Class #4 Flashcards

1
Q

How do the kidneys maintain bone calcium levels?

A

By Activating vitamin D

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2
Q

What is Glomerulonephritis?

A

2nd leading cause of kidney failure

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3
Q

What causes Glomerulonephritis?

A

-Hereditary
-Other disease process
-Injury from antibodies reacting with antigens in the glomeruli
injury from circulating antibody/antigen complexes that lodge in the glomeruli

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4
Q

What are the 4 types of glomerularnephritis?

A
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)
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5
Q

Manifestations of Acute Nephritic Syndrome

A
Hematuria** HALLMARK SIGN
Decreased GFR
Azotemia (build up of nitrogenous waste)
Oliguria
Fluid retention (edema, HTN)
*Shortness of Breath from the buildup of fluid*
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6
Q

What is Acute Nephritic Syndrome?

A

Inflammatory response that damages the glomerular capillary wall

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7
Q

How can nephritic syndrome be treated?

A
  • children have spontaneous recovery
  • Adults–treat the symptoms
  • antibiotics
  • fluids
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8
Q

What is rapidly progressive glomerulonephritis? Explain the patho.

A

signs of severe glomerular injury without a specific cause.

*Proliferation of glomerular cells, with monocytes & macrophages destroy Bowman space

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9
Q

Name a rare type of rapidly progressive glomerulonephritis

A

Goodpastures Syndrome

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10
Q

What is Nephrotic Syndrome?

A

Damage to the integrity of the glomerular membrane caused by medications, neoplasms, inflammation

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11
Q

Symptoms of Nephrotic Syndrome?

A
  • 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
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12
Q

What is acute pyelonephritis? What causes it?

A

Caused by Bacterial infection of upper UT with infrarenal reflux, or movement of urine in the wrong direction

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13
Q

TRUE OR FALSE

Nephritic syndromes are characterized by blood in the urine?

A

TRUE

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14
Q

What are contributing factors to acute pyelonephritis?

A
Outflow obstruction
Catheterization
Vesicoureteral reflux (urine moves backwards from the ureters into the bladder and into the kidney)
Pregnancy
-Neurogenic Bladder
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15
Q

Manifestations of acute pyelonephritis

A
Rapid chills and fever
Ache/pain unilateral or bilateral
   *Costovertebral Angle
-Dysuria, frequency, urgency
-N/V, abdominal pain radiating to the back
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16
Q

Treatment of acute pyelonephritis

A

Symptomatic pain relief
Fluids to aid dysuria
Antibiotics

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17
Q

Chronic pyelonephritis. What does it usually affect?

A

Scarring and deformation of renal calyces and pelvis, with atrophy and thinning of cortex
Usually affects the proximal and distal tubules

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18
Q

What causes chronic pyelonephritis?

A
  • Recurrent or persistent infection

- Intrarenal reflux

19
Q

What does the effect of toxin-related nephropathies dependent on?

A
  • Action of drugs/toxins
  • Number of toxins involved
  • Existence of pre-renal issues that decrease blood flow to kidney
  • Formation of crystals
  • Hypersensitivity response
20
Q

What is polycyctic Kidney Disease?

A

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

21
Q

Manifestations of PKD

A

Pain
Hematuria
Infected cysts—UTI
HTN

22
Q

Complications of PKD

A
  • Nephrolithiasis (REALLY COMMON! kidney stones)
  • Valvular deformities (inflammation, bacterial involvment)
  • Cerebral artery aneurysm
23
Q

What can obstruct flow in the ureters?

A

Calculi, pregnancy, tumors, stricture, congenital origins

24
Q

obstructions in the bladder & the ureter

A

Calculi, neurogenic bladder, cancer, Benign prostatic hypertrophy, strictures

25
Q

What are the 2 main causes of stasis of urine?

A

UTI, stone formation

26
Q

What is hydronephrosis?

A

anything that causes urine buildup in in renal pelvis and calyces d/t obstruction of outflow, leading to atrophy of kidney

27
Q

Manifestations of urinary obstruction

A
  • Recurrent UTI
  • Minimal to severe pain dependent of level and degree of obstruction
  • Complete obstruction with oliguria/anuria and renal failure
28
Q

Look at pg 633 for types of stones

A

NOW!

29
Q

What causes calcium kidney stones

A
  • immobilization
  • hyperparathyroidism
  • diffuse bone disease
30
Q

What causes Magnesium ammonium phosphate kidney stones?

A

UTIs

31
Q

Manifestations of Kidney stones

A
-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
32
Q

How can you treat kidney stones?

A

-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

33
Q

What is Wilms Tumor?

A

Most common malignant abdominal tumor in children

-usually encapsulated, therefore it can usually be removed

34
Q

Symptoms of Wilms Tumor?

A

Abdominal mass, HTN, Abdominal pain, vomitting

35
Q

What is renal cell carcinoma? Symptoms?

A

Kidney cancer

-Hematuria, flank pain, mass

36
Q

What puts you at high risk for renal cancer?>

A

Smoking

37
Q

What is pre-renal failure

A

problems in the kidney that result from decreased blood flow to the kidney

38
Q

How is pre-renal kidney failure caused?

A
hypovolemia
heart failure
cardiogenic shock
sepsis
certain medications or toxins
39
Q

Manifestations of pre-renal kidney failure?

A
  • decreased urinary output
  • elevation of BUN proportionally to creatinine 20:1
  • Azotemia (Build up of nitrogenous waste in blood)
40
Q

Most common indicator for acute renal failure?

A

AZOTEMIA

41
Q

If your patient has pre renal failure, would you expect the delivery of intravenous fluids to help the patients outcome?

A

YES! because “not enough blood flow to the kidneys” is the problem, and fluids can help that!

42
Q

What is Intrinsic Renal Failure? What can it be caused by?

A

Disorder within the kidney structure

  • Prolonged ischemia
  • injury to tubular structures
  • intratubular obstruction
  • Infection
  • nephrotoxic agent (IRON)
43
Q

3 Phases of Acute Tubular Necrosis

A
  1. Onset- development up to time of ischema
  2. Maintenance- Decreased GFR and urinary output (Edema, pulmonary congestion, HTN)
    - Retention of urea/K/Sulfate, creatinine
  3. RECOVERY
    - gradually increased output
44
Q

How can you treat Renal Failure?

A
PREVENTION
EARLY DIAGNOSIS
-fluids (be careful!)
-Electrolytes
-calories
-dialysis
-continuous renal replacement therapy