Disorders of the Renal System Flashcards
Urinary Tract Obstruction
- what is it
- what 2 things can cause it
- bloackage of urine within the urinary tract
- usually due a stone or tumor
where is a urinary obstruction most likely located?
-in the kidneys or the ureters
what determines how serve the urinary blockage is?
- location
- incomplete or complete obstruction of urine flow
- duration
- cause
- is it in one or both of the urinary tracts
calculi or urolithiasis- what are they made of
- stone
- crystals or proteins
risk factors for renal calculi
-gender
-race
geographic location
seasonal factors
dec fluid intake
high protein intake , high na intake, alot of sugar, corn syrup, grapefruit, apple juice
family hx
if you get your first one before 25 chances inc a lot to get another one
-people who have chrons disease are more likely to get it bc they have MG malabsorption
patho of renal stones
-supersaturation of one or more stone
basically higher amounts of salts then there is water to dissolve them
so salt percipiated into a solid mass
aggregation makes it bigger also
types of renal stone
- calcium oxalate or calcium phosphate seen in hyperparathryiodism
- struvite- women have this one 2x more, MG AM-phosphate
- uric acid- people with gout have this
- cystinuric- rare and genetic
manifestations of a renal stone
- Really bad flank pain : indicates the stone is in the upper ureter or kidney
- plain that extends to the scrotum or the vulva- stone is in the bladder or the ureter
- nausea and vomiting
when does the pain get worse for people with a renal stone
- hydration
- when the stone is moving
hydroureter
ureter dilates
happens to people with stones
hydronephrosis
fluid builds up into the kidneys
how do the stone move in the renal system
-form in the kidneys and they move to the ureter and they get lodged into a space that the ureter bends or changes shape
what evaluations are done for someone who we suspect to have a kidney stone
-urinalysis for blood or WBC
-x-ray
intravenous pyelogram IVP- use contrast to see any obstruction
abdominal CT
analysis the stone once it comes out
treatments goals for people with stones
- prevent new ones
- remove old ones
kidney stones can lead a person to develop what 4 things
-hydroureter
hydroenphrosis
-pyelonephritis- kidney infection
actue renal failure
what is an UTI
-inflammation of the urinary epithelium due to invasion and colonization by bacteria or fungus
what is a women’s risk and why is it higher
-location of the anus is closer to the urethra and E.coli is one of the main reasons UTI occur 30% risk
UTI are the most common cause of what disease in hospitalized PT and it is due to what
- sepsis
- due to catheters for long periods of time
what hapthogens cause UTI
- USUALLY FROM THE GI TRACT
- E.Coli
- Enterobacter
- Pseudomonas or Klebsiella which are resistent
- staph
risk factors for UTI
-urinary stasis
-people are immobile
-urinary retention from meds like beta blockers
-benign prostate hyperplasia is obstruction the urethra
-urinary stone lead to obstruction of urine
-CATHETERS ARE THE NUMBER ONE REASON
-fistulas expose the urinary stream to skin or vagina to GI tract
-sex
-immunocompromised
-constiatpation
neurological disorders that make it hard for PT to pee
cystitis
2 types explain each
- inflammation of the bladder
- UTI causes this
- could be caused by trauma, autoimmune disease or meds but usually caused by the growth of bacteria, virus or fungus which is infectious cystitis the other ones are noninfectious
where can a UTI occur
in the kidneys or the bladder anywhere the urinary system
manifestations of a UTI
- LUTS- low urinary tract symptoms
- lower abdominal or supra-pubic pain
- urgency to pee
- dysuria
- frequency inc
what are the manifestations of UTI in older people
- they usually don’t have the LUTS they get delirious- confused and agitated
treatment for a UTI
- drink alot of water
- antimicrobial meds
- avoid bladder irritants like caffeine
- cranberry juice is really good for preventing but so has constant hydration
pyelonephritis
- upper urinary tract infection could be acute or chronic
actue pyelonephritis
- what areas can it impact
- what does it usually begin as?
- infection of the ureter, renal pelvis, renal parenchyma
- usually begins as a bacterial infection that spread up the urethra or traveled through the blood tot he kidney
manifestations of acute pyelonephritis
- rapid onset of fever
- chills
- flank pain
- malaise
treatment for acute pyelonephritis
-antibiotics for 10-14 days
what organisms can cause acute pyelonephritis
- E.coli
- Hospital Acquired Infection - colform bacteria but could also be because of the resistent klebsiella and pseudomonas
chronic pyelonephritis
-persistent or occurrent episodes of acute pyelonephritis
in what group of people does risk for chronic pyelonephritis inc
- individuals who have renal infections
- obstructive condition
what can chronic pyelonephritis lead to?
- loss of tubular function and the loss of the ability to concentrate urine
- poluria
- protienuria
- nocturia
- end stage renal failure in 10 %
Glomeruli
-filtering uint of the kidneys
glomerulonephritis GN
- several diseases of the kidney that usually impact both of them
- one of the leading causes of end stage kidney disease
what do the many of the glomerulonephritis present as?
- inflammation of the glomeruli or of the small blood vessels in the kidneys
- but some do not have the inflammation
- they have a collection of immune complexes in the glomeruli made up of antigens and antibodies
- the antigens can be part of the normal kidney tissue or something dissolved in the blood or body fluid
- viruses and bacteria are also antigens
- exposure to bacteria, viruses, drugs or toxins can trigger the glomerular injury
some autoimmune diseases that trigger GN
-lupus and diabetic nephropathy
GN causes what
4things
-serve inflammatory response which leads to a dec functioning of the kidneys causes retention of wastes
-dec GFR
-cell proliferation
congestion in the kidney
how is GN classified
extent of damage that was done
initial cause of the the damage- scleroderma, lupus, strepp
In GN describe the steps leading to the disease
- presence of anti-strep antibodies
- formation of the antibody-antigen complex
- complement is activated
- glomeruli have an inflammatory response leading to the accumulation of antigen and antibody and compliment
- increases the capillary permeability so there is leakage of some large protein and RBC into the urine
Acute GN happens after what?
Who is it more common in?
men
after a strep oral infection
when do symptoms appear for acute GN
-10 days after the infection began
Clinical Manifestations of GN
-dark and cloudy urine bc blood and protein are passing through it
-high blood pressure bc inc renin secretion and dec GFR
-flank or back pain - bc of edema and stretchig of renal capsule
-facial and preorbital edema then general edema
-general signs of inflammation
dec urine output
diagnostic tests for GN
-blood tests high serum urea and creatinine bc the kidneys aren't removing it well strep antibodies -will have metabolic acidosis -urinalysis- check for blood (will have it, rusty urine), protein, in urine, inc BUN dec GFR no evidence of infection
treatments of GN
-steroids LIKE GLUCOCORDITIDS to reduce inflammation
-high BP meds
dec protein, Na and water intake bc they are retaining these things already
Polycystic Kidney Disease
- life threatening genetic disorder
-usually starts in one kidney and progresses to both
-growth of fluid filled cysts on the kidney which causes enlargement of the kidneys
functional tissue is replaced
reduced perfusion of the kidneys
tubule obstruction
in serve cases of PKD what gets damaged?
-the liver, pancreas via pancreatic cysts and the heart and brain cerbral aneurysms
two forms of PKD
determined by the way they are inherited Autosomonal dominant Autosomonal recessive (less common)
clinical manifestations of PKD
enlarged kidneys usually both HTN Flank pain bc of the enlarged kidneys altered fluid and electrolyte imbalances renal calculi UTI
diagnosing PKD
-family history
-genetic testing
-physical exam- HTN, Ultrasound or CT to see the cyst
LABS- GFR, BUN, creatinine
treatments for PKD
control the symptoms like pain, treat infections, control BP
promotion of renal function- dialysis 3-4 hours a week, renal transplant
