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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
Q

RCC Etiology

A

Hereditary basis, genetic mechanisms

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26
Q

RCC Risk Factors

A

Males, smoking, obesity, alcohol, HTN, occupational exposure, BBQ meats

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27
Q

RCC Classic Triad of Symptoms

A

Flank pain, hematuria, palpable abdominal mass

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28
Q

RCC signs

A

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
Q

RCC Treatment

A

Surgery-radical neprhectomy and regional lymph node dissection

30
Q

Wilms Tumor Definition

A

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
Q

Wilms Tumor Signs

A

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
Q

Wilms Tumor Treatment

A

Surgical resection of the kidney most common; chemo and radiation

33
Q

Renal Calculi (Kidney Stones) Definition

A
  • 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
Q

Renal Calculi Signs

A

-Severe flank and upper outer abdominal quadrant pain-renal colic

35
Q

Renal Calculi Treatment

A

Meds, antibiotics, H2O basket extraction, extracorporeal shock wave lithotripsy

36
Q

Chronic Renal Failure Definition

A

Loss of nephrons results in deterioration of glomerular filtration, tubular reabsorption, and endocrine functions of the kidney

37
Q

Chronic Renal Failure: 4 Stages

A
  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
Q

Chronic Renal Failure Etiology

A

HTN, urinary tract obstruction, infection, hereditary, glomerular disorders, diabetes, lupus, analgesics

39
Q

Chronic Renal Failure Treatment

A

treat HTN, restrict dietary protein, recombinant human EPO, treat electrolyte dysfunction, dialysis or transplant

40
Q

Chronic Renal Disease Exercise Prescription

A

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
Q

Peritoneal Dialysis

A

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
Q

Hemodialysis

A

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
Q

PT Implications for Dialysis

A

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
Q

Bladder Cancer Etiology

A

Unknown; may be environmental factors

Most arise from epithelium-transitional cell carcinoma

45
Q

Bladder Cancer Signs

A

Hematuria, voiding dysfunction, lymphedema, hepatomegaly

46
Q

Bladder Cancer Stages

A
  1. Limited to mucosal lining
  2. Invasion of smooth muscle wall
  3. Extends beyond bladder wall
  4. Tumor involving prostate with distant mets
47
Q

Bladder Cancer Treatment

A

Radical cystectomy in stage 2, chemo

Then have tube in kidneys that empty into a bag

48
Q

Neurogenic Bladder associated disorders

A 
CVA
Dementia
PD
MS
SCI
Brain tumors 
HNP
Vascular Lesions
Myelitis
SC tumors
DM
Spina Bifida
49
Q

Urinary Incontinence Types and Treatment

A

Functional, stress, urge, overflow

Meds, PFM exercise, biofeedback/emg, voiding schedule, surgery

50
Q

Renal Labs- Blood Urea Nitrogen

A

BUN 10-20 mg/dl

Increase = decreased kidney function, artificially elevated if you are dehydrated

51
Q

Renal Labs- Creatinine

A

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
Q

Renal Labs- Omolality

A

Particles in urine/blood; determines kidney ability to concentrate urine, hydration status

Protein Urine= 30-140 mg/24 hours

53
Q

Lab Renal- Uric Acid Blood

A

4-8.5 male, 2.8-7.3 female

-Assess for gout, monitor patient with renal failure

54
Q

Labs Renal- Uric Acid Urine

A

250-750 mg/day

-screen for stone risk, identify cause of kidney stones

55
Q

Diagnostic Tests

A

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
Q

Prostatitis Definition

A

Inflammation of the prostate gland, acute or chronic, and bacterial or non-bacterial

57
Q

Non-bacterial Prostatitis Symptoms

A

Urinary freq and urgency, dysuria, impotence, pain-rectal, scrotal, or LBP

58
Q

Acute Bacterial Prostatitis

A

Urinary freq and urgency, dysuria, urethral discharge, high fever, arthralgia, pain-rectal, lower abd, sacral, low back

59
Q

Chronic Bacterial Prostatitis

A

Urinary freq and urgency, dysuria, arthralgia, myalgia, PAIN-LOW BACK*****, and rectal

60
Q

BPH definition

A

Age-related nonmalignant enlargement of the prostate gland. Multiple prostatic nodules resulting from proliferation of epithelial cells, small muscle cells, and fibroblasts

61
Q

BPH Signs

A

Urinary freq and urgency, dysuria

62
Q

Orchitis

A

Inflammation of testis often associated with gram-bacteria and chlamydia; testicular pain and swelling, fever, discomfort may spread

63
Q

Epididymitis

A

Inflammation of epididymis caused by bacteria; urethritis and problems with voiding

64
Q

Testicular Torsion

A

Abnormal twisting of spermatic cord, abrupt onset of scrotal pain with swelling, surgery if does not fix on own

Seen in kids

65
Q

Testicular Cancer Definition

A

Majority are germ cell tumors which result in seminomas (solid, gray-white growths)

66
Q

Testicular CA signs

A

Enlargement of testis, pain in abdomen or scrotum, sensation of heaviness in scrotum, breast development if HCG present

67
Q

Testicular CA risk factors

A

Sunlight, smoking, undescended testicle

–monthly exams are suggested!

68
Q

Testicular CA possible presentation patter:

A

Back pain, abdominal mass, cervical and supraclavicular lymph node enlargement, pulmonary symptoms

69
Q

Testicular CA Treatment

A

Orchiectomy, chemo, radiation, peritoneal lymphatic dissection

Patho Quiz 2 (1 decks)

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