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S3 - Pathophysiology > Primary Glomerular Pathologies, Kidney Stones, Neurogenic Bladder Disorders > Flashcards

Primary Glomerular Pathologies, Kidney Stones, Neurogenic Bladder Disorders Flashcards

1
Q

PRIMARY GLOMERULAR DISEASES

A

PRIMARY GLOMERULAR DISEASES

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2
Q

Primary glomerular diseases are a group of disorders characterized by ________ alterations in normal glomerular ________ and ________, independent of _________ disease processes such as diabetes and HTN.

A
  • pathologic
  • structure and function
  • systemic
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3
Q

Primary glomerular diseases result from damage to what?

A

Kidney’s filtering units i.e. capillary-Bowman’s capsule interface

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4
Q

Primary glomerular diseases pathologies involve immune function in what 2 ways?

A
  • 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).
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5
Q
  • 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 __________.
A
  • glomerular epithelial walls
  • proteinuria

-hematuria

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6
Q

What are the clinical signs of primary glomerular diseases?

A
  • Proteinuria
  • Hematuria
  • HTN (kidney damage and hypervolemia)
  • Decline in GFR
  • Edema
  • Hypoalbuminemia
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7
Q

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.
A
  • albumin, kidney
  • edema
  • hypovolemia
  • increasing
  • hypervolemia
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8
Q

What are the treatments for the following due to primary glomerular diseases?

  • Hypervolemia
  • Renal HTN
  • Edema
  • Hypercholesterolemia
  • Anemia
  • Immune Associated Injury
A
  • Hypervolemia = fluid restriction
  • Renal HTN = ACE inhibitors, ARBs
  • Edema = diuretics
  • Hypercholesterolemia = statins
  • Anemia = EPO is secreted
  • Immune Associated Injury = glucocorticoids, cyclosporine
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9
Q

Patients on statins should not have new or noticeable ______ pain.

A

muscle

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10
Q

What are the 2 types of glomerular diseases?

A
  • Nephritic

- Nephrotic

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11
Q
  • What is the key feature of nephritic?

- What is the key feature of nephrotic?

A
  • Nephritic = blood in the urine (hematuria)

- Nephrotic = protein in the urine (proteinuria) but often little to no blood in urine

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12
Q

KIDNEY STONES (RENAL CALCULI)

A

KIDNEY STONES (RENAL CALCULI)

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13
Q
  • Kidney Stones are the ___ most common urinary tract disorder behind _______ and __________.
  • They are classified by their location; kidney (__________), ureter (__________), or bladder
A
  • 3rd behind UTI and prostate disease

- kidney (nephrolithiasis), ureter (ureterolithiasis)

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14
Q

What is the pain pattern of kidney stones?

A
  • flank
  • abdominal
  • groin
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15
Q

What is hydronephrosis?

A

Distension and dilation of the renal pelvis and calyces secondary to urine accumulation.

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16
Q

Is hydronephrosis associated with chronic or acute kidney stones?

A

chronic

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17
Q

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.

A
  • ureter

- renal pelvis

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18
Q

Kidney stones are ______ acutely, and ______ threatening chronically.

A
  • painful

- kidney

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19
Q

What is the treatment of kidney stones?

A
  • Watchful waiting (most stones <5mm pass)

- Shock wave lithotripsy (ultrasound) (5mm1cm)

20
Q

What is ureteroscopy?

A

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.

21
Q

Kidney Stone Treatment:

  • <5mm = ___________
  • 5mm-1cm = ____________
  • > 1cm = _____________
A
  • watchful waiting
  • shock wave lithotripsy (US)
  • Surgery (ureteroscopy)
22
Q

What is the most intensive treatment of Kidney Stones and how is it done?

A

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.
23
Q

What is MOFS?

A

Multiple Organ Failure Syndrome (MOFS)
-Progressive deterioration of organ function secondary to disease in distant organs. Must involve 2 or more organ systems.

24
Q

What are some causes of MOFS?

A
  • renal failure
  • shock
  • acute brain injury
  • acute respiratory failure
  • sepsis
  • burns
  • severe necrosis
  • major surgery
  • multiple blood transfusions
25
Q

MOFS is typically seen in the ____ and is linked to _______.

A
  • ICU

- sepsis

26
Q
  • Hypervolemia = too ____ fluid

- Hypovolemia = too _____ fluid

A
  • much (weight gain, edema)

- little (decreased CO, BP, hypernatremia)

27
Q

NEUROGENIC BLADDER DISORDER

A

NEUROGENIC BLADDER DISORDER

28
Q

What are the 3 main parts of the urinary bladder?

A
  • Detrusor muscles
  • Internal urethral sphincter
  • External urethral sphincter
29
Q

__________ muscles line the wall of the urinary bladder and are innervated by ____________ neurons. Input is normally inhibited and neural stimulation is required for _________.

A
  • Detrusor muscles
  • parasympathetic
  • micturation
30
Q

The internal urethral sphincter is ________ muscle and is innervated by _________ neurons.

A
  • smooth

- sympathetic

31
Q

The external urethral sphincter is _______ muscle and is _________ controlled.

A
  • skeletal

- voluntarily

32
Q

During collection/storage phase the detrusor muscle is _______, the internal and external sphincter muscles are _________.

A
  • relaxed

- contracted (sealing)

33
Q

In short, to pee:

  • Detrusor muscles = ___________ innervation to contract muscles
  • Internal urethral sphincter = __________ innervation to relax muscles
  • External urethral sphincter = ___________ control
A
  • parasympathetic
  • sympathetic
  • voluntary
34
Q

Micturation 4 basic steps?

A
  • Coordinated activity
  • Remove inhibition of detrusor muscle
  • Remove stimulation of internal sphincter muscle
  • Reduce tonic activity to the external sphincter
35
Q
  • 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.
A
  • voiding

- inhibition

36
Q

What is Sensory Neurogenic Bladder?

A

Disruption of sensory information to the spinal cord or CNS.

37
Q

What is Motor Paralytic Bladder?

A

Destruction of the parasympathetic nerves to the bladder. Inability to initiate or maintain a urine stream.

38
Q

What is Reflex Neurogenic Bladder?

A

Complete disruption between the sacral spineal cord and the brainstem. Acute post spinal cord injury.

39
Q

What is Autonomous Neurogenic Bladder?

A

Neurologic isolation of the bladder from the spinal sacral cord. Complete loss of sensory and motor input to and from the sacral spinal cord.

40
Q

What is urinary incontinence and what are the 2 main causes of it?

A
  • 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
41
Q

What are some other causes of urinary incontinence other than age and pelvic floor weakness.

A
  • benign prostatic hyperplasia (male)
  • obesity
  • XRT injury
42
Q

What are the 4 types of incontinence?

A
  • Functional
  • Stress
  • Urge
  • Overflow
43
Q

What is the difference between functional incontinence and stress incontinence?

A

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.

44
Q

What is urge incontinence?

A

Sudden and unexpected urge to urinate and an inability to prevent the loss of urine.

45
Q

What is overflow incontinence?

A

Constant leaking of urine from a bladder that is full but unable to be emptied.

S3 - Pathophysiology (14 decks)

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