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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
Q

Tx of renal cell carcinoma

A

surgery, chemotherapies.

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26
Q

Bladder cancer

A

Cancer that forms in the tissue of the bladder
Metastasis is common to the pelvic lymph nodes, liver, and bone

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27
Q

RF for bladder cancer

A

advancing age, men, Caucasians, working with chemicals, smoking, excessive use of analgesics, experience recurrent UTIs, long-term catheter placement, chemotherapy, and radiation

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28
Q

Bladder cancer s/sx

A

painless hematuria, abnormal urine color, frequency, dysuria, UTIs, and back or abdominal pain

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29
Q

Bladder cancer dx

A

ultrasound, cystoscopy, biopsy

30
Q

Bladder cancer tx

A

surgical removal, radiation, chemotherapy.

31
Q

UTI

A

Extremely common in women
Acute Cystitis
Lower tract most frequent site -> Escherichia coli

32
Q

RF for UTI

A

female

benign prostatic hypertrophy (BPH) (men)

Urinary Stasis -> Obesity, pregnancy, stones, immobility

Poor Hygiene

Immunosuppressed

33
Q

UTI manifestations

A

may be asymptomatic,
urgency,
dysuria,
frequency,
hematuria, bacteriuria,
cloudy and foul-smelling urine, and symptoms of infection

34
Q

UTI dx

A

history, physical examination, urinalysis -> WBCs, nitrites
urine culture
Cysto
CBC

35
Q

UTI tx

A

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
Q

Cystitis

A

Chronic Interstitial Inflammation of the bladder
The bladder and urethra walls to become red and swollen

Dx and tx same for UTI

37
Q

Causes of cystitis

A

infection, irritants, idiopathic

38
Q

Cystitis s/sx

A

UTI symptoms, abdominal pain, and pelvic pressure

39
Q

Pyelonephritis

A

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
Q

Pyelonephritis s/sx

A

Manifestations: severe UTI symptoms, flank pain, fever

41
Q

Pyelonephritis dx

A

history, physical examination, urinalysis, urine and blood cultures, complete blood count, cystoscopy, intravenous pyelogram (like XR of urinary tract), ultrasound

42
Q

Pyelonephritis tx

A

usual UTI treatments, but long-term antibiotics (4–6 weeks) are usually required

43
Q

RFT

A

BUN, serum Cr, 24hr urine collection for Cr clearance, urinalysis, IVP, PSA

44
Q

BUN

A

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
Q

Serum creatinine

A

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
Q

24-hr urine collection for cr clearance

A

Measures GFR and is dependent upon renal artery effusion and GF

47
Q

Urinalysis

A

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
Q

IVP

A

IV-admin, radiopaque ye allows the visualization of the kidneys, renal pelvis, ureters, and bladder

49
Q

PSA

A

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
Q

Renal failure

A

Kidneys are unable to function adequately
Classified as either acute or chronic

51
Q

AKI

A

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
Q

AKI s/sx

A

Decreased UO
Electrolyte Disturbances
Azotemia -> increased waste products in blood
Metabolic Acidosis

53
Q

AKI tx

A

Dialysis
Manage electrolytes
HTN management
Anemia Treatment
Prevent Infection

54
Q

Causes of AKI: prerenal

A

Sudden and severe drop in BP (she) or interruption of BF to the kidneys from severe injury or illness.

Hypotension, HF, NSAIDS

55
Q

Intrarenal causes of AKI

A

Direct damage to the kidneys by inflammation, toxins, drugs -ab and ace inhibitors, infection, or reduced blood supply -tissue ischemia

56
Q

AKI causes: Post-renal

A

Sudden obstruction of urine flow dt enlarged prostate, kidney stones, bladder tumor, or injury

57
Q

Chronic kidney dz

A

Gradual loss of kidney function which is irreversible
During the disease process scar tissue replaces injured nephrons

58
Q

Causes of CKD

A

Diabetes (leading cause)
HTN
Urine obstructions
Renal Diseases
Exposure to Toxins
Smoking
Aging

59
Q

CKD 5 stages

A

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
Q

Multisystemic effects of CKD

A

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
Q

Dx of CKD

A

Blood Chemistry (BUN Creatinine)

62
Q

CKD tx

A

Stop progression. (main goal)
Manage underlying causes
Prevent complications
Adjust medication dosages
Renal dialysis
Without treatment- mortality is 100%

63
Q

Renal electrolytes

A

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
Q

Glomeulonephritis

A

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
Q

Nephrotic syndrome

A

• proteinuria (> 3.5 gms/day)
• hypoalbumenia -> decreases on oncotic pressure -> decreased osmotic pressure -> edema
• edema
• hyperlipidemia
• lipiduria

66
Q

Causes of glo

A

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
Q

Primary glo

A

(idiopathic) -> majority

68
Q

Secondary glo

A

autoantibodies, infections, malignancy, autoimmune, medications

69
Q

Most common group for glo

A

*most commonly affects Caucasian adults

70
Q

Glo tx

A

Primary -Steroids -> mixed results
Secondary- Treat underlying disease
Untreated could progress to Renal Failure

71
Q

Glo sx

A

HA, HTN, facial/periorbital edema, lethargic, low grade fever, weight gain (edema), proteinuria, hematuria, oliguria, dysuria

Adv. Patho (5 decks)

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