Chapter 33 Flashcards
name three types of disorders of renal function
- obstructive disorders
- glomerular damage
- tubulointerstital disorders
any age, any level of urinary tract. partial or incomplete. sudden or insidious. unilateral or bilateral.
obstructive disorders
name some causes of obstructive disorders
infection/inflammation, kidney stones, bengin prostatic hypertrophy, pregnancy, tumors, fibrosis, congenital structural defects.
mechanisms of renal damage:
degree and duration
effects of obstruction
stasis of urine and progressive dilation of renal collecting ducts and tubular structures
bilateral or unilateral obstruction causes
reduced perfusion, reduced GFR, reduced blood flow and renal failure
two types of outflow obstruction:
urethral stricture and hydronephrosis
causes bladder distention and progresses to ureters and the kidneys
urethral stricture
kidney enlarges as urine collects and to dilates the renal pelvis and calyces proximal to a blockage
hydronephrosis
kidney stones most commonly develop in the
renal pelvis but can be anywhere
predisposing factors of kidney stones:
dehydration, prolonged immoblization, infection, obstruction/stasis, anything that causes urine to be alkaline, metabolic factors
which theory: urine is supersaturated with stone components
saturation theory
which theory: organic material acts as a nucleus for stone formation
matrix theory
deficiency of substance that inhibit stone formation
inhibitor theory
four types of kidney stone
calicum stones, magnesium ammonium phospate, uric acid stones, cystine stones
calicum stones have increased concentration in
blood and urine
contributors to calicum stones
excessive bone resorption and high oxalate concentrations in blood and urine
what type of kidney stone: form in alkaline urine. Must have bacteria. alos called staghorn stones. large
MAP (magnesium ammonia phosphate)
what kind of kidney stone: elevated uric acid. not visble on xrays. form in acid urine. most common in those with guot.
uric acid stone
complication of obstruction:
if untreated what can happen in 48 hours?
permanet damage
inflammation of the urinary epithelieum caused by bacteria
UTI
cystitis is an __________ of the bladder
inflammation
nonbacterial infectious cysititis
interstital cystits
intersitital cystitis is most common in
women 20-30 years old
what are the manifestations of interstitial cystitis?
bladder fullness, frequency, small urine volume, pelvic pain
acute infection of the renal pelvis interstitium
acute pyelonephritits
persistent or recurring episodes of acute pyelonephritis that leading to scarring.
chronic pyelonephritis
absence of known predisposing factors that affect the microbiolgy, incidence and recurrence rates of UTI.
uncomplicated UTI
people who are more at risk for a UTI
those with neurogenic bladder disorders, obstruction and reflux, pregnant women, indwelling catheter, men with prostate problems and diabetics
what are some reasons for recurrent UTI?
reflux flow of urine and resistant bacteria
glomerular damage will:
- decrease efficency of filtration
- allow blood cells, lipids or proteins to pass into urine
- may interfere with clearance of waste
glomerulonephritis =
inflammation
manifestations of glomerulonephritis is
RBC casts and proteins/lipids escape
nephritic syndrome =
proliferative inflammatory response
nephritic syndrome:
RAA pathway activated=
hypertension
nephritic syndrome:
the inflammatory process damages the
capillary wall
nephritic syndrome:
RBC escape into the
urine –> hematuria with red cell casts
nephritic syndrome:
hemodynamic changes decrease the
GFR (<120)
- azotemia
- oliguria
- will also see proteinuria
constellation of clinical findings resulted from increased in glomerular permeability ad loss of plasma proteins (albumin) in the urine- which will also mean low albumin in the blood
nephrotic syndrome
which is worse nephrotic or nephritic
nephrotic
damage to vessels; thickening and scarring
diabetic nephrtopathy
widespread thickening of glomerular capillary basement membrane. ulimate obliteration of glomerulus
diabetic glomerulosclerosis
microalbuminuria is an early sign of
vascular damage
diabetic neuropathy and diabetic glomerulosclerosis is believed to be related to
elevated blood glucose, HTN, cigarette smoking.
inability to concentrate urine. interference with acidification of urine (inability to excrete acid). diminished tubular reabsorption of Na+ and other substances.
tubulointerstital disorders
tubulointerstital disorders are caused by
infections, drug induced damage, toxic injuries
