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Renal Week 3 > Obstructive Nephropathy - NACE > Flashcards

Obstructive Nephropathy - NACE Flashcards

1
Q

What is Hydronephrosis?

A

Dilation of the Renal Pelvis

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2
Q

What is proximal and distal when discussing the urinary tract?

A

Proximal = Close to the kidney

Distal = Far from the kidney

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3
Q

What is an example of a function obstruction in urinary outflow?

A

• Neurogenic Bladder

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4
Q

What are some common intraluminal causes of mechanical Obstruction to urinary outflow?

A 
Intraluminal
• Stones
• Blood Clots
• Papillary Necrosis (SODA; sickle-cell, obstructive pyelonephritis, diabetes, analgesic use)
• Tumors
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5
Q

What are some intramural causes of mechanical obstruction to urinary outflow?

A
  • Neurologic/Neuromuscular dysfunction (kind of a functional problem too)
  • Strictures (from infection or instrumentation)
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6
Q

What are some common causes of compression in the urinary tract?

A
  • Retroperitoneal Tumors (from prostate tumors)
  • Local Extension of Prostate Cancers, Colon Cancer, Cervical Carcinoma
  • AAA
  • PROSTATIC HYPERTROPHY = big one
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7
Q

Differentiate the severity of disease on the basis of UT obstruction relative to bladder?

A

Distal to Bladder:
• this BAD because it leads to damage in BOTH kidneys - something the body is not well-equipped to handle

Proximal to Bladder:
• Will lead to damage of single kidney only - body can handle this

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8
Q

How can radiocontrast be used to detect Ureter Obstruction?

A

RETROGRADE PYLOGRAPHY can be performed

  • inject radiocontrast from beginning of ureter in the bladder and follow it backwards
  • It will stop wherever the obstruction is located
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9
Q

What would you expect to see happen on Retrograde Pylography of someone with Retroperitoneal Fibrosis?

A

• Contrast Will just stop wherever retroperitoneum has fibrosed over the ureter

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10
Q

What are the two types of consequence that result from obstruction in the GU system?

A
  • Mechanical Consequences

* Functional Consequences

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11
Q

What are the MECHANICAL consequences of GU obstruction?

A
  • Dilation of the urinary Tract Proximal to the Obstruction

* Eventual Compression and thinning of the renal cortex with parenchymal Atrophy over time

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12
Q

What are the FUNCTIONAL consequences of GU obstruction?
• early.
• Time associated with this?

A

Early (4-6 hours):
• Ureteral Pressure and Renal Blood flow increase, PROSTAGLANDINS (Vasoactive mediators) are released to attempt to maintain GFR

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13
Q

What are the FUNCTIONAL consequences of GU obstruction?
• later.
• Time associated with this?

A

Later (greater than 6 hours)
• Vasocontrictors (Renin, Angiotensin, Thromboxane) are produced in the MACULA DENSA

• Leads to GRADUAL SUSTAINED decrease in GFR to about 20% of pre-obstructive values

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14
Q

What are the FUNCTIONAL consequences of GU obstruction?

•Chronically

A

Chronic

• Ischemia and Inflammatory cytokines result in interstitial fibrosis

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15
Q

What is the histopathology seen on H and E in the late stages of obstructive nephropathy?

A

INFLAMMATION and FIBROSIS

• both mononuclear cells and fibrin

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16
Q

Why is GFR not completely predictive of renal damage?

A

• Other Nephrons Hypertrophy and Hyperfiltrate to pick up the slack

This means creatinine isn’t a great indicator of damage especially in unilateral renal dysfunction

17
Q

What important factors determine the signs and symptoms seen in urinary tract obstruction?

A
  • Time Course
  • Degree of Obstruction
  • Level of Obstruction
  • Cause
  • Developement of Secondary Complications
18
Q

What are some secondary complications that may result from urinary tract obstruction?

A
  • Infection
  • Fluid and Electrolytes
  • Renal Failure
19
Q

T or F: chronic progressive obstruction in urinary tract may be asymptomatic.

A

True, acute obstructions are more likely to have symptoms

20
Q

How will complete and partial obstruction affect urinary outflow?
• creatinine

A

Complete:
• ANURIA
• Serum Creatinine results in full blown renal failure

Partial:
• POLYURIA - this is the result of concentrating defects
• small transient effect on Serum Creatinine

21
Q

What type of GU obstruction is associated with the following:
•acute, excruciating flank pain radiating to the groin

A

Ureteral Stones

22
Q

What type of GU obstruction is associated with the following:
prevention of complete emptying of the bladder, producing urinary hesitancy,
diminished stream, dribbling, nocturia, frequent small volume voiding, and straining

A

Prostatic Disease

23
Q

What type of GU obstruction is associated with the following:
Gross Hematuria

A

may suggest a clot as the cause of obstruction or may accompany a kidney stone
or sloughed papilla (from papillary necrosis).

24
Q

**What are the Functional Consequences of CHRONIC Bilateral PARTIAL obstruction of ureters?

A

SYMPTOMS RESEMBLE Type 4 RTA (renal tubule acidosis)

  • Polyuria
  • Volume Depletion
  • Azotemia
  • ELECTROLYTE PROFILE of non-anion gap metabolic acidosis
  • Hyperkalemia
25
Q

What diagnostic Tests are useful in determining if there has been an obstruction in the GU system?
• advantages and disadvantages to each.

A

Ultrasound:
•Advantage: easy availability, good at detecting kidney stones

•Disadvantage: Depends on demonstration of hydronephrosis

CT:
• Advantages: Highly sensitive for obstruction, no contrast is necessary for this indication

• Disadvantages: Inconvenient, Ionizing radiation

26
Q

Why is it a disadvantage that ultrasound depends on hydronephrosis to aid in Dx?

A

Hydronephrosis Can be FALSELY NEGATIVE in cases of:
• Recent Obstruction
• Volume Depletion
• Retroperitoneal Fibrosis

27
Q

What are your 3 Treatment goals for a patient with Urinary Tract Obstruction?

A
  1. Relieve the Obstruction
  2. Treat the underlying Cause
  3. Prevent and Treat Infection*** this is a big one because obstruction + infection = BAD combo. for the kidney
28
Q

T or F: recovery of the kidney even after LONG periods (several days/weeks) of obstruction is possible.

A

True, degree of recovery will be correlated to the extend of obstruction and duration

29
Q

What are some common locations of intraluminal obstruction?

A

• Uretero-Pelvic Junction, Uretero-Vescicle Junction, Intersection of Ureters and Iliac Vessels

30
Q

An adult male with 2 healthy kidneys developes ACUTE RENAL FAILURE. What is the most likely obstructive cause?
• what would his labs show?

A

• Urethral Obstruction by Prostatic Hyperplasia

Labs:
• Hyperchloremic Metabolic Acidosis with Hyperkalemia

31
Q

T or F: UT obstruction is always associated with Intraluminal Obstruction or Extrinsic Compression.

A

FALSE

32
Q

T or F: allergy medication s may cause difficulty urinating

A

True

33
Q

NOTE about distention of structures under acute and chronic conditions

A

ACUTE:
• things that distend quickly Hurt

CHRONIC:
• things that gradually distend will distend much more and be less symptomatic

34
Q

What determines the consequences and symptoms of obstruction?

A

The level at which it occurs

35
Q

T or F: polyuria excludes UT obstruction

A

FALSE, could be bilateral partial obstruction

36
Q

How would EKG indicate Chronic Obstruction?

• explain these findings

A

EKG:

• Big T waves from HYPERKALEMIA - (excessve repolarization)

37
Q

T or F: if you put the catheter in and they start making a lot of urine, you have made the diagnosis

A

True, ***note that if someone has been obstructed for a long time and you catheterize them they may DIURESE SO MUCH THEY THEY BECOME HYPOCALCEMIC.

Renal Week 3 (16 decks)

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