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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
Q

what are the classic symptoms of BPH

A
  1. weak stream
  2. hesitancy
  3. frequency
  4. nocturne
  5. post-void dribble
26
Q

what are the 3 options for treatment of BPH

A
  1. 5 alpha-reductase inhibitors - finasteride (Proscar)
  2. Alpha-1 blockers, Tamulosin (Flomax)
  3. Surgically - TURP : transurethral prostatectomy
27
Q

5 alpha-reductase inhibitors

brand name and generic
describe MOA

A

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
Q

alpha-1 blockers

brand name and generic
describe MOA

A

tamulosin (Flomax)

relax prostatic smooth muscle by blocking alpha stimulation = facilitating urine flow.
these drugs act more rapidly - within 24-48 hours

29
Q

TURP treatment for BPH puts patient at risk for what?

A

sexual dysfunction

30
Q

Predisposing factors for Renal Calculi

A
  1. high [ ] of salts in urine
  2. UTI
  3. Urinary tract obstruction
31
Q

high [ ] of salts in urine - saturates urine causing salt to precipitate & form calculi
1.
2.

A

URIC ACID IN GOUT

CALCIUM SALTS IN HYPERPARATHYROIDISM

32
Q

explain how UTIs can lead to Renal Calculi

A

UTIs reduce solubility of salts in urine; clusters of bacteria are site where urinary salts may crystallize to form stones

33
Q

explain how urinary tract obstructions cause Renal Calculi

A

obstructions cause urine stagnation, which promotes stasis and infection, further increasing stone formation.

34
Q

may form anywhere in the urinary tract

A

renal calculi

35
Q

small stones may pass through the ureters to the bladder causing ___ and ___

A

renal colic and hematuria

36
Q

explain how renal calculi may lead to AKI

A

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
Q

Staghorn Calculus

A

urinary stones that increase in size to form large branching structures that adopt to the counter of the pelvis and calyces - “casts”

38
Q

two manifestations of renal calculi

A
  1. renal colic associated with passage of stone

2. obstruction of urinary tract causes Hydronephrosis & hydroureter proximal to obstruction

39
Q

3 treatment options for renal calculi

A
  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
Q

blockage of urine outflow leads to progressive ___ of urinary tract proximal to obstruction.
this eventually causes ___ of kidneys

A

leads to progressive dilation of urinary tract

eventually causes atrophy of kidneys

41
Q

two manifestations of urinary obstruction / retention

A
  1. hydroureter = dilation of ureter

2. hydronephrosis = dilation of pelvis and calyces

42
Q

causes of urinary retention :

bilateral vs unilateral

A

bilateral = obstruction of bladder neck by enlarged prostate or urethral stricture

unilateral = ureteral stricture, calculus, tumor

43
Q

complications, dx and tx of urinary obstruction/retention

A

complications = infection, stone formation

dx = renal ultrasound, CT-abd/pelvis

tx = removal of obstruction or stenting

44
Q

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?

A

diabetic patients

45
Q

cause of Glomerulonephritis

A

inflammation of glomeruli is caused by Antigen-Antibody reaction within the glomeruli

46
Q

explain pathogenesis of glomerulonephritis

A
  • 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
Q

glomerulonephritis is common seen in who?

A
  1. connective tissue disorders - lupus

2. also triggered by multiple types of infections

48
Q

clinical manifestations of glomerulonephritis

A
  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
Q

treatment for glomerulonephritis

A

control BP

limit renal damage and monitor for recovery

RENAL: KCPA SU'17 (4 decks)

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