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renal 22 Flashcards

1
Q

what are some possible locations for a urinary tract obstruction?

A 
can be mechanical or functional 
Locations: 
-renal pelvis 
-ureters 
-bladder 
-urethra
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2
Q

consequences of Urinary tract obstruction?

A
  • obstructive uropathy
  • urinary statis
  • both ultimately lead to renal distruction
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3
Q

what is obstructive uropathy?

A
  • due to urinary tract obstruction
  • hydroureter- accumulation of urine in the ureter
  • hydronephrosis- accumulation of urine in kidney
  • ureterohydronephorosis- combo of both
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4
Q

what is urinary stasis

A
  • infection

- calculi formation (formation of stones)

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5
Q

factors affected severity of damage due to obstruction

A

-location of obstruction
-completeness of blockage
-duration of obstruction- how long as it been there?
severe duration by 4 weeks

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6
Q

what are the two types of obstruction?

A

mechanical: Renal calculi (kidney stones)
functional: neurogenic bladder

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7
Q

what are renal calculi?

A
  • kidney stones

- masses of crystals, protein, or other

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8
Q

common contents of kidney stones?

A

1) calcium-oxalate or calcium-phosphate
2) Struvite (Mg-ammonium-phosphate)
3) uric acid

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9
Q

risk factors for renal calculi?

A
  • age 35 and up
  • strongly related to dehydration
  • geographical location -summer season
  • fluid intake
  • excess calcium intake (predisposes us)
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10
Q

manifestations of renal calculi?

A
  • intense pain, scrapping of stones though ureter
  • causes blood in urine
  • flank: radiation to the groin, lower abdomen
  • hematuria: scar tissue forms and narrowing of ureter
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11
Q

Diagnosis of Renal Calculi?

A
  • history, physical exam
  • urinalysis
  • CT scan
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12
Q

managment of Renal Calculi?

A
  • pain managment
  • antiemetics to control nausea
  • main tx is to let is pass naturally
  • filter urine to find stone to confirm it has passed
  • ultrasound waves to break stones into smaller pieces
  • surgery is rate
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13
Q

what is neurogenic bladder?

A
  • functional obstruction due to neurologic disorders secondary due to stroke, brain or spinal cord injury, MS
  • aka paralyzed bladder that Is overdistended
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14
Q

what do lesions above the micturition center in the pons cause?

A
  • automatic emptying
  • spasmic bladder
  • risk factors are stroke, dementia, brain injury, and tumor above brain stem
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15
Q

what do lesions above the micturition centre in the pons but above the sacral micturition center cause?
(anything between pons and sacrum)

A
  • cause dyssynergia
  • loss of coordination
  • bladder contracts and sphincter relaxes
  • Dyssynerigia is when the sphincter and bladder contract at the same time -causing overactive bladder
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16
Q

what do lesions at or below the micturition centre in the sacral area cause?

A
  • areflexia
  • urinary retention
  • atonic bladder (flaccid bladder overfills, causing incontinence, is overactive
  • multiple sclerosis, very low spinal cord injury
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17
Q

what is the ultimate consequence of urinary tract obstruction?

A

-obstruction uropathy, urinary stasis, and ultimately, renal distraction (destruction of anything that feeds into tube with blockage

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18
Q

what are urinary tract infections?

A
  • second most common type of infections after respiratory
  • 80% are due to e.coli
  • location is either in bladder (cystitis) or kidneys (pyelonephritis)
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19
Q

what are some predisposing factors of UTI?

A
  • gender (more common in women cuz anus is closer to vagina, women have 1 sphincter men have 2, and women have a shorter urethra)
  • obstruction (stasis of urine)
  • systemic disease (diabetes affects immune system)
  • disease that suppresses immune system or meds that do so
  • poor hygienic practices
  • surgical procedures on urinary tract- indwelling catheters
  • premature infants
20
Q

what is cystitis (acute)

A
  • most common site of UTI

- causes by e.coli pathogen

21
Q

manifestations of cystitis?

A
  • can be asymptomatic
  • urgency and frequency
  • dysuria= painful urination
  • suprapubic (above pubis) or low back pain
  • hematuria, cloudy urine
22
Q

what is diagnosis for Cystitis?

A

-urine cultures and analysis

23
Q

tx for cystitis?

A

-removal of causative agent
antibiotics
repeat cultures

24
Q

what is pyelonephritis? (acute)

A
  • ascending pathogens from bladder UTI spread to kidney
  • or pathogens from bloodstream
  • circulation from golmerus- if infecc somewhere else in body this can affect the kidney
  • infiltration of renal pelvis, calyces and medulla
  • inflammation, edema, and pus
25
manifestations of pyelonephritis?
- fever - chills - flank pain "costoverebral tenderness" -tenderness in this angle - manifestations In children and older adults- more vague
26
diagnosis of pyelonephritis?
- urine culture - blood culture - differences from cystitis - IVP-put dye in blood - WBC "casts" - like a print when WBC'c clump together to resemble the structure of the kidney- indicated kidney infections
27
management of pyelonephritis?
- correct the case | - antibiotics
28
what is chronic pyelonephritis?
- persistent or recurrent infection | - chronic inflammation = scarring of renal calyces and pelvis= atrophy and loss of function
29
what is glomerulus?
- acute and chronic | - common in children
30
what is acute glomerulonephritis triggered by?
- triggered by group A beta hemolytic streptococci (also straph and viral infections) - strep throat triggers immune response - strep binds with antibiotics- becomes trapped in glomeruli - triggered by inflammation of kidneys
31
what type of immune response is glomerulonephritis?
-type 3 -antigen antibody complex circulate through blood stream -becomes trapped in glomeruli = inflammation of glomerulus
32
onset of acute glomerulonephritis?
-sudden onset of symptoms 7-10 days after streptococcal infection (time span needed to make antibiotics)
33
manifestations of acute glomerulonephritis?
- hematuria (same happens with blood) - proteinuria (protein in urine)- inflammation cause leaky capillaries which allows blood and protein to fall out of glomerulus - hypertension - edema - azotemia: accumulation of urea and creatine - usually resolves without severe loss of function or long term consequences
34
what is renal failure?
- a condition in which the kidney fail to remove metabolic end products from the blood and regulate fluid, electrolyte, and pH balance of the extracellular fluids - can be acute or chronic
35
what does renal failure also affect?
- renin-angiotensin system (BP) | - RBC formation
36
what Is acute kidney injury?
-rapid reduction of renal function, reversible if tx early -includes categories: prerenal intrarenal postrenal
37
what is chronic kidney disease?
-progressive decrease in function over months and years until end-stage failure is reaches, refers to declining GFR
38
what is prerenal in acute kidney injury?
-injury that affects flow of blood to kidney : | shock (hypovolemic shock, burn injuries, sepsis, heart failure, anything that affects flow of blood into kidneys)
39
what is intrarenal in acute kidney injury?
-occurs within kidney | toxins, drugs, tumors, acute kidney infection
40
what is postrenal in acute kidney injury?
- occurs in tube going to bladder | - kidney stones, enlarged prostate, anything that causes obstruction of urine out of kidneys
41
what is the initiation phase of acute kidney injury?
- time of precipitating events until injury starts | - hours to days
42
what is the maintenances phase of acute kidney injury
- oliguria - retention of eater - fluid retention - electrolytes and pH imbalance
43
recovery phase of acute kidney injury?
- diuresis (lots of dilute urine, but still have issues with acid base, electroyles - this is a good sign because kidneys are recovering - full recovery can take up to a year
44
what are some common causes of chronic kidney disease?
- diabetes - chronic hypertension - intrinsic kidney disease
45
when do symptoms start occurring in chronic kidney disease?
-starts occurring when renal function decreases to about 25%
46
when does end-stage renal failure occur?
when 10% or less of function remains resulting in uremia

Path midterm 2 (13 decks)

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