renal conditions

Question 1

describe the pathophysiology of urinary tract obstruction

Answer 1

urinary tract obstruction is a backup of urine which leads to nephron and glomerular damage. this is caused by:

• anatomical obstruction- obvious blockage, compression or narrowing of the tract
• functional obstruction- an actual problem with the tract such as decreased muscle action

Question 2

outline the effects and pathophysiology of infections of the urinary tract

Answer 2

a urinary tract infection is inflammation of the urinary tract epithelium by microorganisms

Question 3

what is acute kidney injury, its causes, pathophysiology and management

Answer 3

it is the decline in renal function which leads to a decrease in fluid, electrolyte and PH balance

caused by:

• pre renal (before the kidneys that can affect kidney function) such as renal artery stenosis
• intra-renal (within the kidney)
• post renal (after the kidneys that can affect kidney function

signs and symptoms

• decreased urination
• oedema
• metabolic acidosis
• GI effects- nausea and vomitting
• nervous system effects- irritable, drowsiness, confusion

treatments:
- specific to cause
- trying to maintain fluid balance, nutrition and dialysis

Question 4

outline the pathophysiology of glomerulonephritis

Answer 4

the inflammation of the glomeruli due to inadequate glomerular filtration rate and an increase in glomerular permeability which causes more stuff to get through that would normally be filtered out

types

• acute- commonly associated with streptococcal infection and treated by antibiotics. Can lead to chronic
• Chronic- commonly associated with various other systemic complications

signs and symptoms

• Protein in urine (proteinuria)
• Blood cells in urine (hematuria)
• Oliguria (decreased urination)
• Hypertension
• Oedema
• Azotemia

Question 5

outline the pathophysiology of tubular necrosis

Answer 5

it occurs when the tubular epithelial cells of the nephron are damaged due to ischemia and/ or nephrons. As the cells of the tubule die, they slough off and plug up the nephron, resulting in a back-up of filtrate and increased capsular hydrostatic pressure. These changes result in a reduced GFR and oliguira.

Question 6

describe chronic renal disease, its causes, pathophysiology and management

Answer 6

progressive and irreversible loss of nephrons which causes

• decreased GFR
• decreased reabsorption
• decreased secretion
• decreased other functions e.g. BP homeostasis

main causes
- diabetes
- hypertension
- glomerulonephritis
- polycystic kidneys
Eventually you will get glomerular hypertension, hyperfiltration, hypertrophy which leads to
Glomerulosclerosis and tubular inflammation and fibrosis which leads to more nephron loss

signs and symptoms

• systemic effects such as fatigue, hypertension and pruritus
• azotemia

treatment

• trying to slow progression with things such as dietary and fluid management
• EPO supplementation
• ACE inhibitors
• Dialysis
• Renal replacement