonephritis)?
lysosomal degradation of basement membrane
Acute Glomerulonephritis
clinical manifestations
1 proteinura
2 oliguria + azotemia
3 edema + hypertension
Acute Glomerulonephritis
treatment
1 steroids
2 plasmapheresis
3 supportive measures (diet + fluid)
4 mgmt of systemic + renal hypertension
Chronic Glomerulonephritis
- progressive course that ultimately dvlps to END-STAGE RENAL DISEASE
- sclerosis + fibrosis of kidney
Chronic Glomerulonephritis
clinical manifestation
- persistent PROTEINURA
- w/ w/o hematuria
- slowly declining renal function
Chronic Glomerulonephritis
treatment
dialysis or kidney transplant is necessary
-supportive interventions throughout course of disease
Nephrotic Syndrome
occurs due to INCREASED flomerular permeability to proteins
-urinary loss of 3-3.5g of protein/day
proteinuria leads to…
1 HYPOALBUMINEMIA
2 generalized EDEMA
3 decr blood colloid osmotic pressure
increase in liver activity can cause…
1 Hyperlipidemia
2 Hypercoagulability
most common finding in nephrotic syndrome?
Edema
Nephrotic Syndrome
clinical manifestation
1 proteinuria (3-3.5g) 1a hypoalbuminemia 1b edema 1c decr blood colloid osmotic pressure 2 incr liver activity 2a hyperlipidemia 2b hypercoagulability
Nephrotic Syndrome
treatment
conservative symptom mgmt 1 diuretics 2 lipid-lowering agents 3 antihypertensives 4 immunosuppression/immunomodulation
- mgmt of underlying process when IDd
- may resolve spontaneously or progress to end-stage renal disease
child w hypertension is a sign of
nephroblastoma/wilm tumor
types of kidney infections
acute pyelonephritis (pelvic/parenchyma infection, FEVER, WBC cast) acute glomerulonephritis (immune, infection, inflammation, lysosomal degradation)
wbc cast
acute pyelonephritis
hydronephrosis
build-up of urine in kidney from backflow due to obstruction below.
