Nephrolithiasis Flashcards
Nephro-
Kidney
Renal
Belonging to the kidneys
nephrology
Study of kidneys
urology
Study of urinary tract
-lithos
Stones
Calculi
Accidental, doesn’t belong to body
obstructive urologic disorders severity depends on
Degree
location
Duration
Timing
where can obstructive urologic disorders occur?
Urethra
Ureters
Bladder
Kidneys
renal pelvis obstruction etiology
Renal calculi
ureter obstruction etiology
Renal calculi
Pregnancy
Tumors
bladder and urethra obstruction etiology
Bladder cancer
Neurogenic bladder
Prostatic hyperplasia
Prosthetic cancer
Urethral strictures – narrowing
Complications of obstructed urology
stasis of urine
Back up pressure – hydroureter, Hydro nephrosis, postrenal acute kidney injury
s/sx acute obstruction
Depends on site, cause, speed of onset
Nephrolithiasis
renal calculi, kidney stones
Clumps of crystals in urinary tract
Forms in renal pelvis
Where can nephrolithiasis occur?
Anywhere between the pelvis and bladder
Nephrolithiasis risk factors
Men
20-30 years old
Caucasian
Family history
Congenital defect
Obesity
Warm weather
etiology of nephrolithiasis
Crystallize solutes in urine, forms stones
Depends on: individual risk factors, characteristics of urine, type of stones formed
calcium oxalate
Most common form of stones
Due to family history, idiopathic*, increase in calcium and oxaluria
struvite “ staghorn”
7 to 10%
Due to UTI, urine splitting bacteria
Uric acid
7 to 10%
Due to gout, elevated levels of purine
pathogenesis of nephrolithiasis
Urine is solution of solvent (water) and solutes (particles)
Problem – supersaturation with solute
Crystals begin forming in nephron
how is crystal formation enhanced?
Dehydration
Immobility/sedentary lifestyle
s/sx acute renal colic
Wavelike pain in ureter
Flank and radiates down groin
Spasms, severe
Intermittent/sharp
N/V
Diaphoresis, cool clammy skin
Increase in heart rate, and respiratory rate
pharm therapy for acute pain
morphine or NSAIDS
IV. Fluids.
pharm therapy for preventative
Calcium – thiazide diuretics
Struvite– antibiotics
urate–allopurinol
UTI protective factors
PH – acidic
Presence of urea
Man – prostatic secretions
Women – urethral gland, secretions
urine flow– unidirectional
Immune system
what structure difference in women makes them more prone to UTIs?
Shorter urethra
Risk factors of UTI
CAUTI
Women
Peri irritation
Increased age
Pregnancy
Sex
Obstruction or reflux
Immobility
Incontinence
Decrease cognition
Bad hygiene
pathogenesis of pyelonephritis
ascending pattern
Starts at: contaminated perineum
Urethra
Bladder – cystitis
Ureter
Kidney
Pyelonephritis
Inflammation of the kidneys
Etiology of pyelonephritis
Ascending infection with E. coli
Bloodstream infection
risk factor for pyelonephritis
Pregnancy
s/sx of pyelonephritis
Opaque and foul smelling urine
Sudden onset – fever, chills, CVA tenderness
lower UTI – dysuria
N/V
Anorexia
pathogenesis of pyelonephritis
Inflammatory response
Kidney tissue damage
Urosepsis
Severe systemic response to UTI
Who is at high risk of urosepsis?
Elderly
Diabetics
Immuno suppressed
Prognosis of urosepsis
High mortality
Kidney cancer
Renal cell carcinoma
Risk factors for kidney cancer
1) smoking
obesity
Increased age, males
Genetics
Prognosis of kidney cancer
If metastasized – high mortality
s/sx late kidney cancer
CVA tenderness
Hematuria
Palpable, abdominal mass
Are there any signs of kidney cancer early on?
No
metastases of kidney cancer
Travels to lung or bone
Can cause dyspnea, cough, bone pain
chemo for kidney cancer
Bio treatments
surgery required to remove effective kidney
Bladder cancer
4th most common cancer in men
Urothelial carcinoma
Risk factors for bladder cancer
1) smoking
Males
Occupations, with exposure to toxins – paint, rubber
Low fluid intake
Early signs of bladder cancer
Hematuria – pink/reddish
later signs of bladder cancer
Frequency, urgency, dysuria
chemo for bladder cancer
Depends on stage
Stage one – intravesical chemo
Advanced stages – systemic chemo
Intravesical therapy
Live BCG vaccine
