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Pathophysiology > Renal Disorders > Flashcards

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

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2
Q

functions of kidneys

A
  • endocrine functions
  • control of solutes and fluids
  • blood pressure control
  • drug metabolism and excretion
  • metabolic waste excretion
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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

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4
Q

Intrarenal acute failure is caused by

A

direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood flow

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5
Q

causes of postrenal failure

A

sudden obstruction of urine flow due to damaged prostate, kidney stones, bladder, or injury

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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%

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7
Q

kidney failure

A

unable to filter waste products from your blood
- less than 10% remains

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8
Q

both renal insufficency and kidney failure cause

A
  • uremia
  • azotemia
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9
Q

uremia

A
  • urea and other waste products build up in the body because the kidneys are unable to eliminate them
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10
Q

azotemia

A

kidneys are no longer able to get rid or enough nitrogen waste
- increased BUN
- blood urea nitrogen

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11
Q

pre renal

A

impaired perfusion
- cardiac failure, sepsis, blood loss, dehydration, vascular occlusion

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12
Q

renal failure

A

Glomerulonephritis , small vessel vasculitis, Acute tubular necrosis (drugs, toxins, prolonged hypotension)
interstitial nephritis (drugs, toxins, inflammatory disease, infection)

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13
Q

post renal failure

A

urinary calculi, benign prostatic enlargement, prostate or cervical cancer, urethral stricture/valves, meatal stenosis, phimosis

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14
Q

acute kidney injury (AKI) be caused by

A

myocardial infraction, hypotension, sepsis shock, peritonitis, and extracellular volume depletion

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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)
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16
Q

AKI prerenal

A
  • dehydration
  • heart failure (cardiorenal syndrome)
  • liver failure (hepatorenal syndrome)
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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)

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18
Q

acute tubular necrosis (ATN) cause

A

sepsis, meds, contrast rhabdo, prolonged prerenal (AKI)

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19
Q

KI post renal

A
  • ureteral obstruction
  • neurological bladder
  • medications
  • benign prostatic hypertrophy (BPH)
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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
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21
Q

what is the most common risk of acute pyelonephritis

A

urinary obstruction and reflux of urine from the bladder

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22
Q

acute pylonephritis causes

A

kidney stones, vesicourental reflux (urine flow back up to kidneys), pregnancy, neurogenic bladder, catherization, endoscopes, female sexual trauma

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23
Q

acute onset of pylonephritis symptoms

A

fever, chills, flank pain (symptoms of UTI)

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24
Q

acute pyelonephritis can lead to

A

AKI

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25
Q

what is chronic pyelonephritis

A
  • continuing infection of the kidney
  • reccurent infections
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26
Q

chronic pyelonephritis symptoms

A
  • may be absent
  • fever, frequency, malaise, and flank pain
  • progressive inflamamtion
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27
Q

progressive inflammation due to chronic pyelonephritis causes

A

alterations of the renal pelvis, destruction of tubules, atrophy or dilation, and diffuse scaring
- leads to impaired ability to concentrate urine

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28
Q

upper urinary tract obstruction can be

A
  • atomical or functional
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29
Q

anatomical

A

obstructive uropathy

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30
Q

upper urinary tract obstruction examples

A

stricture, kidney stones, or calculi

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31
Q

hydrponephorsis

A

swelling of the kidney due to backup

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32
Q

upper urinary tract obstruction risk factors

A
  • age, gender, ethnicity, geographical location, fluid intake, diet, occupation
  • geographical: temperature, humidity, and rainfall
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33
Q

ph >7

A

increased risk of calcium phosphate stone

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34
Q

ph < 5

A

increased risk of uric acid stone

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35
Q

upper urinary tract obstruction cause

A
  • supersaturation of salt in urine
  • precipitation
  • growth through crystalization
  • absense of stone inhibitors
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36
Q

signs and symptoms of upper urinary tract obstruction

A

Renal Colic - moderate to severe pain in your flank
- pain= nausea and vomiting
*hematuria may be present

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37
Q

pain radiating to groin indicates

A

obstruction of renal pelvis or porximal ureter

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38
Q

pain radiating to lateral flank or lower abdomen indicates

A

obstruction of the midureter

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39
Q

uregency, frequency, urge incontinence is indicative of

A

obstruction of the lower ureter

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40
Q

neurogenic bladder above C2

A

hyper-reflexia
- urgency and urine leakage
- bladder empties automatically when it is full

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41
Q

neurogenic bladder above C2 is cuased by

A

stroke, TBI, MS, cerebral palsy, Alzheimers disease, brain tumours

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42
Q

neurogenic bladder between C2 and S1

A

hyper-reflexia with spincter dyssynergia
- muscle contraction and external sphincter contraction occurs at the same time = functional obstruction of the bladder

43
Q

neurogenic bladder between C2 and S1 is caused by

A

SCI, MA Guillian Barre syndrome, vertebral disc problem

44
Q

neurogenic bladder below S1

A

atonic bladder
- urine rentention and distention
- full bladder is sensed, but detrusor does not contact
- underactive bladder
- stress and overflow incontience

45
Q

neurogenic bladder below S1 is cuased by

A

peripheral neuropathy, MS, spinal injury t12-S1

46
Q

what is urethral stricture

A

scarring that narrows the urethra and restricts flow from urine to the bladder

47
Q

what is urethral stricture caused by

A

injury, infection, or surgical manipulation that produces scar

48
Q

treatment of urethral stricture

A
  • dialation
  • cutting stricture with a laser
  • surgery to remove stricture with reconnection and reconstruction
49
Q

prostate enlargement is caused by

A

acute inflammation, BPH or cancer

50
Q

pelvic organ prolapse

A
  • bladder outlet obstruction
  • herniation of bladder descends below level of urethral output
51
Q

UTI cause

A

bacteria from gut flora

52
Q

UTI occurs

A

anywhere in the bladder

53
Q

who is at risk for UTIs

A

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
Q

why are UTIS more common in women

A

shorter urethra and closer to anus

55
Q

uncomplicated UTI

A

asymtopmatic, mild, without complications

56
Q

complicated UTI

A
  • compromised host defences
  • HIV, kidney transplant, DM, spinal cord injury
57
Q

40% of septic shock is cuased by

A

urosepsis

58
Q

how does the normal bladder function

A
  • 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
Q

what is acute cystitis

A

is a sudden inflammation of the urinary bladder.

60
Q

what is the most common form of acute cystitis

A

UTI

61
Q

hemorrhagic cystitis

A

more advanced

62
Q

suppurative cytisis

A

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
Q

acute cystitis causes

A

most common: migration of bacteria through retrograde movement into the urethra and bladder
- infections cause inflammation

64
Q

edema in the bladder leads to

A

stimulating stretch receptors causing sensation of bladder fullness and frequent urination

65
Q

acute cystitis sings and symptoms

A
  • most asymptomatic
  • frequency, urgency pain, and suprapubic and low back pain
  • older adults: confused or vague abdominal discomfort
66
Q

phases of acute kidney injury

A
  • oliguric phase (decreased urine output)
  • diuretic phase (increased urine output)
  • recovery phase (glomerular filtration rate normalizes)
67
Q

oliguric phase

A

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
Q

diuretic phase

A

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
Q

recovery phase

A

glomerular filtration rate normalizes
- BUN and creatine levels have returned to normal
- urine output has returned to normal

70
Q

chronic kidney disease

A
  • basement membrane under the epithelium becomes damaged
71
Q

chronic kidney disease is associated with

A

systemic diseases such as DM, HTN, lupus

72
Q

chronic kidney disease is caused by

A

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
Q

CKD stage 1

A

kidney damage with normal kidney fucntion
- GFR > 90
- asymptomatic
- may have HTN

74
Q

CKD stage 2

A

kidney damage with mild loss of kidney function
- GFR 60-89
- subtle changes
- HTN, increasing creatine and urea

75
Q

CKD stage 3

A

mild to moderate loss of kidney finction
- GFR 30-59

76
Q

CKD stage 4

A

severe kidney damage
- GFR 15-29
- metabolic acidosis, hyperkalemia, salt or water retention

77
Q

CKD stage 5

A

end stage kidney disease
- GFR <15
- need treatment
- dialysis or transplant to live

78
Q

who are the individuals at risk for CKD

A

African american descent, older age, low birth rate, family history, smoking, obestiy, HTN, and DM

79
Q

hoe does CKD effect fluid and electrolyte balances

A
  • 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
Q

how does CKS effect creatine and urea clearance

A
  • creatine increases and GFR decreases
  • urea increases (flucuates with dehydration)
81
Q

in CKD patients developes

A

uremia

82
Q

uremia symptoms

A

progressive weakness, easy fatigue, loss of appetite

83
Q

how does CKD effect calcium, phosphate and bone

A

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
Q

how does CKD effect vitamin deficiency

A

leads to further hyperthyroidism
- leads to dystrophic growth of bones

85
Q

how is protein effected in CKD

A
  • serum levels of protein are decreased and ther is a loss of muscle mass
  • high protein diets may cuase damage to the kidneys
86
Q

how does CKD effect the cardiovascular system

A

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
Q

how does CKD effect respiration

A
  • fluid overload, heart failure, and pulmonary edema
88
Q

what is BUN

A

blood urea nitrogen

89
Q

BUN is a measure of

A

indirect and rough measurement of renal fucntion
- created in the liver during metabolism, excreted by the kidneys

90
Q

BUN is also elevated in conditions such as

A

shock, dehydration, and heart failure

91
Q

if kidney disease in unilateral what is the affect on BUN

A

unaffected kidney would compensate and BUN would not be affected

92
Q

creatine

A

byproduct of muscle contraction
- only excreted by the kidneys

93
Q

what can affect creatine levels

A

muscle mass and protein intake

94
Q

Creatine levels will increase with

A

impaired renal function (sign of CKD)
- increase with renal function also rhabdomyolysis (injury to muscle fibres)

95
Q

what is normal BUn to creatine ratio

A

between 1:10 and 1:20

96
Q

decreased BUN to creatinne ratio may be caused by

A

acute renal problems

97
Q

GFR is a measure of

A

how well the kidneys are functioning
- estimates how much blood passes through the glomeroli each minute

98
Q

filtration occurs due to

A

pressure gradient in the glomerulus

99
Q

increased blood volume and pressure effect on GFR

A

increases GFR

100
Q

what will decrease GFR

A
  • constriction of the afferent arterioles and dilation of the efferent arterioles
101
Q

GFR is equal to

A

percentage of kidney function

102
Q

GFR below 60 is indicative of

A

kidney failure

103
Q

GFR below 15 usually requires

A

intervention

104
Q

presence of protien in urinalysis is indicative of

A

nephrotic syndrome

Pathophysiology (22 decks)

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