CoC for Patients With Kidney Disorders

Question 1

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Pathophysiology
> E. coli is most common cause; also viruses & bacteria
> Inflammation of renal parenchyma & urinary collecting system

Epidemiology
> Infants & elderly @ inc risk reflecting anatomical changes & hormonal status
> Young women affected by sexual activity

Answer 1

Pyelonephritis

Question 2

Pyelonephritis - Clinical Manifestations

• S/S of UTI - freq/painful hematuria, fever, elevated WBC
• Flank/back pain & tenderness @ CVA

Answer 2

! Tapping w/a fist along the CVA will illicit tenderness in the flank. Useful for differentiating from a UTI

Question 3

Pyelonephritis - Management

• UA, urine/blood cultures, CBC
• CT, US, emergency surgery; abx & fluid replacement

Answer 3

• Recurrent infections can lead to scarring, CKD, or permanent damage

Question 4

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• Is the 3rd leading cause of renal failure
  > D/t autoimmune disorders, Goodpasture’s syndrome, lupus, vasculitis, or infection (i.e., Streptococcus)
• Protein & blood seen in urine as well as WBC’s & casts
• Pts present edematous w/dec u/o & HTN

Answer 4

Acute Glomerulonephritis

• Classified as acute or chronic
• Has 2 types; both result in accumulation of antigens, antibodies, & complement in glomeruli & GBM, which leads to injury to glomerular membrane & a dec in effective filtration through glomeruli

Question 5

Acute Glomerulonephritis - Management

• Labs: CBC w/diff, BUN/creatinine
• 95% recover if treated early; abx

Question 6

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• Is 1 of the most common genetic renal disorders (autosomal recessive)
• 2 forms: childhood & adult

> Can lead to ESRD

Answer 6

Polycystic Kidney Disease (PKD)

Question 7

PKD - Pathophysiology

• Cysts develop as a result of a repeated cell division process within the renal tubule known as a cystogenic process that happens a # of times over life pt w/PKD

Answer 7

PKD - Clinical Manifestations

• Manifest UTI; urinary frequency; calculi that cause severe pain d/t obstruction of urinary flow; lbp; hematuria; HA or abd pain
• HTN is 1st sx

Question 8

PKD - Management

• UA; abd US; MRI
• IV pyelogram; CT scan
• HD or PD
• Renal transplant

Question 9

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• Cigarettes, pipes, cigars pose high risk for development; 14,000 die/yr; more often males age 50-70 than females

Answer 9

Renal Cell Carcinoma (RCC)

Question 10

RCC - Pathophysiology

• Tumors compress underlying tissues, reducing circulation to renal structures & damaging underlying tissues
• Compression can lead to compromised renal functioning or failure

Answer 10

• Usually found in cortex or pelvis of the kidney

Question 11

RCC - Clinical Manifestations

! Initially asymptomatic (wt loss, HTN, fever, anemia)

10% present w/classic triad of __, __, __

Answer 11

Flank mass, flank pain, hematuria

Question 12

___ is used to detect most masses

Other tests
> US (can differentiate b/t solid masses, tumors, & cysts)
> Angiography, percutaneous needle aspiration, CT, MRI
> Radionuclide isotope imaging - to detect metastasis
> Urine cytology
> Renal biopsy

Answer 12

IVP

Question 13

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Removes the involved kidney, adrenal gland, & surrounding tissues like the fascia, part of the ureter, & draining lymph nodes

Answer 13

Radical nephrectomy

Question 14

Additional Treatment

• Embolization
• Chemotherapy
• Radiation

Question 15

Nephrotoxic Rx’s

1. NSAIDs [ibuprofen, naproxen, Aleve]
2. Vancomycin [abx]
3. Diuretics [thiazide, loop, potassium-sparing]
4. Iodinated radiocontrast

Answer 15

5. ACE inhibitors [lisinopril, enalapril, ramipril]
6. Empagliflozin [Jardiance] (DM rx)
7. Aminoglycoside antibiotics (! neomycin; gentamycin, tobramycin, amikacin, streptomycin)

Question 16

8. HIV medications/antiretrovirals [Viread, Retataz]
9. Zoledronate [Zometa, Reclast]
10. Foscarnet (a rarely prescribed antiviral; ICP pts)