Exam 3 - Alterations of Renal and Urinary Tract Function Flashcards
1
Q
What is a urinary tract obstruction?
A
blockage of urine flow within the urinary tract
2
Q
What 2 things can an obstruction be caused by?
A
- anatomic defect
2. functional defect
3
Q
What are 4 complications associated with upper urinary tract obstructions?
A
- hydrometer
- hydronephrosis
- ureterohydronephrosis
- tubulointerstitial fibrosis
4
Q
define hydroureter
A
dilation of ureters
5
Q
define hydronephrosis
A
dilation of renal pelvis and calyces
6
Q
define ureterohydronephrosis
A
dilation of both ureters and the renal pelvis and calyces
7
Q
define tubulointersitial fibrosis
A
- deposition of excess amounts of extracellular matrix
2. leads to cellular destruction and death of nephrons
8
Q
define compensatory hypertrophy
A
partially counteracts the negative consequences of unilateral obstruction
9
Q
What are the 2 types of growth with compensatory hypertrophy?
A
- obligatory growth
2. compensatory growth
10
Q
what is caused by relieve of an upper urinary tract obstruction?
A
post obstructive diuresis
11
Q
What can post obstructive diuresis cause?
A
fluid and electrolyte imbalance
12
Q
What are kidney stones also called?
A
renal calculi or urolithiasis
13
Q
what are kidney stones?
A
masses of crystals, protein or mineral salts form and may obstruct the urinary tract
14
Q
What are 4 risk factors for kidney stones?
A
- male
- most develop before 50 years of age
- inadequate fluid intake
- geographic location
15
Q
What are kidney stones mostly composed of?
A
calcium oxalate or calcium phosphate
16
Q
How can genetic disorders of amino acid metabolism lead to kidney stone formation?
A
low pH
17
Q
What are stag horn calculi?
A
large kidney stones
18
Q
What does a alkaline urinary pH increase the risk for?
A
it increases risk for calcium phosphate stone formation
19
Q
What does an acidic urine increase the risk for?
A
uric acid stone
20
Q
What is 1 clinical manifestation of kidney stones?
A
renal colic (pain)
21
Q
what is a process where crystals grow from a small nidus or nucleus to larger stones?
A
growth into a stone via crystallization or aggregation
22
Q
What are 5 common treatments for kidney stones?
A
- parenteral and/or oral analgesics for acute pain
- medical therapy that promotes that stone passage
- high fluid intake
- alteration in urine pH
- removal of stones
23
Q
What is a neurogenic bladder?
A
bladder dysfunction caused by neurologic disorders
24
Q
What are two syndromes associated with dysfunction of the upper motor neurons?
A
- detrusor sphincter dyssynergia
2. overactive bladder syndrome
25
What is 1 syndrome associated with dysfunction of the lower motor neurons?
detrusor areflexia (underachieve bladder)
26
What are 4 common causes of lower urinary tract obstruction?
1. prostate enlargement
2. urethral stricture
3. severe pelvic organ prolapse
4. low bladder wall compliance
27
What are some clinical manifestations of lower urinary obstructions?
1. frequent daytime voiding
2. nocturne: night-time voiding
3. urgency
4. dysuria
5. poor force of stream
6. feelings of incomplete bladder emptying
28
What is overactive bladder syndrome chronic syndrome of?
detrusor overactivity
29
What are the symptoms of overactive bladder syndrome?
1. syndrome of urgency, with or without urge incontinence
| 2. frequency and nocturne
30
What is underactive bladder syndrome?
bladder contraction of reduced strength and/or duration
31
What is underactive bladder syndrome associated with?
prolonged bladder emptying or incomplete bladder emptying, or both
32
What is an underactive syndrome caused by?
1. spinal cord injury
2. stroke
3. multiple sclerosis
4. parkinson disease
5. diabetic neuropathy
6. aging
33
What are symptoms of an underactive bladder?
1. weak stream
2. intermittency
3. hesitancy
4. straining
34
What is a benign renal tumor?
renal adenomas
35
What is the rarest renal tumor?
renal transitional cell carcinoma
36
what is the most common renal tumor?
renal cell carcinoma
37
where is the mutation with renal cell carcinoma?
mutation of gene on chromosome 3p
38
what are manifestations of renal cell carcinoma?
hematuria, dull and aching flank pain
39
What is the most common bladder tumor?
urothelial (transitional cell)
40
What is a urinary tract infection?
inflammation of the urinary epithelium after invasion and colonization by some pathogen in the urinary tract
41
how is a urinary tract infection classified?
location and complicating factors
42
True or false: UTI's can be either complicated or uncomplicated
true
43
define cystitis
bladder inflammation
44
define pyelonephritis
inflammation of upper urinary tract
45
Define the pH and osmolality of urea that helps protect against UTI's:
low pH and high osmolality of urea
46
What kind of effect do secretions from the uroepithelium?
bactericidal effect
47
what does the ureterovesical junction do to protect against UTI's?
closes to prevent reflux of urine to the ureters and kidneys
48
What do women have that protect against UTI's?
mucus-secrting glands
49
What do men have that protect against UTI's?
length of the male urethra
50
What are the 2 most common pathogens that cause UTI's?
1. escherichia coli
| 2. staphylococcus saprophyticus
51
What are 3 ways that uropathogens are virulent?
1. ability to evade or overwhelm host defense mechanisms and cause disease
2. adherence to uroepithelium
3. ability to resist the host's defense mechanisms
52
define cystitis?
inflammation of the bladder
53
What are 2 clinical manifestations of cystitis?
1. asymptomatic
| 2. frequency, dysuria, urgency, and lower abdominal and/or suprapubic pain
54
define acute pyelonephritis:
acute infection of the ureter, renal pelvis, and/or renal parenchyma
55
What are 3 contributing factors to
1. cystitis
2. urinary tract obstruction with reflux infection
3. women are 5 times more likely to develop pyelonephritis
56
What are 4 clinical manifestations of acute pyelonephritis?
1. flank pain
2. fever, chills
3. costovertebral tenderness
4. purulent urine
57
What is chronic pyelonephritis?
persistent or recurrent infection of the kidneys, leading to scarring
58
Where is inflammation and fibrosis of chronic pyelonephritis located?
in interstitial spaces between tubules, leading to chronic kidney failure
59
What is glomerulopathies?
disorders that directly affect the glomerulus
60
What are glomerulopathies a significant cause of?
1. chronic kidney disease
| 2. end-stage renal failure worldwide
61
What is glomerulonephritis?
inflammation of the glomerulus
62
What are the most common problems associated with glomerulonephritis?
immunologic abnormalities
63
What is the most common form of acute glomerulonephritis?
IgA nephropathy
64
What is the most rapidly progressive form of acute glomerulonephritis?
crescentic glomerulonephritis
65
What is the most common cause of acute glomerulonephritis?
membraneous nephroptahty
66
What are 2 other types of acute glomerulonephritis?
1. membranoproliferazive glomerulonephritis
| 2. mesangial proliferative glomerulonephritis
67
What is the patho of acute glomerulonephritis?
1. Formation of immune complexes (antigen/antibody) in the circulation with subsequent deposition in glomerulus
2. Antibodies produced against the strep organism cross-react with the glomerular endothelial cells (may be related to inadequately treated strep)
3. Activation of complement
4. Recruitment/activation of immune cells and mediators
68
What is decreased glomerular filtration rate?
decreased glomerular perfusion as a result of inflammation
69
What does decreased glomerular filtration rate result on?
glomerular scarring
70
What happens to the basement membrane with GFR?
thickening, and increased permeability to proteins and RBCS
71
What are the manifestations of acute glomerulonephritis?
1. hematuria with RBC casts
| 2. proteinuria
72
What are 2 types of urinary sediment changes with acute glomerulonephritis?
1. nephrotic sediment
| 2. nephritic sediment
73
What is characteristic of nephrotic sediment?
contains massive amounts of protein and lipids and sometimes trace blood
74
What is characteristic of nephritic sediment?
blood is present in urine with red cell casts, white cell casts
75
What is chronic glomerulonephritis?
glomerular diseases with a progressive course, leads to chronic kidney failure
76
What are secondary causes of chronic glomerulonephritis?
1. diabetic neuropathy
| 2. lupus nephritis
77
What are the 2 clinical manifestations of chronic glomerulonephritis?
1. proteinuria
| 2. hypercholesterolemia
78
What happens with protein excretion in nephrotic syndrome?
exertion of 3 g or more of protein in the urine
79
What is protein excretion the result of nephrotic syndrome?
result of glomerular injury
80
What are 3 clinical manifestations of nephrotic syndrome?
1. hypoalbuminemia
2. peripheral edema
3. prone to infection
81
How can you classify kidney dysfunction?
1. acute or chronic
| 2. reversible or irreversible
82
define renal insufficiency
decline of renal function to approximately 25% of normal
83
define renal failure
significant loss of renal function
84
define end-stage renal failure
less than 10% of renal function remains
85
What is a syndrome of renal failure?
uremia
86
which levels are elevated with uremia?
blood urea and creatinine
87
What happens in the body with uremia?
1. retention of toxic wastes
2. deficiency states
3. electrolyte disorders
4. pro inflammatory state
88
Which levels are elevated with azotemia?
serum urea and creatinine
89
what causes azotemia
1. renal insufficiency
| 2. renal failure
90
What do azotemia and uremia have in common?
accumulation of nitrogenous waste products in the blood
91
What is acute kidney injury
sudden decline in dinner function with decrease in glomerular filtration and accumulation of nitrogenous waste products in blood
92
What lab values increase with acute kidney injury?
serum creatinine and BUN
93
How can you classify (diagnose) renal failure
RIFLE: Risk; Injury; Failure; Loss; End-state disease
94
What causes prerenal acute kidney injury?
renal hypoperfusion: most common cause
95
What causes intrarenal acute kidney injury?
1. disorders involving the renal parenchymal or interstitial tissue
2. acute tubular necrosis (ATN) caused by ischemia: MOST COMMON CAUSE
96
What causes postrenal acute kidney injury?
disorders associated with acute urinary tract obstruction
97
postrenal acute kidney injury rare or common?
rare
98
What is the initiation phase of acute kidney injury?
reduced perfusion or toxicity, during which renal injury is evolving
99
How long does the initiation phase of acute kidney injury last?
24 to 36 hours
100
Is prevention of injury possible during the initiation phase of acute kidney injury?
yes
101
What is the maintenance or oliguric phase of acute kidney injury?
Period of established renal injury and dysfunction after the initiating event has been resolved.
102
How long does the maintenance or oliguric phase last for acute kidney injury?
weeks to months
103
What are some symptoms of the maintenance phase for acute kidney injury?
Urine output is lowest, and serum creatinine, blood urea nitrogen, and serum potassium increase, metabolic acidosis develops, and salt and water overload occurs.
104
What is the recovery phase for acute kidney injury?
Renal injury is repaired, and normal renal function is reestablished.
105
What returns to normal with the recovery phase for acute kidney injury?
GFR returns toward normal, but the regenerating tubules cannot concentrate the filtrate.
106
What is common with the recovery phase for acute kidney injury?
Diuresis is common
107
What is chronic kidney disease?
progressive loss of renal function associated with systemic disease
108
In order to be diagnosed with CKD, what levels do you have to report?
GFR less than 60 ml/min/1.73 m2 for 3 months or more, regardless of cause
109
Clinical manifestations for CKD do no occur until when?
until renal function declines to less than 25% of normal
110
What is the intact nephron hypothesis for CKD?
Loss of nephron mass with progressive kidney damage causes surviving nephrons to sustain normal function
111
What are factors that advance CKD?
1. proteinuria
| 2. angiotensin II
112
What are factors that contribute to CKD progression?
Glomerular hypertension; hyperfiltration; tubulointerstitial injury; fibrosis
113
CKD affects what part of the body?
every body system
114
What is uremic syndrome?
pro inflammatory state with accumulation of urea and other nitrogenous compounds
115
What does uremic syndrome cause?
alterations in fluid and electrolyte and acid-base balance
116
What lab values does CKD increase?
1. serum creatinine
| 2. urea
117
How does CKD affect fluid and electrolyte balance?
mention of sodium, water, and potassium in late stages
118
How does CKD affect calcium, phosphate, and bones?
1. decreases calcium
| 2. increase phosphate levels
119
How does CKD affect acid-base imbalance?
metabolic acidosis is common
120
How does CKD affect protein, carb and fat metabolism?
1. negative nitrogen balance, serum protein decreases
2. glucose intolerance
3. high ratio of LDL to HDL, high triglycerides
121
How does CKD affect cardiovascular system?
CV disease, anemia, hypertension
122
How does CKD affect pulmonary system?
dyspnea; kussmaul
123
How does CKD affect hematologic system?
1. normochromic normocytic anemia
| 2. impaired platelet function and hyper coagulability
124
How does CKD affect the immune system?
1. immune suppression
2. deficient response to vaccination
3. increased risk for infection
125
How does CKD affect eh neurologic system?
1. impaired concentration
2. memory loss
3. impaired judgement
4. seizures, coma
126
How does CKD affect the gastrointestinal system?
1. uremic gastroenteritis: bleeding ulcer and sig blood loss
2. anorexia, nausea, vomiting, constipation or diarrhea
3. uremic fetor: bad breath
4. malnutrition: common
127
How does CKD affect the endocrine and reproductive system?
1. Decreased libido
2. Insulin resistance
3. Low thyroid hormone levels
128
How does CKD affect the integumentary system?
1. Anemia
2. Bleeding
3. Retained urochromes: sallow skin color
4. Hyperparathyroidism and uremic skin residues (uremic frost)
129
How do you treat CKD?
1. Manage protein intake
2. Supplement vitamin D
3. Maintain sodium & fluid
4. Restrict potassium
5. Manage dyslipidemia
6. Maintain adequate caloric intake
7. Erythropoietin as needed
8. ACE inhibitors/receptor blockers (control HTN and protect kidneys)
