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Patho Quiz 2 > Renal > Flashcards

Renal Flashcards

1
Q

Function of Kidneys

A 
Excretion metabolic waste
Regulation of water and electrolyte balances
Regulation of arterial pressure
Regulation of acid-base balance
EPO production 
Regulation of vitamin D3 production
Gluconeogenesis during prolonged fasting 
Secretion of hormones
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2
Q

Renal Control of Arterial BP

A

Many steps—ends with:

Water follows sodium into blood vessels–> plasma volume increases–> BP increases

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3
Q

What occurs with aging at the Kidneys?

A

Decrease blood flow to kidneys
Reduction of nephrons (toxication issues)
Increase in response to vasoconstrictor stimuli (inc. BP)
Alterations in the functional balance of fluid and electrolytes (Na+ regulation not as effective)
Mild hyponamtremia (most common electrolyte imbalance)
Shift to night production of urine

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4
Q

Hyponatremia

A

Can cause anxiety, headaches, muscle twitching, tachycardia, hypotension, decreased skin turn or, cold clammy skin
–some signs are also of dehydration, so need to be careful! (Hyponatremia worsens with water intake)

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5
Q

UTI Signs and Symptoms

A 
Frequency
Urgency
Incontinence
Nocturnal
Pain in shoulder, back, flank, pelvis, lower abdomen
Costovertebral tenderness
Fever and chills
Hyperesthesia of dermatomes
Dysuria, hematuria, pouring, dyspareunia
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6
Q

UTI Etiology

A

Among the most common bacterial infections
Kidneys, ureters, bladder, and urethra all susceptible
Complicated or uncomplicated/relapsed or recurrent
Numerous risk factors
Catheter–up to 40% of infections in health care facilities

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7
Q

Clinical Manifestations of UTI in frail older adults?

A

Malaise
Anorexia
Mental status change-confusion
New onset of Delirium in all older adults may occur

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8
Q

Hemturia

A

Blood in urine

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9
Q

Polyuria

A

Large production of urine

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10
Q

Oliguria/Anuria

A

Lack of urine output

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11
Q

Pyuria

A

Pus in urine

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12
Q

What is strep throat a risk factor for?

A

Kidney and heart diseases

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13
Q

Pyelonephritis Definition

A

Upper UTI, acute or chronic inflammatory disease in the kidney parenchyma and renal pelvis

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14
Q

Pyelonephritis Risk Factors

A

Urinary tract instrumentation, vesicoureteral refleux, pregnancy, diabetes, neurogenic bladder

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15
Q

Pyelonephritis Signs

A

Usually abrupt with acute pyelonephritis, fever, chill, back pain, tenderness over the costovertebral angle, bladder irritation, increased frequency/urgency, dysuria, hematuria, pyuria

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16
Q

Pyelonephritis Diagnosis and Treatment

A

Dx: urinalysis and culture
Tx: antibiotic

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17
Q

Diabetic Nephropathy Definition

A

Systemic vascular changes in kidney resulting in scarring of glomeruli
-20-30% of diabetics

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18
Q

Diabetic Nephropathy Signs

A

Microalbuminiuria, oliguria, anuria, peripheral edema (body swells up)

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19
Q

Diabetic Nephropathy Treatment

A

strict glycemic control, decreased protein intake, hydration, dialysis

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20
Q

Value for A1C for people with diabetes should be:

A

Less than or equal to 6.5

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21
Q

Renal Artery Stenosis Definition

A

Narrowing of renal artery from atherosclerosis, emboli

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22
Q

Renal Artery Stenosis Signs/Symptoms

A

Decreased renal perfusion, HTN, microscopic hematuria, flank or upper abdominal pain, renal artery bruits (noise Artery makes when blockage), peripheral edema

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23
Q

Renal Artery Stenosis Treatment

A

Bypass surgery, angioplasty with stent, anticoagulation, dialysis

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24
Q

Renal Cell Carcinoma (RCC)

A

Most common adult renal neoplasm, accounts for 90% of renal tumors

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25
RCC Etiology
Hereditary basis, genetic mechanisms
26
RCC Risk Factors
Males, smoking, obesity, alcohol, HTN, occupational exposure, BBQ meats
27
RCC Classic Triad of Symptoms
Flank pain, hematuria, palpable abdominal mass
28
RCC signs
Symptoms associated with mets (lungs, regional lymph nodes, bones, liver) Hematuria is most common finding (50% of cases) Paraneoplastic Symptoms (fever, HTN, hepatic dysfunction, hypercalcemia) Hormone production by CA tumor
29
RCC Treatment
Surgery-radical neprhectomy and regional lymph node dissection
30
Wilms Tumor Definition
Also called nephroblastoma most common malignant kidney neoplasm in children approx 500 new cases/year in US most commonly in first 6 years of life African American girls Several hereditary syndromes that predispose Molecular genetics plays a role in development
31
Wilms Tumor Signs
Difficult to discover--grows very larger before symptoms start Most do not metastasize Abdominal mass most common along with hematuria, abdominal pain, malaise, loss of appetite
32
Wilms Tumor Treatment
Surgical resection of the kidney most common; chemo and radiation
33
Renal Calculi (Kidney Stones) Definition
- Urinary stone, nephrolithiasis - 1-5 mm cause obstruction - Increased blood level of the principle component of the stone (inc intestinal absorption of Calcium and dec reabsorption through tubules) - occurs at ureteropelvic junction, ureter as it crosses over iliac vessels, or at ureterovesical junction
34
Renal Calculi Signs
-Severe flank and upper outer abdominal quadrant pain-renal colic
35
Renal Calculi Treatment
Meds, antibiotics, H2O basket extraction, extracorporeal shock wave lithotripsy
36
Chronic Renal Failure Definition
Loss of nephrons results in deterioration of glomerular filtration, tubular reabsorption, and endocrine functions of the kidney
37
Chronic Renal Failure: 4 Stages
1. Diminished renal reserve (GFR=50%) 2. Renal Insufficiency (GFR: 20-35%, azotemia (inc BUN and creatinine), HTN, anemia) 3. Renal Failure (GFR <20%, edema, metabolic acidosis) 4. End Stage Renal Disease (GFR <5%, uremia, atrophy of kidney, survival depends upon dialysis or transplant) - --do not come back from stage 4!
38
Chronic Renal Failure Etiology
HTN, urinary tract obstruction, infection, hereditary, glomerular disorders, diabetes, lupus, analgesics
39
Chronic Renal Failure Treatment
treat HTN, restrict dietary protein, recombinant human EPO, treat electrolyte dysfunction, dialysis or transplant
40
Chronic Renal Disease Exercise Prescription
Low level exercise--40-70% THR or 20BAR Three times per week Exercise on dialysis and non-dialysis days Watch for hypotension and muscle cramping Fluid restriction (eat ice chips) Patients will be fatigued! Autonomic dysfunction with end-stage renal disease
41
Peritoneal Dialysis
Uses the peritoneal cavity as a semi-permeable membrane to exchange substances and water between the dialysate fluid and blood vessels of the abdominal cavity -done 4x daily or overnight
42
Hemodialysis
Arterial blood is circulated through semipermeable tubing that is surrounded by dialysate solution in an artificial kidney. Arterial blood is being filtered and then is returned to patients venous circulation -3 sessions per week for 4 hours
43
PT Implications for Dialysis
Fluid shifts common Monitor BP in arm opposite shunt Rehab on dialysis days-rarely productive Can perform aerobic and resistant (low-moderate) exercise during hemodialysis in the first 2 hours (must lay down after this) Be aware of use of meds
44
Bladder Cancer Etiology
Unknown; may be environmental factors | Most arise from epithelium-transitional cell carcinoma
45
Bladder Cancer Signs
Hematuria, voiding dysfunction, lymphedema, hepatomegaly
46
Bladder Cancer Stages
1. Limited to mucosal lining 2. Invasion of smooth muscle wall 3. Extends beyond bladder wall 4. Tumor involving prostate with distant mets
47
Bladder Cancer Treatment
Radical cystectomy in stage 2, chemo | Then have tube in kidneys that empty into a bag
48
Neurogenic Bladder associated disorders
``` CVA Dementia PD MS SCI Brain tumors HNP Vascular Lesions Myelitis SC tumors DM Spina Bifida ```
49
Urinary Incontinence Types and Treatment
Functional, stress, urge, overflow | Meds, PFM exercise, biofeedback/emg, voiding schedule, surgery
50
Renal Labs- Blood Urea Nitrogen
BUN 10-20 mg/dl | Increase = decreased kidney function, artificially elevated if you are dehydrated
51
Renal Labs- Creatinine
Serum= .6-1.2 mg/dl Urine= 1-2 g/24 hours Clearance 10-20 ml/minute= renal failure **Probably just know that if creatinine is going up, acute renal failure
52
Renal Labs- Omolality
Particles in urine/blood; determines kidney ability to concentrate urine, hydration status Protein Urine= 30-140 mg/24 hours
53
Lab Renal- Uric Acid Blood
4-8.5 male, 2.8-7.3 female | -Assess for gout, monitor patient with renal failure
54
Labs Renal- Uric Acid Urine
250-750 mg/day | -screen for stone risk, identify cause of kidney stones
55
Diagnostic Tests
Renal arteriogram Abdominal-Pelvic CT Kidney MRI- masses Cystography (uses scope) Ultrasounds: --Bladder: assess UTI, check for residual after voiding, tumors; --Kidney: tumor vs. cyst, stones, infections
56
Prostatitis Definition
Inflammation of the prostate gland, acute or chronic, and bacterial or non-bacterial
57
Non-bacterial Prostatitis Symptoms
Urinary freq and urgency, dysuria, impotence, pain-rectal, scrotal, or LBP
58
Acute Bacterial Prostatitis
Urinary freq and urgency, dysuria, urethral discharge, high fever, arthralgia, pain-rectal, lower abd, sacral, low back
59
Chronic Bacterial Prostatitis
Urinary freq and urgency, dysuria, arthralgia, myalgia, PAIN-LOW BACK*****, and rectal
60
BPH definition
Age-related nonmalignant enlargement of the prostate gland. Multiple prostatic nodules resulting from proliferation of epithelial cells, small muscle cells, and fibroblasts
61
BPH Signs
Urinary freq and urgency, dysuria
62
Orchitis
Inflammation of testis often associated with gram-bacteria and chlamydia; testicular pain and swelling, fever, discomfort may spread
63
Epididymitis
Inflammation of epididymis caused by bacteria; urethritis and problems with voiding
64
Testicular Torsion
Abnormal twisting of spermatic cord, abrupt onset of scrotal pain with swelling, surgery if does not fix on own Seen in kids
65
Testicular Cancer Definition
Majority are germ cell tumors which result in seminomas (solid, gray-white growths)
66
Testicular CA signs
Enlargement of testis, pain in abdomen or scrotum, sensation of heaviness in scrotum, breast development if HCG present
67
Testicular CA risk factors
Sunlight, smoking, undescended testicle | --monthly exams are suggested!
68
Testicular CA *possible* presentation patter:
Back pain, abdominal mass, cervical and supraclavicular lymph node enlargement, pulmonary symptoms
69
Testicular CA Treatment
Orchiectomy, chemo, radiation, peritoneal lymphatic dissection

Patho Quiz 2 (1 decks)

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