disorders of the renal system

Question 1

urinary tract obstruction is a ___ of __ ___ within the urinary tract

Answer 1

blockage

urine flow

Question 2

severity of urinary tract obstruction is based on

Answer 2

Location
Completeness
Involvement of one or both upper urinary tracts
Duration
Cause

Question 3

calculi or urinary stones/ urolithiasis

Answer 3

Masses of crystals, protein, or other substances that form within and may obstruct the urinary tract

Question 4

risk factors of calculi or urinary stones

Answer 4

gender
race
 geographic location
seasonal factors 
fluid intake
diet
occupation

Question 5

calculi/ urinary stone pathophysiology

Answer 5

• Supersaturation of one or more salts/substances
• Precipitation of a salt from liquid to solid state
• Growth through crystallization or aggregation

Question 6

types of renal stones

Answer 6

• calcium oxalate or calcium phosphate
• struvite stones (magnesium- ammonium-phosphate)
• uric acid stones
• cystinuric stones (genetic disorder)

Question 7

CM of renal calculi

Answer 7

flank pain
hydration makes pain worse
N/V

Question 8

Evaluation of renal calculi

Answer 8

urinalysis
kidney, ureter, bladder (KUB) xray
iv pyelogram (IVP)
abdominal CT
stone analysis

Question 9

treatment goals of renal calculi

Answer 9

remove stones

prevent formation of new stones

Question 10

risks of renal calculi

Answer 10

hydronephrosis
pyelonephritis
acute renal failure

Question 11

UTI is an ___ of the urinary ___ following invasion and colonization by some pathogen within the urinary tract

Answer 11

inflammation

epithelium

Question 12

most common pathogens in a UTI

Answer 12

e. coli
staphylococuus saprophyticus
enterobacter

Question 13

UTI causes ___, an inflammation of the bladder

Answer 13

cystitis

Question 14

cystitis can be caused by

Answer 14

trauma
autoimmune disease
certain medications

Question 15

manifestations of UTI

Answer 15

frequency
dysuria
urgency
lower abdominal and suprapubic pain

Question 16

elderly and UTI

Answer 16

usually none of the normal sx, but with delirium

Question 17

treatment of UTI

Answer 17

antimicrobial therapy
increased fluid intake
avoid bladder irritants
cranberry capsules have been shown to reduce risk in those with chronic infection

Question 18

acute pyelonephritis is an acute infection of the ____, ___ ____ and/ or ___ ___

Answer 18

ureter
renal pelvis
renal parenchyma

Question 19

manifestations of pyelonephritis

Answer 19

rapid onset of fever
chills
malaise
flank pain

Question 20

treatment of acute pyelonephritis

Answer 20

antibiotics

generally resolves in 10-14 days

Question 21

chronic pyelonephritis

Answer 21

persistant or recurring episodes of acute pyelonephritis

Question 22

people with ___ ____ and some type of ____ pathological condition are at risk for chronic pyelonephritis

Answer 22

renal infections

obstruction

Question 23

chronic pyelonephritis can lead to

Answer 23

loss of tubular function
ability to concentrate urine
this leads to polyuria, nocturia, proteniuria and maybe eventual end stage renal failure

Question 24

Glomerulonephritis

Answer 24

• presence of anti- steptococcal antibodies:
  1. formation of antigen- antibody complex
  2. activates complement system
  3. inflammatory response in glomeruli causing leakage of some protein and RBC
• severe inflammatory response
  1. congestion and cell proliferation; decreased GFR leading to retention of fluids and wastes

Question 25

CM of Glomerulonephritis

Answer 25

``` urine is dark and cloudy facial and per-orbital edema elevated BP flank back pain general signs of inflammation decreased urine output ```

Question 26

dx of Glomerulonephritis

Answer 26

blood tests metabolic acidosis urinalysis

Question 27

blood tests for Glomerulonephritis

Answer 27

- elevated serum urea and creatinine - elevated anti-DNase B, streptococcal antibodies, anti- spteptolysin, anti- streptokinase - decreased complement levels (used in renal inflammation)

Question 28

urinalysis of Glomerulonephritis

Answer 28

proteniuria hematuria erythrocyte casts no evidence of infection

Question 29

tx of Glomerulonephritis

Answer 29

sodium restriction protien and fluide intake decreased drug treatment like glucorticoids and anti-hypertensives

Question 30

polysystic kidney disease

Answer 30

growth of fluid filled cysts BILATERALLY in kidneys , resulting in replacement of functional tissue, reduced profusion, tubule obstruction

Question 31

PKD categories

Answer 31

Genetic, autosomal dominant Genetic, autosomal recessive Acquired

Question 32

CM of PKD

Answer 32

``` Enlarged kidneys Hypertension Flank pain Altered fluid, electrolyte balance Renal calculi- Diverticular disease Urinary tract infection Liver, pancreatic cysts Cardiac valvular disease Cerebral aneurysms ```

Question 33

PKD dx

Answer 33

``` Family history Genetic testing Physical exam Hypertension Imaging studies Presence of > 3 kidney cysts on ultrasound Extrarenal cysts Laboratory confirmation of renal failure ```

Question 34

PKD treatment

Answer 34

Symptomatic care - Pain control - Treatment of infection - Blood pressure control Promotion of renal function - Dialysis - Renal transplant - Supportive care during end-stage renal disease