Class #4 Flashcards
How do the kidneys maintain bone calcium levels?
By Activating vitamin D
What is Glomerulonephritis?
2nd leading cause of kidney failure
What causes Glomerulonephritis?
-Hereditary
-Other disease process
-Injury from antibodies reacting with antigens in the glomeruli
injury from circulating antibody/antigen complexes that lodge in the glomeruli
What are the 4 types of glomerularnephritis?
Proliferative Infiltration of WBCs and proliferation of glomerular cells Membranous Thickening of glomerular capillary wall Sclerotic Increased extracellular matrix Diffuse/focal/segmental Ex: Mesangial (involves only these cells)
Manifestations of Acute Nephritic Syndrome
Hematuria** HALLMARK SIGN Decreased GFR Azotemia (build up of nitrogenous waste) Oliguria Fluid retention (edema, HTN) *Shortness of Breath from the buildup of fluid*
What is Acute Nephritic Syndrome?
Inflammatory response that damages the glomerular capillary wall
How can nephritic syndrome be treated?
- children have spontaneous recovery
- Adults–treat the symptoms
- antibiotics
- fluids
What is rapidly progressive glomerulonephritis? Explain the patho.
signs of severe glomerular injury without a specific cause.
*Proliferation of glomerular cells, with monocytes & macrophages destroy Bowman space
Name a rare type of rapidly progressive glomerulonephritis
Goodpastures Syndrome
What is Nephrotic Syndrome?
Damage to the integrity of the glomerular membrane caused by medications, neoplasms, inflammation
Symptoms of Nephrotic Syndrome?
- Increased GFR, but you are losing things into your urine that you shouldnt
- Massive proteinuria
- Hypoalbuminemia
- Edema (anasarca) : When you lose the protein in your urine, the blood doesn’t have the osmotic pressure to hold fluid in your vascular space
- Lipiduria–Lose lipids in your urine
- Hyperlipidemia–compensatory action when you lose proteins and lipids and your liver synthesis more proteins to increase lipids
What is acute pyelonephritis? What causes it?
Caused by Bacterial infection of upper UT with infrarenal reflux, or movement of urine in the wrong direction
TRUE OR FALSE
Nephritic syndromes are characterized by blood in the urine?
TRUE
What are contributing factors to acute pyelonephritis?
Outflow obstruction Catheterization Vesicoureteral reflux (urine moves backwards from the ureters into the bladder and into the kidney) Pregnancy -Neurogenic Bladder
Manifestations of acute pyelonephritis
Rapid chills and fever Ache/pain unilateral or bilateral *Costovertebral Angle -Dysuria, frequency, urgency -N/V, abdominal pain radiating to the back
Treatment of acute pyelonephritis
Symptomatic pain relief
Fluids to aid dysuria
Antibiotics
Chronic pyelonephritis. What does it usually affect?
Scarring and deformation of renal calyces and pelvis, with atrophy and thinning of cortex
Usually affects the proximal and distal tubules
What causes chronic pyelonephritis?
- Recurrent or persistent infection
- Intrarenal reflux
What does the effect of toxin-related nephropathies dependent on?
- Action of drugs/toxins
- Number of toxins involved
- Existence of pre-renal issues that decrease blood flow to kidney
- Formation of crystals
- Hypersensitivity response
What is polycyctic Kidney Disease?
Inherited autosomal dominant
Generally older population; progresses slowly
Fluid-filled cysts in kidney and liver
Deformity of epithelial cell interfere with fluid absorption/cellular maturation resulting in cyst formation
-Inflammatory mediators accumullate, and renal tubular cells are destroyed
Kidneys are enlarged
Manifestations of PKD
Pain
Hematuria
Infected cysts—UTI
HTN
Complications of PKD
- Nephrolithiasis (REALLY COMMON! kidney stones)
- Valvular deformities (inflammation, bacterial involvment)
- Cerebral artery aneurysm
What can obstruct flow in the ureters?
Calculi, pregnancy, tumors, stricture, congenital origins
obstructions in the bladder & the ureter
Calculi, neurogenic bladder, cancer, Benign prostatic hypertrophy, strictures
What are the 2 main causes of stasis of urine?
UTI, stone formation
What is hydronephrosis?
anything that causes urine buildup in in renal pelvis and calyces d/t obstruction of outflow, leading to atrophy of kidney
Manifestations of urinary obstruction
- Recurrent UTI
- Minimal to severe pain dependent of level and degree of obstruction
- Complete obstruction with oliguria/anuria and renal failure
Look at pg 633 for types of stones
NOW!
What causes calcium kidney stones
- immobilization
- hyperparathyroidism
- diffuse bone disease
What causes Magnesium ammonium phosphate kidney stones?
UTIs
Manifestations of Kidney stones
-pain (Ureter stone: severe flank/upper abdominal pain that radiates Renal pelvis stone: less severe) -nausea and vomiting -Pallor, diaphoresis -Frequency and burning -Fever and chills -Hematuria
How can you treat kidney stones?
-Analgesics, Anti-spasmotics
-Allopurinol (GOUT) that
changes pH to decrease acidity
-Increased fluids to produce 2 liter/day
-Strain urine
-Diet modification
-Extrancoporeal shockwave lithotripsy (ESWL)
-Ureteroscopic removal
-Percutaneous nephrolithotomy
What is Wilms Tumor?
Most common malignant abdominal tumor in children
-usually encapsulated, therefore it can usually be removed
Symptoms of Wilms Tumor?
Abdominal mass, HTN, Abdominal pain, vomitting
What is renal cell carcinoma? Symptoms?
Kidney cancer
-Hematuria, flank pain, mass
What puts you at high risk for renal cancer?>
Smoking
What is pre-renal failure
problems in the kidney that result from decreased blood flow to the kidney
How is pre-renal kidney failure caused?
hypovolemia heart failure cardiogenic shock sepsis certain medications or toxins
Manifestations of pre-renal kidney failure?
- decreased urinary output
- elevation of BUN proportionally to creatinine 20:1
- Azotemia (Build up of nitrogenous waste in blood)
Most common indicator for acute renal failure?
AZOTEMIA
If your patient has pre renal failure, would you expect the delivery of intravenous fluids to help the patients outcome?
YES! because “not enough blood flow to the kidneys” is the problem, and fluids can help that!
What is Intrinsic Renal Failure? What can it be caused by?
Disorder within the kidney structure
- Prolonged ischemia
- injury to tubular structures
- intratubular obstruction
- Infection
- nephrotoxic agent (IRON)
3 Phases of Acute Tubular Necrosis
- Onset- development up to time of ischema
- Maintenance- Decreased GFR and urinary output (Edema, pulmonary congestion, HTN)
- Retention of urea/K/Sulfate, creatinine - RECOVERY
- gradually increased output
How can you treat Renal Failure?
PREVENTION EARLY DIAGNOSIS -fluids (be careful!) -Electrolytes -calories -dialysis -continuous renal replacement therapy
