chap 15 - kidney and lower urinary tract (start of unit 5) Flashcards

Question

bilateral renal agenesis

Answer 1

rare, associated with other congenital anomalies, incompatible with life

Answer 2

common, asymptomatic, other kidney enlarges to compnesate

Answer 3

associated with fusion of kidneys, horseshoe

Answer 4

Kidney does not fully develop during embryonic period Small kidney, normal nephron, less # Relatively common 1 in 200 babies Unilateral or bilateral Small kidney, disorganized and malformed tissue Develop into cysts, not kidneys Unilateral or bilateral Severe bilateral dysplasia generally do not survive until birth

Answer 5

Kidney contains many cysts - Cysts grow and replace normal kidney function Caused by two genetic diseases - Autosomal recessive polycystic kidney disease - Autosomal dominant polycystic kidney disease

Answer 6

Infancy and early childhood Always has associated liver involvement Involves large gene called PKHD1 Rare = 1 in 20,000 births Can be seen on prenatal ultrasound if severe

Answer 7

Does not manifest until adulthood Fairly common Liver involvement less severe More result from mutations in PKD1 or PKD2 Cysts develop insidiously Reduced life expectancy Can cause hypertension and chronic renal failure

Answer 8

- Urine normally prevented from flowing back into the ureters during urination - Retrograde flow of urine - Failure of mechanisms allow urine to reflux into ureter during voiding - Predisposes to urinary tract infection - Pyelonephritis

Answer 9

Very common Bacteria contaminate perianal and genital areas and ascend urethra Host defenses include: - Washout phenomenon - Complete bladder emptying - Free urine flow - Normal bacterial flora - Acid urine Symptoms? Treatment? Risk factors - Any conditions that impairs free drainage of urine - Female - Sexual activity - Diabetes - Vesicoureteral reflux - Catheterization

Answer 10

Infection of the kidneys - Usually develops from infection spreading from lower urinary tract - Infection can also occur from bacteria spread through bloodstream to kidneys Symptoms of pyelonephritis include sudden onset of: - Flank pain - Fever - Leukocytosis Gently thumping flank on affected side can elicit excruciating pain Diagnosis - Urinalysis shows kidney has white cells - Urine may also have pus Treatment - Antibiotic therapy - Alleviation of factor that has predisposed its development

Answer 11

May form anywhere in urinary tract Stones composed of calcium, uric acid Symptoms - Hematuria - Flank pain Risk factors - Dehydration - Metabolic disorders = gout Diagnosis - X-ray - Ultrasound Treatment - Time to pass - Cystoscopy: snares and removes stones lodged in distal ureter - Pain medication and large volumes of water - Shock wave lithotripsy: stones lodged in proximal ureter are broken into fragments that are readily excreted

Answer 12

Blockage of urine outflow leads to dilation of urinary tract upstream, eventually causes compression and atrophy of kidneys Causes - Bilateral: obstruction by enlarged prostate - unilateral: kidney stones, tumor Complications -Stone formation; infections

Answer 13

Group of diseases Due to damage of major components of the glomerulus Endothelium Podocytes Basement membrane Immunologically mediated Immune complexes form in blood in response to non-kidney related disease and are deposited on basement membrane of glomerulus Antibodies are formed against components of glomerulus Basement membrane of glomerulus Can be considered in terms of whether they are primary or secondary to some other systemic disease → diabetes mellitus, hypertension, SLE Patterns of injury can be further defined by: Chronic or acute Whether injury involves majority of glomeruli or some glomeruli Whether the entire glomerulus or only parts of it are involved What anatomic part of the glomerulus is affected First layer is the endothelial cells Sit on basement membrane Podocytes

Answer 14

loss of kidney function, edema

Answer 15

classification of glomerular disease Massive proteinuria The protein comes from albumin in the blood Leads to hypoalbuminemia Lost in osmotic pressure which is what results in edema Results in edema

Answer 16

- inflammation induced injury of capillary - less severe proteinuria - hematuria classification of glomerular disease

Answer 17

Not all glomeruli are affected Only parts of affected glomeruli are sclerotic Epithelial cell foot processes are disrupted Protein deposits occlude capillaries Glomeruli become progressively sclerotic Can lead to end-stage renal disease Where your kidneys aren’t able to do their job -- dialysis -Sclerosis = hardening Focal = one small part of the whole thing

Answer 18

Acute post infectious glomerulonephritis Inflammation of the glomerulus (break down the word) Usually follows a bacterial infection Circulating antigen and antibody complexes deposit on glomeruli Leukocytes release enzymes, causing inflammation

Answer 19

Clinical course Sudden onset in child Edema Nausea, malaise, fever Oliguria - urinating less than normal - tells you the kidneys are starting to not work as well Hypertension - because you aren’t getting rid of the fluids that you would during urination, so the fluids just stay in your body, blood volume goes up -- blood pressure goes up Elevation of BUN = blood urea nitrogen - what is filtered most by the kidney Urine RBC Protenuria Prognosis = 95% children recover - if caught on time, if not then waste products can accumulate

Answer 20

Nephrosclerosis, sclerosis = hardening Complication of hypertension, diabetes If you have both of these it can make it even worse Renal arteries undergo thickening, scarring Glomeruli and tubules undergo secondary degenerative changes Narrowing of lumen and reduction in blood flow Reduced glomerular filtration Kidneys shrink - atrophy Supplying it with less blood May lead to chronic renal failure Treatment? Dialysis

Answer 21

Pathology of the nephron due to diabetes (breaking down the word) Complication of long-standing diabetes (type I and type II) Damage to micro vessels (due to sugar getting attached to the blood vessels and leading to damage) Most common cause of renal failure Glomerulosclerosis Decreased surface area for filtration Manifestations Progressive impairment of renal function No specific treatment can arrest progression of disease Controlling blood sugars, know that you are diabetic Progressive impairment of renal function may lead to renal failure

Answer 22

Interstitial nephritis = inflammation Spaces between tubules become inflamed Most commonly caused by allergic reaction to drug Your kidneys filter out the antibiotics, so they are exposed to high levels of the drug that you are taking so if you are allergic it can have a negative impact May be completely asymptomatic or may cause Fever Nausea and vomiting Skin rash Edema and hematuria

Answer 23

Urothelial carcinoma Smoking = most common risk factor Exposed to high levels of toxins

Answer 24

Nephroblastoma = wilms tumor (of the kidneys) Rare, highly malignant

Answer 25

renal cell carcinoma Risk factors Smoking Age Males Chronic kidney disease Hematuria often first symptom

Answer 26

Does not occur until both kidneys are severely compromised Less waste is removed - waste starts to build up Types Acute - often reversible Chronic Problem = more waste remains in the blood

Answer 27

Manifested as uremia = urine in the blood Renal filtering function decreases Altered fluid and electrolyte balance Acidosis, hyperkalemia, salt wasting, hypertension Wastes build up in blood Increaseed creatinine and BUN Toxic to CNS, RBCs, platelets Kidney metabolic functions decrease Decreased erythropoietin Less red blood cells → anemia Decreased vitamin D activation Vitamin D → bone building, have to activate vitamin D in order for it to be used by the body, so no matter how much you consume the kidneys are required to bind it and make it work

Answer 28

Sudden and rapidly progressive within hours (often reversible) abrupt reduction in renal function Oliguria, anuria

Answer 29

Chronic, slowly progression to end-stage renal failure over months or years

Answer 30

damage to tubules Pathogenesis Impaired renal blood flow Shock DIC Toxic drugs or chemicals Antifungal medications Antibiotics Clinical manifestation Acute renal failure Oliguria, anuria Survival rate 50% Tubular function may gradually recover Treated by dialysis until function returns

Answer 31

The irreversible loss of renal function that affects nearly all organ systems Little bit lost at a time and continues to be lost Main causes in U.S Hypertension Diabetes Progression Reduced renal reserve Renal insufficiency Renal failure End-stage renal disease

Answer 32

dialysis - peritoneal or extracorporeal kidney transplant