Ch. 30 Urinary/renal Flashcards
Abnormal bladder contraction and emptying due to neurologic conditions
Neurogenic bladder
Lack of coordinated neuromuscular contraction of bladder
Dyssynergia
With ______, as the bladder contracts, the sphincter closes
Dyssynergia
Associated with spinal cord injuries above T6
Dyssyngergia
A lesion above the micturition center in the pons caused from stroke or TBI causes what?
Dyssynergia; detrusor hyper-reflexia. Overactive reflex emptying when full
A lesion below micturition center in pons, but above sacral causes what?
(dyssynergia) detrusor hyper-reflexia, like when lesions are above, but with vesicosphincter.
OBS
Overactive bowel syndrome–hyperflexia but without VS dyssynergia. urgency with or without urge, incontinence, often frequency
What happens when lesions affect the sacral micturition center
Detrusor areflexia. Underactive, atonic bladder with retention, stress, and overflow incontinence
What are the common causes of bladder outlet obstruction, which blocks urine flow
- Urethral stricture- narrowing of urethral lumen (often due to scarring)
- Prostate enlargement- due to benign prostatic hyperplasia (BPH), acute prostatitis, or prostate cancer
- Pelvic organ prolapse–blockage to urine flow occurs when the bladder herniates into the lower vagina
Urethral stricture causes what
Bladder outlet obstruction
Prostate enlargement can cause what? (blocks urine flow)
Bladder outlet obstruction
Blockage to ___ flow occurs when the bladder herniates into the lower vagina.
urine
Treatment of Dyssynergia
Adrenergic blocking medications, urethral dilation, or surgical repair
What is the most common renal tumor
Renal cell carcinoma
Renal adenomas are benign or malignant?
Benign
renal cell carcinoma are ___________, usually arising from tubular epithelium (cortex of kidney)
Adenocarcinomas
Risk factors for renal tumors
Tobacco smoking, obesity, and HTN(uncontrolled)
Early stages of renal tumors are symptomatic or asymptomatic?
Asymptomatic
Dx of renal tumros?
Intravenous pyelogram (IVP), CT scans, etc. Nephrectomy with chemotherapy
WHat is the most common bladder tumor
Transitional cell carcinoma
What are the risk factors for transitional carcinoma and where are they found
Bladder; Males older than 60, smokers, chemical exposures
What is the pathogenesis of bladder tumors
Genetic alteration in normal bladder epithelium
Evaluation/Dx of bladder tumors
Cystoscopy, tissue biopsy
Tx of bladder tumors
Intravesical chemotherapy, bladder resection or removal, and adjuvant chemotherapy
Inflammation of the urinary epithelium caused by bacteria
UTI
Other names for UTI
Acute cystitis and pyelonephritis
Another word for kidney infection (considered a UTI)
Pyelonephritis
Name for infection of bladder
acute cystitis
Risk factors for UTI
- Female (especially postmenopausal)
- Indwelling catheters
- Bladder disorders
what is urosepsis
Sepsis caused by prolonged, untreated bladder infection
Who is at risk for urosepsis
Elderly
Most common pathogen for UTI
Escherichia Coli
Inflammation of the bladder is called
Acute cystitis
Manifestations of acute cystitis
- Frequency
- Dysuria
- Urgency
- Lower abdominal and/or suprapubic pain
Dx of acute cystitis
Urinalysis or urine culture with sensitivity
Tx of acute cystitis
- Antimicrobial therapy
- Increase fluid intake
- Urinary analgesics
Acute pyelonephritis occurs in the upper or lower urinary tract
Upper
Acute infection of the ureter, renal pelvis, and interstitium is called
Acute pyelonephritis
What causes Acute Pyelonephritis
Vesicoureteral reflex, E. Coli, proteus, and psuedomonas. Reflex and E. Coli are in red
what is vesicoureteral reflex
when urine flows in wrong direction
Pathophysiology of pyelonephritis
Inflammation of urinary tract structures, renal edema, and possible abscess formation. Followed by tubular damage/fibrosis and necrosis of renal papillae
Clinical manifestations of pyelonephritis
Systemic signs of inflammation/infection including: fever, chills flank/groin pain, dysuria, and frequency (older adults have blunted symptoms. i.e confusion)
Chronic pyelonephritis leads to
scarring of tissue
Risk of chronic pyelonephritis increases in individuals with…
renal infections and some type of obstructive pathologic condition
Interstitial cystitis is also known as
Painful bladder syndrome
What are the two types of interstitial cystitis
- Nonbacterial infectious cystitis, and noninfectious
List what causes nonbacterial infectious cystitis
Viruses, chlamydia, and fungi
List what causes noninfectious cystitis
Chemical, autoimmune, radiation, hypersensitivity
What is the pathogenesis of painful bladder syndrome (IC)
Uncertain…perhaps a defet in the bladder epithelium, autoimmune reaction triggering inflammation, or inflammation that caused fibrosis with hemorrhagic ulcers
Manifestations of interstitial cystitis (painful bladder syndrome)
- common in women 20-30 yrs
- Bladder fullness/pressure, frequency, small urine volume, chronic pelvic pain
Tx of Painful bladder syndrome (IC)
- no single treatment is effective. Strategies for symptom relief include:
- oral medications such as nsaids, or bladder instillations of a variety of substances
What is the glomerulus
bundle of capillaries that filters plasma; where urine is made
What is glomerulonephritis
inflammation of the glomerulus
What is the most common cause of glomerulonephritis
immunologic abnormalities such as acute post-streptococcal glomerulonephritis…damage caused by immune complexes…antibodies against . the group A beta hemolytic
antibiotics, drugs, toxins, vasculitis, HIV, and diabetes mellitus can all be causes of _____nephritis
Glomerulonephritis
Type III hypersensitivity along with deposition of circulating soluble antigen-antibody complexes (immune complexes) and nonimmunes such as drugs, toxins, and ischemia, are all mechanisms of what
Glomerular injury
Manifestations of glomerulonephritis: the two major symptoms
Hematuria with red blood cell casts, and proteinuria exceeding 3-5 days with albumin as the major protein
Other more minor manifestations of glomerulonephritis
Oliguria (not enough urine) hypertension, edema
What are the two types of glomerulonephritis
Membranous and rapidly progressing. Membranous is an autoimmune response to renal antigen, idiopathic, or secondary to systemic diseases. Rapidly progressing: immune complexes leak into bowman space, form crescent shaped lesions
Chronic glomerulonephritis is an umbrella for several glomerular diseases, it is progressive, and leads to what?
Chronic renal failure ):
Which type of glomerulonephritis is associated with crescent shaped lesions
Rapidly progressing
Antiglomerular basement membrane disease (goodpasture syndrome) is associated with which type of glomerulonephritis
Rapidly progressing
Which type of glomerulonephritis is associated with an autoimmune response to a renal antigen, is idiopathic, or secondary to a systemic disease
Membranous nephropathy
Nephrotic syndrome: _______: degenerative disease of the tubules (non-inflammatory)
Nephrosis
Nephrotic goes with ______ and Nephritic goes with ______
Nephrotic=nephrosis
Nephritic=nephritis
Nephrosis is the degenerative disease of tubules and is caused by ____ ____
glomerular injury
Is nephrosis non-inflammatory?
Yes
Inflammation of the kidneys: _______
nephritis
Nephritis is the inflammation of the kidneys. It is caused by increased permeability of the _____ ____
glomerular membrane
Nephrotic is an ______ to the glomerular basement membrane and podocytes, whereas nephritic is an ______ injury to the glomerulus
Nephrotic is an injury, and nephritic is an immune injury
Clinical manifestations of nephrotic syndrome?
Massive proteinuria: excretion of 3.5g or more of protein in urine per day. And edema
Clinical manifestations of nephritic syndrome?
Microscopic hematuria, and mild, mild, mild proteinuria
Tx of nephrotic syndrome?
Restrictions on protein
Tx of nephritic syndrome?
High-dose corticosteroids
Pathophysiology of acute kidney injury
Ischemic injury due to decreased renal blood flow. Hypovolemia. Sepsis induced injury
Most common cause of acute KI?
Prerenal. Due to decreased RBF, and glomerular filtration rate decreases as well
What is the most common cause of intrarenal AKI?
Acute tubular necrosis (ATN). Post-ischemic–inflammatory response with necrosis along any part of nephron
_______ AKI occurs with urinary tract obstructions that affect the kidneys bilaterally
Postrenal
What are the three phases of AKI
Initiation, maintenance(oliguric), and recovery (polyuric)
Which AKI phase is this:
-Kidney injury is evolving, and prevention of injury is possible
Initiation phase
Which AKI phase is this:
-Established kidney injury and dysfunction. Urine output is lowest during this phase (hence oliguric),and serum, creatine, and blood urea nitrogen both increase
Maintenance (oliguric)
Which AKI phase is this:
-Injury repaired and normal renal function reestablished. Diuresis common. Decline in serum creatine and urea.
Recovery (polyuric)
Prevention of AKI is kinda important, not a big deal, or paramount
paramount
Tx of AKI
Correct fluid and electrolyte disturbances
Progressive loss of renal function that affects nearly all organ systems is
Chronic Kidney Disease
What is CKD associated with
HTN, diabetes, intrinsic kidney disease
What is the initial adaptation to the loss of nephron mass
Hypertrophy and hyperfunction.
Is the initial adaptation of CKD enough to compensate the loss of nephron mass?
No. Compensatory capacity fails.
Clinical manifestations of CKD if damage is primarily vascular or glomerular
Proteinuria, hematuria, nephrotic syndrome, and uremia
Clinical manifestations of CKD if damage is primarily to tubules
-Renal tubular acidosis, salt wasting, and difficulty regulating urine concentration
What happens as glomerular filtration rate declines?
Plasma creatine level increases. Plasma urea level also increases. However, the level of urea in the plasma is a less sensitive indicator of GFR
Is an increased level of urea in the plasma a strong enough indicator of GFR?
No.
Explain the sodium and water balance due to CKD
Sodium excretion increases, with obligatory (bc water follows salt) water excretion leading to sodium deficit and volume loss
Explain the potassium balance due to CKD
Tubular secretion increases early (hypokalemia, so the potassium in blood decreases) However, once oliguria sets in, potassium is retained
Explain the acid-base balance due to CKD
Metabolic acidosis occurs when glomerular filtration rate declines to 30-40%
Explain the calcium and phosphate balance due to CKD
Decreased renal synthesis of 1,25-(OH)v2, Vitamin D3, and hypocalcemia (due to decrease calcium in gut). The parathyroid released pthormone to compensate
CKD causes an increased risk of _____
Fractures
Altered protein is another metabolic disruption due to CKD. Dyslipidemia. T or F
True (dyslipidemia: increased amount of carbs and fat in blood)
Risk factors of the CV system when pt is diagnosed with CKD
HTN, dyslipidemia, risk for heart failure, and pericarditis
Pulmonary risk for patients with CKD
Pulmonary edema, compensation for metabolic acidosis (kussmauls respirations=deep in an attempt to release excess CO2)
Hematologic issues with CKD?
Anemia (decreased EPO)
Immune issues with CKD?
Suppression of phagocytosis, decreased antibody production, decreased T-cell function
Neuro issues with CKD?
Elevated nitrogenous wastes
GI issues with CKD
Uremic gastroenteritis, anorexia
Endocrine and reproductive issues with CKD
Insulin resistance: big one. others: decreased sex hormone, hypothyroidism
Skin issues with CKD
Uremic frost. d/t deposition of nitrogenous wastes = itching
Dx of CKD
Serum creatinine, BUN, GFR. CT scan
Tx of CKD
Dialysis :( which is renal replacement therapy. Treatment is supportive, and prevention is important.
