Ch-30 Alteration in Renal and Urinary Tact Function Flashcards
What are the most common urinary disorders? (2 pts)
bladder infection (1) & stones, tumours and inflammation that can obstruct UT
Renal dysfunction are disorders of ____(1) or ____ (2) diseaes affecting kidney can result in:
_____ (3) kidney injury
_____(4) kidney injury
______ (5) failure = life threatening condition
- kidney
- systemic
- acute
- chronic
- kidney
What are the UPPER urinary tract and the LOWER urinary tract?
UPPER – kidneys and ureters
LOWER – bladder and urethra
What is urinary tract obstruction?
interference with urinary flow along urinary tract
Impeded flow = increased risk of ____
infection
What is obstructive uropathy?
anatomic changes cause obstruction
Obstruction of the UUT results in ____ up of urine = dilation
backing
In UUT, pressure is transmitted to glomerulus = _____ filtration
reduced
What is hydorureter and hydronephrosis?
hydroureter – accumulation of urine in ureter
hydronephrosis – accumulation of urine in calyces and renal pelvis
T or F: Dilation is late response to obstruction.
FALSE; Dilation is an early response to obstruction
What is compensatory hypertrophy?
unobstructed kidney increases in size of glomeruli and tubules (not total # of nephrons)
With UUT infections, _____ (1) (cessation of urinary flow) occurs above obstruction
stasis
With UUT infections, within ___ (1) days = tubulointerstitial ____ (2) = excessive collagen, hardening and scarring
__ (3) days = both distal & _____ (4) nephron affected
___ (5) days glomeruli damaged
- 7
- fibrosis
- 14
- proximal
- 28
What are kidney stones?
masses of crystals, proteins.
Where can you find kidney stones?
kidneys, ureters and bladder
What are other contributing factors for kidney stones to occur?
Urine pH
= greater than 7.0
= less than 5.0
T or F: Size of the stone determines its ability to be passed out through urination
TRUE
Urine pH:
greater than 7.0 = increased risk of _____ (1) phosphate stone.
less than 5.0 = increased risk of _____ (2) acid stone
- calcium
- uric
What are some manifestations for kidney stones?
radiating pain & urgency to urinate
What are some tx for kidney stones? (4 pts)
= imaging studies
= meds
= high fluid intake
= surgery
What is the surgery used to take out kidney stones?
ureteroscopy with laser lithotripsy
What is the most common symptom for lower urinary tract obstruction?
incontinence – loss of bladder control
Lower Urinary Tract Obstruction disorders are related to:
- urine ____ (1) in bladder
- empyting of urine in bladder
- obstruction can be ____ (2) or anatomical or ____ (3)
- storage
- neurogenic
- both
What are the 3 types of neurogenic bladder?
- Above C2: hyper-reflexia
- Between C2-S1: hyper-reflexia with sphincter contraction
- Below S1: atonic without tone bladder
What is the cause of above C2: hyper-reflexia? (4pts)
stroke, TBI, MS and Alzheimer’s disease
What are some characteristics of above C2: hyper-reflexia?
urgency to urinate and urine leakage – bladder automatically empties when full
What causes below C2-S1: hyper-reflexia with sphincter contraction? (3 pts)
spinal-cord injury, Guillain-Barre syndrome & vertebral disc issues
The characteristic of hyper-reflexia with sphincter contractions is that ____ (1) contractions and _____(2) sphincter contraction at the same time = functional obstruction of bladder.
- muscle
- external
WH
What is the cause of atonic without tone bladder (below S1) (3pts)
peripheral neuropathy, MS and spinal injury
Some of the characteristics of atonic without tone bladder are urine _____ (1) & distension. Another one is that full bladder is sensed, but ____ (2) does not contract = unreactive bladder
retention (1) & detrusor (2)
What is urethral constriction?
scarring that narrows urethra and restricts blood flow of urine from bladder
T or F: Urethral constriction is rare in men.
FALSE; It’s most common in MEN than women; rare in women
What is the tx for urethral constriction?
urethrotomy
What is the cause for prostate enlargement?
caused by acute inflammation
What are some tx for prostate enlargement?
meds like alpha-blockers like terazosin (Hytrin) or tamsulosin (Flomax)
What disorder could lead with prostate enlargement? (2pts)
prostate cancer & benign prostatic hyperplasia
Which type of UTI is associated with INFLAMMATION of bladder and the most common site of UTI?
acute cystitis
What are the 3 types of acute cystitis?
- mild infection - mucosa is hyperemic
- hemorrhagic cystitis – advanced; diffuse hemorrhage
- suppurative cystitis – pus forms on epithelial bladder surface.
UTI- AC: Prolonged infection can result in _____ (1) of bladder mucosa = ulcer formation and possible necrosis of bladder wall.
Bacteria bind to bladder mucosa — shedding is a _____ (2) immune defense
However, bladder wall now ___ (3) protected from salts, toxins
- shedding
- natural
- not
What is the cause of PBC/IC?
unknown
What are the most common pathogens in acute cystitis?
E.coli, Staphylococcus saprophyticus & parasite Schistosomiasis
What are the types of PBS/IC?
non-bacterial infection and non-infectious cystitis
What is the difference between non-bacterial infection and non-infectious cystitis?
Non-bacterial infection - viral & fungal. Common among IMMUNOCOMPROMISED
Non-infectious cystitis - associated with radiation and chemo tx for pelvic regions
What are the symptoms for PBS/IC?
bladder fullness, nocturia, CHRONIC PELVIC PAIN lasting longer than 9 months
What is the tx for PBS/IC?
sacral nerve stimulation & sugery for refractory cases (difficult to cure and long lasting)
What type of UTI is associated with sudden/severe kidney infections infecting ONE or BOTH UPPER urinary ureters?
acute pyelonephritis
What are the common risk for acute pyelonephritis?
urinary obstruction & REFLUX OF URINE FROM BLADDER
T or F: Acute pyelonephritis is more common in men.
FALSE; MORE COMMON IN WOMEN
What bacteria is most commonly associated with acute pyelonephritis?
E.coli
Pathophysiology of AP:
E.coli splits ___ (1) into NH4 = ____(2) urine= increased risk of stone formation.
Infection affects mostly ____ ___ (3) and calyces/ infection causes influx of ___(4) into kidney MEDULLA = inflammation and edema
- urea
- alkaline
- renal pelvis
- WBC
What is the tx for acute pyelonephritis?
specific antibiotics
Which type of UTI is associated with persistent/recurrent infections leads to scaring of both kidneys?
chronic pyelonephritis
What is the tx for chronic pyelonephritis?
related to specifics of underlying infections
What does chronic pyelonephritis results from?
Chronic kidney disease
What is the progression of Chronic Kidney Disease?
kidney failure
What is glomerulonephritis?
inflammation of glomerulus caused by primary glomeruli injury.
Glomerulonephritis Pathophysiology:
____(1) mechanisms major cause of injury resulting in damage to glomeruli filtration membrane
Injury caused by ____(2) and ____(3).
Complements form _____(4)/ cytokines cause invasion of macrophage, neutrophils and T cells.
Result: Glomeruli filtration rate is reduced = _____(5) injury
Loss of ____ (6) charge across glomeruli filters results in proteins leaking into nephron
- immune
- complement
- cytokines
- porins
- hypoxic
- negative
Chronic glomerulonephritis leads to ____ (1) kidney disease/ ____ (2) or kidney transplant may be required
chronic (1) & dialysis
What is the difference between nephrotic and nephritic syndromes?
Nephrotic - filtration exceed tubular reabsorption
Nephritic – hematuria and red blood cell casts
What is red blood cell casts?
cylindrical structures created by kidney containing RBC excreted in urine
T or F: Nephritic Syndrome is a characteristic of Glomerular injury.
FALSE; Nephrotic syndrome is
Which kidney disease is associated with sudden decline in kidney function with a DECREASE Glomerular function and urine output?
Acute kidney disease
What is the result of accumulation of NITROGENOUS waste products in blood for AKD?
elevation in plasma creatinine & BUN levels
Pathophysiology of AKD:
AKD is due from ____ (1) injury related to decreased ____ (2) blood flow, toxic injury from chemicals, and sepsis-induced injury.
Injury initiates _____ (3) response = cell death = ALTERATIONS in kidney function.
- ischemia
- renal
- inflammatory
What is urea composed of? (4 pts)
O2, C, N, and H
What does BUN tests measures?
nitrogen in blood
Nitrogen in blood = ___ in blood
urea
Increased urea in blood = ____ dysfunction
kidney
What are the 3 phases of AKD?
- oliguric phase
- diuretic phase
- recovery phase
What is oliguria?
urinary output is less than 400 mL/day
What is the recovery phase?
begins with GFR normalization & BUN and creatinine levels begin to normalize
What is the cause of diuretic phase?
kidney’s loss of ability to concentrate urine
What are some characteristics of diuretic phase (3 pts)
weight loss and hypovolemia/hypotension due to increased urine output
urine output: normal to high
What are some characteristics of oliguric phase? (3 pts)
- hyperkalemia & hyponatremia
- urinalysis: demonstrates casts
- elevated BUN and creatinine levels
What kidney disease is associated with progressive loss of renal function?
Chronic Kidney Disease (CKD)
What is the most significant factor of Chronic kidney disease?
Diabetes mellitus
CKD Pathophysiology:
Sequence of events leading to ____ (1) and _____ (2)
- Infiltration of damaged kidney with inflammatory cells.
- Loss of renal cells through ____ (3) and necrosis
- Production of ____ (4)
- scarring
2.fibrosis - apoptosis
- fibroblasts
Mechanisms of CKD lead to ____ ____ ________ (scar tissue in glomerulus)
focal segmental glomerulosclerosis
