Renal Diseases Prt. 3 Flashcards
•Pathophysiology: Excessive ADH secretion or action
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
•Clinical Features: Headache, nausea, confusion, seizures
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
• Laboratory Findings:
• Hyponatremia
•Concentrated urine despite hypotonicity
• Urine sodium_____
•Normal renal, adrenal, and thyroid function
• Euvolemia
> 20 mEq/L
-URINARY TRACT INFECTION
•Lower UTI: (2)
(pain or burning sensation on urination, frequent urge to urinate)
urethritis and cystitis
-URINARY TRACT INFECTION
•Upper UTI: (2)
(fever, back or flank pain)
pyelitis and pyelonephritis
Urinalysis findings: WBCs, bacteria, mild proteinuria and hematuria, increased pH
UTI
UTI
______times more common in females
• Short___ with proximity to the vagina and the rectum
•___ that enhance bacterial adherence to mucosa
• Absence of____ and its antibacterial action
• ‘Milking’ of bacteria up the urethra during
10
urethra
Hormones
prostatic fluid
85% of UTI is caused by…
Gram-negative rods
Klebsiella
Enterobacter
E. coli
Proteus
Pseudomonas
UTI
Gram-positive agents include
S. faecalis
S. saprophyticus
S. aureus
• Conditions that interfere with the downward flow of urine
- Renal calculi, catheterization, sepsis, pregnancy, DM, immunosuppressive therapy
- Vesicoureteral reflux
“ACUTE PYELONEPHRITIS
• Most frequently occurs because of the ascending movement of bacteria from a lower UTI into the tubules and interstitium
• May also be due to hematogenous infection
“ACUTE PYELONEPHRITIS
• Urinalysis findings
• WBCs, bacteria, WBC casts (pathognomonic of upper UTI)
Acute Pyelonephritis
• Bacteria multiply in the interstitium and cause acute inflammation
• Tubular necrosis
• Bacterial toxins and leukocyte enzymes cause the formation of abscess
“ACUTE PYELONEPHRITIS
• Persistent inflammation of renal tissue and causes permanent scarring
• Mostly due to congenital urinary structural defects producing reflux nephropathy (vesicoureteral reflux and intrarenal reflux) and chronic urinary tract obstruction
‘CHRONIC PYELONEPHRITIS
• Note: INCREASED NUMBER OF EOSINOPHILS in differential analysis
-ACUTE INTERSTITIAL NEPHRITIS
- Major cause: allograft rejection of transplanted kidney
• Other causes: antibiotics, NSAIDs (NO EOSINOPHILURIA), antiepileptic agents, diuretics, and certain diseases
-ACUTE INTERSTITIAL NEPHRITIS
- Cell-mediated immune response that causes damage to the interstitium and renal tubular epithelium (3-21 days after exposure to the offending agent)
ACUTE INTERSTITIAL NEPHRITIS
Urinalysis findings
• Hematuria, proteinuria, WBCs, WBC casts without bacteria
ACUTE INTERSTITIAL NEPHRITIS
•YEAST INFECTIONS
• More common in women
• Yeasts like_____ are normal flora in the Gl tract and vagina and kept in check by the bacterial flora
Candida albicans
• Occurs when the bacterial flora is disrupted by antibiotics or pH changes
Yeast infections
• Renal calculi or kidney stones
• Vary in size from barely visible to large, staghorn calculi
• When urine becomes supersaturated with insoluble material because excretion rates are excessive and/or because water conservation is extreme, crystals form and may grow and aggregate to form a stone
NEPHROLITHIASIS
PATHOGENESIS OF STONES
•Conditions favoring the formation of renal calculi:
• Chemical concentration or supersaturation of chemical salts in urine
• Optimal pH
• Urinary stasis
• Nucleation or initial crystal formation
______: constant and unchanging urine ph
______: less soluble in neutral or alkaline urine
______: less soluble in acidic urine
• Urea-splitting organisms
Isohydruria
Inorganic salts
Organic salts
75-85% of calculi are…
calcium oxalate
calcium phosphate
: medication for HIV patients; poor solubility in physiologic pH
• Indinavir
: in conjunction with hereditary disorders of cystine metabolism
• Cystine (1%)
: food rich in purine and with uromodulin-associated kidney disease
• Uric acid (5-10%)
: accompanied by chronic urinary infections involving urea-splitting bacteria, usually Proteus species
• Magnesium ammonium phosphate/struvite/staghorn (5%)
•Urinalysis findings
• Crystals in urine, microscopic hematuria
NEPHROLITHIASIS
• May be a gradual progression from the original disorder to chronic renal failure or end-stage renal disease
RENAL FAILURE
Sudden loss of renal function caused by:
• sudden decrease in renal blood flow (25%)
• acute glomerular and tubular disease (65%, 99% of cases is due to ATN), or
• renal calculi or obstructions (10%, high BCHP equates to low GFR)
Acute Renal Failure
• Now known as acute kidney injury
ACUTE RENAL FAILURE IN CHILDREN
•________
• One of the most common causes of acute renal failure in children
• Commonly occurs after ingestion of meat infected with verocytotoxin-producing E. coli, most often serotype______
• The toxin damages the endothelium, reducing nitric oxide, promoting vasoconstriction and necrosis, and promoting thrombosis
HEMOLYTIC-UREMIC SYNDROME
Serotype 0157: H7
RENAL FAILURE
• Progressive loss of renal function caused by an irreversible and intrinsic renal disease and progresses to end-stage renal disease
Chronic Renal Failure
RENAL FAILURE
• Marked decrease in GFR, slow but continuous (< 25 ml/min)
• Steadily rising serum BUN and creatinine values
• Electrolyte imbalance
• Isosthenuric urine
• Proteinuria and glycosuria
• Abundance of granular, waxy, and broad casts (telescoped urine sediment)
Chronic Renal Failure
