Renal Flashcards
Anatomic changes in the urinary system caused by obstruction are referred to as
obstructive uropathy
Dilation of the ureter
hydroureter
Enlargement of the renal pelvis and calyces
hydronephrosis
Dilation of both the ureter and the pelvicaliceal system
ureterohydronephrosis
The deposition of excessive amounts of extracellular matrix (collagen and other proteins) by activated fibroblasts with associated areas of tubular atrophy
Tubulointerstitial fibrosis
When distal tubular damage occurs in the kidney what is the result?
It decreases the kidneys ability to concentrate urine and then increasing urine volume despite decrease in GFR
Ultimately the obstructed kidney cannot conserve sodium, bicarbonate, or water to excrete hydrogen or potassium this leads to
metabolic acidosis and dehydration
Kidney stones that are large and fill the minor and major calyces
Staghorn calculi
Kidney stones that are variable size are are located in the calyces in the renal pelvis or various sites along the ureter
Nonstaghorn calculi
The presence of a higher concentration of a salt within a fluid than the volume is able to dissolve to maintain equilibrium
supersaturation
Hydroxyapatite deposits that become exposed and serve as sites for calcium oxalate stone formation
Randall plaque
How does the size of the stone predict its ability to pass spontaneously?
<5 mm have a 50% chance of passing spontaneously. Stones that are 1 cm or larger have almost no chance of spontaneously passing.
Women are at greatest risk for which kind of kidney stone?
Struvite because of their increased incidence of urinary tract infection
Someone with gouty arthritis, has a high consumption of purines, and acidic urine is at high risk for which type of kidney stones?
Uric acid
These kidney stones are caused by genetic disorders of amino acid metabolism and are due to their excess in urine
Cystinuric and xanthine stone
Moderate to severe pain often originating in the posterior hypochondrium (flank) and radiating to the groin
Renal colic
Lesions that develop in the upper motor neurons of the brain and spinal cord result in a loss of coordinated neuromuscular contraction and overactive or hyperreflexive bladder function called…
dyssynergia
Lesions that develop in the sacral area of the spinal cord or peripheral nerves result in this type of bladder disorder
hypotonic, atonic (flacid) bladder function
Involuntary loss of urine associated with an abrupt and strong desire to void common in older adults.
Urge incontinence
Involuntary loss of urine during coughing sneezing, laughing, and is common in women younger then 60 and men who have had prostate surgery
stress incontinence
Involuntary loss of urine with over-distention of the bladder
Overflow incontinence
Involuntary loss of urine caused by dementia or imobility
Functional incontinence
An atonic bladder with retention of urine and distention. The full bladder is sensed but the detrusor will not contract causing an underactive bladder wyndrome with symptoms of stress and overflow incontinence.
Detrusor areflexia
A chronic syndrome of bladder contraction of reduced strength and/or duration, resulting in prolonged bladder emptying or a failure to achieve complete bladder emptying, or both within a normal time span and may be characterized by a weak stream, intermittency, hesitancy, and straining to void.
Underactive bladder syndrome
What are anatomic causes of resistance to urine flow for men and women?
Urethral stricture, prostatic enlargement in men, pelvic organ prolapse in women, and tumor compression
A narrowing of the urethral lumen and occurs when infection, injury, or surgical maniuplation produces a scar that reduces the caliber of the urethra.
Urethral stricture
What is the most common pelvic organ prolapse, in a woman, that causes bladder outlet obstruction?
Cystocele
What can happen to men that creates bladder outlet obstruction that is similar to pelvic organ prolapse in women?
Bladder herniates into the scrotum
If partial obstruction of the bladder outlet or urethra persists it leads to
urinary urgency, overactive detrusor contractions, and ultimately the bladder wall loses its ability to stretch and accommodate urine
The inability to stretch and accommodate urine is called
low bladder wall compliance
Low bladder wall compliance chronically (blank) which greatly increases the problems of (blank, blank, and blank).
elevates intravesicular pressure, hydroureter, hydronephrosis, and impaired renal function
A benign renal tumor that is solid, encapsulated, usually located near the cortex of the kidney and because they can become malignant are usually surgically removed.
Renal Adenomas
The most common renal neoplasm, an adenocarcinoma that arises from tubular epithelilum.
Renal cell carcinoma
The most common type of RCC is
Clear cell tumor
Which genetic mutation is associated with RCC?
von Hippel-Lindau
A rare renal neoplasm that primarily arises in the renal parenchyma and renal pelvis.
Renal transitional cell carcinoma
Hematuria, dull and aching flank pain, and palpable flank mass in thinner individuals as early signs and weight loss, fatigue, intermittent fever, anemia, hypertension, and alterations in liver function tests are late symptoms of
Renal Cancer
The most common bladder malignancy; appearing on the inner lining of the bladder.
Urothelial (transitional cell) carcinoma
Which mutation and inactivation are genomic subtypes of bladder cancer
TP53 mutation and retinoblastoma gene inactivation
Someone who presents with painless gross microscopic hematuria with nonspecific lower urinary tract symptoms should be screened for…
Bladder cancer
An inflammation of the urinary epithelium usually caused by bacteria from gut flora
UTI
Why is cystitis more common in women?
Because of the shorter urethra and the closeness of the urethra to the anus
What are UTI mechanisms are in place to protect men and women?
Periurtherial mucus secreting glands in women, length of the urethra and secretions from the prostate in men.
Why are certain individuals with certain Lewis blood groups more prone to UTIs?
Because they secrete fewer antigens capable of resisting bacterial adherence by pilus formation
An inflammation of the bladder and the most common site of a UTI
Acute cystitis
a UTI that shows acute hemorrhage
hemorrhagic cystitis
A UTI with pus formation or suppurative exudates
Suppurative cystitis
Prolonged infection that leads to the sloughing of the bladder mucosa with ulcer formation
Ulcerative cystitis
The most severe UTI infection that may cause necrosis of the bladder wall
Gangrenous cystitis
An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder associated with lower urinary tract symptoms of more than 6 weeks’ duration in the absence of infection or other identifiable causes.
Interstitial cystitis/Painful bladder syndrome
An infection of one or both upper urinary tracts (ureter, renal, pelvis, and kidney)
Pyelonephritis
Which bacteria are associated with pyelonephritis?
E.coli, proteus, pseudomonas
A person with acute fever, chills, flank or groin pain, frequency, dysuria, and cstovertebral tenderness may have
pyelonephritis
A persistent or recurrent infection of the kidney leading to scarring of the kidney
Chronic pyelonephritis
Lesions of chronic pyelonephritis are sometimes called
chronic interstitial nephritis
What three imbalances tend to develop if someone has chronic pyelonephritis?
Inability to conserve sodium, hyperkalemia, and metabolic acidosis
Glomerulonephritis caused by immunologic responses, ischemia, free radicals, drug toxins, vascular disorders, and infection is termed…
primary glomerular injury
This renal disease develops from metabolic, inflammatory, macrovascular,and microvascular complications related to chronic hyperglycemia.
Diabetic nephropathy
Diabetic nephropathy causes what kind of change in the glomberular basement and mesengial matrix?
Thickening and fibrosis of the glomerular basement membrane and expansion of the mesangial matrix
This type of renal disease may be caused by the formation of autoantibodies against double-stranded DNA and nucleosomes with glomerular deposition of the immune complexes
Lupus nephritis
Hematuria and red blood cell casts in the urine with less severe proteinuria and occurs with infectoin-related glomerulonephritis, RPGN, and lupus nephritis
Nephritic syndrome
A decline in renal function to about 25% of normal or a GFR of 25 to 30 mL/minute
renal insufficiency
A significant loss of renal function
Renal failure
When less than 10% of renal function remains this is termed
end-stage kidney disease (ESKD)
Characterized by increased serum urea levels and frequently increased creatinien levels and is caused by renal insufficiency or renal failure.
Azotemia
The sudden decline in kidney function with a decrease in glomerular filtration and urine output with an accumulation of nitrogenous waste products in the blood as demonstrated by an elevation in plasma creatinine and blood urea nitrogen levels.
Acute Kidney Injury (AKI)
The three categories of Acute Kidney Injury (AKI) are…
renal hypoperfusion, disorders involving the renal parenchymal or interstitial tissue, and disorders associated with acute urinary tract obstruction
The most common cause of AKI and results from inadequate kidney perfusion.
Prerenal acute kidney
Why does the GFR in prerenal acute injury ultimately decline?
the decrease in filtration pressure
An acute kidney injury that results from iscehmic acute tubular necrosis, nephrotaxic ATN, acute glomerulonephritis, vascular disease, allograft rejection, or interstitial disease.
Intrarenal acute kidney injury
What is the most common cause of intrarenal AKI?
Ischemia
This type of acute tubular necrosis is caused by radiocontrast media and numerous antibiotics such as aminoglycosides because tehy accumulate in the renal cortex.
Nephrotoxic ATN
The most rare form of acute kidney injury usually occurs with urinary tract obstruction that affects the kidneys bilaterally.
Postrenal acute kidney injury
Less than 400 ml of urine output per day
Oliguria
What are the three mecahnisms cause Oliguria?
Alteration in renal blood flow, Tubular obstruction, and tubular backleak
What are the phases of acute kidney injury?
The initiation phase, extension phase, maintenance/oliguric phase, recovery phase
Urine output less than 50 mL/day
Anuria
This disorder is associated with toxin exposure or drug toxicity, the urine output may be greater than 2L/day but teh BUN and creatinine concentrations increase.
Nonoliguric renal failure
The progressive loss of renal function associated with systemic diseases such as hypertension, diabetes mellitus, hypertension, SLE, or intrinsic kidney disease.
Chronic kidney disease
A proinflammatory state with many systemic effects and is associated with the accumulation of urea and other nitrogenous compounds and toxins.
Uremic syndrome
What is uremic fetor?
A form of bad breath caused by the breakdown of urea by salivary enzymes
