Alterations of Renal & Urinary Tract (BOLDED ONLY)

Question 1

upper urinary tract obstruction - compensatory hypertrophy and hyperfunction

Answer 1

loss of function of one kidney with obstructive disease leads an increase in size and increased function of the unaffected kidney

Question 2

relief of upper urinary tract obstruction is usually followed by _______ and may cause fluid and electrolyte imbalance

Answer 2

obstructive diuresis

typically mild, but can cause dehydration and f/e imbalance

Question 3

also called renal calculi or urolithiasis, and what are they made of?

Answer 3

kidney stones

-masses of crystals, proteins, or mineral salts form in the urinary tract and may obstruct the urinary tract

Question 4

kidney stone risk factors

Answer 4

-male, less than 50, inadequate fluid intake, geographic location (temperature, humidity, rain fall, fluid, and dietary pattern

Question 5

most common mineral salts kidney stones and what increases risk?

Answer 5

calcium oxalate and calcium phosphate (70-80%)

• alkaline urine increases risk
• can prevent with potassium citrate, pyrophosphate, and magnesium

Question 6

kidney stone formation - precipitation of a salt from a liquid to a solid state - what influences this? what is most important?

Answer 6

temperature and pH or urine influence the risk of precipitation and calculus formation, but pH IS MORE IMPORTANT

Question 7

s/s of kidney stones - renal colic that is mod to severe pain originating in the flank and radiating to the groin indicates?

Answer 7

indicates obstruction of RENAL PELVIS OR PROXIMAL URETER

Question 8

renal colic that radiates to the lateral flank or lower abd = obstruction in _______

Answer 8

the midureter

Question 9

lower urinary tract obstruction - overactive bladder syndrome (OAB)

syndrome of? characterized by?

Answer 9

• syndrome of detrusor overactivity
• characterized by urgency with involuntary detrusor contractions during bladder filling that are either spontaneous or provoked
• coordination b/w contracting bladder and external sphincter maintained
• detrusor too weak to empty bladder and results in urinary retention with overflow or stress incontinence
• symptom syndrome of urgency, with or without urge incontinence and associated with frequency and nocturia

Question 10

renal tumors - renal adenomas…what kind of tumors? located where? can become what?

Answer 10

renal adenomas are typically benign tumors located near cortex of kidney, and can become malignant

Question 11

renal transitional cell carcinoma is what?

Answer 11

rare

Question 12

renal cell carcinoma (RCC) - m or w more? risk factors? what type of cancer? which has better and worse prognosis?

Answer 12

most common

men>women in 5th and 6th decade of life

risk factors: cigarette smoking, obesity, HTN

RCC are adenocarcinomas that arise from tubular epithelium in the renal cortex

Clear cell - better prognosis most common

Papillary - worst prognosis

Question 13

classic clinical manifestations of renal tumors

early stages are often?

Answer 13

HEMATURIA, dull and aching flank pain, palpable flank mass in thinner individuals

early stages often silent

Question 14

bladder tumors (urological tumors) - this was not bolded

urothelial carcinoma is also called? risk factors?

Answer 14

urothelial (transitional cell) carcinoma is the most common type of bladder tumor

risk factors: smoking, exposure to metabolites of aniline dyes or other aromatic amines or chemicals, high arsenic in drinking water, heavy consumption of phenacetin

Question 15

clinical manifestations of bladder tumors (think urothelial/transitional cell carcinoma)

Answer 15

GROSS PAINLESS MICROSCOPIC HEMATURIA

hematuria episodes tend to recur, and are accompanied by lower urinary tract symptoms including daytime voiding frequency, nocturia, urgency, and urge urinary incontinence

more common in M over 60 and smokers

Question 16

UTI - cystitis - what is it?

Answer 16

inflammation of the bladder

*most of the time cystitis is caused by a UTI

Question 17

interstitial cystitis - caused by?

Answer 17

also called bladder pain syndrome

nonbacterial infectious cystitis

thought to be the result of autoimmune reaction responsible for inflammatory response that includes mast cell activation, altered epithelial permeability, and increased sensory nerve sensitivity

Question 18

interstitial cystitis manifestations

Answer 18

• age 20-30 females
• bladder fullness, frequency, small urine volume, urgency, chronic pelvic pain
• urine cultures negative
• most common in immunocompromised

Question 19

pyelonephritis - what is it?

Answer 19

infection of one or both upper urinary tracts (ureter, renal pelvis, and interstitium)

Question 20

acute pyelonephritis - most common cause? what does it cause? primarily affects?

Answer 20

acute infection of the renal pelvis interstitium

e.coli most common cause

causes medullary infiltration of WBCs with renal inflammation, renal edema, and purulent urine

PRIMARILY AFFECTS TUBULES, GLOMERULI USUALLY SPARED

rarely causes renal failure

Question 21

acute glomerulonephritis (the glomerulus is affected*) pathophysiology

clinical manifestations

Answer 21

formation of immune complexes (antigen/antibody) in the circulation with subsequent deposition in glomerulus

antibodies produced against the organism that cross-react with the glomerular endothelial cells

clinical manifestations: hematuria with RBC casts; smoky, brown-tinged (or cola colored) urine from RBCs, HTN d/t fluid retention…

Question 22

nephrotic sediment vs nephritis sediment

Answer 22

nephrotic: contains massive amounts of PROTEIN AND LIPIDS and either a microscopic amount of blood or no blood
nephritic: BLOOD is present in the urine with RED CELL CASTS, WHITE CELL CASTS, AND VARYING DEGREES OF PROTEIN, which is not usually severe

Question 23

nephrotic syndrome

clinical manifestations

Answer 23

• excretion of 3g or more of protein in the urine - causes foamy urine
• protein excretion as a result of glomerular injury

clinical manifestations: hypoalbuminemia (peripheral edema), prone to infection, vit D deficient, hyperlipidemia and lipiduria, hypothyroidism

Question 24

nephritic syndrome caused by?

Answer 24

increased permeability of the glomerular filtration membrane

Question 25

nephrotic syndrome caused by

Answer 25

altered glomerular permeability and loss of negative charge (loss of negative charge causes protein loss) - albumin is also negatively charged, and this usually prevents loss

Question 26

RIFLE

Answer 26

classification of acute kidney injury

risk, injury, failure, loss, end-stage disease

• Risk GFR decrease > 25%, increased creatinine x1.5
• Injury GFR decreases >50%, creat x 2
• Failure GFR decreases >75%, creat x3
• Loss - persistent acute renal failure: complete loss of kidney function >4 weeks
• End-stage kidney disease - complete loss of kidney function >3months

Question 27

acute kidney injury

Answer 27

sudden decline in kidney function with a decrease in glomerular filtration and accumulation of nitrogenous waste products in the blood

• increase in BUN and creatinine
• 3 categories: pre-renal, intra, and post

Question 28

pre-renal acute kidney injury

Answer 28

renal hypo-perfusion: most common cause

reversible
elevation BUN and creatinine
GFR decline

Question 29

intra-renal AKI

Answer 29

disorders involving the renal parenchymal or interstitial tissue

ACUTE TUBULAR NECROSIS (ATN) CAUSED BY ISCHEMIA IS THE MOST COMMON CAUSE
*occurs most often after surgery s/t hypovolemia and third spacing due to increase in inflammation, but ATN also associated with sepsis, obstetric complications, burns, trauma

*anesthesia can also mess with neural controls of the bladder resulting in retention

there is kidney damage

Question 30

post-renal AKI

Answer 30

rare

disorders associated with acute urinary tract obstruction

Question 31

Intra-renal AKI generally described as _____ or ______

Answer 31

POSTISCHEMIC - involves persistent hypotension, hypoperfusion, and hypoxemia producing ischemia, reduced ATP, and generate toxic oxygen-free radicals with loss of antioxidant production that causes cell swelling, injury, necrosis

or

NEPHROTOXIC produced by numerous abx; neomycin, gentamycin, and tobramycin are the major culprits
*drugs accumulate in renal cortex and can cause renal failure

Question 32

post-renal

Answer 32

occurs with urinary tract obstructions that affect the kidneys bilaterally
*bilateral ureteral obstruction, bladder outlet obstruction -prostatic hypertrophy, tumors, or neurogenic bladder (extra renal), and urethral obstruction

clinical manifestations: pattern of several hours of anuria with flank pain followed by polyuria
*can occur after catheterization of ureter, which causes inflammation of the tubular lumen

Question 33

the phases of AKI

Answer 33

initiation phase - prevention of injury possible, usually lasts 24-36 hours

oliguric phase - period of established renal injury and dysfunction after the initiating event has been resolved?

• may last from weeks to months
• urine output low, BUN + creat high, K+ high, Na+ and H20 overload, metabolic acidosis develops

recovery phase - renal injury repaired, GFR returns to normal, but the regenerating tubules cannot concentrate the filtrate, diuresis common, decline in serum BUN/creat
*polyuria can result in loss of sodium, water, K+

Question 34

CKD causes four bolded things

Answer 34

immune system suppression d/t loss of proteins (Ig) - lack of response to vaccines, increase r/f infection

neurologic system - impaired concentration, memory loss, impaired judgement, seizures, coma - think toxin build-up uremia

endocrine and reproductive systems - decrease in sex steroids (loss of protein), decreased libido (loss of testosterone), insulin resistance, low thyroid hormone levels

integumentary system: anemia causes pallor (anemia from decreased EPO), bleeding - hematomas and ecchymosis (platelet dysfunction), retained urochromes = sallow skin color,
-hyperparathyroidism (probably d/t low calcium levels b/c PTH results in increased calcium) and uremic skin residues, known as uremic frost - causes irritation, and pruritus with scratching, excoriation, and increased r/f infection