Renal and Metabolic Diseases II Flashcards
What is the most common bacterial cause of UTIs?
E. coli
This group of disorders usually involves infections and inflammatory conditions
interstitial disorders
This disorder is known as a lower UTI or bladder infection; includes burning and pain in urination, dysuria, and increased frequency of urination (mental confusion in elderly)
Cystitis
What are common lab findings in cystitis?
Normal BUN/Crea, postive urine culture; URinalysis: Leukocyte Esterase pos, bacteria small to large, no casts
This disorder is an infection of the tubules and interstitium; caused by ascending movement of bacteria from a lower UTI or from reflux nephropathies; symptoms include burning during urination, flank and lower back pain, nausea and headache
acute pyelonephritis
What are common lab findings in acute pyelonephritis?
Urine culture positive; urinalysis: leukocyte esterase usually positive, WBC casts present, bacteria small to large
What is the prognosis of acute pyelonephritis?
proper antibiotic treatment should resolve the problem without permanent damage to tubules
This disorder occurs when persistent inflammation of the renal tissue causes permanent scarring that involves the renal calyces and pelvis; most common cause is reflux nephropathies
Chronic pyelonephritis
What are common lab findings in chronic pyelonephritis?
Increased BUN, Urine culture positive; urinalysis: leukocyte esterase positive, WBC Casts, Granular/Waxy/Broad Casts, blood present
What is the prognosis for chronic pyelonephritis?
Usually diagnosed in childhood, 10-15% will end in renal failure requiring dialysis
This disorder is caused by inflammation of the renal interstitium followed by inflammation of the renal tubules; often caused by allergic reactions to medications; usually presents with a skin rash, oliguria, and/or edema
acute interstitial nephritis
What are common lab findings in acute interstitial nephritis?
Increase BUN, GFR, and crea; fever; Urinalysis: WBCs numerous with NO bacteria seen, Eosinophils, mild to mod proteinuria
This group of disorders results from any conditions which reduces the blood flow to the kidneys
vascular disorders
This disorder is characterized by a SUDDEN onset, decrease in GFR, azotemia, and has a high mortality
Acute Renal Failure
what are the three stages of acute renal failure?
pre-renal, renal, and post-renal
This mechanism of acute renal failure is caused by decrease in blood flow below 80 mmHg, decreased cardiac output, blood loss, severe diarrhea, and vomiting
pre-renal
This mechanism of acute renal failure is due to damage to the glomerulus or tubular regions, usually in acute tubular necrosis
renal
This mechanism is due to obstructions in urine flow such as crystalline deposition (calculi) or neoplasms
post-renal
What is the prognosis for acute renal failure?
high mortality rate, usually caused by simultaneous infection or potassium intoxication; monitor electrolytes and fluids along with dialysis to control azotemia
Common lab findings in acute renal failure
urine osmo greater than serum osmo, BUN increased, GFR decreased, edema, oliguria
This disorder is caused by a gradual loss of function caused by glomerulonephropathies, diabetic nephropathy, chronic pyelonephritis, and hypertension
chronic renal failure
Common lab findings in chronic renal failure
azotemia, decreased GFR, bleeding, electrolyte imbalance; urinalysis: isotenuria, mk’d protein, all types of casts (ESPECIALLY waxy and broad)
This disorder is caused by renal calculi as they form in the calyces and pelvis of the kidney, ureters, and bladder; 75% are composed of calcium oxalate or calcium phosphate
renal lithiasis
What factors affect the formation of kidney stones?
supersaturation of chemical salts in urine, optimal urinary pH, urinary stasis, nucleation or initial crystal formation
What are some common sympotms of kidney stones?
pain radiating from kidney and continuing down to genitalia and legs, nausea, vomiting, sweating, increased urge to urinate, bloody urine
What is the GFR historical reference method?
inulin clearance
What is the most common assessment of glomerular function?
creatinine clearance
this is the use of high energy waves to break stones into smaller pieces
lithotripsy
Describe the creatinine clearance test
not affected by urine flow rate, not reabsorbed by tubules, not affected by diet, produced at a constant rate, dependent on muscle mass
How is a creatinine clearance tested?
Timed specimen is necessary (24 hour urine collection); avg production of crea= 1.2 mg/day, make sure to preserve because bacteria can lower crea
What is considered a normal GFR?
120 mL/min (if >90 mL/min patient is considered normal)
This calculation uses serum crea, age, gender, and ethnicity; typically reported in patients with <60 mL/min GFR
estimated GFR
this assessment of glomerular function is a more sensitive indicator of a decrease in GFR than crea clearance; not reliable in patients with immunologic disorders or malignancy; good test to assess tubular function; it dissociates from the membrane of nucleated cells at a constant rate and is rapidly filtered by the glomerulus and reabsorbed and catabolized by the tubules
Beta2-Microglobulin
This is produced at a constant rate by all nucleated cells; readily filtered by the glom and reabsorbed and broken down by tubules; recommended test for peds, elderly, diabetics, and critically ill; INDEPENDENT of muscle mass
Cystatin C
What are the 3 treatment options for renal failure?
Hemodialysis, Peritoneal dialysis, and renal transplant
In this treatment, the patient’s blood is cleansed as particles diffuse across a semipermeable membrane into a commercially available dialysis solution; preferred access point is through a fistula
Hemodialysis
This treatment involves using a sterile solution of dialysis solution allowing it to drain into the peritoneal cavity; the peritoneal membrane acts as a selectively permeable membrane that allows diffusion and osmosis of wastes into the dialysis solution; this solution is then drained and discarded
peritoneal dialysis
