Exam 4- Renal And Urinary

Question 1

Renal stones and hypertension

Answer 1

The most common type of renal stone is Calcium oxalate. Passage of kidney stones can be extremely painful and may produce “referred pain” to umbilicus area.

The reduced perfusion (kidneys require at least 20-25% cardiac output – MAP) of the affected kidney activates the renin-angiotensin-aldosterone system (RAAS), which causes constriction of peripheral arterioles (HTN).

Question 2

UTIs

Answer 2

Clinical manifestations of a urinary tract infection in an older adult are confusion and poorly localized abdominal discomfort. Can be very difficult diagnose due to vague symptoms.

Question 3

Pyelonephritis

Answer 3

Pyelonephritis is an infection of one or both upper urinary tracts (ureter, renal pelvis, and kidney interstitium). Urinary obstruction and reflux of urine from the bladder (vesicoureteral reflux) are the most common underlying risk factors

Question 4

Painful bladder syndrome/ cystitis

Answer 4

Painful bladder syndrome/interstitial cystitis (PBS/IC) is a condition that includes nonbacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal) and noninfectious cystitis (radiation, chemical, autoimmune, hypersensitivity). The cause of PBS/IC is unknown, but an autoimmune reaction may be responsible for the inflammatory response.

Differentiating symptoms of cystitis from those of pyelonephritis by clinical assessment alone is difficult. The specific diagnosis is established by urine culture, urinalysis, and clinical signs and symptoms. Lumbar percussion positive: upper UTI.
White blood cell casts indicate pyelonephritis.

Question 5

ARF

Answer 5

BUN / creatinine
Volume/day

Pre-renal / renal / post-renal
BUN/Cr ratio

Renal:
Glomerulonephritis…PSGN
Acute interstitial nephritis…Allergy
Acute tubular necrosis

Question 6

Glomelular disorders

Answer 6

Reduced GFR during glomerular disease is evidenced by elevated plasma urea, creatinine concentration, or reduced renal creatinine clearance.

Ex; glomerulonephritis and nephrotic syndrome

Question 7

Acute glomelular nephritis

Answer 7

Acute glomerulonephritis includes renal diseases in which glomerular inflammation is caused by immune mechanisms that damage the glomerular capillary filtration membrane. Symptoms: hematuria and proteinuria (milder than nephrotic syndrome), and in more severe cases, these symptoms are also accompanied by edema, hypertension, and impaired renal function.

Question 8

Nephrotic syndrome

Answer 8

Nephrotic syndrome is the excretion of 3.0 g or more of protein (massive proteinuria) in the urine per day, hypoalbuminemia (less than 3.0 g/dl), and peripheral edema. Nephrotic syndrome is characteristic of glomerular injury

Question 9

AKI

Answer 9

Acute Kidney injury may be acute and rapidly progressive (within hours), and the process may be reversible. Kidney failure also can be chronic, progressing to end-stage kidney failure over a period of months or years. Levels of serum creatinine and urea are mildly elevated. However, changes in serum creatinine level occur only if more than 50% of glomerular filtration is lost and are often delayed by more than 24 hours.