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HLSC 222 - Pathophysiology Across the Lifespan > Chapter 30 - Alterations in Renal and Urinary Function > Flashcards

Chapter 30 - Alterations in Renal and Urinary Function Flashcards

1
Q

What are the two most common urinary disorders?

A

-bladder infection
-obstruction of urinary tract via stones, tumours, inflammation

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2
Q

What are the 3 possible outcomes of disorders of the kidney (or systemic diseases involving the kidney)?

A

-acute or chronic kidney injury
-kidney failure

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3
Q

Kidney failure is a _____ ________ condition

A

life threatening

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4
Q

What is a urinary tract obstruction?

A

interference with urinary flow along the urinary tract

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5
Q

Impeded urine flow increases risk of __________

A

infection

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6
Q

What does obstructive uropathy mean?

A

anatomical changes causing obstruction

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7
Q

What two parts make up the upper urinary tract?

A

kidneys and ureters

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8
Q

What two parts make up the lower urinary tract?

A

bladder and urethra

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9
Q

Obstruction of the UUT results in the _____ ___ of urine and dilation of the area

A

backing up

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10
Q

Pressure from UUT obstruction on the glomerulus reduces __________

A

filtration

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11
Q

Hydroureter

A

accumulation of urine in the ureter

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12
Q

Hydronephrosis

A

accumulation of urine in calyces and renal pelvis

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13
Q

__________ is an early response to obstruction

A

dilation

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14
Q

Where does stasis occur with a UUT infection?

A

above the obstruction - between obstruction and glomerulus

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15
Q

Stasis

A

cessation of urinary flow

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16
Q

Within ____ days, tubulointerstitial fibrosis occurs

A

7

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17
Q

What is tubulointerstitial fibrosis?

A

excessive collagen, hardening, and scarring

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18
Q

Within _____ days both the distal and proximal nephron are affected

A

14

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19
Q

Glomerular damage occurs in ____ days

A

28

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20
Q

What is compensatory hypertrophy?

A

when the unobstructed kidney increases the size of glomeruli and tubules (not the total # of nephrons)

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21
Q

Interstitial

A

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

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22
Q

What are kidney stones?

A

masses of crystals, proteins, etc.

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23
Q

Where do kidney stones affect?

A

kidneys, ureters, bladder

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24
Q

Kidney stone formation starts with the supersaturation of ______ in urine

A

salts

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25
Q

Is Na+ the only ion that forms salts?

A

no, many do

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26
Q

In step 2 of kidney stone formation, precipitation of salts converts them from _____ to ______ state

A

liquid to solid

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27
Q

In step 3 the _________ of salts into stone occurs

A

aggregation

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28
Q

Step 4 involves the absence of stone ________

A

inhibitors

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29
Q

Urine pH >____ increases risk for calcium phosphate stone

A

7.0

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30
Q

Urine pH <_____ increases risk for uric acid stone

A

5.0

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31
Q

What determines the ability of the stone to be passed out during urination?

A

size of stone

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32
Q

What is the manifestation of kidney stone?

A

pain

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33
Q

Moderate to severe pain in flank that radiates to groin indicates _____ ______ obstruction

A

renal pelvis

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34
Q

Flank

A

sides and back of abdomen

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35
Q

Lower abdomen pain indicates _______ ______ obstruction

A

mid-ureter

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36
Q

Urgency to urinate and incontinence indicate ______ _______ obstruction

A

lower ureter

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37
Q

What is the treatment for kidney stones?

A

-imagine to determine location
-medication
-high-fluid intake
-surgery

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38
Q

Why is high-fluid intake necessary for kidney stone?

A

to reduce stone-forming substances

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39
Q

What type of surgery is done for kidney stones?

A

uteroscopy with laser (lithotripsy) to break the stones up

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40
Q

Lower urinary tract obstructions are related to:

A

-urine storage in bladder
-emptying urine

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41
Q

LUT obstruction can be ________ or ________ or both

A

neurogenic or anatomical

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42
Q

__________ is a common symptom of LUT obstruction

A

incontinence

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43
Q

What is a neurogenic bladder dysfuntion?

A

bladder dysfunction caused by neurological disorders

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44
Q

The type of neurogenic bladder dysfunction is related to the location of the ________

A

nerve

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45
Q

Dysfunction above ____ is called hyper-reflexia

A

C2

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46
Q

Hyper-reflexia involves…

A

-urgency to urinate
-urine leakage
-automatic bladder emptying when full

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47
Q

Stroke, TBI, MS, and Alzheimer’s are causes of _____________

A

hyper-reflexia

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48
Q

Dysfunction between ___ and ___ is called hyper-reflexia with sphincter contraction

A

C2 and S1

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49
Q

What happens with hyper-reflexia with sphincter contraction?

A

muscle contractions and external sphincter contraction occur at the same time causing a functional obstruction

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50
Q

Spinal-cord injury, Guillain-Barre syndrome, and vertebral disc issues cause…

A

hyper-reflexia with sphincter contraction

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51
Q

Dysfunction below ____ is called atonic (without tone) bladder

A

S1

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52
Q

What happens with atonic bladder?

A

urine retention and distention - a full bladder is sensed but the detrusor doesn’t contract leaving an unreactive bladder

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53
Q

Peripheral neuropathy, MS, and spinal injury are causes of _______ _______

A

atonic bladder

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54
Q

LUT anatomical obstructions can be urethral _________ or _________ enlargement

A

constriction; prostate

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55
Q

What is urethral constriction?

A

scarring that narrows the urethra and restricts urine flow from the bladder

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56
Q

Urethral constriction is more common in ______

A

men

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57
Q

How is urethral constriction treated?

A

urethrotomy (knife used to widen urethra)

58
Q

What 3 things can cause prostate enlargement?

A

-acute inflammation
-benign prostatic hyperplasia
-prostate cancer

59
Q

Prostate enlargement is treated with which medication?

A

alpha-blockers - terazosin (Hytrin) or tamsulosin (Flomax)

60
Q

What is acute cystitis?

A

inflammation of the bladder

61
Q

Where is the most common site of UTI?

A

blader

62
Q

Hyperemic (red) muscosa indicates ______ infection

A

mild

63
Q

What is hemorrhagic cystitis?

A

a more advanced infection with diffuse hemorrhage

64
Q

What forms on the epithelial bladder surface with suppurative cystitis?

A

pus

65
Q

Prolonged bladder infection can result in _________ of the bladder mucosa which can lead to ______ formation and possible _______

A

shedding; ulcer; necrosis

66
Q

Shedding of the bladder mucosa is a natural response to..

A

bacteria binding to the mucosa

67
Q

The bladder wall is not protected from _____, _____, etc.

A

salts, toxins

68
Q

What are the 3 most common pathogens that causes acute cystitis?

A

-E. coli bacteria
-Staphylococcus saprophyticus bacteria
-Schistosomiasis parasite

69
Q

Urine is normally ______ but contamination can occur when gram-______ E. coli move from the urethra to the _______

A

sterile; negative; kidney

70
Q

What structure on E. coli allows bacteria to bind and resist flushing during micturition?

A

fimbriae

71
Q

Bladder inflammation stimulates _______ receptors that initiate a feeling of ________ with a _____ volume in the bladder

A

stretch; fullness; small

72
Q

What is the treatment for acute cystitis?

A

antibiotics

73
Q

Painful bladder syndrome/Interstitial cystitis (PBC/IC) includes non-______ infection and non-_______ cystitis

A

bacterial; infection

74
Q

What causes (PBC/IC) non-bacterial infection?

A

virus or fungi

75
Q

Non-bacterial infection (PBC/IC) is most common among which group?

A

immunocompromised

76
Q

Non-infectious cystitis (PBC/IC) is associated with pelvic _________/__________

A

radiation/chemotherapy

77
Q

What causes PBC/IC

A

unknown

78
Q

What are the symptoms of PBC/IC

A

-bladder fullness
-nocturia
-chronic pelvic pain (>9 months)

79
Q

What is the treatment for PBC/IC?

A

-sacral nerve stimulaation
-surgery for refractory cases

80
Q

Refractory Cases

A

long lasting or difficult to cure

81
Q

What is acute pyelonephritis?

A

sudden or severe kidney infections of one or both upper urinary ureters

82
Q

What are the 2 most common risk factors for acute pyelonephritis?

A

-urinary obstruction
-reflux of urine from bladder

83
Q

Acute pyelonephritis is more common in ________

A

women

84
Q

With AP, _______ splits urea into ______ making urine more ______ and increasing the risk of stone formation

A

E. coli; ammonia; alkaline

85
Q

AP is mainly an infection of the renal ______ and _____ but causes an influx of WBCs into the renal ________ leading to inflammation and edema

A

pelvis; calyces; medulla

86
Q

What is the treatment for AP?

A

-antibiotics

87
Q

How long does it take AP to respond to antibiotics?

A

2-3 weeks

88
Q

Bacteria decreases until urine becomes ______ again

A

sterile

89
Q

What is chronic pyelonephritis?

A

persistent or recurrent infections that lead to scarring of both kidneys

90
Q

Chronic pyelonephritis prevents elimination of __________

A

bacteria

91
Q

Progressive inflammation from CP destroys tubules and impairs urine-___________ ability

A

concentration

92
Q

CP results in…

A

chronic kidney disease (CKD)

93
Q

Progression of CP can lead to _____ ______

A

kidney failure

94
Q

Treatment for CP is related to…

A

underlying infection

95
Q

What is glomerulonephritis?

A

inflammation of the glomerulus caused by primary glomeruli injury

96
Q

Primary glomeruli injury can be…

A

-immune response
-ischemia
-free radicals
-medications
-infection from Streptococcal pathogens

97
Q

______ mechanisms are the major cause of injury to glomeruli filtration membrane

A

immune

98
Q

Immune injury is due to ________ and cytokines

A

complement

99
Q

What do compliments do?

A

form porins

100
Q

What do cytokines do?

A

cause invasion of macrophage, neutrophils, and T cells

101
Q

Glomerulonephritis results in the _____ being reduced leading to hypoxic injury

A

GFR

102
Q

Loss of negative charge across glomeruli filter results in ________ (neg. charged) leaking into the nephron

A

proteins

103
Q

Chronic glomerulonephritis can lead to _____ ____ _____ and may require dialysis or _____ _____

A

chronic kidney disease; kidney transplant

104
Q

Nephrotic Syndrome occurs when filtration of proteins exceeds _____ _______

A

tubular reabsorption

105
Q

Nephrotic Syndrome definition: excretion of ____g or more of protein of urine per day

A

3.5

106
Q

Nephrotic syndrome is a characteristic of _________ injury

A

glomerular

107
Q

Nephritic syndrome is characterized by _________ and red blood cell casts in urine

A

hematuria

108
Q

Hematuria

A

red blood cells in urine

109
Q

Red Blood Cell Casts

A

cylindrical structure created by kidney that contain red blood cells

110
Q

How does nephritic syndrome appear?

A

bleeding in nephron

111
Q

What is acute kidney disease (AKD)?

A

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

112
Q

AKD results in accumulation of ___________ waste products in blood

A

nitrogenous

113
Q

Accumulation of nitrogenous waste in blood is demonstrated by:

A

elevation in plasma creatinine and BUN levels

114
Q

Increased BUN = ______ dysfunction

A

kidney

115
Q

AKD results from ischemic injury from decreased renal ____ _____, _____ injury from chemicals, and _____-induced injury

A

blood flow; toxic; sepsis

116
Q

AKD injury initiated the _________ response which alters kidney function

A

inflammatory

117
Q

What is BUN?

A

blood urea nitrogen test

118
Q

What makes up urea?

A

oxygen, carbon, nitrogen, hydrogen

119
Q

Do BUN tests measure urea or nitrogen in blood?

A

nitrogen

120
Q

Nitrogen in blood = _____ in blood

A

urea

121
Q

What does increased urea in blood lead to?

A

kidney dysfunction

122
Q

Acute kidney injury has 3 phases that are:

A

oliguric, diuretic, recovery

123
Q

Oliguria is urine output less than ____ mL/day

A

400

124
Q

Oliguria occurs within __ to ___ days of kidney injury

A

1 to 7

125
Q

Urinalysis during the oliguric phase demonstrates _____

A

casts

126
Q

Oliguric phase involves _________ and ___________, with elevated BUN and creatinine

A

hyperkalemia and hyponatremia

127
Q

Hyperkalemia

A

increased blood K+

128
Q

Hyponatremia

A

lowered blood Na+

129
Q

How long does the diuretic phase last?

A

1-2 weeks or longer

130
Q

Urine output during the diuretic phase is ______ to _____

A

normal to high

131
Q

The diuretic phase is cause by the kidneys inability to ________ urine

A

concentrate

132
Q

What occurs during the diuretic phase due to decreased urine output?

A

-weight loss
-hypovolemia/hypotension

133
Q

What happens to BUN and creatinine during the diuretic and recovery phase?

A

they begin to normalize

134
Q

The recovery phase begins with ____ normalization

A

GFR

135
Q

What is chronic kidney disease?

A

progressive loss of renal function

136
Q

Chronic kidney disease is associated with diabetes _______, ____tension, systemic lupus, intrinsic kidney disease

A

mellitus; hypertension

137
Q

What is the most significant risk factor for CKD?

A

diabetes mellitus

138
Q

What is systemic lupus?

A

an autoimmune disease where the immune system attacks its own tissues

139
Q

What is intrinsic kidney disease?

A

direct damage to kidneys that results in sudden loss of kidney function

140
Q

How does scarring and fibrosis occur with CKD?

A

-infiltration with inflammatory cells
-loss of renal cells via necrosis and apoptosis
-production of fibroblasts

141
Q

Which mechanisms accelerate CKD progression?

A

-hypertension
-glomerular hypertrophy
-increased calcium phospahte

142
Q

What is focal segmental glomerulosclerosis?

A

scar tissue in glomerulus

HLSC 222 - Pathophysiology Across the Lifespan (17 decks)

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