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RENAL: KCPA SU'17 > Renal Disorders > Flashcards

Renal Disorders Flashcards

1
Q

renal agenesis

A

failure of one or both kidneys to develop

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2
Q

rare, associated with other congenital anomalies, incompatible with life

A

bilateral renal agenesis

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3
Q

common, ASYMPTOMATIC; the other kidney enlarges to compensate

A

unilateral renal agenesis

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4
Q

Duplication of urinary tract: complete vs incomplete

A

complete duplication - formation of extra ureter and renal pelvis

incomplete duplication - only upper part of excretory system is duplicated

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5
Q

Associated with fusion of kidneys; “horseshoe kidney”; fusion of upper pole

A

Malposition

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6
Q
  • very common
  • may be acute or chronic
  • most infections are caused by Gram Negative Bacteria
  • MC pathogen is E. coli
  • organisms contaminate perianal and genital areas and ascend the urethra
A

UTI

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7
Q

list 4 conditions that are protective against UTI

A
  1. free urine flow
  2. large urine volume
  3. complete bladder emptying
  4. acid urine: most bacteria grow poorly in an acidic environment
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8
Q

4 predisposing factors for UTI

A
  1. any condition that IMPAIRS drainage of urine
  2. STAGNATION of urine - favors bacterial growth
  3. INJURY to mucosa by kidney stone - disrupts protective epithelium allowing bacteria to invade deeper tissue.
  4. introduction of CATHETER or other instruments into bladder - may carry bacteria or injure urethral mucosa
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9
Q

an untreated UTI may result in ____ if allowed to progress

A

pyelonephritis

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10
Q

infection that affects ONLY the bladder

A

cystitis/UTI

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11
Q

Cystitis/UTI is MC in ?

A

women due to shorter urethra

- also common in young sexually active women because intercourse promotes transfer of bacteria from urethra to bladder

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12
Q

when is cystitis/uti seen in males?

A

MC in older men because enlarged prostate interferes with complete bladder emptying

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13
Q

clinical manifestations of UTI/Cystitits

A
  1. Burning & pain on urination
  2. desire to urinate frequently
  3. no fever, no high WBC count
  4. Urine contains many bacteria and leukocytes –> we compare the number of epithelial cells to number of leukocytes in urinalysis - if lots of epithelial cell = unclean sample.
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14
Q

Involvement of UPPER urinary tract from
- Ascending infection from the bladder (Ascending ___)

OR

  • carried to the kidneys from the bloodstream (Hematogenous ____) –> Secondary infection
A

pyelonephritis

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15
Q

clinical manifestations of pyelonephritis - similar to cystitis

A
  1. localized pain & TTP over affected kidney area
  2. responds well to ABX
  3. cystitis and pyelonephritis are frequently associated
  4. some cases become chronic and lead to kidney failure
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16
Q

inflammation, sometimes caused by bacterial infection of the prostate - multiple types

A

prostatitis

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17
Q

Acute Bacterial Prostatitis

A
  • considered subset of UTI
  • due to ascending urethral organisms invading prostatic ducts.
  • same risk factors as UTI
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18
Q

symptoms of Acute Bacterial Prostatitis

A

similar to UTI with a few important additions:

  1. fever
  2. chills
  3. systemic symptoms
  4. perineal/ rectal dull achy pain
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19
Q

Treatment for Acute bacterial prostatitis

A

4+ weeks of ABX & if untreated or poorly treated, may result in abscess

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20
Q

when would we expect to see CHRONIC bacterial prostatitis

A

in male patients with recurrence of UTIs

21
Q

symptoms of Chronic Bacterial Prostatitis

A

less systemically ill & do not have fever or chills

22
Q

treatment of chronic bacterial prostatitis

A

very challenging and long abx therapy - many do not penetrate the chronically inflamed prostate well.

23
Q

a very common age related, NON-malignant nodular enlargement of the prostate.
- likely due to decreased cell death

A

Benign Prostatic Hypertrophy (BPH)

24
Q

describe what is happening in BPH

A

as the prostate increases in size, it compresses the urethra at the bladder neck –> leading to classic symptoms of BPH.

25
what are the classic symptoms of BPH
1. weak stream 2. hesitancy 3. frequency 4. nocturne 5. post-void dribble
26
what are the 3 options for treatment of BPH
1. 5 alpha-reductase inhibitors - finasteride (Proscar) 2. Alpha-1 blockers, Tamulosin (Flomax) 3. Surgically - TURP : transurethral prostatectomy
27
5 alpha-reductase inhibitors brand name and generic describe MOA
finasteride (Proscar) reduce prostate size gradually over time by blocking the affects of androgens on growth - causing slow but durable atrophy of the prostate gland epithelial cells, reducing prostate volume by 20-30%
28
alpha-1 blockers brand name and generic describe MOA
tamulosin (Flomax) relax prostatic smooth muscle by blocking alpha stimulation = facilitating urine flow. these drugs act more rapidly - within 24-48 hours
29
TURP treatment for BPH puts patient at risk for what?
sexual dysfunction
30
Predisposing factors for Renal Calculi
1. high [ ] of salts in urine 2. UTI 3. Urinary tract obstruction
31
high [ ] of salts in urine - saturates urine causing salt to precipitate & form calculi 1. 2.
URIC ACID IN GOUT CALCIUM SALTS IN HYPERPARATHYROIDISM
32
explain how UTIs can lead to Renal Calculi
UTIs reduce solubility of salts in urine; clusters of bacteria are site where urinary salts may crystallize to form stones
33
explain how urinary tract obstructions cause Renal Calculi
obstructions cause urine stagnation, which promotes stasis and infection, further increasing stone formation.
34
may form anywhere in the urinary tract
renal calculi
35
small stones may pass through the ureters to the bladder causing ___ and ___
renal colic and hematuria
36
explain how renal calculi may lead to AKI
some calculi may become impacted in the ureter & need to be removed - because backs up urine into kidney - stretching out renal capsule - could cause acute kidney injury
37
Staghorn Calculus
urinary stones that increase in size to form large branching structures that adopt to the counter of the pelvis and calyces - "casts"
38
two manifestations of renal calculi
1. renal colic associated with passage of stone | 2. obstruction of urinary tract causes Hydronephrosis & hydroureter proximal to obstruction
39
3 treatment options for renal calculi
1. cystoscopy = snares and removal of stone which are lodged in distal ureter 2. shock wave lithotripsy = stones lodged in proximal ureter are broken into smaller fragments so that they are readily excreted. - for stones higher up in ureter 3. ureteral stents to open up ureter
40
blockage of urine outflow leads to progressive ___ of urinary tract proximal to obstruction. this eventually causes ___ of kidneys
leads to progressive dilation of urinary tract eventually causes atrophy of kidneys
41
two manifestations of urinary obstruction / retention
1. hydroureter = dilation of ureter | 2. hydronephrosis = dilation of pelvis and calyces
42
causes of urinary retention : | bilateral vs unilateral
bilateral = obstruction of bladder neck by enlarged prostate or urethral stricture unilateral = ureteral stricture, calculus, tumor
43
complications, dx and tx of urinary obstruction/retention
complications = infection, stone formation dx = renal ultrasound, CT-abd/pelvis tx = removal of obstruction or stenting
44
urinary obstruction/ retention is due to mechanical obstruction or because bladder doesn't have enough tone to empty - latter cause is commonly seen in who?
diabetic patients
45
cause of Glomerulonephritis
inflammation of glomeruli is caused by Antigen-Antibody reaction within the glomeruli
46
explain pathogenesis of glomerulonephritis
- circulation Ag-Ab complexes are filtered then trapped by glomeruli & incite inflammation - plugging the glomerular capillaries causes localized inflammatory reaction --> leukocytes release lysosomal enzymes that cause injury to glomeruli
47
glomerulonephritis is common seen in who?
1. connective tissue disorders - lupus | 2. also triggered by multiple types of infections
48
clinical manifestations of glomerulonephritis
1. patients develop HTN, cola-colored urine, & nephritic range proteinuria (301mg - 3gms) --> body losing protein quickly so pt develops compensatory changes like HTN and edema 2. RBC casts in urine sediment are pathognomic for glomerulonephritis 3. AKI on labs - because kidney not able to filter out just the bad stuff so build up of wastes over time
49
treatment for glomerulonephritis
control BP | limit renal damage and monitor for recovery

RENAL: KCPA SU'17 (4 decks)

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