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N339 > N339 Exam 5: Renal Disorders > Flashcards

N339 Exam 5: Renal Disorders Flashcards

1
Q

What 4 types of renal disorders?

A
  1. Congenital Kidney Abnormaliities
  2. Kidney Neoplasms
  3. Kidney Infections
  4. Urinary Tract Obstructions
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2
Q

Describe pain manifestations of kidney disease (3)

A
  1. Starts with flank pain
  2. moves to Scrotal pain in men or
  3. Labial pain in women
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3
Q

With kidney disease, abnormal urinalysis is determined using ___ and microscopic ____. Additional diagnostic tests include ___, ___ scan and ____ imaging.

A 
dipstick
analysis
KUB (kidney, ureter, bladder) xray
CT
MRI
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4
Q

With Microsopic Urinalysis, the following findings indicate?

  1. RBCs
  2. WBCs
  3. Casts: Hyaline
  4. Casts: Fatty
  5. Casts: RBC
  6. Cast: WBC
  7. Crystals: calcium oxalate
A
  1. UTI, trauma or obstructive disorder; glomerulopathies.
  2. Infection or inflammation
  3. chronic kidney disease or pyelonephritis
  4. Nephrosis
  5. glomerulnephritis
  6. acute glomerulenphritis
  7. kidney stones (calcium calculi)
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5
Q

Pain with Kidney disease is perceived at the ______. Expansion of the ureter causes the first pain then pain refers to ____ then down to scrotum or ____.

A
  1. constovertebral angle
    hip
    labia
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6
Q

Congenital Kidney Abnromalities include (3)

A
  1. Renal Agenesis
  2. REnal Hypoplasia
  3. Cystic Kidney Disease
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7
Q

With respect to congenital kidney abnormalities, Renal agenesis is failure of one or both ____ to develop. Failure of both is ____ with life.

A

kidneys

incompatible

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8
Q

With respect to congenital kidney abnormalities, Renal Hypoplasia is failure of full kidney ____ to develop. This is a significant cause of end-stage reanl disease in _____.

A

mass

children

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9
Q

With respect to congenital kidney disease abnormalitiies, Cystic kidney disease is a ____ ____ disease.

A

genetically inherited

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10
Q

Cystic kidney disease includes which two types of polycystic kidney disease?

A
  1. Autosomal Recessive

2. Autosomal dominant

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11
Q
  1. Autosomal recessive polycystic kidney disease is ____ at birth.
  2. Large fluid filled ____ develop that ____ the vasculature and are associated with ____.
  3. This type of disease progresses to end stage kidney disease by age ____.
  4. Polycystic kidney disease and hepatic diseases are associated with chromosome _ gene.
A
  1. present
  2. cysts, compress, ischemia
  3. 15
  4. 6
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12
Q
  1. Autosomal dominant polycystic kidney disease is _____ and usually occurs b/w 40-___ years old.
  2. It is the cause of ___% of end-stage kidney disease.
A
  1. Systemic

2. 10%

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13
Q

Autosomal dominant polycystic kidney disease is associated with pathologies of other body systems. 50% of cases have cysts in the ____, spleen, liver and ____.
10-30% have ____ aneurysms in cerebral ____ of ____ circulation.

A 
pancrease
lung
berry
Circle
Willis
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14
Q

With Autosomal dominant polycystic kidney disease, ____ is common occurence b/c of the volume of blood from _____ activation. 60% of patients experience _____.

A

hypertension
RAAS
pain

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15
Q

What are the 3 types of kidney neoplasms?

A
  1. Benign Renal Neoplasm
  2. Renal Cell Carcinoma
  3. Nephroblastoma
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16
Q

Benign tumors are ____. They include renal coricial adenoma, metanephric adenoma, oncocytoma, angiomyolipoma and nephroma. Remember, ____ is the most common and ____ is the initial treatment.

A

not encapsulated
oncocytoma
nephrectomy

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17
Q

Renal Cell Carcinoma is the most ____ kidney neoplasm. It appears in the ____ and represents __% of cases of renal cancer. some are hereditary but often ______ until cancer is quite advanced.

A

malignant
60s
85
asymptomatic

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18
Q

Renal cell carcinoma is the most malignant kidney neoplasm because it is ____ to chemo, radiation and immunotherapy.

A

refractory

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19
Q

The survival rate from diagnosis for renal cell carcinoma is ___ years.

A

< 5 years

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20
Q

Risk factors for renal cell carcinoma inlcude? (8)

A
  1. cigarettes
  2. obesity
  3. hypertension
  4. diabetes
  5. Asbestos exposure
  6. Prior oophorectomy or hysterectomy
  7. LT renal dialysis
  8. kidney transplantation
21
Q

Nephroblastoma is a kidney neoplasm that is the most common _____ cancer. ___% of cases are diagnosed before ___ years of age.

A

childhood
80%
5

22
Q

Nephroblastoma typically presents with ___ pain and _____ that may be ____ and only picked up in ____.

A

abdominal
hematuria
microscopic
urinalysis

23
Q

Metastasis of the Brain, bone and liver are associated with _____.

A

nephroblastoma

24
Q

Nephroblastoma responds well to ___ and ____ with a cure rate of ____%

A

radiation
chemo
85%

25
Q

Nephroblastoma typically present with abdominal pain; on palpation mass, also present w/ ____ (pathology that causes ____that triggers ____)
With hematuria: destruction of renal _____causes bleeding,

A

hypertension
ischemia
RAAS
parenchyma

26
Q

What are 3 types of kidney infections?

A
  1. UTI
  2. Acute Pyelonephritis
  3. Chronic Pyelonephritis
27
Q

UTI are the __ most common infection in the US. They are caused by ____, enterobacter, enterococcus, proteus and klebseilla.

A

2nd

E. Coli

28
Q

Risk factors for UTI include (why?):

  1. Increasing Age
  2. Female Gender
  3. Pregnancy
  4. Diaphragms and spermicidal agents
  5. Neurogenic Bladder
A
  1. incontinence (increases with age) leads to exposure to E. coli
  2. females have a shorter urethra
  3. Expanding uterus compresses ureters allowing bacteria to flourish.
  4. Introduction of bacteria on insertion
  5. Low spinal cord injury (S2-4), paralyzed bladder so can’t control, end up with urinstalsis, bact colonization/multiplication.
29
Q

Risk factors for UTI include (why?): contd

  1. Catheterization, cytoscopy
  2. Urinary obstruction
  3. Glucocoricoids, radiation, cytoxic chemo
  4. Diabetes
  5. Obesity
  6. Sickle Cell Trait
A
  1. introduce bacteria
  2. Calculi- stones; BPH in males; or prostatic cancer.
  3. cause swelling; knock out immune fxn (chemo)
  4. sweet urine provides bacteria with nutrients
  5. probably same as pregnancy
  6. sickle cells clog vessels block WBCs can’t get in to mount defense.
30
Q

What is one of the most significant preventative intervention for UTIs?

A

Early removal of catheters

31
Q

Acute pyelonephritis is an infection of the kidney and ____ caused by an _____ infection.

A

Renal Pelvis

Ascending

32
Q

Risk factors for Acute pyelonephritis include:
1. Diabetes Mellitus
2. anatomical abnormalities of _____.
3. obstructive causes (allows ___ to multiply b/c of a ____ back up)
4 Pregnant women (____ obstructs the UT)

A
  1. Urinary tract
  2. bacteria, urine
  3. uterus
33
Q

With acute pyelonephritis, ____ formation is a complication. This can lead to ____ shock which leads to _____.

A

abscess
septic
ARDS

34
Q
  1. Chronic pyelonephritis results from a recurrent or inadequatley managed ____.
  2. It is characterized by small ____ kidneys with diffuse _____.
  3. Chronic _____ inflammation leads to ______.
A
  1. UTI
  2. atrophied, scarring
  3. interstitial, fibrosis
35
Q

With chronic pyelonephritis,

  1. Unmanaged UTIs causes _____ build-up in kidney itself that then
  2. compresses ____, ends up ischemic
  3. _____ kidney leads to _____.
  4. Ultimately, Decreases ____.
A
  1. Connective tissue
  2. vasculature
  3. atrophied, fibrosis
  4. glomular filtration rate
36
Q

What is the vesicoureteral junction prevent?

A

prevents reflux of urine from the bladder to the kidneys (via contraction of the vesicoureteral junction when the bladder fills).

37
Q

Why is Vesicoureteral reflux a risk factor for UTI?

A

Part of ascending pathway to renal infection: bacteria from bladder ascend thru deranged VSCU jxn, the reflux allows bacteria to head up ureter to kidney. In most men over 50 that have benign prostatic hyperplasia, the constricted prostate can cause VCUR swelling.

38
Q

What are the two pathways of renal infection? what is the most common pathway to acute pyelonephritis?

A
  1. Ascending
  2. Hematogenous (pre-renal septecemia, bacteria from blood)
    Ascending is the most common pathway:
    if E. Coli in urethra are not flushed out, they colonize and multiply cause cystitis (infection of bladder) Then with deranged vesicoureteral junction, urine reflux takes bacteria back to kidney.
39
Q

Explain normal vesicoureteral function compared to deranged.

A

Normally, when ureter enters the bladder, it doesn’t go directly in, courses through muscular wall before it empties into bladder. When contract muscle to urinate, squeezes of the ureter so no reflux. With deranged, ureter goes directly in, has short intermuscular course so consequently, not enough squeezing with contraction end up with reflux.

40
Q

What are two types of Urinary tract obstructions?

A 
Benign Prostatic Hypertrophy
Renal Calculi (Nephrolithiasis)
41
Q

BPH is the most common ____ in males over 50 years old. The enlarged _____ gland impedes urine flow.

A

obstruction

prostate

42
Q

Renal Calculi (nepthrolithiasis) is ____ stones formed by _____ w/in the ____ tract. The two most common types of kidney stones are?

A
  1. kidney
  2. crystallization
  3. urinary
    most common: calcium oxalate then
    -struvite (develops in kidney parenchyma, branches, doens’t move; staghorn)
43
Q
  1. Kidney stones can result in ____ damage to the kidneys.
  2. If stone moves and blocks the ureter, ____ flow back into the kidneys occur.
  3. The kidney has no ____ receptors and back pressure causes kidney ____ and ____ the vasculature inside the kidney
  4. end up with thin kidney wall, get ____ and atrophy of kidney tissue.
A
  1. permanent
  2. retrograde
  3. pressure, expansion, compresses
  4. ischemia
44
Q 
Urinary tract obstruction can occur at the urethra, bladder, Ureter and Pelvis. Describe what types of issues occur at each one. 
1. Urethra 
2. Bladder
3/4. Ureter- extrinsic and intrinsic
5. Pelvis
A
  1. urethra: posterior valve structure tumors also prostate issues block urethra…
  2. Bladder: calculi, tumors, neurogenic
  3. Ureter-extrinsic: pregnancy, tumors, retroperitoneal fibrosis (immune response that constricts ureter)
  4. Ureter- intrinsic: calculi, tumors, clots, inflammation, slough papillae
  5. Pelvis- calculi, tumors, ureteropelvic stricture (embryonic dvlpt, stx that develops descends
45
Q

Posterior valve stricture?

A

Abnormal formation when the ureter starts out, leads to posterior valve sturcture tumors

46
Q

ureteropelvic stricture

A

During embryonic dvlpt, kidneys descend at same time as ureter dvlpt kidney descends too much causes kink in ureter.

47
Q

General contributing factors to nephrolithisis?

A
  1. hyperparathyroidism
  2. diet
  3. past medical history
  4. diet,
  5. obesity
  6. DM
  7. dehydration concentration of urine causes stones.
  8. prolonged immobility
  9. vesicoureteral reflux
48
Q

Interventions for kidney stones

A

fluid and pain managment:

  • narcotics
  • increase fluids to spontaneously pass
  • ** <4mm in size will typically pass kidney stone
  • shock wave
  • fiber optics
  • diet modification
  • meds that stop chem formation alnopurinol and uric acid stones…

N339 (7 decks)

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