Kidney stuff

Question 1

Pyelonephritis

Answer 1

Kidney infection plus the upper tract

Question 2

What is often the cause of a kidney infection?

Answer 2

Often ascends from the lower urinary tract but can be from a bloodstream infection
- most often E. coli

Question 3

Risk factors for pyelonephritis

Answer 3

Pregnancy, recurring lower UTIs, abx-resistant strains (from lower UTI)

Question 4

Pyelonephritis patho

Answer 4

INFLAMMATION causes kidneys swelling, fill with infectious exudate, can compress renal artery if bad enough and cause necrosis or abscesses

Question 5

What does chronic pyelonephritis lead to

Answer 5

CKD or sepsis

Question 6

Pyelonephritis CM

Answer 6

SUDDEN fever, chills, CVA tender, flank pain, look and feel sick, lower UTI sx (dysuria, hematuria), N/V, anorexia

Question 7

Pyelonephritis tx

Answer 7

• 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

Question 8

Which population should not take trimethoprim sulfamethoxazole?

Answer 8

Pregnant

Question 9

Big complication of pyelonephritis

Answer 9

Urosepsis
- WORSE IN ELDERLY
- severe systemic response
- high mortality rate

Question 10

Causes of blockages in the ureters

Answer 10

pregnancy, renal calculi, tumors

Question 11

Causes of blockages in the bladder and urethra

Answer 11

bladder cancer, neurogenic bladder, prostate hyperplasia, prostate cancer, urethral stricture

Question 12

Complications of obstruction

Answer 12

Stasis, back up pressure, acute obstruction

Question 13

Hydroureter

Answer 13

ureter holding urine; may be emergency if complete blockage - surgery needed

Question 14

hydronephrosis

Answer 14

Kidneys holding urine; may be emergency if complete blockage - surgery needed

Question 15

Postrenal kidney injury

Answer 15

Complication of obstruction

Question 16

Acute obstruction factors

Answer 16

• site
• cause
• speed of onset

Question 17

Kidney stones aka nephrolithiasis

Answer 17

RENAL CALCULI
- clumps of crystals in the urinary tract
- small or big, smooth or jagged
- most common cause of renal obstruction

Question 18

Patho of kidney stones

Answer 18

Urine becomes super saturated with solutes (particles) and crystals form in nephrons

Question 19

Factors that enhance kidney stones

Answer 19

pH (UTI), excess concentration of insoluble salts (gout, bone disease, renal disease, dehydration), urinary stasis

Question 20

Risk factors for kidney stones

Answer 20

male, young ppl (20-30s), white, family history (parent or grandparent), congenital defects (stasis), obesity, weather (hot, dehydrating conditions)

Question 21

CM of kidney stones

Answer 21

flank pain, N/V, dysuria, hematuria, diaphoresis, foul smelling urine, chill/fever (if infx present too–often pyelonoephritis)

Question 22

Calcium oxalate or Calcium phosphate stones

Answer 22

• most common
• idiopathic
• risks: family history, inc oxaluria, inc calcemia from diet, inc protein intake

Question 23

struvite stones

Answer 23

• “staghorn”
• UTI

Question 24

Pharm for kidney stones

Answer 24

• NSAIDs or opioids until stone passes
• IVF

Question 25

Prevent of kidney stones

Answer 25

• thiazide diuretics (calcium)
• abx (struvite)
• allopurinol - gout (urate)

Question 26

Causes of blockages in the renal pelvis

Answer 26

Often renal calculi

Question 27

Manifestations of acute obstruction depend on…

Answer 27

site and cause (eg stones vs prostate problem)

Question 28

Which factor primarily determines severity of acute obstruction pain

Answer 28

Speed of onset - stones much more painful than prostate block that gradually grew

Question 29

Uric acid stones are r/t…

Answer 29

Gout

Question 30

Characteristics of renal colic

Answer 30

flank pain spasms (15-20 min intervals), radiating pain to lower abdomen and groin, sharp (when calculi scrape the ureter wall)