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Patho 2 > Renal > Flashcards

Renal Flashcards

1
Q

Lower UTI

A

Usually Bacterial Infection (E. coli)

Ascending infection via urethra (or via blood)

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2
Q

Lower UTI: defences

A
  • Local immune response (IgA most common)
  • Mucin layer (glycoprotein produced by cells lining the bladder) is protective against bacteria
  • Washout - forceful flushing of urine through the urethra during urination
  • Prostatic Fluid
  • Normal/vaginal flora - microbial antagonist
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3
Q

Lower UTI: risks

A

Urinary Tract obstruction > Stasis > Reflux

Urinary catherization

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4
Q

Lower UTI: mnfts

A

Abrupt onset
Frequency
Dysuria d/t urethra inflammation
Lower abdomen & back pain

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5
Q

Lower UTI: Dx

A

Presentation
Urinalysis - infection? Hematuria?
Stat Antibiotics

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6
Q

Lower UTI: Tx

A

oral antibiotics
Fluids & lytes (in clinical setting)
Treat underlying cause > obstruction, urine stasis, renal calculi, BPH

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7
Q

Pyelonephritis

A

Upper UTI > infection in the renal pelvis and/or calyces of the kidney
Infection and inflammation of renal pelvis & parenchyma
Acute and chronic forms

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8
Q

Pyelonephritis:Et

A

Various bacteria
> usually E.coli (ascending)
> Staphylococcus aureus via blood - reaches the kidney by circulation

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9
Q

Pyelonephritis: risks

A

immunocompromised
catheterization
urine stasis and reflux
diabetes

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10
Q

Pyelonephritis: patho

A

Ascending infection and inflammation
urethra > bladder > ureter > kidney

Fibrosis and scarring? > impaired renal Fx

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11
Q

Pyelonephritis: chronic form

A

Recurrent infections will lead to obstruction and reflux

Progressive renal damage > renal failure?

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12
Q

Pyelonephritis: mnfts

A 
Acute onset
Lower back pain
Fever
Dysuria, frequency, urgency
Pyuria (pus in urine)
Severe HTN in chronic form d/t fluid retention % RAAS compromised
Renal insufficiency
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13
Q

Pyelonephritis: Tx

A

Antibiotics (10-14 days) - oral/IV

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14
Q

Glomerular Disease

A

In the majority of cases is immune based (2 mechanisms)

1) Antibodies react with fixed antigen (proteins that are part of the glomerulus)
2) Circulating immune complexes lodge in the glomerulus; Immune complex does not disintegrate

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15
Q

Glomerular Disease: 5 categories

A

1) Nephrotic syndromes: increased glomerular permeability > incr. proteinuria > hypoalbuminuria and lipiduria
2) Nephritic syndromes: decreased glomerular permeability > decreased GFR - fluid and nitrogenous waste retention > edema, HTN, azotemia

3) Asymptomatic proteinuria and hematuria
Less than nephrotic syndrome therefore no s+s
No obvious decline in renal fx

4 acute & 5 chronic glomerulonephritis

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16
Q

Glomerulonephritis

A

Glomerular inflammation

Several types

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17
Q

Post-infectious (proliferative) GN

A

Complication of an infection - the most common form
Not age specific, but most common in children (95%), more severe in adults may lead to renal failure
Type III Hypersensitivity
Preceded by Beta hemolytic Strep Infections (7-12 d) - skin or pharynx
Immune complexes traps in glomerulus >GFR impeded
> inflammatory damage

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18
Q

Post-infectious (proliferative) GN: characteristics (physical changes)

A

Hypercellularity
> influx of cells into the site (leukocytes) to deal with injury
> hyperplasia
> proliferation of mesangial & endothelial cells
> enlargement of the glomerulus

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19
Q

Post-infectious (proliferative) GN: mnfts

A 
oliguria
proteinuria
hematuria
azotemia
fluid retention > edema, HTN > complications
20
Q

Post-infectious (proliferative) GN: Tx

A 
usually self-limiting 
Symptom tx
antiinflammatories?
immune suppression?
deal with complications
21
Q

Nephrolithiasis

A

aka Renal Calculi, Kidney Stones in Urinary Tract

Higher prevalence in male (2-3x higher) can migrate > obstruction?

22
Q

Nephrolithiasis: Et

A 
complex
>structural changes (eg.BPH)
>super saturated urine (components that easily precipitate) > hypertonic urine
>fluid, dietary & metabolic factors
>nuclei for stone formation

genetics

23
Q

Nephrolithiasis: Patho

A

Protective: stone inhibitors and prevent stones from forming > Mg & Citrate

With the increase of solute concentration and/or urine stasis

Precipitators accumulate in urine > nucleus (nidus) > crystalization

24
Q

Nephrolithiasis: Mnfts

A

> Severe renal colic > spasmodic pain d/t migration of stone > begins to distent ureter
non-colicky pain - distension of renal pelvis or renal calyces

N+V, diaphoresis d/t severe pain

25
Q

Nephrolithiasis: Dx

A

Pain pattern - analgesia delayed to allow dx
US
CT (faster)
Urinalysis (hematuria?, infection, pH, crystals)
IVP - Intravenous pyelogram - not used anymore- iv contrast medium

26
Q

Nephrolithiasis: Tx

A

Supportive > address pain and N&V
Narcotics (morphine) and antispasmodics (buscopan)
Most passed/voided sponteously (<5mm)
Identify stone to id cause (diet change & increase fluid intake)

27
Q

Acute Renal Failure

A

acute loss of renal failure - abrupt onset
typically reversible
Decreased GFR (hr or days)
Fluid & electrolyte imbalance & azotemia

Progression to anuria if no fx

oliguria: 100-400mL/day
anuria: <100mL

minimum of 400mL/day avoids azotemia

28
Q

Acute Renal Failure: Et

A

Mostly caused by ischemia, hypotension & hypovolemia
Pre-renal
Intra-renal
Post-renal

29
Q

Acute Renal Failure: Patho

A

Pre-renal: dehydration- hypovolemia & hypotension; decreased renal perfusion

Intra-renal: eg. glomerulonephritis
acute renal damage > necrosis
- initiating phase -tubular damage
-Maintenance phase - problem persists - decreased GFR, oliguria, azotemia, edema, pulmonary congestion
- recovery phase - repair with gradual increase of GFR

Post-renal: obstruction of urine flow (eg. BPH)

30
Q

Acute Renal Failure: mnfts

A

oliguria or anuria
fluid-electrolyte imbalance - pH
azotemia
edema, HTN, proteinuria, hematuria

31
Q

Acute Renal Failure: Dx

A 
(BUN, *Creatinine, *GFR &amp; *urinary output)
RIFLE categories:
Risk of renal Fx
Injury in the kidney
Failure of kidneys
Loss of renal fx
End stage of renal failure (ESRF)

Depends on measurements of *
RIFLE helps to understand what tx or management

NEW MARKERS:
IL18 - mediator released by proxima tubule in early renal ischemia

32
Q

Acute Renal Failure: Tx

A 
Stat intervention to reverse
Fluids &amp; lytes (caution d/t renal failure - risk of exacerbation)
renal diet - cautions about proteins
intermittent dialysis
- hemodialysis
- peritoneal dialysis

CRRT ( continuous renal replacement therapy)
- hemodynamic instability - usually in ICU

33
Q

Chronic Renal Failure

A

Long term - progressive - gradual - stages dictated by GFR levels
Irreversible damage

1) Diminished renal reserve:GFR < 50% (N= 120-130)
no mfts of renal failure

2) Renal insufficiency: GFR -20%-50%
not adequate, but kidneys still working

3) Renal failure:
GFR <20%
End-stage <5%

34
Q

Wilms Tumour

A

Most common primary neoplasms of younger children
May occur in one or both kidneys
Histologically the tumour resembles normal fetal tissue
Association with other congenital abnormalities
WT1 gene in Ch. 11

35
Q

Wilms Tumour: Stages

A

Stage 1: tumour is limited to kidney; can be excised with renal capsular intact
Stage 2: extension of the tumour into renal capsule; can be excised
Stage 3: extension of tumour but confined to the abdomen
Stage 4: hematogenous metastasis (involves lung commonly)

36
Q

Wilms Tumour: Mnfs

A

Asymptomatic
Large abdominal mass
HTN (d/t increased renin secretion)

Some children may present with abdominal pain, vomiting or both

37
Q

Wilms Tumour: Tx

A

Sx
Chemotherapy
Radiation Tx

38
Q

Renal Cell Carcinoma

A

Onset: 55yo-84yo
Approx. 90-95% of renal tumours
Idiopathic
Possible correlation with heavy smoking and renal CA, obesity in women, environmental exposure (heavy metals, asbestos, ..)

39
Q

Renal Cell Carcinoma: variants

A 
Clear cell carcinoma
Papillary tumours
Chromophobic
Oncocytomas
Collecting duct tumours
40
Q

Renal Cell Carcinoma: mnfts

A 
Silent disorder in early stages
When advanced: 
-hematuria
-flank pain
-presence of palpable mass
41
Q

Renal Cell Carcinoma: Dx

A

US
CT Scan
MRI

42
Q

Renal Cell Carcinoma: Tx

A

Sx - radical nephrectomy with lymph node dissection

5 year survival rate - 90%
If tumour has not extended the renal capsule
If so it drops to 30% survival rate

43
Q

Bladder CA

A 
Most common cause of UT CA
Fall into 2 major groups
- Low grade non invasive
- High grade invasive (worse prognosis)
Idiopathic
Evidence suggests carcinogens excreted (eg. Smoking, chronic bladder stones, infections, ..)
44
Q

Bladder CA: Mnfts

A 
Painless hematuria (may be intermittent)
Frequent, urgency, dysuria
45
Q

Bladder CA: Dx

A

Cytologic studies
Excretory urography
Cystoscopy
Biopsy

46
Q

Bladder CA: Tx

A 
Depends on extent of lesion
Endoscopic resection
Diathermy for removal of tumours
Segmental Sx resection
External beam radiation

Patho 2 (7 decks)

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