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Renal conditions Flashcards

1
Q

what is pyelonephritis?

A

Upper UTI, kidney infection, inflammation of the kidneys

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2
Q

what is the etiology of pyelonephritis?

A

ascending infection or bloodstream infection

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3
Q

what are the 3 risk factors associated with pyelonephritis?

A
  1. recurrent lower UTI
  2. pregnancy
  3. abx resistant strains
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4
Q

the inflammatory response with pyelonephritis leads to what?

A

kidney tissue damage

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5
Q

what are the clinical manifestations associated with pyelonephritits?

A
  • sudden onset with fever, chills, and CVA tenderness
  • lower UTI symptoms
  • hematuria
  • N/V
    -anorexia
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6
Q

what are the 3 main treatments for pyelonephritis?

A

bactrim, nitrofurantoin, and ciprofloxacin

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7
Q

what class of medication is ciprofloxacin?

A

fluoroquinolone

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8
Q

What is the MOA of ciprofloxacin?

A

destroys bacteria by altering their DNA via DNA enzymes

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9
Q

What are the major indications of ciprofloxacin?

A

UTI, anthra

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10
Q

What is the major adverse effect of ciprofloxacin?

A

arthropathy

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11
Q

is arthropathy related to ciprofloxacin reversible or irreversible?

A

irreversible

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12
Q

does ciprofloxacin cross the BBB?

A

yes

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13
Q

what is the age range for patients that can take ciprofloxacin

A

18-60

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14
Q

does ciprofloxacin work on fast or slow growing organisms?

A

both

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15
Q

what class of medication is sulfamethoxazole + trimethoprim?

A

sulfonamide

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16
Q

what is the MOA of sulfamethoxazole + trimethoprim

A

Inhibits growth by preventing the synthesis of folic acid

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17
Q

What are the general indications of sulfamethoxazole + trimethoprim?

A

UTI, some respiratory infections, salmonella, and shigellosis

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18
Q

What is the primary side effect with sulfamethoxazole + trimethoprim?

A

Photosensitivity

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19
Q

what type of allergy would be contraindicated with sulfamethoxazole + trimethoprim?

A

sulfa allergies

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20
Q

urosepsis is more likely to occur in what group of people

A

elderly

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21
Q

what are the 3 locations in which you can have a urinary obstruction?

A

renal pelvis, ureter, bladder/pelvis

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22
Q

what is the common cause of obstruction at the renal pelvis level?

A

renal calculi (stones)

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23
Q

what are the common causes of obstruction at the ureter level?

A

renal calculi, pregnancy, tumors

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24
Q

what are the common causes of obstruction at the bladder / urethra level?

A

bladder cancer, neurogenic bladder, prostatic hyperplasia, prostate cancer, urethral strictures

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25
Q

what are the 2 primary complications with urinary blockages?

A

urinary stasis (which can lead to infection) or back up pressure

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26
Q

what is it called when urine backs up and causes inflammation / swelling to the kidney?

A

hydronephrosis

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27
Q

what is it called when urine backs up and causes inflammation / swelling to the ureters?

A

hydroureter

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28
Q

with urinary obstructions what primarily determines the severity of the pain?

A

speed of onset

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29
Q

what is nephrolithiasis?

A

kidney stones / renal calculi, clumps of crystals in the urinary tract

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30
Q

what is the size range of kidney stones?

A

can be as small as a grain of sand or as large as a golf ball

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31
Q

what are the shapes of renal calculi?

A

can be smooth or jagged

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32
Q

What is the most common cause of renal obstruction?

A

kidney stones

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33
Q

what are 3 times that crystal formation is enhanced in regards to nephrolithiasis?

A
  1. pH changes
  2. excessive concentrations of insoluble salts in the urine
  3. urinary stasis
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34
Q

are men or women more likely to develop kidney stones?

A

men

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35
Q

what is the highest risk age range for kidney stones?

36
Q

what is the ethnicity that is most at risk for kidney stones?

37
Q

is there a risk of family history with kidney stones?

38
Q

what weather is more likely to precipitate kidney stones? why?

A

hot weather - because the urine becomes more concentrated d/t fluid loss

39
Q

what are the risk factors specific to calcium oxalate and calcium phosphate kidney stones

A

family history, idiopathic, increased levels of calcemia and oxaluria

40
Q

what are the risk factors specific to struvite kidney stones?

41
Q

what is another term for struvite kidney stones?

A

staghorn kidney stones

42
Q

what are the risk factors specific to uric acid kidney stones?

43
Q

what is the typical location of pain with kidney stones?

A

flank pain

44
Q

does pain r/t kidney stones radiate - if so, where?

A

yes - it radiates to the back and groin area

45
Q

is the pain associated with kidney stones constant or intermittent - explain:

A

intermittent - they present as colicky spasms that last 20-60 minutes d/t ureter spasms

46
Q

what would cause a sharp pain associated with kidney stones?

A

when / if the kidney stone scratches / scrapes the ureter walls

47
Q

what are the typical accompanying symptoms with kidney stones?

A

-hematuria
-dysuria
-N/V
-chills, fever (if infection)
-foul smelling urine
-diaphoresis

48
Q

what is the typical plan of action with acute pain associated with kidney stones?

A

Morphine, NSAIDS, IVF

49
Q

what is a potential preventative medication for calcium phosphate or calcium oxalate kidney stones?

A

thiazide diuretics

50
Q

what is a potential preventative medication for struvite kidney stones?

51
Q

what is a potential preventative medication for uric acid kidney stones?

A

allopurinol

52
Q

what are the risk factors for kidney caner (also called renal cell carcinoma)?

A

-smoking
-male
-obesity
-increasing age
-family hx

53
Q

what typically determines the prognosis of kidney cancer?

A

metastasis

54
Q

what are the early manifestations of kidney cancer?

A

none - this is why it can go undiagnosed for so long

55
Q

what are the late manifestations of kidney cancer?

A

-CVA tenderness
-cola-colored urine (hematuria)
-palpable abdominal mass

56
Q

What are the typical metastasis for kidney cancer?

A

bone and lung

57
Q

is kidney cancer usually receptive to chemotherapy?

A

no, usually need to look into surgical removal

58
Q

where are the cancer cells for bladder cancer typically found?

A

in the lining of the bladder

59
Q

what are the risk factors for bladder cancer?

A

-smoking
-male
-occupations with exposure to toxins (ie rubber factory or paint)
-low fluid intake (d/t not flushing kidneys)

60
Q

what are the early manifestations of bladder cancer?

A

hematuria - pink/reddish color

61
Q

what the late clinical manifestations of bladder cancer?

A

frequency, dysuria, urgency

62
Q

what is the typical treatment for stage 1 bladder cancer?

A

BCG vaccine as intravesical chemo

63
Q

what is the typical treatment for advanced bladder cancer?

A

systemic chemo

64
Q

define glomerulonephritis:

A

a variety of conditions that cause inflammation of the glomeruli

65
Q

does glomerulonephritis affect both kidneys at the same time?

A

not always, can be focal or diffuse in the kidneys too

66
Q

what are the 3 layers of the capillary membrane of the glomerulus?

A

endothelium
basement membrane
podocytes (these are special cells that begin the urine formation process)

67
Q

where is the damage to the kidneys associated with glomerulonephritis?

A

glomerulus and tubules

68
Q

what are the 2 types of reactions that lead to glomerulonephritis?

A

type II and type III reactions

69
Q

what is the type II reaction that leads to glomerulonephritis?

A

anti-GBM antibodies attach to antigens in the basement membrane of the kidneys and cause tissue injury

70
Q

it is common for patients that have a type II reaction (r/t glomerulonephritis) to have what symptom NOT related to the urinary system?

A

hemoptysis

71
Q

what is the type III reaction that can lead to glomerulonephritis?

A

antibodies react with circulating antigens and are deposited as immune complexes in the glomerular basement membrane

72
Q

which reaction is most common in glomerulonephritis?

73
Q

both types of reactions that can lead to glomerulonephritis have what 2 things in common?

A
  1. accumulation of antigens, antibodies, and complements
  2. complement activation of some kind leads to tissue injury
74
Q

what are the clinical manifestations of acute glomerulonephritis?

A

-hematuria
-azotemia
-retention (more Na+ and water retained = edema = HTN)
-proteinuria

75
Q

What are the common triggers for acute glomerulonephritis?

A

post-infections, primary disease (Berger’s disease), or multisystem diseases (ie: goodpasture syndrome, lupus)

76
Q

what type of reaction occurs in Berger’s disease r/t to acute glomerulonephritis? Explain.

A

Type III - build up of antibody IgA in the kidneys that cause inflammation

77
Q

what is chronic glomerulonephritis?

A

long term inflammation of the glomerulus, increased scarring decreases filtration ability

78
Q

what are the clinical manifestations of chronic glomerulonephritis?

A

the same as acute glomerulonephritis:
Hematuria
Azotemia
Retention
Proteinura

79
Q

what is the normal prognosis of chronic glomerulonephritis?

A

slow, progressive destruction towards ESRD

80
Q

what occurs with nephrotic syndrome?

A

the glomerulus is too permeable to plasma protein

81
Q

on average, how much protein does someone with nephrotic syndrome excrete?

A

> 3 g per day

82
Q

what is the etiology of nephrotic syndrome?

A

glomerulonephritis and DM

83
Q

what are the clinical manifestations of nephrotic syndrome?

A
  • edema
  • HTN
  • hyperlipidemia
  • hypercoagulation
  • loss of antithrombin III and plasminogen
84
Q

how does diabetic nephropathy lead to ESRD?

A

gross thickening of GBM that decreases GFR

85
Q

how much urine is considered oliguria (per day)?

Patho1 (22 decks)

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