Kidney stuff Flashcards
Pyelonephritis
Kidney infection plus the upper tract
What is often the cause of a kidney infection?
Often ascends from the lower urinary tract but can be from a bloodstream infection
- most often E. coli
Risk factors for pyelonephritis
Pregnancy, recurring lower UTIs, abx-resistant strains (from lower UTI)
Pyelonephritis patho
INFLAMMATION causes kidneys swelling, fill with infectious exudate, can compress renal artery if bad enough and cause necrosis or abscesses
What does chronic pyelonephritis lead to
CKD or sepsis
Pyelonephritis CM
SUDDEN fever, chills, CVA tender, flank pain, look and feel sick, lower UTI sx (dysuria, hematuria), N/V, anorexia
Pyelonephritis tx
- urine specimen to determine specific abx but start with broad spectrum
- Abx especially trimethoprim/sulfamethoxazole, Bactrim, ciprofloxacin, nitrofuratoin
- usually short course but longer (7-14d) if recurring
- if more severe, may need IV abx
Which population should not take trimethoprim sulfamethoxazole?
Pregnant
Big complication of pyelonephritis
Urosepsis
- WORSE IN ELDERLY
- severe systemic response
- high mortality rate
Causes of blockages in the ureters
pregnancy, renal calculi, tumors
Causes of blockages in the bladder and urethra
bladder cancer, neurogenic bladder, prostate hyperplasia, prostate cancer, urethral stricture
Complications of obstruction
Stasis, back up pressure, acute obstruction
Hydroureter
ureter holding urine; may be emergency if complete blockage - surgery needed
hydronephrosis
Kidneys holding urine; may be emergency if complete blockage - surgery needed
Postrenal kidney injury
Complication of obstruction
Acute obstruction factors
- site
- cause
- speed of onset
Kidney stones aka nephrolithiasis
RENAL CALCULI
- clumps of crystals in the urinary tract
- small or big, smooth or jagged
- most common cause of renal obstruction
Patho of kidney stones
Urine becomes super saturated with solutes (particles) and crystals form in nephrons
Factors that enhance kidney stones
pH (UTI), excess concentration of insoluble salts (gout, bone disease, renal disease, dehydration), urinary stasis
Risk factors for kidney stones
male, young ppl (20-30s), white, family history (parent or grandparent), congenital defects (stasis), obesity, weather (hot, dehydrating conditions)
CM of kidney stones
flank pain, N/V, dysuria, hematuria, diaphoresis, foul smelling urine, chill/fever (if infx present too–often pyelonoephritis)
Calcium oxalate or Calcium phosphate stones
- most common
- idiopathic
- risks: family history, inc oxaluria, inc calcemia from diet, inc protein intake
struvite stones
- “staghorn”
- UTI
Pharm for kidney stones
- NSAIDs or opioids until stone passes
- IVF
Prevent of kidney stones
- thiazide diuretics (calcium)
- abx (struvite)
- allopurinol - gout (urate)
Causes of blockages in the renal pelvis
Often renal calculi
Manifestations of acute obstruction depend on…
site and cause (eg stones vs prostate problem)
Which factor primarily determines severity of acute obstruction pain
Speed of onset - stones much more painful than prostate block that gradually grew
Uric acid stones are r/t…
Gout
Characteristics of renal colic
flank pain spasms (15-20 min intervals), radiating pain to lower abdomen and groin, sharp (when calculi scrape the ureter wall)
