8 renal disease

Question 1

Localized manifestations of renal disease

Answer 1

Flank pain
Dysuria 
Colic (spasmodic pain)
Polyuria 
Oliguria 
Anuria

Question 2

Oliguria definition

Answer 2

<30ml/hr or 400ml/day

Question 3

Localized

Answer 3

Proteinuria
Glucosuria
Hematuria
Pyuria - pus in the urine

Question 4

Systemic manifestations (vary depending on etiology)

Answer 4

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

Question 5

Uremia defintion

Answer 5

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

Question 6

Renal insufficiency

Answer 6

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

Typically has mildly elevated BUN and creatinine

Question 7

End stage renal failure

Answer 7

Less than 10% function

Question 8

Renal failure

Answer 8

Inability of kidney to maintain normal function

Question 9

Symptoms of uremia

Answer 9

Elevated creatinine and BUN

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

Question 10

Pruritus

Answer 10

Severe itching of the skin as a symptom of various ailments

Question 11

Oliguria

Answer 11

Reduced urine output

Question 12

Acute renal failure

Answer 12

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

Question 13

Three classifications of acute renal failure

Answer 13

Pre, intra and post renal

Question 14

Prerenal ARF

Answer 14

Most common cause of ARF

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

Question 15

Causes of prerenal failure

Answer 15

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)

Question 16

Three types of intrarenal ARF

Answer 16

Acute tubular necrosis (ATN)
Acute glomerulonephritis
Acute pyelonephritis

Question 17

Acute tubular necrosis (ATN)

Answer 17

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

Question 18

Ischemia in ARF

Answer 18

Surgery, sepsis, hypovolemia, trauma, burns

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

Question 19

Nephrotoxins (ATN)

Answer 19

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

Question 20

Intratubular obstruction (ATN)

Answer 20

Rhabdomyolsis or

Hemoglobinuria from anemia’s and transfusion reactions

Question 21

Acute glomerulonephritis intrarenal ARF

Answer 21

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

Question 22

Clinic manifestations of glomerulonephritis

Answer 22

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

Question 23

Acute pylonephritis intrarenal ARF

Answer 23

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

Question 24

Acute pylonephritis patho

Answer 24

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

Question 25

Clinical manifestations of acute pylonephritis

Answer 25

``` 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 ```

Question 26

Postrenal ARF

Answer 26

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

Question 27

Three phases of ARF

Answer 27

Oliguria, Diuresis, Recovery

Question 28

Phase 1 manifestations of ARF

Answer 28

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

Question 29

Phase 2 of ARF

Answer 29

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

Question 30

Phase 1 of ARF

Answer 30

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

Question 31

Phase 3 of ARF

Answer 31

Recovery, may take 3-12 months

Question 32

Chronic renal failure (CRF)

Answer 32

``` 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 ```

Question 33

CRF classifications in GFR mL/mn/1.73m2

Answer 33

``` Normal,mild,moderation,severe and failure >90 60-90 30-60 15-30 <15 ```

Question 34

Clinical manifestations of CRF

Answer 34

``` 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) ```

Question 35

Azotemia

Answer 35

Accumulation of N2 wastes

Question 36

Chronic Renal Failure presentation

Answer 36

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

Question 37

Terry's Nails

Answer 37

Most of the plate turns white (not from being detached) | A sign of decreased blood supply (anemia)

Question 38

Myoglobinuria

Answer 38

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

Question 39

UTIs - Cystitis

Answer 39

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

Question 40

UTIs cystitis

Answer 40

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

Question 41

Cystitis patho

Answer 41

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

Question 42

Neurogenic bladder

Answer 42

Dysfunction from neuro damage (spastic or flaccid) | Incontinence, frequency, urgency, urge incontinence, retention.

Question 43

Suppuration

Answer 43

The process of pus forming

Question 44

Renal Calculi

Answer 44

Renal stones from metabolic disorders, common cause of UT obstruction

Question 45

Renal Colic

Answer 45

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

Question 46

Renal Calculi - stone types

Answer 46

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

Question 47

Patho of renal calculi

Answer 47

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

Question 48

Clinical manifestations of renal calculi

Answer 48

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

Question 49

Pain of Renal calculi

Answer 49

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