Primary Glomerular Pathologies, Kidney Stones, Neurogenic Bladder Disorders Flashcards
PRIMARY GLOMERULAR DISEASES
PRIMARY GLOMERULAR DISEASES
Primary glomerular diseases are a group of disorders characterized by ________ alterations in normal glomerular ________ and ________, independent of _________ disease processes such as diabetes and HTN.
- pathologic
- structure and function
- systemic
Primary glomerular diseases result from damage to what?
Kidney’s filtering units i.e. capillary-Bowman’s capsule interface
Primary glomerular diseases pathologies involve immune function in what 2 ways?
- Deposition of antigen/antibody complexes into some portion of the glomerulus → inflammatory response → sclerotic damage.
- Deposition of an antigen in the glomerulus → localized antigen/antibody reaction → inflammation and sclerotic damage (lupus nephritis).
- Primary glomerular diseases can cause damage to the _________ ________ walls and allow larger molecules (proteins) to escape the circulation and enter the proximal tubule resulting in _________.
- Primary glomerular diseases can also damage the __________ wall allowing RBCs to escape into the proximal tubule resulting in __________.
- glomerular epithelial walls
- proteinuria
-hematuria
What are the clinical signs of primary glomerular diseases?
- Proteinuria
- Hematuria
- HTN (kidney damage and hypervolemia)
- Decline in GFR
- Edema
- Hypoalbuminemia
Describe how primary glomerular diseases causes hypoalbuminemia:
- Secondary to increased filtration of _______ at the level of the ________ leading to proteinuria.
- Contributes to the observed ______.
- Edema results in _____volemia.
- Kidney responds by ________ reabsorption of water.
- Activation of RAS cascade leading to _____volemia.
- albumin, kidney
- edema
- hypovolemia
- increasing
- hypervolemia
What are the treatments for the following due to primary glomerular diseases?
- Hypervolemia
- Renal HTN
- Edema
- Hypercholesterolemia
- Anemia
- Immune Associated Injury
- Hypervolemia = fluid restriction
- Renal HTN = ACE inhibitors, ARBs
- Edema = diuretics
- Hypercholesterolemia = statins
- Anemia = EPO is secreted
- Immune Associated Injury = glucocorticoids, cyclosporine
Patients on statins should not have new or noticeable ______ pain.
muscle
What are the 2 types of glomerular diseases?
- Nephritic
- Nephrotic
- What is the key feature of nephritic?
- What is the key feature of nephrotic?
- Nephritic = blood in the urine (hematuria)
- Nephrotic = protein in the urine (proteinuria) but often little to no blood in urine
KIDNEY STONES (RENAL CALCULI)
KIDNEY STONES (RENAL CALCULI)
- Kidney Stones are the ___ most common urinary tract disorder behind _______ and __________.
- They are classified by their location; kidney (__________), ureter (__________), or bladder
- 3rd behind UTI and prostate disease
- kidney (nephrolithiasis), ureter (ureterolithiasis)
What is the pain pattern of kidney stones?
- flank
- abdominal
- groin
What is hydronephrosis?
Distension and dilation of the renal pelvis and calyces secondary to urine accumulation.
Is hydronephrosis associated with chronic or acute kidney stones?
chronic
The hallmark of stones is that they obstruct the ________ or _____ _______ and is excruciating intermittent pain that radiates from the flank to the groin or to the inner thigh.
- ureter
- renal pelvis
Kidney stones are ______ acutely, and ______ threatening chronically.
- painful
- kidney
What is the treatment of kidney stones?
- Watchful waiting (most stones <5mm pass)
- Shock wave lithotripsy (ultrasound) (5mm1cm)
What is ureteroscopy?
Procedure in which a small scope is inserted into the bladder and ureter and is used to diagnose and treat a variety of problems in the urinary tract.
Kidney Stone Treatment:
- <5mm = ___________
- 5mm-1cm = ____________
- > 1cm = _____________
- watchful waiting
- shock wave lithotripsy (US)
- Surgery (ureteroscopy)
What is the most intensive treatment of Kidney Stones and how is it done?
Surgery- Percutaneous Nephrolithotomy
- In pt procedure to remove large stones or a large number of small stones.
- Involves small incision in the back.
- Urologist works with an interventional radiologist to create a path to the drainage system of the kidney.
- Once stones are located, they are broken up and pieces are removed.
- Drain tube left in the kidney.
What is MOFS?
Multiple Organ Failure Syndrome (MOFS)
-Progressive deterioration of organ function secondary to disease in distant organs. Must involve 2 or more organ systems.
What are some causes of MOFS?
- renal failure
- shock
- acute brain injury
- acute respiratory failure
- sepsis
- burns
- severe necrosis
- major surgery
- multiple blood transfusions
MOFS is typically seen in the ____ and is linked to _______.
- ICU
- sepsis
- Hypervolemia = too ____ fluid
- Hypovolemia = too _____ fluid
- much (weight gain, edema)
- little (decreased CO, BP, hypernatremia)
NEUROGENIC BLADDER DISORDER
NEUROGENIC BLADDER DISORDER
What are the 3 main parts of the urinary bladder?
- Detrusor muscles
- Internal urethral sphincter
- External urethral sphincter
__________ muscles line the wall of the urinary bladder and are innervated by ____________ neurons. Input is normally inhibited and neural stimulation is required for _________.
- Detrusor muscles
- parasympathetic
- micturation
The internal urethral sphincter is ________ muscle and is innervated by _________ neurons.
- smooth
- sympathetic
The external urethral sphincter is _______ muscle and is _________ controlled.
- skeletal
- voluntarily
During collection/storage phase the detrusor muscle is _______, the internal and external sphincter muscles are _________.
- relaxed
- contracted (sealing)
In short, to pee:
- Detrusor muscles = ___________ innervation to contract muscles
- Internal urethral sphincter = __________ innervation to relax muscles
- External urethral sphincter = ___________ control
- parasympathetic
- sympathetic
- voluntary
Micturation 4 basic steps?
- Coordinated activity
- Remove inhibition of detrusor muscle
- Remove stimulation of internal sphincter muscle
- Reduce tonic activity to the external sphincter
- Stretch of the bladder initiates the ________ reflex which involves removing inhibition of the parasympathetic neurons which cause detrusor muscles to contract rhythmically.
- This initiates an __________ of the sympathetic nerves which deinnervate the internal urethral sphincter causing it to relax.
- voiding
- inhibition
What is Sensory Neurogenic Bladder?
Disruption of sensory information to the spinal cord or CNS.
What is Motor Paralytic Bladder?
Destruction of the parasympathetic nerves to the bladder. Inability to initiate or maintain a urine stream.
What is Reflex Neurogenic Bladder?
Complete disruption between the sacral spineal cord and the brainstem. Acute post spinal cord injury.
What is Autonomous Neurogenic Bladder?
Neurologic isolation of the bladder from the spinal sacral cord. Complete loss of sensory and motor input to and from the sacral spinal cord.
What is urinary incontinence and what are the 2 main causes of it?
- Involuntary loss of urine that is sufficient to be a problem and occurs most often when bladder pressure exceeds sphincter resistance.
- Age and pelvic floor weakness
What are some other causes of urinary incontinence other than age and pelvic floor weakness.
- benign prostatic hyperplasia (male)
- obesity
- XRT injury
What are the 4 types of incontinence?
- Functional
- Stress
- Urge
- Overflow
What is the difference between functional incontinence and stress incontinence?
Functional
-Normal urine control but who have trouble reaching a toilet in time b/c of muscle or joint dysfunction.
Stress
-Loss of urine during activities that increase intraabdominal pressure i.e. coughing, lifting, laughing, Valsalva.
What is urge incontinence?
Sudden and unexpected urge to urinate and an inability to prevent the loss of urine.
What is overflow incontinence?
Constant leaking of urine from a bladder that is full but unable to be emptied.
