Disorders Of Renal & LUT Function Flashcards
Renal agenesis
without a kidney
Renal hypoplasia
small kidney or fewer nephrons
renal dysplasia
structures in the kidney are not well differentiated
When are kidneys formed?
- 1st month of pregnancy
- less amniotic fluid means the fetus’ kidney aren’t working well
Autosomal dominant polycystic kidney disease
development of cysts on the nephrons and collecting tubules
-causes pain, HTN, infection from sitting urine, hematuria
autosomal recessive polycystic kidney disease
almost always progresses to renal failure
-causes pain, HTN, infection from sitting urine, hematuria
Medullary cystic kidney disease
occurs in adults only
Nephronophthisis
occurs in kids; progresses to renal failure
Acquired form of renal cystic disease
results from dialysis
Acute nephritic syndrome
- caused by strep
- 7 to 12 days later you have oliguria
Most common type of kidney cancer
Wilms tumor/ nephroblastoma (same thing)
Who gets Wilms tumors?
Children 3-5 years old
Distinctive feature of Wilms tumors
hypertension
Renal cell carcinoma: who gets it; symptoms
- Adults: usually over 55
- silent in early stages so it is usually caught in advanced stages
- late stages: hematuria and flank pain, can metastasize to the lung
What happens when kidneys fail?
- Less waste is removed and more remains in the blood
- unable to regulate fluid, electrolyte, and pH balance
- nitrogenous compounds build up in the blood
Acute renal failure
abrupt onset and usually reversible but can develop into chronic
Chronic renal failure
develops slowly over time and ends up in renal failure
How do we test nitrogenous build up in the blood
BUN and creatinine
Prerenal injury
- marked decreased in renal blood flow
- caused by shock, dehydration, vasoconstricion, clot, atherosclerosis
- causes decreased CO, and makes them susceptible to ischemia
Intrinsic renal injury
- damage to structures within the kidney (something is wrong with the glomerulus, bowmans capsule or basement membrane
- caused by ischemia, toxins, intratubular obstruction
Postrenal injury
- obstruction of urine outflow from the kidney
- caused by stones, tumors, enlarged prostate
Acute tubular necrosis
- outcome of prerenal issues in oxygen and blood supply to the kidney
- if we can’t fix ischemia, we get necrosis or infarct
Which type of kidney injury (AKI) would be most likely to accompany BPH?
Postrenal
chronic kidney disease
- decreased GFR greater than 3 months
- fewer nephrons are functioning
- remaining nephrons must filter more which leads to hypertrophy
manifestations of chronic kidney diesase (Uremia, fluid, CV, and GI)
- Uremia/azotemia: CNS, GI, and immune disturbances
- Fluid: Salt wasting, acidosis, hyperkalemia
- CV: HTN, heart disease
- GI: Anorexia, N/V, ulcerations
mineral metabolism disorders from chronic kidney disease lead to…
metastatic calcifications and bone disease
hyperphosphatemia in chronic kidney disease
hyperphosphatemia → hypocalcemia → increased PTH → calcium resorption from bone → bone loss → metastatic calcifications
decreased vitamin D in chronic kidney disease
decreased vitamin D → increased PTH and impaired osteoblasts
Manifestations of chronic kidney disease (systemic, CNS and PNS, sexual function, skin)
-systemic: decreased inflammation and immunity
CNS/PNS: peripheral neuropathy, RLS, uremic encephalopathy
sexual: impotence, hyppfertility, dysmenorrhea
skin: dryness, bruising, Terry nails
How can the kidney dysfunction affect the CV system
- causes anemia: decreased blood viscosity → increased HR and peripheral vasodilation
- angina
- decreased platelets → bleeding
lower urinary tract disorders: obstruction
- occurs below the bladder
- retention or stasis of urine will cause stone to form
s/s of lower urinary tract obstruction
frequency, hesitancy, straining, weak stream (esp in men, post-void residual greater than 200 ml
bladder wall hypertrophy
huge prostate has narrowed urethra
neurogenic bladder disorders
problems coming from neurological mis-signaling
- bladder overactivity
- areflexic bladder dysfunction
Bladder overactivity
failure to relax and store urine
- hyperactivity
- common in spinal cord injury and MS
Areflexic bladder dysfunction
failure to contract and empty (ANS controls bladder, so when it is stimulated, you get lots of bad reactions)
- HTN, bradycardia, sweating
- lethal if not fixed
- common is sacral cord injuries, trauma, spina bifida
Autonomic hyperreflexia/ dysreflexia
- failure to store urine
- spinal cord injury
- from outside or bodily
- causes sudden hypertensive crisis
uninhibited bladder
- problem with brain signaling
- failure to store urine
- stroke, MS, lesions
Detrsor-sphincter dyssynergia
- failure to store urine
- detrusor muscles and bladder sphincter can’t work together because of trauma or lesions
stress incontinence
weakness of detrusor muscles
- common in women who’ve given birth, elderly, obese
- do kegel exercises
urge incontinence
have to go right away
mized incontinence
stress+urge
-common in elderly and menopausal women, women who’ve given birth, and obesity
overflow incontinence
- obstruction or large prostate, tumor
- causes dribbling, leaking, or weak stream
nocturnal enuresis
- urinate at night
- normal in children up to 6 years old, lots of drugs or night sedation
postmicturition dribble
you think its empty but you get dribble a few mins later
continuous urinary leakage
- problems with storing urine or neurological damage that does’t allow sphincter to close
- tumor
UTI
(usually) a bacterial infection that entered from the urethra
host defenses for UTIs
- washout phenomenon: body will make a lot of urine to remove bacteria
- protective mucin layer: keeps bacteria from colonizing in the bladder
- Local immune responses and IgA
- Phagocytic blood cells
- normal flora and prostate secretions
UTI during pregnacy
want to avoid at all costs because it could irritate the uterus and cause premature labor
Normal flora and prostate secretions that protect from UTIs
- vagina has lactobascillus which inhibits baterial growth in the same place
- prostate has a fluid that comes out with seminal fluid that is antimicrobial
urothelial neoplasias: invasive urothelial cell carcinomas
- high grade: infiltrate the structure around the bladder
- malignant and spread
1 sign of invasive urothelial cell carcinomas
painless hematuria (infection causes flank pain, so painless hematuria is much worse)
urothelial neoplasias: Malignant tumors
-usually occur in the inside of the bladder lining
IgA nephropathy
Buerger’s disease
Azotemia
Presence of nitrogenous waste in the blood
Nephrotic Syndrome: Proteins in Urine
- Albumin–> edema & increased free drug
- Immunoglobulins & complement–> immune suppression
- Binding proteins–> low ions & hormones
- Clotting & anticlotting factors–>thrombosis
Nephritic Syndrome
Inflammatory process damages the capillary wall
Good pasture syndrome
- nephritic syndrome
- antibodies to your basement membrane
Acute tubular necrosis
lack of blood supply to the kidney (think of as renal MI)
Tubulointerstitial nephritis
inability to concentrate urine
Acute pyelonephritis
- abrupt onset
- painful urination
- usually caused by E. coli
Chronic pyelonephritis
- scarring & atrophy
- reflux: urine backs up
- ends with renal failure
Uncomplicated pyelonephritis
no other comorbidities
Complicated pyelonephritis
Pyelonephritis r/t obstruction, catheterization, renal surgery, spinal cord injury, pregnancy, reflux
Hydronephrosis
Obstruction resulting from urine filled calculi
Ex: stones, scarring, or tumors can cause this
Calcium stones treatment
- Treat underlying conditions
- Increased fluid intake
- Thiazide diuretics
Magnesium ammonium phosphate stones treatment
- Treat UTI
- Acidification of urine
- Increase fluid intake
Cystine Stones
- Kids usually get these
- not infectious for kids
Uric acid stones
Gout
