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Pathology > 8 renal disease > Flashcards

8 renal disease Flashcards

1
Q

Localized manifestations of renal disease

A 
Flank pain
Dysuria 
Colic (spasmodic pain)
Polyuria 
Oliguria 
Anuria
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2
Q

Oliguria definition

A

<30ml/hr or 400ml/day

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3
Q

Localized

A

Proteinuria
Glucosuria
Hematuria
Pyuria - pus in the urine

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4
Q

Systemic manifestations (vary depending on etiology)

A

Bacterial infection - fever, chills, general malaise
Renal failure - Uremia + other S&S of chronic renal failure
Hyperkalemia, hypercalcemia
Anemia

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5
Q

Uremia defintion

A 
Blood excess of:
Urea (BUN)
Creatinine
Other metabolic end products
Chronic uremia can cause neuro changes and CNS depression
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6
Q

Renal insufficiency

A

25% of normal or GFR 25-30ml/min

Typically has mildly elevated BUN and creatinine

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7
Q

End stage renal failure

A

Less than 10% function

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8
Q

Renal failure

A

Inability of kidney to maintain normal function

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9
Q

Symptoms of uremia

A

Elevated creatinine and BUN

Fatigue, anorexia, N/V, pruritus and neuro changes

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10
Q

Pruritus

A

Severe itching of the skin as a symptom of various ailments

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11
Q

Oliguria

A

Reduced urine output

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12
Q

Acute renal failure

A

Abrupt reduction in renal function with uremia
Usually oliguria (can be normal or increased)
Both kidneys
Reversible if treated early
Extra systemic waste, less stuff normally kept by kidneys

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13
Q

Three classifications of acute renal failure

A

Pre, intra and post renal

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14
Q

Prerenal ARF

A

Most common cause of ARF

Decreased blood flow, which drops GFR because of inadequate filtration pressure

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15
Q

Causes of prerenal failure

A

Hypovolemia - trauma, GI bleed, childbirth, burns, peritonitis, water and lytes loss (vomiting/diarrhea/bowel obstruction/beeties/diuretics)
Hypotension - Sepsis, cardiac, PE, renal artery stenosis, vasoconstriction (PIH, hepatorenal syndrome)

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16
Q

Three types of intrarenal ARF

A

Acute tubular necrosis (ATN)
Acute glomerulonephritis
Acute pyelonephritis

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17
Q

Acute tubular necrosis (ATN)

A

Destruction of tubular epithelial cells by:
Iscehmia, nephrotoxins, intratubular obstruction, acute renal diseases
Usually multifactoral, lead to necrosis through a combination of the above causes
Least reversible as cell death is present

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18
Q

Ischemia in ARF

A

Surgery, sepsis, hypovolemia, trauma, burns

ATN from trauma and burns is multifactoral and can involve nephrotoxins and obstruction

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19
Q

Nephrotoxins (ATN)

A

Carbon tetrachloride, NSAIDS, tylenol, aminoglycoside, antibiotics (gentamycin, garamycin)
Radiocontract medium
Hemoglobin, myoglobin
Bacterial endotoxins (E.coli)

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20
Q

Intratubular obstruction (ATN)

A

Rhabdomyolsis or

Hemoglobinuria from anemia’s and transfusion reactions

21
Q

Acute glomerulonephritis intrarenal ARF

A

Inflammation of glomeruli, often from immune or autoimmune
Type 2HR (strep A)
Type 3 HR (SLE)
HTN
Diabetes
Eventually inflammation causes tissue damage and decreased function

22
Q

Clinic manifestations of glomerulonephritis

A 
NephrItic syndome (IN) Decreased GFR due to inflammatory occlusion - Hematuria/oliguria/ edema/HTN
NephrOtic syndrome (things go OUT)
Increased GFR due to inflammatory perm
Proteinuria
Hypoalbuinema
Hyperlipidema
Edema
Clotting disorders
23
Q

Acute pylonephritis intrarenal ARF

A

UTI affecting renal pelvis and renal parenchyma
More common in women and especially preggos
Urinary catheterization, immunosuppression, the beeties, anything that obstructs flow, improper hygiene, systemic infections

24
Q

Acute pylonephritis patho

A

Begins in urethra, travels to kidneys
Must affect both kidneys to be ARF
Purulent exudate fills renal pelvis and begins to obstruct surrounding structures
Abscess formation and inflamm causes tissue necrosis

25
Q

Clinical manifestations of acute pylonephritis

A 
Dull achy lower back/flank pain which is reproducible with palp to costoverterbral angle
Dysuria with urgency and frequency
Malaise
N/V
Fever
Urinalysis shows infection
26
Q

Postrenal ARF

A 
Rarest cause of ARF
Ureteral destruction (edema, tumors, stones, clots)
Bladder neck obstruction (enlarged prostate)
27
Q

Three phases of ARF

A

Oliguria, Diuresis, Recovery

28
Q

Phase 1 manifestations of ARF

A

Oliguria - other manifestations depend on underlying cause
Elevated BUN makes pt prone to hyperK+
Edema from fluid retention
N/V, fatigue, lyte issues
Delayed wound healing/increased risk of infection
Increased BUN and creatinine

29
Q

Phase 2 of ARF

A

Diuresis
Progressive increase in urine volume as function improves. Tubular damage is still present and reabsoprtion may not recover as fast as glomerular filtration
Na+ and K+ loss - risk of hypo K+
Volume depletion may occur

30
Q

Phase 1 of ARF

A

Back leak and obstruction of tubules causes lack of urine, occurs one day after hypotensive event
Lasts 1-2 weeks depending on severity
Can become anuria

31
Q

Phase 3 of ARF

A

Recovery, may take 3-12 months

32
Q

Chronic renal failure (CRF)

A 
AKA CRD
A slow progressive loss of nephrons
Changes not evident until 25% of normal
From ARF (chronic pyelonephritis)
or congenital polycystic kidney disease
or HTN/beeties
33
Q

CRF classifications in GFR mL/mn/1.73m2

A 
Normal,mild,moderation,severe and failure
>90
60-90
30-60
15-30
<15
34
Q

Clinical manifestations of CRF

A 
Accumulation of nitrogenous wastes
High BUN and creatinine
Moves from azotemia to uremia
Fluid/lyte/pH disorders
Bone disorders
Hematologic disorders - anemia, coagulopathies (bleeding disorders and thrombotic)
35
Q

Azotemia

A

Accumulation of N2 wastes

36
Q

Chronic Renal Failure presentation

A 
HTN, HD, pericarditis
Anorexia, n/v, ulcers
Uremic encephalopathy, decreased sensory and motor
Risk of infection
Abnormal pigment, terry nails
ED
Impaired drug elimination
37
Q

Terry’s Nails

A

Most of the plate turns white (not from being detached)

A sign of decreased blood supply (anemia)

38
Q

Myoglobinuria

A

Life threatening - from severe muscle trauma
Renal threshold is low (0.5mg/100mL)
Released from sarcolemma membrane, along with CK and massive amounts of other serum enzymes. Prerenal ARF

39
Q

UTIs - Cystitis

A

Inflammation of the bladder, usually from retrograde bacteria
Hemorrhage, suppuration, ulceration, gangrene

40
Q

UTIs cystitis

A

10-20% more common in women
Frequency, urgency dysuria and suprapubic/low back pain
Hematuria and flank pain
Can be asymptomatic

41
Q

Cystitis patho

A

Sexually active females
Pregnancy
Indwelling caths
Beeties, neurogenic bladder, poor hygiene and UT obstruction

42
Q

Neurogenic bladder

A

Dysfunction from neuro damage (spastic or flaccid)

Incontinence, frequency, urgency, urge incontinence, retention.

43
Q

Suppuration

A

The process of pus forming

44
Q

Renal Calculi

A

Renal stones from metabolic disorders, common cause of UT obstruction

45
Q

Renal Colic

A

Spasms of ureter, can be induced by passage of renal calculi

46
Q

Renal Calculi - stone types

A

Calcium salts, often associate with hypersecretion of calcium - forms 70-80%
Struvite - magnesium ammonia phosphate (10%)
Uric acid (5-10%) related to gout
Cysteine (<1%) from errors of amino acid metabolism

47
Q

Patho of renal calculi

A

Stones usually grow on papillae or, renal tubules, calcyces, renal pelvis
Mostly <3-5mm diamater
More common in men
5% of all adults

48
Q

Clinical manifestations of renal calculi

A

Pain
Usually asymptomatic above ureters unless infection or obstruction occurs, or until migrates to ureter and obstructs lumen
Colicky pain occurs as ureter contracts to attempt to advance the stone
Distension and spasm follow when urine builds

49
Q

Pain of Renal calculi

A

Flank pain at costovertebral angle (last rib and lumbar)
Radiation to groin if lower in ureter
N/V hematuria

Pathology (24 decks)

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