Chapter 39: Alterations Of Renal System Flashcards
Hydronephrosis
Abnormal dilation of the renal pelvis and the calyces of one or both kidneys
Excess fluid in the kidney DT back up of urine
Causes of hydronephronsis
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
Hydronephrosis s/sx
Manifestations: colicky,
flank pain or pressure; bloody, cloudy, or foul-smelling urine
dysuria
decreased urine output frequency; urgency
nausea; vomiting
abdominal distension
UTIs
Complications of hydronephrosis
Kidney failure
Dx of hydronephrosis
history, physical examination, urinalysis, renal ultrasound, computed tomography
Hydronephrosis tc
ureteral stents, stone removal, surgery
Nephrolithiasis
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
Types of kidney stones
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
RF for nephrolithiasis
Excessive concentration of insoluble salts in the urine,
Urinary stasis,
Family history
Obesity,
Hypertension
Diet
Male
Nephrolithiasis s/sx
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
Nephrolithiasis dx
history, physical examination, urine examination, CT of kidneys, ultrasound, calculi analysis
*non-contrast CT -> contrast binds with stones
Nephrolithiasis tx
strain all urine, increase fluids, shock wave lithotripsy, surgery, pain management, dietary changes, and physical activity
Neurogenic bladder
Bladder dysfunction caused by an interruption of normal bladder nerve innervation causing incontinence
Typically self-cath for rest of life
Cases of neurogenic bladder
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
BPH
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
Complications of BH
urinary stasis, hydronephrosis, and UTIs
BPH s/sx
frequency, urgency, retention, difficulty initiating urination, weak urinary stream, dribbling urine, nocturia, bladder distension, overflow incontinence, and erectile dysfunction
BPH s/sx
History, physical examination, urinalysis, prostate-specific antigen (PSA), biopsy, DRE -> draw blood before
BPH tx
Medications to relax and /or shrink the prostate or complete surgical removal of the prostate, and avoid alcohol and smoking
Elevated PSA causes
PSA is nonspecific, increased with large prostate
Enlarged prostate
Prostatitis
Prostate cancer
Recent ejaculation
DRE
Bicycle riding
Renal cell carcinoma
Most frequently occurring kidney cancer in adults ages 50-70
Primary tumor arising from the renal tubule
Cause unknown
RF of renal cell carcinoma
being male and smoking
Metastasis to the liver, lungs, bone, or nervous system is common
Renal cell carcinoma s/sx
May be asymptomatic,
painless hematuria
dull and achy flank pain,
urinary retention,
palpable mass over affected kidney
unexplained weight loss, night sweats fever.
Dx of renal cell carcinoma
history, physical examination, urinalysis, computed tomography, cystoscopy, biopsy, and blood chemistry
Tx of renal cell carcinoma
surgery, chemotherapies.
Bladder cancer
Cancer that forms in the tissue of the bladder
Metastasis is common to the pelvic lymph nodes, liver, and bone
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
Bladder cancer s/sx
painless hematuria, abnormal urine color, frequency, dysuria, UTIs, and back or abdominal pain
Bladder cancer dx
ultrasound, cystoscopy, biopsy
Bladder cancer tx
surgical removal, radiation, chemotherapy.
UTI
Extremely common in women
Acute Cystitis
Lower tract most frequent site -> Escherichia coli
RF for UTI
female
benign prostatic hypertrophy (BPH) (men)
Urinary Stasis -> Obesity, pregnancy, stones, immobility
Poor Hygiene
Immunosuppressed
UTI manifestations
may be asymptomatic,
urgency,
dysuria,
frequency,
hematuria, bacteriuria,
cloudy and foul-smelling urine, and symptoms of infection
UTI dx
history, physical examination, urinalysis -> WBCs, nitrites
urine culture
Cysto
CBC
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
Cystitis
Chronic Interstitial Inflammation of the bladder
The bladder and urethra walls to become red and swollen
Dx and tx same for UTI
Causes of cystitis
infection, irritants, idiopathic
Cystitis s/sx
UTI symptoms, abdominal pain, and pelvic pressure
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
Pyelonephritis s/sx
Manifestations: severe UTI symptoms, flank pain, fever
Pyelonephritis dx
history, physical examination, urinalysis, urine and blood cultures, complete blood count, cystoscopy, intravenous pyelogram (like XR of urinary tract), ultrasound
Pyelonephritis tx
usual UTI treatments, but long-term antibiotics (4–6 weeks) are usually required
RFT
BUN, serum Cr, 24hr urine collection for Cr clearance, urinalysis, IVP, PSA
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
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
24-hr urine collection for cr clearance
Measures GFR and is dependent upon renal artery effusion and GF
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
IVP
IV-admin, radiopaque ye allows the visualization of the kidneys, renal pelvis, ureters, and bladder
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
Renal failure
Kidneys are unable to function adequately
Classified as either acute or chronic
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
AKI s/sx
Decreased UO
Electrolyte Disturbances
Azotemia -> increased waste products in blood
Metabolic Acidosis
AKI tx
Dialysis
Manage electrolytes
HTN management
Anemia Treatment
Prevent Infection
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
Intrarenal causes of AKI
Direct damage to the kidneys by inflammation, toxins, drugs -ab and ace inhibitors, infection, or reduced blood supply -tissue ischemia
AKI causes: Post-renal
Sudden obstruction of urine flow dt enlarged prostate, kidney stones, bladder tumor, or injury
Chronic kidney dz
Gradual loss of kidney function which is irreversible
During the disease process scar tissue replaces injured nephrons
Causes of CKD
Diabetes (leading cause)
HTN
Urine obstructions
Renal Diseases
Exposure to Toxins
Smoking
Aging
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
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
Dx of CKD
Blood Chemistry (BUN Creatinine)
CKD tx
Stop progression. (main goal)
Manage underlying causes
Prevent complications
Adjust medication dosages
Renal dialysis
Without treatment- mortality is 100%
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
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.
Nephrotic syndrome
• proteinuria (> 3.5 gms/day)
• hypoalbumenia -> decreases on oncotic pressure -> decreased osmotic pressure -> edema
• edema
• hyperlipidemia
• lipiduria
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
Primary glo
(idiopathic) -> majority
Secondary glo
autoantibodies, infections, malignancy, autoimmune, medications
Most common group for glo
*most commonly affects Caucasian adults
Glo tx
Primary -Steroids -> mixed results
Secondary- Treat underlying disease
Untreated could progress to Renal Failure
Glo sx
HA, HTN, facial/periorbital edema, lethargic, low grade fever, weight gain (edema), proteinuria, hematuria, oliguria, dysuria
