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Adv. Patho > Chapter 39: Alterations Of Renal System > Flashcards

Chapter 39: Alterations Of Renal System Flashcards

1
Q

Hydronephrosis

A

Abnormal dilation of the renal pelvis and the calyces of one or both kidneys
Excess fluid in the kidney DT back up of urine

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2
Q

Causes of hydronephronsis

A

tones, tumors, benign prostatic hyperplasia, strictures, stenosis, and congenital urologic defects
*all secondary to a blockage

Unilateral renal involvement indicates an obstruction in one of the ureters

Bilateral renal involvement indicates an obstruction in the urethra

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3
Q

Hydronephrosis s/sx

A

Manifestations: colicky,
flank pain or pressure; bloody, cloudy, or foul-smelling urine
dysuria
decreased urine output frequency; urgency
nausea; vomiting
abdominal distension
UTIs

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4
Q

Complications of hydronephrosis

A

Kidney failure

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5
Q

Dx of hydronephrosis

A

history, physical examination, urinalysis, renal ultrasound, computed tomography

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6
Q

Hydronephrosis tc

A

ureteral stents, stone removal, surgery

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7
Q

Nephrolithiasis

A

Kidney Stones!

Presence of renal calculi, hard crystals composed of minerals that the kidneys normally excrete

More common in men and Caucasians

Calculi can form in the renal pelvis, ureters, and bladder

The most frequent type of calculi contains calcium in combination with either oxalate or phosphate
Most common is Ca oxalate (commonly get from green leafy veg)

Other types include struvite , uric acid stones, and cysteine stones

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8
Q

Types of kidney stones

A

Ca stones

Struvite second most common. Caused by kidney infections.

UA stone from too much protein and genetics.
Rare: cystine stone -> more serious illness like cancer

<5mm stone can typically pass with little pain. 5-10mm pass half of the time, painful. >10mm need help passing

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9
Q

RF for nephrolithiasis

A

Excessive concentration of insoluble salts in the urine,
Urinary stasis,
Family history
Obesity,
Hypertension
Diet
Male

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10
Q

Nephrolithiasis s/sx

A

Manifestations:
colicky pain in the flank area that radiates to the lower abdomen and groin
bloody, cloudy, or foul-smelling urine
dysuria
frequency
genital discharge; nausea; vomiting; fever; and chills

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11
Q

Nephrolithiasis dx

A

history, physical examination, urine examination, CT of kidneys, ultrasound, calculi analysis
*non-contrast CT -> contrast binds with stones

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12
Q

Nephrolithiasis tx

A

strain all urine, increase fluids, shock wave lithotripsy, surgery, pain management, dietary changes, and physical activity

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13
Q

Neurogenic bladder

A

Bladder dysfunction caused by an interruption of normal bladder nerve innervation causing incontinence

Typically self-cath for rest of life

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14
Q

Cases of neurogenic bladder

A

brain or spinal cord injury, nervous system tumors, brain or spinal cord infections, dementia, diabetes mellitus, stroke, vaginal childbirth, multiple sclerosis, chronic alcoholism, SLE, and herpes zoster

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15
Q

BPH

A

A common, nonmalignant enlargement of the prostate gland that occurs as men age
The exact cause is unknown
As the prostate expands, it presses against the urethra and obstructs urine flow

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16
Q

Complications of BH

A

urinary stasis, hydronephrosis, and UTIs

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17
Q

BPH s/sx

A

frequency, urgency, retention, difficulty initiating urination, weak urinary stream, dribbling urine, nocturia, bladder distension, overflow incontinence, and erectile dysfunction

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18
Q

BPH s/sx

A

History, physical examination, urinalysis, prostate-specific antigen (PSA), biopsy, DRE -> draw blood before

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19
Q

BPH tx

A

Medications to relax and /or shrink the prostate or complete surgical removal of the prostate, and avoid alcohol and smoking

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20
Q

Elevated PSA causes

A

PSA is nonspecific, increased with large prostate
Enlarged prostate
Prostatitis
Prostate cancer
Recent ejaculation
DRE
Bicycle riding

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21
Q

Renal cell carcinoma

A

Most frequently occurring kidney cancer in adults ages 50-70
Primary tumor arising from the renal tubule
Cause unknown

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22
Q

RF of renal cell carcinoma

A

being male and smoking
Metastasis to the liver, lungs, bone, or nervous system is common

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23
Q

Renal cell carcinoma s/sx

A

May be asymptomatic,
painless hematuria
dull and achy flank pain,
urinary retention,
palpable mass over affected kidney
unexplained weight loss, night sweats fever.

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24
Q

Dx of renal cell carcinoma

A

history, physical examination, urinalysis, computed tomography, cystoscopy, biopsy, and blood chemistry

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25
Tx of renal cell carcinoma
surgery, chemotherapies.  
26
Bladder cancer
Cancer that forms in the tissue of the bladder Metastasis is common to the pelvic lymph nodes, liver, and bone
27
RF for bladder cancer
advancing age, men, Caucasians, working with chemicals, smoking, excessive use of analgesics, experience recurrent UTIs, long-term catheter placement, chemotherapy, and radiation
28
Bladder cancer s/sx
painless hematuria, abnormal urine color, frequency, dysuria, UTIs, and back or abdominal pain
29
Bladder cancer dx
ultrasound, cystoscopy, biopsy
30
Bladder cancer tx
surgical removal, radiation, chemotherapy.
31
UTI
Extremely common in women Acute Cystitis Lower tract most frequent site -> Escherichia coli
32
RF for UTI
female benign prostatic hypertrophy (BPH) (men) Urinary Stasis -> Obesity, pregnancy, stones, immobility Poor Hygiene Immunosuppressed
33
UTI manifestations
may be asymptomatic, urgency, dysuria, frequency, hematuria, bacteriuria, cloudy and foul-smelling urine, and symptoms of infection
34
UTI dx
history, physical examination, urinalysis -> WBCs, nitrites urine culture Cysto CBC
35
UTI tx
antibiotics, increasing hydration, avoiding irritants, performing proper perineal hygiene, wearing cotton underwear, not delaying urination, adequately emptying the bladder, and providing appropriate catheter care
36
Cystitis
Chronic Interstitial Inflammation of the bladder The bladder and urethra walls to become red and swollen Dx and tx same for UTI
37
Causes of cystitis
infection, irritants, idiopathic
38
Cystitis s/sx
UTI symptoms, abdominal pain, and pelvic pressure
39
Pyelonephritis
Infection that has reached one or both kidneys -> E. coli is the most common culprit Kidneys become grossly edematous and fill with exudate, compressing the renal artery Abscesses and necrosis can develop, impairing renal function and causing permanent damage May be acute or chronic
40
Pyelonephritis s/sx
Manifestations: severe UTI symptoms, flank pain, fever
41
Pyelonephritis dx
history, physical examination, urinalysis, urine and blood cultures, complete blood count, cystoscopy, intravenous pyelogram (like XR of urinary tract), ultrasound
42
Pyelonephritis tx
usual UTI treatments, but long-term antibiotics (4–6 weeks) are usually required
43
RFT
BUN, serum Cr, 24hr urine collection for Cr clearance, urinalysis, IVP, PSA
44
BUN
The end product of protein metabolism is urea, which is excreted entirely by the kidneys; therefore BUN is an indicator of liver and kidney function
45
Serum creatinine
Creatinine is formed when creatinine phosphate is send in skeletal mm contractions. Bc it is entirely excreted by the kidneys, the serum cr level is an indication of renal function (best). The cr level is not affected by hepatic function, so it is more precise indication of renal function than is BUN. A 50% reduction in GRF doubles the cr level
46
24-hr urine collection for cr clearance
Measures GFR and is dependent upon renal artery effusion and GF
47
Urinalysis
Cloudy, fol-smelling, WBCs =UTI. Dark yellow = dehydration Acetone odor =DKA Presence of protein = injured glo membrane Glucose = DM Ketones = fatty acid metabolism Crystals = possible renal stone formation Many hyaline cast = proteinuria Cellular cast = nephrotic syndrome
48
IVP
IV-admin, radiopaque ye allows the visualization of the kidneys, renal pelvis, ureters, and bladder
49
PSA
PSA is a glycoprotein found in al prostatic epithelial cells. An increase may be indicative of prostatic enlargement; thus this test is send to screen for prostatic cancer and as an indicator of tx success/failure
50
Renal failure
Kidneys are unable to function adequately Classified as either acute or chronic
51
AKI
Sudden loss of renal function Generally reversible Most common in critically ill, hospitalized patients especially with advanced age 1/3 of hospitalized ICU pt get AKI 15-20% overall hospitalized pt get AKI
52
AKI s/sx
Decreased UO Electrolyte Disturbances Azotemia -> increased waste products in blood Metabolic Acidosis
53
AKI tx
Dialysis Manage electrolytes HTN management Anemia Treatment Prevent Infection
54
Causes of AKI: prerenal
Sudden and severe drop in BP (she) or interruption of BF to the kidneys from severe injury or illness. Hypotension, HF, NSAIDS
55
Intrarenal causes of AKI
Direct damage to the kidneys by inflammation, toxins, drugs -ab and ace inhibitors, infection, or reduced blood supply -tissue ischemia
56
AKI causes: Post-renal
Sudden obstruction of urine flow dt enlarged prostate, kidney stones, bladder tumor, or injury
57
Chronic kidney dz
Gradual loss of kidney function which is irreversible During the disease process scar tissue replaces injured nephrons
58
Causes of CKD
Diabetes (leading cause) HTN Urine obstructions Renal Diseases Exposure to Toxins Smoking Aging
59
CKD 5 stages
CM begin to appear slowly as renal function declines by 50% Even with declining GFR, the kidneys can maintain relatively normal function Over time waste products begin to accumulate Stage 1: 90%+, kidney damage, normal function Stage 2: 60-89%, kidney damage, mild loss of function Stage 3: 30-59%, mod-severe loss of function Stage 4: 15-29%, severe loss of function Stage 5: 0-14%,, kidney failure, need tx to live
60
Multisystemic effects of CKD
Neuro: coma, HA, inattentiveness, lethargy, sz Hematologic: bleeding, immunosuppression, plt dysfunction Resp: pleural effusions CV arrhythmias, edemas, HF, HTN, pericarditis, GU: amenorrhea, hemtaria, proteinuria, Dermatological: dry skin, pour healing, pruritus, uremic frost GI: anorexia, decreased appetite, gastric hypo-motility, glucose intolerance, hyperP Skeletal: hyperP, hypoCa, weak brittle bones
61
Dx of CKD
Blood Chemistry (BUN Creatinine)
62
CKD tx
Stop progression. (main goal) Manage underlying causes Prevent complications Adjust medication dosages Renal dialysis Without treatment- mortality is 100%
63
Renal electrolytes
BUN and CR increase bc of increased waste products FVE -> HTN Na can vary –depends on stage of RF. Often have high levels bc of retention/lack of clearance K -> only excreted by kidneys. Increased K with AKI Cl follows Na, but, Metabolic acidosis -> CO2 decreased and CO2 and Cl are inverse so CL goes up Ca decreased, inverse to P and no vit D synthesis P increase, no excretion by kidneys Mg -> increased bc it is primarily excreted through kidneys
64
Glomeulonephritis
aka membranous neuropathy, is where the glo BM becomes inflamed and damaged, results in increased permeability and proteins being able to filter through the urine, causing nephrotic syndrome.
65
Nephrotic syndrome
• proteinuria (> 3.5 gms/day) • hypoalbumenia -> decreases on oncotic pressure -> decreased osmotic pressure -> edema • edema • hyperlipidemia • lipiduria
66
Causes of glo
Immune Complexes Damage GBM • Autoantibodies: target GBM ->Two major antigen targets thatve been identify are M-type phospholipase A2 receptor and neutral endopeptidase, which are both expressed on the polo type surface -the cells that line the BM, we know this bc a large proportion of cases, people with. People with membranous glo have antibodies against these autoantigens in their bloodstream. • May form outside kidney and carried to it ->Cationic bovine serum albumin. Present I cows milk and beef protein, and can escape the intestinal baker -> immune complex formation • Subepthelial deposits -> activate complement system -> membrane attack complex -> directly damages podocytes as well as mesangial cells, which are the cells that work to remove trapped residue and debris.complement system also recruits inflammatory cels that release proteases and oxidants-> damage BM and increase permeability -> allowing proteins to urine -> nephrotic syndrome • As a reaction to immune deposits, GM matrix is deposited bw the immune complexes, which makes GBM appear thicken on histology. On electron microscopy, looks like “spike and dome” pattern and effacement or flattening of the foot processes of the podocytes. On immunoflorscence, see deposits of immune complexes, which appear granular or sprinkled throughout GBM
67
Primary glo
(idiopathic) -> majority
68
Secondary glo
autoantibodies, infections, malignancy, autoimmune, medications
69
Most common group for glo
*most commonly affects Caucasian adults
70
Glo tx
Primary -Steroids -> mixed results Secondary- Treat underlying disease Untreated could progress to Renal Failure
71
Glo sx
HA, HTN, facial/periorbital edema, lethargic, low grade fever, weight gain (edema), proteinuria, hematuria, oliguria, dysuria

Adv. Patho (5 decks)

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