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6010 Advance Patho Test 5 COMPLETE ☑️ > Module 9: Urinary Tract Obstructions, Tumors & UTI’s (b) // Glomerular Disorders AKI & CKD > Flashcards

Module 9: Urinary Tract Obstructions, Tumors & UTI’s (b) // Glomerular Disorders AKI & CKD Flashcards

1
Q

Urinary Tract Obstructions

-Definition

A
  1. Defined as a blockage of urine flow w/in the urinary tract

Can be caused by

  • Anatomic defect
  • Functional defect
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2
Q

Urinary Tract Obstructions

-Severity is based on?*TEST

A
  1. Location
  2. Completeness
  3. Involvement of one or both upper urinary tracts
  4. Duration
  5. Cause
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3
Q

Urinary Tract Obstructions

-Examples

A
  1. Polycystic Kidney Dz — Cyst in the kidney or Hilum
  2. Blood clots
  3. Ureteral Stones
  4. Renal cell carcinoma — transitional cell carcinoma of bladder — Carcinoma of cervix
  5. BPH
  6. Fibrous bands — Endometriosis — Pregnancy
  7. Urethral sphincter — Functional Issue
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4
Q

Urinary Tract Obstructions

-Upper Tract Obstructions

A
  1. Early complications
    - Hydroureter — Dilation of ureter
    - Hydronephrosis — Dilation of renal pelvis and cálices
    - Ureterohydronephrosis — Dilation of both ureter and renal pélvis/cálices
  2. Later Complications
    - Tubulointestinal fibrosis — Extracellular matrix laid down — Leads to cellular destruction & death of nephrons
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5
Q

Urinary Tract Obstructions

-Renal Calculi Risks

A
  1. Masses of crystals, protein, or mineral salts form in urinary tract and may obstruct the tract
  2. RISK factors include:
    - Male
    - Most develop before 50 yrs of age
    - Inadequate fluid intake
    - Geographic location — hotter climates

Anytime you have higher concentration of urine leads to stone formation
Other risks
-DMT2, HTN, dysmetabolic syndrome & Genetic component

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6
Q

Urinary Tract Obstructions

-Kidney Stone Composition?

A
  1. Composition of mineral salts**
    - MOST COMMON — calcium oxalate and calcium phosphate 70-80% — Alkaline urine pH >7.0
    - Struvite —Magnesium, ammonium phosphate 10-15% — Most often composition of STAGHORN Calculi (massive stones)
    - Uric acid 7% — pH <5
  2. Xanthine stones are caused by genetic disorders of amino acid metabolism
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7
Q

Urinary Tract Obstructions

-Kidney Stone Clinical Manifestations

A
  1. Renal Colic
    —Mid Ureter Obstruction — Colic that radiates to lateral flank or lower abdomen
    —Lower Ureter Obstruction — Urgency, frequency or urge incontinence
  2. Moderate to Severe pain — Can have Severe pain leading to N/V, gross hematuria associated w/ pain
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8
Q

Functional Urinary Tract Obstructions

-Neurogenic Bladder TEST

A
  1. Upper motor neuron dysfunction — Dyssynergia is loss of coordinated neuromuscular contraction
    —Loss of synergy between the bladder and the urinary sphincter (Both internal and external)

—Detrusor hyperreflexia — Bladder empties automatically when it becomes full and urinary sphincter functions normally. More forceful than normal depending on severity — Manifestations are Urge incontinence and urinary leakage

—Detrusor hyperreflexia w/ detrusor sphincter dyssynergia — Both bladder and urinary sphincter are contracting at the same time
Manifestations is a functional urinary tract obstruction — Severe case leads to tubal interstitial fibrosis

  1. Lower Motor Neuron dysfunction
    —Detrusor areflexia (W/out reflex) — Underactive, hypotonic, or atonic bladder — Ex Cauda Equina Syndrome*

SEE PHOTO IN PHONE

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9
Q

Lower Urinary Tract Syndrome LUTS

-What is it?

A
  1. Prostate enlargement
  2. Urethral stricture
  3. Severe pelvic organ prolapse
  4. Partial obstruction of bladder outlet or urethra — Low bladder wall compliance
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10
Q

Overactive Bladder Syndrome

A
  1. Chronic syndrome of detrusor over activity
    - Urgency w/ our w/out urge incontinence
    - Usually associated w/ frequency and Nocturia

Tx w/ lifestyle modification and behavioral therapy

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11
Q

Renal Tumors

-Info/Risks

A
  1. Renal Cell Carcinoma — MOST COMMON
  2. Renal adenomas — Benign
  3. Renal Transitional cell carcinoma — Rare <10% — Highly malignant

Risks for carcinomas

  • Men 2x as likely to have renal cell carcinomas
  • Smoking & long term tobacco use
  • HTN & Obesity
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12
Q

Renal Tumors

-Renal Cell Cancers Clinical Manifestations

A
  1. Hematuria
  2. Dull and achy flank pain
  3. Palpable flank or abdominal mass (depending on body habitus)
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13
Q

Bladder Tumors

-Info

A
  1. Papillary Tumors — 80% of tumors —Tuft-like lesions

2. Nonpapillary Tumors —METs to lymph nodes, liver, bone lungs and adrenal glands —POOR PROGNOSIS — 20%

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14
Q

Bladder Tumors

-Clinical Manifestations

A
  1. Early Stage
    - May be asymptomatic or Painless Hematuria
  2. Late Stage
    - Frequent urination
    - Pelvic pain

SMOKING common risk factor >60 yr old male

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15
Q

Urinary Tract Infection

-Info

A
  1. Inflammation of the urinary epithelium after invasion and colonization by some pathogen in the urinary tract
  2. Retrograde movement of bacteria into urethra and bladder
  3. Classification — Location or complicating factors
    - Complicating factors include — Urethral strictures, Neurogenic bladder, Infections in immunocompromised individuals, pregnancy, atypical organisms, infections in males (UTI in males is STI until proven otherwise)**
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16
Q

Urinary Tract Infections

-Risk Factors

A
  1. Being female but especially
    - Sexually active and pregnant women
    - Women treated w/ antibiotics that disrupt vaginal flora
    - Postmenopausal women
  2. Indwelling catheters
  3. DM
  4. Neurogenic bladder
  5. Lower Urinary Tract Obstruction
17
Q

Urinary Tract infections

-Most common pathogens

A
  1. E. Coli 80-85%
18
Q

Urinary Tract infections

-Host Defenses against UTI’s?

A
  1. Washout phenomena — Sterile urine washes out bacteria
  2. Protective mucin layer —Higher risk in elderly due to decreased mucin production
  3. Local immune responses
  4. Peristaltic movement of ureters
19
Q

Cystitis

-Info/Manifestations

A 
1. Inflammation of the bladder 
Manifestations 
-Frequency
-Dysuria
-Urgency
-Lower abdominal and/or suprapubic pain

—Older adults w/ cystitis may be Asymptomatic or demonstrate CONFUSION or vague abdominal discomfort TEST

20
Q

Pyelonephritis

-Info/Manifestations

A
  1. Acute infection of the ureter, renal pelvis, and/or renal parenchyma
  2. Manifestations TEST
    —Flank pain (SIGNIFICANT PAIN)
    —Fever including chills
    —Costovertebral Tenderness
21
Q

Pyelonephritis

-Evaluation

A
  1. UA — Pyuria — Presence of WBC casts supports dx of acute pyelonephritis — Casts not always presence
  2. Sensitivity is probability of testing positive when disease is present
    —High sensitivity test has FEW false negatives and effective at ruling conditions OUT
    —CVA tenderness is only 21% sensitive — NOT a good Exam to R/O
  3. Specificity — Probability of testing negative when a disease is absent
    —High specificity test has few false positives and is good at ruling condition IN
    — 88% of pt’s who do not have Pyelonephritis will NOT have CVA tenderness — Good Test for Ruling IN pyelonephritis
22
Q

Acute Glomerulonephritis

Info and Types

A
  1. Immune Mechanisms
    - Formation of immune (Antigen/antibody) Complexes — Complement activation — Ex: Acute Strep Glomerulonephritis
  2. Non-Immune Mechanisms
    - Systemic diseases — Diabetes & Lupus (Type 2 and type 3 hypersensitivity reactions in lupus)
    - Ischemia —AKI; Acute tubular necrosis; Renal artery stenosis
    - Drugs or toxins
23
Q

Acute Glomerulonephritis

-Clinical Findings

A
  1. Decreased GFR

2. Proteinuria/Hematuria — increased permeability is d/t loss of negative electrical charge of basement membrane

24
Q

Acute Glomerulonephritis

-Clinical Manifestations

A
  1. Hematuria w/ RBC casts
    - Smoky, brown-tinged urine
  2. Proteinuria including loss of albumin
    - Low serum albumin
    - Edema
  3. Severe or progressive glomerular disease — Eventual oligúria
    —Oligúria = Urine output <30 ml/hr or <400 ml/day
25
Q

Acute Glomerulonephritis

-Nephrotic Sediment

A
  1. Contains massive amounts of PROTEIN and lipids and either a microscopic amount of blood or NO blood
26
Q

Acute Glomerulonephritis

-Nephritic Sediment

A
  1. BLOOD is present in urine w/ RBC casts, WBC casts, and varying degrees of protein, which is not usually severe
27
Q

Acute Glomerulonephritis

-Nephrotic Syndrome

A
  1. Heavy Proteinuria >3.5G/24hrs protein in urine
  2. Serum hypoalbuminemia
  3. Peripheral edema

NEED ALL 3 to be considered nephrotic syndrome

  1. Manifestations
    - Prone to infections
    - Hypothyroidism
    - Vitamin D deficiency
    - Hyperlipidemia
    - Lipiduria
28
Q

Acute Glomerulonephritis

-Nephritic Syndrome

A
  1. Hematuria (usually microscopic) and RBC casts are present in the urine in addition to proteinuria, which is not severe
  2. Advanced stages include — HTN, uremia, & Oligúria
  3. Caused by increased permeability of glomerular filtration membrane
    —Pore sizes enlarge
    —RBC’s and protein pass through
29
Q

Acute Glomerulonephritis

-Nephritic Syndrome Causes

A
  1. Post-Streptococcal glomerulonephritis
  2. IgA Nephropathy
  3. Lupus
  4. Diabetic Glomerulonephritis
30
Q

AKI

-Definition

A
  1. Sudden decline in kidney function w/ a decrease in GFR and accumulation of nitrogenous wast products in the blood
  2. Increase in serum creatinine and BUN
31
Q

AKI

-Types

A
  1. Pre-Renal — Hypo-perfusion of kidney — MOST COMMON overall
  2. Intra-Renal — Involving renal parenchymal or interstitial tissue — Acute tubular necrosis — ISCHEMIC is Most common intra-renal cause
  3. Post-Renal — RARE — Acute urinary tract obstruction
32
Q

CKD

-Info

A
  1. Progressive loss of renal function associate w/ systemic diseases — ie: DM, Lupus, HTN
  2. Kidney damage — GFR < 60 ml/min/1.73 m2 for 3 months or more **
  3. Clinical manifestations DO NOT occur until renal function declines to less than 25% of normal**
33
Q

CKD

-Clinical Manifestations

A
  1. Affects ALL Body systems
  2. Uremic Syndrome
    -Pro-inflammatory state w/ the accumulation of urea and other nitrogenous compounds
    -Toxins — result of accumulation of end-products of protein metabolism
    —Alteration of gut flora creating more toxins

LOOK AT PHOTO ON PHONE

34
Q

CKD Manifestations

TEST

A
  1. Calcium, phosphate, and bone — Decreased calcium, causing renal osteodystrophies — Hyperphosphatemia
  2. Acid-base balance — Metabolic acidosis COMMON — Hydrogen stays in circulation
  3. Protein, carbs, and fat metabolism — Serum protein decreases, glucose intolerance, Increase LDL, Low HDL, High Triglycerides
    —Liver is compensating for loss of albumin in the kidneys
  4. Cardiovascular System — Major cause of morbidity/mortality — Anemia (Lack of erythropoietin) — HTN d/t volume overload
  5. Pulmonary system — Dyspnea and Kussmaul respiration’s
  6. Hematologic Alterations — Normochromic normocytic anemia — Impaired platelet function (Bleeding) — Hypercoagulability
  7. Immune System — Immune suppression — Deficient response to vaccination — Increased risk for infection
  8. Neurologic System — Impaired concentration & Memory loss — Impaired judgement — Seizures, Coma
  9. GI System — Bleeding ulcers, blood loss — N/V/D or constipation — Uremic fetor (bad breath)
  10. Endocrine & Reproductive — Decrease sex steroids — Low libido — insulin resistance — low thyroid hormone levels
  11. Integumentary System — Anemia: pallor — Bleeding Sallow skin (Pale sickly skin)

6010 Advance Patho Test 5 COMPLETE ☑️ (6 decks)

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