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Pathophysiology > Chapter 30 - Alteration In Renal And Urinary Tract Function > Flashcards

Chapter 30 - Alteration In Renal And Urinary Tract Function Flashcards

1
Q

Most common urinary disorders are

A

-bladder infection
-stones, tumours, inflammation causing obstructed urinary tract

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2
Q

Disorders of kidney or systemic diseases affecting kidney can result in

A

-acute kidney injury
-chronic kidney injury
-kidney failure (life threatening)

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3
Q

Urinary tract obstruction

A

Interference with urinary flow along urinary tract

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4
Q

Impeded flow =

A

Increased risk of infection

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5
Q

Obstructive uropathy

A

Anatomical changes causing obstruction

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6
Q

Upper vs lower urinary tract

A

U: kidneys and ureters

L: bladder and urethra

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7
Q

Upper urinary tract infections

A

Obstruction of the UUT results in BACKING UP of urine
-dilation

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8
Q

Upper urinary tract infections: pressure is transmitted to

A

Glomerulus which causes reduced filtration

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9
Q

Hydroureter

A

Accumulation of urine in ureter

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10
Q

Hydronephrosis

A

Accumulation of urine in calyces and renal pelvis

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11
Q

What is an early response to obstruction

A

Dilation

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12
Q

Upper urinary tract infections: stasis

A

Cessation of urinary flow
-occurs above obstruction between obstruction and glomerulus

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13
Q

Within 7 days (of Upper urinary tract infections)

A

Tubulonintersitial fibrosis
-excessive collagen, hardening and scarring

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14
Q

Upper urinary tract infections: 14 days

A

Both distal and proximal nephron affected

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15
Q

Upper urinary tract infections: 28 days

A

Glomeruli damaged

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16
Q

Compensatory hypertrophy

A

Unobstructed kidney increases the size of glomeruli and tubules
-but not the total number of nephrons

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17
Q

Interstitial

A

Relating to spaces between cells, tissues or organs in the body

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18
Q

Kidney stones (CALCULI)

A

Masses of crystals, proteins etc
-located in kidneys ureters and bladder

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19
Q

Progression of stone formation (4)

A
  1. Supersaturation of salts in urine (many ions capable of forming salts)
  2. Precipitation of salts from liquid to solid state
  3. Aggregation of salts into stone
  4. Absence of stone inhibitors
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20
Q

Urine contributing factors: >7.0

A

Increased risk of calcium phosphate stone

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21
Q

Urine contributing factors: <5.0

A

Increased risk of urine acid stone

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22
Q

Size of stone determines

A

It’s ability to be passed out through urination

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23
Q

Moderate to severe pain in flank (sides and back of abdomen) radiating to groin indicates

A

Obstruction of renal pelvis

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24
Q

Lower abdomen pain =

A

Obstruction in mid ureter

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25
Q

Urgency to urinate or incontinence =

A

Obstruction in lower ureter

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26
Q

TX for kidney stones

A

-imaging studies to determine location
-medications
-high fluid intake to reduce
-surgery (laser lithotripsy)

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27
Q

Lithotrispy

A

To fragment stones
-ureteroscopy with laser

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28
Q

Lower urinary tract obstructions are related to

A

-urine storage in bladder
-emptying of urine
-neurogenic/anatomical (or both)

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29
Q

Common symptom associated with lower urinary tract obstruction

A

Incontinence

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30
Q

Neurogenic bladder

A

Bladder dysfunction caused by neurological disorders

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31
Q

Type of dysfunction is related to

A

Related nerve location

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32
Q

Above C2 is

A

Hyper-reflexia

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33
Q

Hyper-reflexia (above C2) is caused by

A

Stroke, TBI, MS, Alzheimer’s

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34
Q

Hyper-reflexia (above C2)

A

Urgency to urinate and urine leakage
-bladder empties automatically when full

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35
Q

Between C2-S1 is called

A

Hyper-reflexia with sphincter contraction

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36
Q

Hyper-reflexia with sphincter contraction (between C2-S1) is caused by

A

Spinal cord injury, Gillian barre syndrome, vertebral disc issues

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37
Q

Hyper-reflexia with sphincter contraction (between C2-S1)

A

Muscle contractions and external sphincter contraction at the same time
-causes functional obstruction of bladder

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38
Q

Below S1 is called

A

Atonic (without tone) bladder

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39
Q

Atonic (without tone) bladder (bellow S1) is caused by

A

Peripheral neuropathy, MS, spinal injury

40
Q

Atonic (without tone) bladder (below S1)

A

Urine retention and distension
-full bladder is sensed, but destrusor does not contract and you have an unreactive bladder

41
Q

Urethral constriction

A

Scarring that narrows urethra and restricts flow of urine from bladder
-mostly in men, rarely in women

42
Q

TX urethral constriction

A

Urethrotomy
-surgical knife used to widen urethra

43
Q

Prostate enlargement is caused by

A

Caused by acute inflammation, benign prostatic hyperplasia, cancer

44
Q

TX for prostate enlargement

A

Medication (alpha blockers such as terazosin (hytrin) or tamsulosin (flomax))

45
Q

Acute cystitis

A

Inflammation of bladder
-most common site of UTI

46
Q

Acute cystitis: mild infection

A

Mucosa is hyperaemic (red)

47
Q

Acute cystitis: hemorrhagic cystitis

A

More advanced, diffuse hemorrhage

48
Q

Acute cystitis: suppurative cystitis

A

Pus forms on epithelial bladder surface

49
Q

Acute cystitis as a prolonged infection

A

Can result in shedding of bladder mucosa
-causing ulcer formation and possible necrosis of bladder wall

50
Q

When bacteria bind to bladder mucosa what is the natural response of the immune system

A

Shedding

51
Q

What is the negative side effect of the immune system shedding

A

Bladder wall now is not protected from salts, toxins etc

52
Q

Most common pathogens in Acute cystitis

A

E. coli, Staph. Saprophyticus and parasite schistosomiasis

53
Q

How does bacterial contamination occur in Acute cystitis

A

Movement of gram negative e.coli from urethra eventually to kidney

54
Q

What allows e.coli to bind to epithelium and resist flushing during micturtiion

A

Fimbriae

55
Q

Result of Acute cystitis

A

Inflammation of bladder stimulates stretch receptors, intimating feeling of fullness with only small volumes in bladder

56
Q

TX for Acute cystitis

A

Antibiotics

57
Q

Painful bladder syndrome/interstitial cystitis: non bacterial

A

Viral or fungal
-most common in immunocompromised

58
Q

Painful bladder syndrome/interstitial cystitis: non infectious cystitis

A

Associated with radiation, chemotherapy treatment for pelvic regions

59
Q

Cause of Painful bladder syndrome/interstitial cystitis

A

Unknown

60
Q

Symptoms of Painful bladder syndrome/interstitial cystitis

A

Bladder fullness, nocturia, chronic pelvic pain lasting longer than 9 months

61
Q

TX for Painful bladder syndrome/interstitial cystitis

A

-sacral nerve stimulation
-surgery for refractory cases

62
Q

Acute pyelonephritis

A

Sudden and severe kidney infection infecting one or both upper urinary ureters

63
Q

Most common risk factors and gender common in Acute pyelonephritis

A

-urinary obstruction and reflux of urine from bladder

-women

64
Q

What bacteria is primary in Acute pyelonephritis, and what does it do

A

-e.coli

-splits urea into ammonia = alkaline urine = increased risk of stone formation

65
Q

Where does the infection mostly occur, and what does the infection cause (Acute pyelonephritis)

A

-renal pelvis and calyces

-causes influx of WBC into kidney medulla causing inflammation and Edelman

66
Q

TX for Acute pyelonephritis

A

-AP responds well to 2-3 weeks of microorganism specific antibiotics
-bacteria will Dec until urine becomes sterile again

67
Q

Chronic pyelonephritis

A

Persistent and recurrent infections leading to scarring of both kidneys

68
Q

Chronic obstruction in Chronic pyelonephritis prevents

A

Elimination of bacteria
-there will be progressive inflammation causing tubule destruction and impaired urine concentration ability

69
Q

Result of Chronic pyelonephritis

A

Chronic kidney disease
-can lead to kidney failure

70
Q

TX for Chronic pyelonephritis

A

Related to specifics of underlying infections

71
Q

Glomerulonephritis (what/cause)

A

Inflammation of glomerulus caused by primary glomeruli injury

72
Q

Primary glomeruli injury can be caused by..

A

-immunological responses
-ischemia
-free radicals
-medications
-infections (strep)

73
Q

What causes the major injuring in Glomerulonephritis, and what does it result in

A

Immune mechanisms
-damages glomeruli filter membrane

74
Q

Glomerulonephritis: injury is caused by

A

Complement (from porins) and cytokines
-cause invasion of macrophage, neutrophils and T cells

75
Q

Result of infiltration in Glomerulonephritis

A

Glomeruli filtration rate is reduced, causing hypoxic injury

76
Q

Glomerulonephritis: loss of negative charge across glomeruli filter results in

A

Proteins (negatively charged) leaking into nephron

77
Q

Chronic Glomerulonephritis leads to

A

Chronic kidney disease
-dialysis or kidney transplant may be required

78
Q

Nephrotic syndrome

A

Occurs when filtration of proteins exceeds tubular reabsorption

79
Q

Nephritic syndrome

A

Characterized by hematuria (RBC in urine) and RBC casts (cylindrical structures created by kidney containing red blood cells) excreted in urine

80
Q

Nephrotic syndrome vs nephritic syndrome

A

Nephrotic: excretion of 3.5g or more of PROTEIN in urine per day, glomerular injury

Nephritic: bleeding in nephron, blood in urine

81
Q

Acute kidney disease

A

Sudden decline in kidney function with a decrease in glomerular filtration and urine output

82
Q

Results of Acute kidney disease

A

Accumulation of nitrogenous waste products in blood which is demonstrated by elevation in plasma creatinine and BUN levels

83
Q

How can we tell there is in an inc of nitrogenous waste products in blood

A

Elevation in plasma creatinine and BUN levels

84
Q

Acute kidney disease results from

A

Ischemic injury related to decreased renal blood flow, toxic injury from chemicals and sepsis induced injury

85
Q

Acute kidney disease: injury initiates inflammatory response =

A

cell death = alterations in kidney function

86
Q

Urea is composed of

A

Oxygen, carbon, nitrogen and hydrogen

87
Q

BUN test measures

A

Nitrogen in blood

Nitrogen in blood = urea in blood
-inc urine in blood = kidney dysfunction

88
Q

Acute kidney injury: oliguric phase

A

Less than 400ml/day urine output
-occurs 1 to u days of kidney injury

-casts, hyperkalemia (inc blood K+), hyponatremia (dec Na+), elevated BUN and creatinine

89
Q

Acute kidney injury: diuretic phase

A

1-2 weeks or possibly longer
-urine output is normal to high (bc kidney has lost ability to concentrate urine)

-weight loss, hypovolemia/hypotension due to inc urine output, BUN and creatinine begin to normalize

90
Q

Acute kidney injury: recovery phase

A

Begins with GFR normalization
-BUN and creatinine levels begin to normalize

91
Q

Chronic kidney disease

A

Progressive loss of renal function

92
Q

Chronic kidney disease is associated with

A

-diabetes mellitus (most significant risk factor)
-hypertension
-systemic lupus
-intrinsic kidney disease

93
Q

Systemic lupus

A

Autoimmune disease where the immune system attacks its own tissues

94
Q

Intrinsic kidney disease

A

Direct damage to kidneys and sudden loss in kidney function

95
Q

Chronic kidney disease: sequences of events leading to scarring and fibrosis

A

-infiltration of damaged kidney with inflammatory cells
-loss of renal cells through apoptosis and necrosis
-production of fibroblasts

96
Q

Mechanisms of accelerated progression of CKD

A

-systemic and intraglomerular hypertension
-glomerular hypertrophy
-inc Ca+ phosphate in kidney

97
Q

Mechanisms in Chronic kidney disease lead to

A

Focal segmental glomerulosclerosis
-scar tissue in glomerulus

Pathophysiology (20 decks)

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