Renal Conditions Flashcards
Pyelonephritis clinical manifestations
CVA Tenderness
Dysuria
Hematuria
N/V
Anorexia
Fever
Chills
Pyelonephritis Treatment
Trimethoprim/Sulfemethaxole (Bactrim)
Ciprofloxacin
Pyelonephritis Risk Factors
Pregnancy
Recurrent lower UTIs
Antibiotic resistant strains
Complications of Pyelonephritis
Urosepsis (sepsis d/t UTI)
More systemic response
High mortality rate
More likely in elderly
Causes of Nephrolithiasis in the renal pelvis
Renal Calculi
Causes of nephrolithiasis in the ureter
Renal Calculi
Pregnancy
tumors
Causes of nephrolithiasis in the bladder/urethra
Bladder cancer
Neurogenic bladder
Prostate hyperplasia
Prostate cancer
Urethral strictures
Complications of nephrolithiasis
Stasis of blood flow
Back-up pressure
Back-up pressure can lead to hydroureter, hydronephrosis, postrenal acute kidney injury
What factors can enhance crystal formation in the kidneys?
- PH changes d/t UTIs
- Excessive concentration of insoluble salts in the urine d/t dehydration, bone disease, gout, renal disease
- Urinary stasis - Immobility/sedentary lifestyle
Risk factors for nephrolithiasis
Men
20-30s
White
Obesity
Family Hx
Congenital defects
Hot weather (dehydration)
Prevalence and risk factors for Struvite kidney stones
15%
UTIs
Prevalence and risk factors for calcium oxalate/phoshpate kidney stones
70-80%
Family Hx
Idiopathic
Increased calcemia
Increased oxaluria
Diet factors: Increased protein, Increased sodium, Increased oxalate
Prevalence and risk factors for Uric acid kidney stones
7%
Gout
Clinical manifestations of nephrolithiasis
Acute renal colic
Chills, fever (only if infection is present)
Dysuria
Hematuria
Foul smelling urine
Diaphoresis
Pharmacologic treatment for different kidney stones
Calcium = Thiazide diruetics
Struvite = abx
Urate = Allopurinol
Risk factors for renal cell carcinoma
Smoking
Obesity
Age
Male
Genetics
When does diagnosis of renal cell carinoma usually happen
Once the cancer cells have metastized
Renal cell carcinoma clinical manifestations
Early - NONE
Late -
1. CVA tenderness
2. Hematuria
3. Possible palpable abdominal mass
Where does renal cell carcinoma usually metastize to
Bones or lungs
How is renal cell carcinoma treated
Surgery to remove kidney
renal cell carcinoma is usually resistant to chemotherapy
Risk factors for urethelial carcinoma
Smoking
Male
Occupations with exposure to toxins
Low fluid intake
Clinical manifestation of urethelial carcinoma
Early - Hematuria
Late -
1. Frequency
2. Urgency
3. Dysuria
Types of chemo treatments for urethelial Carcinoma
Stage 1 - Intravesical chemo
Advanced stages - Systemic chemo
BCG vaccine
Indications, MOA, and adverse effects
Indications: 1st stage of urethelial carcinoma
MOA: Stimulates inflammatory response to the bladder
Adverse effects: Bladder irritation, systemic infection
BCG Vaccine
Patient instructions
- Empty bladder
- Instill BCG vaccine into the bladder through I/O Catheter (Dwells for 2 hours)
- Change positions q 15 minutes
BCG vaccine
safety precautions
Live vaccine - Contraindicated in immunocompromised
HIV, AIDS, etc
Type 2 vs Type 3 Sensitivity Reactions
Type 2: Reactions occur on the cell surface and result in cell death or malfunction
Type 3: Immune complexes are deposited into tissues and the resulting inflammation destroys the tissue
2 Types of injuries resulting in glomerulonephritis
- Antibodies attach to antigens of the glomerular basement membrane (“Anti-GBM Antibodies) - 5%
- Antibodies react with circulating antigens and are deposited as immune complexes in the GBM - 95%
Clinical manifestations of acute glomerulonephritis
Hematuria
Azotemia
Retention of Na+ and water (decreased uOP leads to HTN and edema)
Proteinuria
HARP
Causes of acute glomerulonephritis
Poststreptococcal infection
Berger disease
Goodpasture syndrome
Systemic lupus erythematosus (SLE)
Vasculitis
Pathogenesis of acute glomerulonephritis
- Trigger
- Immune complexes form
- Complement activated
- release of mediators
- tissue injury
- Hematuria, proteinuria, decreased GFR
Prognosis for chronic glomerulonephritis
Slow progressive desruction of glomerulus leading to ESRD
What is nephrotic syndrome?
The glomerulus is too permeable leading to plasma proteins leaking into the urine
Elimination of >3g of protein per day into the urine
What diseases cause nephrotic syndrome
Glomerulonephritis
Diabetes mellitus
Pathogenesis of nephrotic syndrome
- Increased glomerular permeability
- Proteinuria
- Hypoalbuminemia
Clinical manifestations of nephrotic syndrome
- Edema
- HTN
- Liver problems -
* Hyperlipidemia
* Hypercoagulation
* Loss of antithrombin III and plasminogen (DVTs and PE)
DM complications r/t nephrotic syndrome
Diabetic neuropathy
* Major complication
* Gross thickening of GBM
* Ultimately leads to ESRD
HTN complications r/t nephrotic syndrome
Hypertensive glomerular disease
Decreased renal perfusion leads to scarring of glomerulus
Clinical manifestations of glomerulopathy
FLuid retention
increased BUN/Cr ratio
Proteinuria
Decreased albumin (blood protein)
