Renal Conditions Flashcards
etiology of pyelo
ascending infection or bloodstream infection
risk factors for pyelo
–pregnancy
–recurrent lower UTIs
–antibiotic resistant strain
what is pyelonephritis?
inflammation of the kidneys
what organism often causes pyelo?
e. coli
what can pyelo cause?
CKD or sepsis
patho of pyelo
inflammatory response –> kidney tissue damage
what can develop from pyelo?
abscesses and necrosis
symptoms of pyelo
–sudden onset of: fever, chills, CVA tenderness
–lower UTI symptoms
–hematuria may occur
–N/V
–anorexia
treatment of pyelo
antibiotics: trimethoprim/sulfamethoxazole (Bactrim), ciprofloxacin/nitrofurantoin (Macrobid)
who can’t Bactrim be prescribed to?
pregnant women
complications of pyelo
urosepsis
specifics of urosepsis
–more likely in elderly
–severe systemic response
–high mortality rates
treatment of severe pyelo
–IV antibiotics
–urinalysis
–urine culture
urinary obstruction locations
–renal pelvis
–ureter
–bladder or pelvis
what causes obstruction in the renal pelvis?
renal calculi
what causes obstruction in ureters?
–renal calculi
–pregnancy
–tumor
what causes obstruction in the bladder and urethra?
–bladder cancer
–neurogenic bladder
–prostatic hyperplasia
–prostate cancer
–urethral strictures
complications of obstruction
–stasis of urine flow
–backup pressure
where does backup pressure affect?
–hydroureter
–hydronephrosis
–postrenal acute kidney injury
potential complication of stasis of urine flow
infection when urine can’t flow freely
manifestations of acute obstruction
–depends on the: site, cause, speed of onset
which manifestation of acute obstruction primarily determines severity of pain?
speed of onset
nephrolithiasis
–renal calculi (kidney stones)
–clumps of crystals in urinary tract
–small as grain of sand to large as a golf ball
–may be smooth or jagged
–most common causes of renal obstruction
patho of nephrolithiasis
–urine is a solution of solvent and solutes
–problem = super-saturation with a solute
–crystals begin forming in the nephron
what is urinary crystal formation enhanced by?
–pH changes (UTI)
–excessive concentration of insoluble salts in the urine (dehydration, bone disease, gout, renal disease)
–urinary stasis (immobility/sedentary lifestyle)
risk factors for nephrolithiasis
–men
–20s-30s
–white
–family history
–congenital defect
–hot weather (dehydration)
–obesity
most common type of kidney stone
calcium oxalate or calcium phosphate
risk factors for calcium oxalate/calcium phosphate
–family history
–idiopathic
–increased calcemia
–increased oxaluria
risk factors for struvite (staghorn) stones
UTIs
risk factors for uric acid stones
gout
types of kidney stones
–calcium oxalate/calcium phosphate
–struvite
–uric acid
causes of calcium oxalate stones
–dehydration
–low urine output
–high sodium intake
–high oxalate intake
–high protein intake
symptoms of renal colic
–flank pain
–radiation to lower abdomen and groin
–colicky spasms (lasting 20-60 minutes)
–intermittent spasms
–sharp pain from ureter scraping ureter wall
accompanying symptoms of nephrolithiasis
–N/V
–dysuria
–chills, fever (only if infection)
–hematuria
–foul smelling urine
–diaphoresis
pharm for nephrolithiasis (acute pain)
–morphine or NSAIDs
–IV fluids
preventative pharm for nephrolithiasis
–calcium = thiazide diuretics
–struvite = antibiotics
–urate = allopurinol
most common type of kidney cancer
renal cell carcinoma
risk factors for kidney cancer
–smoking
–obesity
–age
–male
–genetics
prognosis of kidney cancer
depends on metastasis
early manifestations of renal cell carcinoma
none
late manifestations of renal cell carcinoma
–CVA tenderness
–hematuria (cola colored)
–possible palpable abdominal mass
metastasis of renal cell carcinoma
usually occurs to bone or lung (bone pain and dyspnea)
treatment of renal cell carcinoma
–usually resistant to chemo
–remove kidney
bladder cancer specifics
–most common cancer in men
–urothelial carcinoma
risk factors for bladder cancer
–smoking
–male
–occupations with exposure to toxins (rubber/paint)
–low fluid intake
early onset symptoms of bladder cancer
hematuria
late onset symptoms of bladder cancer
–frequency
–urgency
–dysuria
treatment of bladder cancer
–chemo depending on stage
–stage 1=intravesical chemo
–advanced stages=systemic chemo
frequency of BCG vaccine
weekly for 6-12 weeks
use for BCG vaccine
intravesical therapy for bladder cancer
MOA of BCG vaccine
–stimulates inflammatory response in the bladder
–goal = immune system to recognize cancerous cells and attack
adverse effects of BCG vaccine
–bladder irritation
–systemic infection
patient instructions for BCG vaccines
–empty bladder
–instill BCG vaccine into the bladder
–change position q 15 minutes
post-treatment instructions for BCG vaccines
–disinfect urine for 6 hours post treatment
–watch for infection
how is urine disinfected?
by bleaching
who shouldn’t receive the BCG vaccine?
immunocompromised and HIV/AIDS patients because it’s a live vaccine
glomerulonephritis
a variety of conditions that cause inflammation of glomeruli
specifics of glomerulonephritis
–can be focal or diffuse
–3rd leading cause of kidney failure in the US
–primarily an immune process
glomerulus
delicate network of arterioles within the Bowman’s capsule
significance of the glomerulus
all blood in the body travels through these
tubules
massive consumer of oxygen
afferent arteriole
takes blood in
efferent arteriole
takes blood away
CO and kidneys
uses about 20% of CO
blood pumps into the afferent arteriole and out of the efferent arteriole through…..?
a pressure gradient
3 layers of glomerular capillary
- endothelium
- basement membrane
- podocytes
podocytes
–special epithelial cells
–produce start of urine
where does the reaction in glomerulonephritis occur?
basement membrane
type II reactions
reactions occur on the cell surface and result in direct cell death or malfunction
type III reactions
immune complexes are deposited into tissues and the resulting inflammation destroys the tissue
type II glomerular injury
antibodies attach to antigens of the glomerular basement membrane (5%)
type III glomerular injury
antibodies react with circulating antigens and are deposited as immune complexes in the GBM (90%)
what do both forms of glomerulonephritis have in common?
–accumulation of antigens, antibodies, and complement
–complement activation results in tissue injury
symptoms of acute glomerulonephritis
–abrupt sudden onset
–Hematuria
–Azotemia
–Retention: sodium and water (oliguria), HTN, edema
–Proteinuria
what does HARP mean?
Hematuria
Azotemia
Retention: oliguria, HTN, edema
Proteinuria
triggers of acute glomerulonephritis
–post-infectious (poststreptococcal usually)
–primary disease (Berger disease)
–multisystem disease (Goodpasteur syndrome, systemic lupus erythmatosus, vasculitis)
Berger disease
buildup of IgA = inflammation in glomerulus
why does acute glomerulonephritis occur post-strep infection?
antibodies that think GBM is foreign and attacks
pathogenesis of acute glomerulonephritis
trigger –> immune complexes form –> complement activated –> release of mediators –> tissue injury –> hematuria/proteinuria/decreased GFR
chronic glomerulonephritis
–long term inflammation of the glomerulus = scar tissue
–symptoms like acute
prognosis of chronic glomerulonephritis
slow progressive disorder = ESRD
nephrotic syndrome
–glomerulus is too permeable to plasma proteins
–elimination of >3 grams of protein per day
What diseases lead to nephrotic syndrome?
–glomerulonephritis
–diabetes mellitus
pathogenesis of nephrotic syndrome
increased glomerular permeability –> proteinuria –> hypoalbuminemia (third space)
symptoms of nephrotic syndrome
–edema
–HTN
–liver problems (HLD, hypercoag, loss of antithrombin III and plasminogen)
function of plasminogen
helps break down clots
what happens with liver problems in nephrotic syndrome?
spilling proteins and losing fluid
diabetic nephropathy
–major complication
–gross thickening of the GBM
–ultimately leading to ESRD
hypertensive glomerular disease
decreased renal perfusion –> sclerotic glomerular changes (increased pressure on blood vessels)
symptoms of glomerulopathy
–hematuria
–oliguria
–fluid retention
–increased BUN/Cr ratio
–proteinuria
–low albumin (hypoproteinemia)
