30. Renal and Urinary Tract Flashcards
irreversible loss of renal function that affects nearly all organ systems
chronic renal failure (CRF)
symptoms of stage 4 and stage 5 CRF
- moderate HTN - EPO deficiency anemia - hyperphosphatemia and hyperkalemia - hyperlipidemia - metabolic acidosis - salt/water retention
Explain why acute renal failure has oliguria present
decreased GFR due to possible glomerular injury (decreased permeability and surface area) or tubular injury that causes obstruction
process causes unobstructed kidney to increase the size of the individual glomeruli and tubules but not the total number of functioning nephrons
compensatory hypertrophy (hyperfunction)
symptoms of acute cystitis
- urinary frequency - dysuria - urinary urgency - lower ABD pain and/or suprapubic pain
most common cause of end-stage renal failure
glomerulonephritis
How are kidney stones evaluated?
- imaging studies determine location of stone (KUB/CT/IVP) - UA to analyze contents of stone
nonbacterial or noninfectious cystitis
interstitial cystitis
incontinence as a result of functional limitations (mobility, arthritis, stroke etc.)
functional incontinence
dilation of the renal pelvis and calyces proximal to the blockage
hydronephrosis
most common cause of intra renal kidney injury/failure
acute tubular necrosis (ATN)
no urgency, occurs with activity (ex. exercise, coughing, lauding, sneezing); more common in women
stress incontinence
excretion of 3.5 g or more of protein in the urine per day; due to glomerular injury
nephrotic syndrome
Common causes of glomerulonephritis
- type II, III, or IV hypersensitivity - drugs or toxins - vascular disorders (vasculitis) - systemic disorders (DM - post-strep infection
risk factors for RCC
- smoking - obesity - analgesic use
urine output less than 400ml/day
oliguria
dilation of the ureter (accumulation of urine in the ureter)
hydroureter
inflammation of the bladder
acute cystitis
Elevated levels of urea and other nitrogen compounds in the blood.
azotemia
causes of decreased renal perfusion
- hypotension - hypovolemia (hemorrhage or fluid loss) - sepsis - inadequate cardiac output - renal artery stenosis
What causes nephrolithiasis
- supersaturation of one or more salts - precipitation of a salt from liquid to solid state - growth into a stone via crystallization or aggregation
inflammation of the urinary epithelium caused by bacteria
urinary tract infection (UTI)
most common cause of UTI
escherichia coli (E. coli)
hits suddenly without warning, no holding time and leakage on the way to the bathroom
urgency incontinence
Stage of CRF w/ normal kidney function (GFR >90 ml/min); HTN
stage 1 CRF
systemic manifestations seen due to urea accumulation because of renal dysfunction
uremic syndrome/uremia
What lab work will be seen w/ glomerular disease?
- decreased GFR - increased plasma creatinine and urea - reduced creatinine clearance
Treatment of kidney stone
- high fluid intake - decreased dietary intake of stone-forming substances - stone removal
persistent or recurring episodes of acute pyelonephritis that leads to scarring
chronic pyelonephritis
Stage of CRF w/ mild kidney damage (GFR 60-89 ml/min); possible elevation of BUN and creatinine and HTN
stage 2 CRF
most common metastasis sites of RCC
- lung - liver - bone - thyroid - CNS
inflammation of the glomeruli
glomerulonephritis
occurs with urinary tract obstructions that affect the kidneys bilaterally
post renal acute kidney injury/failure
Stage of CRF w/ moderate kidney damage (GFR 30-59 ml/min); mild w/ HTN
Stage 3 CRF
clinical manifestations of nephrotic syndrome
- hypoalbuminemia -> edema - hyperlipidemia and lipiduria (low albumin stimulates lipoprotein synthesis by liver) - vitamin D deficiency (decreased D activation by kidneys) - proteinuria - microscopic hematuria and RBC casts
3 causes of urinary tract obstruction
- stones (calculi) - stricture (narrowing of structures) - tumor
ESRF w/ GFR < 15 ml/min
Stage 5 CRF
benign encapsulated tumors located near the cortex of the kidney
renal adenoma
symptoms of pyelonephritis
- fever/chills - flank or groin pain - other symptoms characteristic of a UTI
Stage of CRF w/ severe kidney damage (GFR 15-29 ml/min)
Stage 4 CRF
moderate to severe pain often originating in the flank and radiating to the groin
renal colic
symptoms of interstitial cystitis
- bladder fullness - urinary frequency - small urine volume - chronic pelvic pain - dyspareunia
mechanical forces on an over-distended bladder (ex. BPH or DM)
overflow incontinence
most common renal neoplasm
renal cell carcinoma (RCC)
glomerular damage causes what 2 things
- decreased glomerular membrane surface area - decreased glomerular capillary blood flow
continuous loss of urinary control; bladder is incapable of holding any urine; most severe type of incontinence
total incontinence
how long after obstruction does renal function begin to be affected?
about 7 days
kidneys can adapt until function decrease to what?
less than 25% of function
acute kidney failure can cause what kind of metabolic dysfunction
metabolic acidosis
organisms associated w/ acute pyelonephritis
- E. coli - Proteus - Pseudomonas
most common bladder malignancy
transitional cell carcinoma
acute infection of the renal pelvis and interstitium; most common cause is vesicoureteral reflux
acute pyelonephritis
narrowing of the lumen of the urethra and occurs when infection, injury, or surgical manipulation produces scar tissue; more common in men
urethral stricture
symptoms are renal cancers
- usually no early symptoms - later sxs include gross, painless hematuria and dull, achy flank pain
sudden decline in kidney function w/ decrease in GFR and urine output and accumulation of nitrogenous waste produces in blood (elevated BUN and creatinine)
acute kidney failure/acute kidney injury
most common types of urinary calculi
- calcium oxalate or calcium phosphate - struvite - uric acid
Explain how glomerular disorders can lead to edema
increased glomerular capillary permeability -> passage of plasma proteins into urine -> hypoalbuminemia -> decreased vessel oncotic pressure and fluid moves into interstitial space -> edema
most common cause of acute kidney injury/failure and caused by sudden and severe drop in renal blood flow
prerenal acute kidney injury/failure
What determines the severity of urinary tract obstruction
- location - involvement of upper urinary tract - completeness - duration - cause
urine output less than 50 ml/day
anuria
rare tumor that arises in the renal parenchyma and renal pelvis
renal transitional cell carcinoma (RTCC)
