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Anatomy and Physiology-DNP > Alterations of Renal and Urinary Tract Function > Flashcards

Alterations of Renal and Urinary Tract Function Flashcards

1
Q

Most common urinary dysfunction

A

-Infection (stones, tumors, inflammation)

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2
Q

Urinary Tract Obstruction

A
  • Blockage or urine flow -Can be anatomical or obstructive

- Severity is based on (location, completeness, involvement of one or both upper urinary, duration)

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3
Q

Upper Urinary Tract Obstruction

A
  • Complications: Hydroureter, hydronephrosis, ureterohydronephrosis, tubulointerstitial fibrosis, leads to excess cellular destruction and death of nephrons
  • Compensatory hypertrophy hyperfunction
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4
Q

Kidney stones

A
  • Renal calculi or urolithiasis
  • Masses of crystals, proteins, or mineral salts form in the urinary tract may obstruct the urinary tract
  • Risk factors: Male, most develop before 50 years, inadequate fluid intake
  • Can be located in the kidney, ureters or urinary bladder
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5
Q

Kidney Stone Treatment

A
  • Parenteral and/or analgesics for acute pain
  • Medical therapy that promotes stone passage
  • High fluid intake
  • Alteration in urine pH
  • Removal of stones using percutaneous nephrolithotomy, ureteroscopy, or ultrasonic or laser lithotripsy to fragment stones for excretion
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6
Q

Lower Urinary Tract Obstruction

A
  • Neurogenic bladder
  • disorders of the lower urinary system are typically related to storage of the urine in the bladder or emptying of urine from the bladder
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7
Q

Neurogenic bladder dysfunctions

A

-Dyssynergia, detrusor hyperflexia, detrusor areflexia

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8
Q

Causes of lower urinary tract obstruction

A
  • prostate enlargement
  • Urethral stricture
  • Severe pelvic organ prolapse
  • Low bladder wall compliance
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9
Q

Clinical manifestation of lower urinary tract obstruction

A
  • Frequent daytime voiding
  • Nocturia
  • Urgency
  • Dysuria
  • poor force of stream, intermittency of urinary stream
  • Feelings of incomplete bladder emptying, despite micturation
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10
Q

Cytometric test

A
  • uses a catheter and manometer to evaluate urine volume and pressure in relation to involuntary bladder contraction and urge to void
  • Used in evals w/ lower urinary tract obstruction
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11
Q

Lower urinary tract obstruction: Prolapse

A
  • Pessary: rubber or silicone device designed to compensate for vaginal wall prolapse
  • Intravaginal hormone replacement therapy and regular follow-up
  • Surgery
  • Pessary-can be removed, cleansed, and/or replaced at home or during a clinic visit
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12
Q

Overactive bladder syndrome

A
  • Chronic syndrome of detrusor overactivity
  • Symptoms syndrome of urgency w/ or w/out incontinence, usually w/ frequency and nocturia
  • Urodynamic eval to confirm dx
  • Tx: lifestyle modification, behavioral therapy, neuromodulation, antimuscarinic agents, surgery
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13
Q

Renal tumors

A
  • Renal adenomas: benign
  • Renal transitional cell carcinoma: rare-arises from renal parenchyma and renal pelvis
  • Renal cell carcinoma: most common (hematuria, dull and aching flank pain)
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14
Q

Bladder tumors

A
  • Urothelial (transitional cell) carcinoma: most common
  • Risk factors: smoking, exposure to meatbolites of anline dyes or other aromatic amines or chemicals, high arsenic in drinking water, heavy consumption of phenacetin
  • Inner lining of the bladder
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15
Q

Bladder tumor Tx

A
  • Transurethral resection or laser ablation, combined w/ intravesical chemo or immunotherapy
  • Radical cystectomy w/ urinary diversion
  • Adjuvant chemo
  • Radiation therapy
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16
Q

UTI

A
  • Inflammation of urinary epithelium after invasion and colonization by some pathogen in the urinary tract
  • Retrograde movement of bacteria in urethra or bladder
  • Can occur at any point along the urinary system (cysitis-bladder inflammation, pyelonephritis-inflammation of upper urinary tract)
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17
Q

UTI protective urinary mechanisms

A
  • Washed out of the urethra during micturation
  • Low pH and high osmolality of urea
  • Presence of tamm-horsfall protein
  • Secretions from the uroepithelium: bactericidal effect
  • Ureterovesical junction: closes to prevent reflux of urine to the ureters and kidneys
  • Women-mucus secreting glands
  • Men: length of male urethra
  • Lewis blood group
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18
Q

UTI pathogens

A

-Escheriicia coli, staphylococcus saprophyticus

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19
Q

Painful bladder syndrome or interstitial cystitis

A
  • Nonbacterial infectious cystitis, noninfectious cystitis and interstitial cystitis (autoimmune, hypersensitivity)
  • S/s: longer than 6 wks but w/ negative urine cultures and no other known cause, bladder fullness, frequency, small urine volume and pelvic pain laster longer than 9 mo
  • TX: oral and intravesical therapies, sacral nerve stimulation, onabotulinumtonxia;surgery
  • Usually in women w/ neg urine cultures
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20
Q

Pyelonephritis

A
  • Acute infection of the ureter, renal pelvis, and/or renal parenchyma
  • s/s: flank pain, fever, chills, costovertebral tenderness, purulent urine
  • Eval: WBC casts
  • Tx: abx
21
Q

Chronic pyelonephritis

A
  • Can see deposition of scar tissue, fibrosis, and atrophy of affected tubules; can see shrinking of the size of the kidney
  • Recurrent infection of kidneys
  • Dx: urine culture, UA, clinical signs
  • TX: Abx
22
Q

Glomerular disorders

A
  • Disorders that directly affect the glomerulus
  • Significant cause of chronic kidney disease and end-stage renal failure worldwide.
  • Secondary disorders (diabetes, SLE)
23
Q

Acute Glomerulonephritis

A
  • Patho: formation of immune complexes in the circulation
  • Antibodies produced against the organism that cross-react w/ glomerular endothelial cells
  • see in young children w/ strep
  • SX: hematuria w/ RBC casts, proteinuria w/ albumin, smoky brown-tinged urine, edema, oliguria
24
Q

Acute glomerulonephritis Tx

A
  • Abx
  • Corticosteroids
  • Cytotoxic agents
  • Anticoagulants
  • dx by urinalysis, decreased GFR, elevated creatinine, plasma urea, and cystatin C levels
25
Q

Chronic Glomerulonephritis

A
  • Leading to chronic kidney failure
  • some secondary causes: diabetes nephropathy, lupus nephritis
  • S/s: proteinuria, hypercholestermia
  • TX: Dialysis, and transplant
26
Q

Diabetic nephropathy

A
  • develops from metabolic, inflammatory, and microvascular complications related to chronic hyperglycemia
  • Will see proteinuria w/ progression to chronic renal failure
27
Q

Nephrotic syndrome

A
  • Excretion of 3g or more of protein in urine
  • Protein excretion as a result of glomerular injury
  • s/s: hypoalbuinemia, peripheral edema, prone to infection, vitamin D deficiency,
  • tx: normal protein, low fat diet, salt restrictions, diuretics, immunosuppression, and heparinoids, immunosuppressive drugs and ACE inhibitors used w/ steroid-resistant
28
Q

Eval of nephrotic syndrome

A

-24 hr urine collection-see an increase in protein, decrease in serum albumin, concentrations of cholesterol, phospholipids, and triglycerides increase

29
Q

Nephritic syndrome

A
  • Hematuria, RBC casts, proteinuria
  • caused by increased permeability of the glomerular filtration membrane
  • Advanced stages-htn, uremia, oliguria
  • Same tx of nephrotic syndrome
30
Q

Classification of kidney dysfunction

A
  • Acute or chronic, reversible or irreversible
  • Renal insufficiency
  • Renal failure
  • End-stage renal failure (less than 10% of renal function remains)
31
Q

Uremia

A
  • Syndrome of renal failure
  • Elevated blood urea and creatinine levels
  • Fatigue, anorexia, nausea, vomiting, pruritus and neurologic changes
  • Retention of toxic wastes, deficiency states, electrolyte disorders and proinflammatory state
32
Q

Azotemia

A
  • increased serum urea levels and frequently increased creatinine levels
  • Renal insufficiency or renal failure, causing azotemia
  • Both azotemia and uremia accumulate of nitrogenous waste products in the blood
33
Q

Acute kidney injury

A
  • sudden decline in kidney function w/ decrease in GFR and accumulation of nitrogenous waste products in the bloods
  • Increased creatinine and BUN
34
Q

AKI Classification

A
  • RIFLE: Risk, injury, failure, loss, end-stage disease
  • Risk: increased creatinine levelx1.5 or GFR decrease >25%, UOP <0.5mL/kg/hr x6hrs
  • Injury: Increased creatinine levelx2 or GFR, decreased >50%, UOP <0.5mL/kg/hrx12HR
  • Failure: increase creatinine levelx3 or GFR decrease >75%, UOP <0.3mL/kg/hrx24 hr or anuria
  • Loss: persistent acute renal failure, complete loss of kidney function >4wks
  • Endstage kidney disease: complete loss of kidney function >3mo
35
Q

AKI type

A
  • Prerenal: renal hypoperfusion: most common cause
  • Intrarenal: disorders involving the renal parenchymal or interstitial tissue, acute tubular necrosis caused by ischemia most common cause
  • Postrenal: rare, disorders associated w/ acute urinary tract obstruction
36
Q

Prerenal AKI

A
  • Most common cause; reduction in arterial blood flow causing hypoperfusion w/ and elevated BUN and Cr, GFR eventually decreases due to decrease in filtration pressure
  • Multiple factors can play a role: artery thrombosis, hypotension, hypovolemia, hemorrhage, renal vasoconstriction, microthrombi, sepsis
37
Q

Intrarenal AKI

A
  • exposure to radiocontrast dye, abx, acute glomerulonephritis, DIC, allograft rejection, interstitial disease-drug allergy, infection, or tumor growth
  • Oliguria and anuria are common w/ intrarenal AKI; increased Cr w/ decreased GFR
38
Q

Post renal AKI

A
  • Rare-occurs w/ renal obstruction that affeccts both kidneys; BPH, neurogenic bladder, tumor.
  • Increase in intraluminal pressure upstream from obstruction and a decrease in GFR; flank pain and anuria followed by polyuria
39
Q

AKI initiation phase

A
  • Reduced perfusion or toxicity, during which renal injury is evolving
  • Usually lasts 24-36 hours
  • Prevention of injury is possible
40
Q

AKI maintenance or oliguric phase

A
  • Period of established renal injury and dysfunction after the initiating event has been resolved
  • May last from wks to months
  • Urine output is lowest and serum Cr, BUN, and serum K increase, metabolic acidosis develops, and salt and water overload occurs
41
Q

AKI recovery phase

A
  • renal injury is repaired and normal renal function is reestablished
  • GFR returns toward normal but the regenerating tubules cannot concentrate the filtrate
  • Diuresis is common, w/ a decline in Cr and urea and increase in creatinine clearance
  • Polyuria can result in excessive loss of Na, K, and water
42
Q

AKI prevention and Tx

A
  • Maintenance of fluid volume before and after surgery or diagnostic procedures or when nephrotoxic drugs or contrast agents are used
  • Tx: correct fluid and electrolytes, manage BP, prevent and treat infections, maintain nutrition, remember certain drugs can be toxic
43
Q

TX hyperkalemia

A
  • restrict sources of K
  • use non-K sparing diuretic agents or use cation-ion exchange resins
  • administer glucose and insulin or Na bicarb to drive K into the cells
  • Administer Ca
  • May need dialysis
44
Q

CKD: Factors that contribute to progression of disease

A
  • glomerular HTN
  • Hyperfiltration
  • tubulointerstitial inflammation
  • Fibrosis
45
Q

CKD manifestations

A
  • affects every body system
  • uremic syndrome
  • Epistaxis
  • sallow pigmentation
  • Pruritic excoriations
  • bruising
  • amenorrhea
  • myopathy
  • peripheral neuropathy
  • Edema
  • frost, red eye
  • anorexia, n/v
  • htn, pericarditis, HF
46
Q

Uremic syndrome

A
  • proinflammatory state w/ accumulation of urea and other nitrogenous compounds
  • Toxins
  • Alterations in fluid and electrolyte and acid-base balance
47
Q

CKD and endocrine and reproductive systems

A
  • decrease in circulating sex steroids
  • Decreased libido
  • insulin resistance
  • low thyroid hormone levels
48
Q

CKD tx

A
  • management of protein intake
  • supplement vit D
  • maintenenace of Na and fluid
  • restriction of K
  • maintenance of adequate caloric intake
  • Mangement of dyslipidemias
  • erythopoietin as needed
  • ACE inhibitors or receptor blockers: controls systemic HTN and provide renoprotection, particularly in the presence of diabetes mellitus
  • Dialysis, transplant

Anatomy and Physiology-DNP (18 decks)

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