Renal Disorders Flashcards
1
Q
fluid and electrolyte balance
A
controls amount of water resorbed or excreted as well as potassium, sodium, hydrogen
- assits with our acid base balance by acting as a compensating mechansism
2
Q
functions of kidneys
A
- endocrine functions
- control of solutes and fluids
- blood pressure control
- drug metabolism and excretion
- metabolic waste excretion
3
Q
Prerenal acute failure is caused by
A
sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness
4
Q
Intrarenal acute failure is caused by
A
direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood flow
5
Q
causes of postrenal failure
A
sudden obstruction of urine flow due to damaged prostate, kidney stones, bladder, or injury
6
Q
renal insufficency
A
poor function of the kidneys that may be due to a reduction in blood flow to the kidneys
- decline of 25%
7
Q
kidney failure
A
unable to filter waste products from your blood
- less than 10% remains
8
Q
both renal insufficency and kidney failure cause
A
- uremia
- azotemia
9
Q
uremia
A
- urea and other waste products build up in the body because the kidneys are unable to eliminate them
10
Q
azotemia
A
kidneys are no longer able to get rid or enough nitrogen waste
- increased BUN
- blood urea nitrogen
11
Q
pre renal
A
impaired perfusion
- cardiac failure, sepsis, blood loss, dehydration, vascular occlusion
12
Q
renal failure
A
Glomerulonephritis , small vessel vasculitis, Acute tubular necrosis (drugs, toxins, prolonged hypotension)
interstitial nephritis (drugs, toxins, inflammatory disease, infection)
13
Q
post renal failure
A
urinary calculi, benign prostatic enlargement, prostate or cervical cancer, urethral stricture/valves, meatal stenosis, phimosis
14
Q
acute kidney injury (AKI) be caused by
A
myocardial infraction, hypotension, sepsis shock, peritonitis, and extracellular volume depletion
15
Q
what are the 3 causes of Oliguria
A
- alterations in blood flow (efferent vasoconstriction)
- tubular obstruction (necrosis of the tubules causes sloughing of cells, cast formation, and ischemic edema)
- tubular backleak (tubular reabsorption is accelerated as a result of increased permeability caused by ischemic and increased pressure due to obstruction)
16
Q
AKI prerenal
A
- dehydration
- heart failure (cardiorenal syndrome)
- liver failure (hepatorenal syndrome)
17
Q
AKI Intrarenal
A
Intrinsic renovascular disease
- hypertensive emergency
- small vessel vasculitis
- TTP/HUS
Glomerular disease
- post infectious glomerulonephritis
Tubulointerstitial disease
- acute tubular necrosis (ATN)
- acute interstitial nephritis (AIN)
18
Q
acute tubular necrosis (ATN) cause
A
sepsis, meds, contrast rhabdo, prolonged prerenal (AKI)
19
Q
KI post renal
A
- ureteral obstruction
- neurological bladder
- medications
- benign prostatic hypertrophy (BPH)
20
Q
what is acute pyelonephritis
A
- sudden and severe kidney infections
- affects both of the upper urinary tracts
- colonization of the bladder, reflux up into ureters to kidneys
21
Q
what is the most common risk of acute pyelonephritis
A
urinary obstruction and reflux of urine from the bladder
22
Q
acute pylonephritis causes
A
kidney stones, vesicourental reflux (urine flow back up to kidneys), pregnancy, neurogenic bladder, catherization, endoscopes, female sexual trauma
23
Q
acute onset of pylonephritis symptoms
A
fever, chills, flank pain (symptoms of UTI)
24
Q
acute pyelonephritis can lead to
A
AKI
25
what is chronic pyelonephritis
- continuing infection of the kidney
- reccurent infections
26
chronic pyelonephritis symptoms
- may be absent
- fever, frequency, malaise, and flank pain
- progressive inflamamtion
27
progressive inflammation due to chronic pyelonephritis causes
alterations of the renal pelvis, destruction of tubules, atrophy or dilation, and diffuse scaring
- leads to impaired ability to concentrate urine
28
upper urinary tract obstruction can be
- atomical or functional
29
anatomical
obstructive uropathy
30
upper urinary tract obstruction examples
stricture, kidney stones, or calculi
31
hydrponephorsis
swelling of the kidney due to backup
32
upper urinary tract obstruction risk factors
- age, gender, ethnicity, geographical location, fluid intake, diet, occupation
- geographical: temperature, humidity, and rainfall
33
ph >7
increased risk of calcium phosphate stone
34
ph < 5
increased risk of uric acid stone
35
upper urinary tract obstruction cause
- supersaturation of salt in urine
- precipitation
- growth through crystalization
- absense of stone inhibitors
36
signs and symptoms of upper urinary tract obstruction
Renal Colic - moderate to severe pain in your flank
- pain= nausea and vomiting
*hematuria may be present
37
pain radiating to groin indicates
obstruction of renal pelvis or porximal ureter
38
pain radiating to lateral flank or lower abdomen indicates
obstruction of the midureter
39
uregency, frequency, urge incontinence is indicative of
obstruction of the lower ureter
40
neurogenic bladder above C2
hyper-reflexia
- urgency and urine leakage
- bladder empties automatically when it is full
41
neurogenic bladder above C2 is cuased by
stroke, TBI, MS, cerebral palsy, Alzheimers disease, brain tumours
42
neurogenic bladder between C2 and S1
hyper-reflexia with spincter dyssynergia
- muscle contraction and external sphincter contraction occurs at the same time = functional obstruction of the bladder
43
neurogenic bladder between C2 and S1 is caused by
SCI, MA Guillian Barre syndrome, vertebral disc problem
44
neurogenic bladder below S1
atonic bladder
- urine rentention and distention
- full bladder is sensed, but detrusor does not contact
- underactive bladder
- stress and overflow incontience
45
neurogenic bladder below S1 is cuased by
peripheral neuropathy, MS, spinal injury t12-S1
46
what is urethral stricture
scarring that narrows the urethra and restricts flow from urine to the bladder
47
what is urethral stricture caused by
injury, infection, or surgical manipulation that produces scar
48
treatment of urethral stricture
- dialation
- cutting stricture with a laser
- surgery to remove stricture with reconnection and reconstruction
49
prostate enlargement is caused by
acute inflammation, BPH or cancer
50
pelvic organ prolapse
- bladder outlet obstruction
- herniation of bladder descends below level of urethral output
51
UTI cause
bacteria from gut flora
52
UTI occurs
anywhere in the bladder
53
who is at risk for UTIs
premature infants, prepubertal children, sexually active and pregnant females, women treated with antibiotics that affects the vaginal flora, post menopasual women, indewlling catheters, Dm, neurogenic blatter, UT obstruction
54
why are UTIS more common in women
shorter urethra and closer to anus
55
uncomplicated UTI
asymtopmatic, mild, without complications
56
complicated UTI
- compromised host defences
- HIV, kidney transplant, DM, spinal cord injury
57
40% of septic shock is cuased by
urosepsis
58
how does the normal bladder function
- most bacteria washed out during urination
- urine inhibits bacterial growth
- ureterovesical junction closes preventing reflux
- longer urethra and presence of prostatic secretions decrease risk in males
59
what is acute cystitis
is a sudden inflammation of the urinary bladder.
60
what is the most common form of acute cystitis
UTI
61
hemorrhagic cystitis
more advanced
62
suppurative cytisis
pus formation on the epithelial surface of the bladder
Severe causes: sloughing of the bladder mucosa with ulcer formation or possible necrosis of the bladder wall
63
acute cystitis causes
most common: migration of bacteria through retrograde movement into the urethra and bladder
- infections cause inflammation
64
edema in the bladder leads to
stimulating stretch receptors causing sensation of bladder fullness and frequent urination
65
acute cystitis sings and symptoms
- most asymptomatic
- frequency, urgency pain, and suprapubic and low back pain
- older adults: confused or vague abdominal discomfort
66
phases of acute kidney injury
- oliguric phase (decreased urine output)
- diuretic phase (increased urine output)
- recovery phase (glomerular filtration rate normalizes)
67
oliguric phase
decreased urine output
- last 2 weeks to several month
- BUN and creatine levels rise (ratio 10:1)
- patient becomes hypovolemic, edema, weight gain, HTN)
68
diuretic phase
increased urine output
- caused by kidney loses the ability to concentrate urine and osmosis diuresis produced by high BUN levels
- weight loss and hypovolemia
- can produce deficit in potassium, sodium, and water
69
recovery phase
glomerular filtration rate normalizes
- BUN and creatine levels have returned to normal
- urine output has returned to normal
70
chronic kidney disease
- basement membrane under the epithelium becomes damaged
71
chronic kidney disease is associated with
systemic diseases such as DM, HTN, lupus
72
chronic kidney disease is caused by
progressice acute kidney injury
- congential anomalies: polycystic kidney disease (multiple cysts that interfere with renal functions - autosomal dominate disease), infection, and obstructive disease can lead to renal insufficency
73
CKD stage 1
kidney damage with normal kidney fucntion
- GFR > 90
- asymptomatic
- may have HTN
74
CKD stage 2
kidney damage with mild loss of kidney function
- GFR 60-89
- subtle changes
- HTN, increasing creatine and urea
75
CKD stage 3
mild to moderate loss of kidney finction
- GFR 30-59
76
CKD stage 4
severe kidney damage
- GFR 15-29
- metabolic acidosis, hyperkalemia, salt or water retention
77
CKD stage 5
end stage kidney disease
- GFR <15
- need treatment
- dialysis or transplant to live
78
who are the individuals at risk for CKD
African american descent, older age, low birth rate, family history, smoking, obestiy, HTN, and DM
79
hoe does CKD effect fluid and electrolyte balances
- GFR cantinues to decline (below 25%)
- kidney loses ability to regulate sodium and water balance (sodium and water are retained)
- edema, hypertension, and increased vascular colume
80
how does CKS effect creatine and urea clearance
- creatine increases and GFR decreases
- urea increases (flucuates with dehydration)
81
in CKD patients developes
uremia
82
uremia symptoms
progressive weakness, easy fatigue, loss of appetite
83
how does CKD effect calcium, phosphate and bone
hypocalemia increased with impaired renal failure
- increased phosphate binds calcium increasing hypocalcemia
- acidosis also contributes to negative calcium
- decreased sodium stimulates parathyroid hormone which mobilizes calcium from bone
- prone to fractures
84
how does CKD effect vitamin deficiency
leads to further hyperthyroidism
- leads to dystrophic growth of bones
85
how is protein effected in CKD
- serum levels of protein are decreased and ther is a loss of muscle mass
- high protein diets may cuase damage to the kidneys
86
how does CKD effect the cardiovascular system
excess sodium and fluid leads to HTN
- accumulation of toxins in the pericardium causes pericarditis
- dyslipidema promotes plaque formation
- declining erythropoetin production causes edema
87
how does CKD effect respiration
- fluid overload, heart failure, and pulmonary edema
88
what is BUN
blood urea nitrogen
89
BUN is a measure of
indirect and rough measurement of renal fucntion
- created in the liver during metabolism, excreted by the kidneys
90
BUN is also elevated in conditions such as
shock, dehydration, and heart failure
91
if kidney disease in unilateral what is the affect on BUN
unaffected kidney would compensate and BUN would not be affected
92
creatine
byproduct of muscle contraction
- only excreted by the kidneys
93
what can affect creatine levels
muscle mass and protein intake
94
Creatine levels will increase with
impaired renal function (sign of CKD)
- increase with renal function also rhabdomyolysis (injury to muscle fibres)
95
what is normal BUn to creatine ratio
between 1:10 and 1:20
96
decreased BUN to creatinne ratio may be caused by
acute renal problems
97
GFR is a measure of
how well the kidneys are functioning
- estimates how much blood passes through the glomeroli each minute
98
filtration occurs due to
pressure gradient in the glomerulus
99
increased blood volume and pressure effect on GFR
increases GFR
100
what will decrease GFR
- constriction of the afferent arterioles and dilation of the efferent arterioles
101
GFR is equal to
percentage of kidney function
102
GFR below 60 is indicative of
kidney failure
103
GFR below 15 usually requires
intervention
104
presence of protien in urinalysis is indicative of
nephrotic syndrome
