Chapter 30 - Alterations in Renal and Urinary Function Flashcards
What are the two most common urinary disorders?
-bladder infection
-obstruction of urinary tract via stones, tumours, inflammation
What are the 3 possible outcomes of disorders of the kidney (or systemic diseases involving the kidney)?
-acute or chronic kidney injury
-kidney failure
Kidney failure is a _____ ________ condition
life threatening
What is a urinary tract obstruction?
interference with urinary flow along the urinary tract
Impeded urine flow increases risk of __________
infection
What does obstructive uropathy mean?
anatomical changes causing obstruction
What two parts make up the upper urinary tract?
kidneys and ureters
What two parts make up the lower urinary tract?
bladder and urethra
Obstruction of the UUT results in the _____ ___ of urine and dilation of the area
backing up
Pressure from UUT obstruction on the glomerulus reduces __________
filtration
Hydroureter
accumulation of urine in the ureter
Hydronephrosis
accumulation of urine in calyces and renal pelvis
__________ is an early response to obstruction
dilation
Where does stasis occur with a UUT infection?
above the obstruction - between obstruction and glomerulus
Stasis
cessation of urinary flow
Within ____ days, tubulointerstitial fibrosis occurs
7
What is tubulointerstitial fibrosis?
excessive collagen, hardening, and scarring
Within _____ days both the distal and proximal nephron are affected
14
Glomerular damage occurs in ____ days
28
What is compensatory hypertrophy?
when the unobstructed kidney increases the size of glomeruli and tubules (not the total # of nephrons)
Interstitial
relating to spaces between cells, tissues, or organs in the body
What are kidney stones?
masses of crystals, proteins, etc.
Where do kidney stones affect?
kidneys, ureters, bladder
Kidney stone formation starts with the supersaturation of ______ in urine
salts
Is Na+ the only ion that forms salts?
no, many do
In step 2 of kidney stone formation, precipitation of salts converts them from _____ to ______ state
liquid to solid
In step 3 the _________ of salts into stone occurs
aggregation
Step 4 involves the absence of stone ________
inhibitors
Urine pH >____ increases risk for calcium phosphate stone
7.0
Urine pH <_____ increases risk for uric acid stone
5.0
What determines the ability of the stone to be passed out during urination?
size of stone
What is the manifestation of kidney stone?
pain
Moderate to severe pain in flank that radiates to groin indicates _____ ______ obstruction
renal pelvis
Flank
sides and back of abdomen
Lower abdomen pain indicates _______ ______ obstruction
mid-ureter
Urgency to urinate and incontinence indicate ______ _______ obstruction
lower ureter
What is the treatment for kidney stones?
-imagine to determine location
-medication
-high-fluid intake
-surgery
Why is high-fluid intake necessary for kidney stone?
to reduce stone-forming substances
What type of surgery is done for kidney stones?
uteroscopy with laser (lithotripsy) to break the stones up
Lower urinary tract obstructions are related to:
-urine storage in bladder
-emptying urine
LUT obstruction can be ________ or ________ or both
neurogenic or anatomical
__________ is a common symptom of LUT obstruction
incontinence
What is a neurogenic bladder dysfuntion?
bladder dysfunction caused by neurological disorders
The type of neurogenic bladder dysfunction is related to the location of the ________
nerve
Dysfunction above ____ is called hyper-reflexia
C2
Hyper-reflexia involves…
-urgency to urinate
-urine leakage
-automatic bladder emptying when full
Stroke, TBI, MS, and Alzheimer’s are causes of _____________
hyper-reflexia
Dysfunction between ___ and ___ is called hyper-reflexia with sphincter contraction
C2 and S1
What happens with hyper-reflexia with sphincter contraction?
muscle contractions and external sphincter contraction occur at the same time causing a functional obstruction
Spinal-cord injury, Guillain-Barre syndrome, and vertebral disc issues cause…
hyper-reflexia with sphincter contraction
Dysfunction below ____ is called atonic (without tone) bladder
S1
What happens with atonic bladder?
urine retention and distention - a full bladder is sensed but the detrusor doesn’t contract leaving an unreactive bladder
Peripheral neuropathy, MS, and spinal injury are causes of _______ _______
atonic bladder
LUT anatomical obstructions can be urethral _________ or _________ enlargement
constriction; prostate
What is urethral constriction?
scarring that narrows the urethra and restricts urine flow from the bladder
Urethral constriction is more common in ______
men
How is urethral constriction treated?
urethrotomy (knife used to widen urethra)
What 3 things can cause prostate enlargement?
-acute inflammation
-benign prostatic hyperplasia
-prostate cancer
Prostate enlargement is treated with which medication?
alpha-blockers - terazosin (Hytrin) or tamsulosin (Flomax)
What is acute cystitis?
inflammation of the bladder
Where is the most common site of UTI?
blader
Hyperemic (red) muscosa indicates ______ infection
mild
What is hemorrhagic cystitis?
a more advanced infection with diffuse hemorrhage
What forms on the epithelial bladder surface with suppurative cystitis?
pus
Prolonged bladder infection can result in _________ of the bladder mucosa which can lead to ______ formation and possible _______
shedding; ulcer; necrosis
Shedding of the bladder mucosa is a natural response to..
bacteria binding to the mucosa
The bladder wall is not protected from _____, _____, etc.
salts, toxins
What are the 3 most common pathogens that causes acute cystitis?
-E. coli bacteria
-Staphylococcus saprophyticus bacteria
-Schistosomiasis parasite
Urine is normally ______ but contamination can occur when gram-______ E. coli move from the urethra to the _______
sterile; negative; kidney
What structure on E. coli allows bacteria to bind and resist flushing during micturition?
fimbriae
Bladder inflammation stimulates _______ receptors that initiate a feeling of ________ with a _____ volume in the bladder
stretch; fullness; small
What is the treatment for acute cystitis?
antibiotics
Painful bladder syndrome/Interstitial cystitis (PBC/IC) includes non-______ infection and non-_______ cystitis
bacterial; infection
What causes (PBC/IC) non-bacterial infection?
virus or fungi
Non-bacterial infection (PBC/IC) is most common among which group?
immunocompromised
Non-infectious cystitis (PBC/IC) is associated with pelvic _________/__________
radiation/chemotherapy
What causes PBC/IC
unknown
What are the symptoms of PBC/IC
-bladder fullness
-nocturia
-chronic pelvic pain (>9 months)
What is the treatment for PBC/IC?
-sacral nerve stimulaation
-surgery for refractory cases
Refractory Cases
long lasting or difficult to cure
What is acute pyelonephritis?
sudden or severe kidney infections of one or both upper urinary ureters
What are the 2 most common risk factors for acute pyelonephritis?
-urinary obstruction
-reflux of urine from bladder
Acute pyelonephritis is more common in ________
women
With AP, _______ splits urea into ______ making urine more ______ and increasing the risk of stone formation
E. coli; ammonia; alkaline
AP is mainly an infection of the renal ______ and _____ but causes an influx of WBCs into the renal ________ leading to inflammation and edema
pelvis; calyces; medulla
What is the treatment for AP?
-antibiotics
How long does it take AP to respond to antibiotics?
2-3 weeks
Bacteria decreases until urine becomes ______ again
sterile
What is chronic pyelonephritis?
persistent or recurrent infections that lead to scarring of both kidneys
Chronic pyelonephritis prevents elimination of __________
bacteria
Progressive inflammation from CP destroys tubules and impairs urine-___________ ability
concentration
CP results in…
chronic kidney disease (CKD)
Progression of CP can lead to _____ ______
kidney failure
Treatment for CP is related to…
underlying infection
What is glomerulonephritis?
inflammation of the glomerulus caused by primary glomeruli injury
Primary glomeruli injury can be…
-immune response
-ischemia
-free radicals
-medications
-infection from Streptococcal pathogens
______ mechanisms are the major cause of injury to glomeruli filtration membrane
immune
Immune injury is due to ________ and cytokines
complement
What do compliments do?
form porins
What do cytokines do?
cause invasion of macrophage, neutrophils, and T cells
Glomerulonephritis results in the _____ being reduced leading to hypoxic injury
GFR
Loss of negative charge across glomeruli filter results in ________ (neg. charged) leaking into the nephron
proteins
Chronic glomerulonephritis can lead to _____ ____ _____ and may require dialysis or _____ _____
chronic kidney disease; kidney transplant
Nephrotic Syndrome occurs when filtration of proteins exceeds _____ _______
tubular reabsorption
Nephrotic Syndrome definition: excretion of ____g or more of protein of urine per day
3.5
Nephrotic syndrome is a characteristic of _________ injury
glomerular
Nephritic syndrome is characterized by _________ and red blood cell casts in urine
hematuria
Hematuria
red blood cells in urine
Red Blood Cell Casts
cylindrical structure created by kidney that contain red blood cells
How does nephritic syndrome appear?
bleeding in nephron
What is acute kidney disease (AKD)?
a sudden decline in kidney function with a decrease in glomerular filtration and urine output
AKD results in accumulation of ___________ waste products in blood
nitrogenous
Accumulation of nitrogenous waste in blood is demonstrated by:
elevation in plasma creatinine and BUN levels
Increased BUN = ______ dysfunction
kidney
AKD results from ischemic injury from decreased renal ____ _____, _____ injury from chemicals, and _____-induced injury
blood flow; toxic; sepsis
AKD injury initiated the _________ response which alters kidney function
inflammatory
What is BUN?
blood urea nitrogen test
What makes up urea?
oxygen, carbon, nitrogen, hydrogen
Do BUN tests measure urea or nitrogen in blood?
nitrogen
Nitrogen in blood = _____ in blood
urea
What does increased urea in blood lead to?
kidney dysfunction
Acute kidney injury has 3 phases that are:
oliguric, diuretic, recovery
Oliguria is urine output less than ____ mL/day
400
Oliguria occurs within __ to ___ days of kidney injury
1 to 7
Urinalysis during the oliguric phase demonstrates _____
casts
Oliguric phase involves _________ and ___________, with elevated BUN and creatinine
hyperkalemia and hyponatremia
Hyperkalemia
increased blood K+
Hyponatremia
lowered blood Na+
How long does the diuretic phase last?
1-2 weeks or longer
Urine output during the diuretic phase is ______ to _____
normal to high
The diuretic phase is cause by the kidneys inability to ________ urine
concentrate
What occurs during the diuretic phase due to decreased urine output?
-weight loss
-hypovolemia/hypotension
What happens to BUN and creatinine during the diuretic and recovery phase?
they begin to normalize
The recovery phase begins with ____ normalization
GFR
What is chronic kidney disease?
progressive loss of renal function
Chronic kidney disease is associated with diabetes _______, ____tension, systemic lupus, intrinsic kidney disease
mellitus; hypertension
What is the most significant risk factor for CKD?
diabetes mellitus
What is systemic lupus?
an autoimmune disease where the immune system attacks its own tissues
What is intrinsic kidney disease?
direct damage to kidneys that results in sudden loss of kidney function
How does scarring and fibrosis occur with CKD?
-infiltration with inflammatory cells
-loss of renal cells via necrosis and apoptosis
-production of fibroblasts
Which mechanisms accelerate CKD progression?
-hypertension
-glomerular hypertrophy
-increased calcium phospahte
What is focal segmental glomerulosclerosis?
scar tissue in glomerulus
