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NUR 326 (Patho 1) > Renal Exam 2 > Flashcards

Renal Exam 2 Flashcards

1
Q

Pyelonephritis

A

Upper UTI or Kidney Infection

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2
Q

Pyelonephritis is

A

Inflammation of one or both kidneys

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3
Q

Pyelonephritis Etology

A

Start as lower uti and goes up the tract. E Coli is most common pathogen

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4
Q

Pyelonephritis risk factors

A

Pregnancy

Recurrent lower utis

Antibiotic resistant strain

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5
Q

Pyelonephritis can lead to

A

permanent kidney damage with abscess and necrosis

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6
Q

Pyelonephritis: Clinical Manifestations

A

Sudden onset:
-Fever
-Chills
-CVA tenderness

Systemic infection = fevers and chills vs those with lower UTI

Hematuria may occur

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7
Q

Pyelonephritis: Treatment

A

Antibiotics

Bactrim - Ciprofloxacin - Nitrofurantoin

Review bactrim and ciprofloxacin for exam

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8
Q

Pyelonephritis complications

A

Urosepsis most likely in elderly and pregnant

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9
Q

Where can you have a urinary obstruction

A

Anywhere along the tract

-Renal pelvis
-Ureter
-Bladder or pelvis

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10
Q

Common Renal Obstruction: Renal Pelvis

A

Renal calculi

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11
Q

Common Renal Obstruction: Ureter

A

Renal calculi
Pregnancy
Tumors

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12
Q

Common Renal Obstruction: Bladder and Urethra

A

Bladder cancer
Neurogenic bladder
Prostatic hyperplasia
Prostate cancer
Urethral strictures

Kidney stones not as common

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13
Q

Complications of Obstruciton

A

Stasis of urine flow. Infections is much likely

Back up pressure
-Hydroureter
-Hydronephrosis
-Post Renal acute kidney injury

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14
Q

Hydronphrosis

A

Back of fluid into kidney

Surgical intervention

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15
Q

Hydroureter

A

Back of fluid in the ureter

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16
Q

Acute Obstruction: Clinical Manifestations

A

Depends on site

Obstruction in renal pelvis does not cause as much pain or difficulty urinating because there is room for the stone there.

Once the stone leave renal area and into the ureter the place is much small and the pain is going to be very severe

Pain comes in waves as the ureter tries to move the stone out

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17
Q

Nephrolithiasis

A

Renal calculi or kidney stones

Clumps of crystals in the urinary tract

Can be small or the size of gold ball

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18
Q

Nephrolithiasis: Pathogenesis

A

Urine is a solution of solvent (water) and solutes (particles)

Super saturation with a solute and crystals begin forming in the nephron of the kidney

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19
Q

Crystal Formation is enhanced by

A

Ph changes: UTI

Excessive concentration of insoluble salts in the urine. (Dehydration - Bone disease - Gout - Renal disease)

Urinary stasis - Immobility/sedentary lifestyle

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20
Q

Nephrolithiasis: Risk Factors

A

-Men

-Age 20-30’s

-White

-Family history

-Congenital defect (long urine in system)

-Weather? Hot weather = dehydration

-Obesity

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21
Q

Types of kidney stones

A

Calcium oxalate or calcium phosphate

Struvite (staghorn)

Uric acid

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22
Q

Types of stones: Calcium oxalate / calcium phosphate RF’s

A

Family history
Idiopathic

Diet
Increase Calcemia
Increase Oxaluria

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23
Q

Types of stones: Struvite Staghorn

A

Risk factor = UTI

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24
Q

Types of stones: Uric Acid

A

Risk factor = Gout

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25
Nephrolithiasis: Clinical Manifestations
Renal Colic: Pain in the flank area that radiates from lower abd and groin. Spazzy. Sharp from stone scraping
26
Accompanying symptoms of neprholithiasis
NV Dysuria Chills and fever with infection Hematuria Foul smelling urine Diaphoresis
27
Nephrolithiasis: Pharmacotherapy
Morphine or NSAIDS IV fluids
28
Preventive Med for Calcium Stones
thiazide diuretics
29
Preventive meds for struite stones
antibiotics
30
Preventive meds for urate stones
allopurinol
31
Urologic Cancers
Kidney cancer Bladder cancer
32
Urologic Cancer: Kidney
Renal cell carcinoma 85% of kidney cancers
33
Kidney cancer: Risk factors
Smoking #1 Obesity Age - Older Male - Men Genetics
34
Renal Cell Carcinoma: Clinical Manifestations
-No early manifestations Late manifestations: CVA tenderness - Hematuria - Possible palpable abdominal mass
35
Metastasis of Renal Cell Carcinoma
Occurs to the bone or lungs
36
Renal cell carcinoma is often
Resistant to chemo so you have to have surgery
37
Bladder Cancer
-Urotherlial carcinoma (>90)
38
Bladder Cancer: Risk facotrs
Smoking #1 Male Occupations with exposure to toxin RUBBER OR PAINT TOXINS Low fluid intake toxins sit in the bladder
39
Bladder Cancer: Clinical Manifestations and Treatment Early and Late
Early = Hematuria Later: -Frequency -Urgency -Dysuria
40
Bladder cancer: Treatment
Stage 1 = Intravesical chemo Advanced stage = systemic chemo
41
Glomerular Disease
Glomerulonephritis Nephrotic Syndrome
42
Glomerulonephritis
A variety of conditions that cause inflammation of the glomeruli Primarily and IMMUNE process
43
Glomerulitis: Where does the damage occur
In the glomerulus: Delicate network of arterioles within the bowman's capsule In the tubules: Massive consumers of oxygen
44
The Glomerulus: 3 Capillary membranes
1. Endothelium 2. Basement membrane (a lot of issues occur here) 3. Podocytes (special epithelia cells) (start of urine)
45
Type II Hypersensitivity Reaction
Reactions occur on the cell surface and results in direct cell death or malfunction Direct cell death
46
Type III Hypersenstivity reaction
Immune complexes are deposited into tissues and the resulting inflammation destroys the tissues Inflammation destroys the tissues by becoming deposited and becoming inflamed
47
Glomerulonephritis: Etiology 2 types of injury
1. Antibodies attach to antigens of the glomerular basement membrane (Anti-GBM antibodies) - 5% = Type II reaction 2. Antibodies react with circulating antigens and are deposited as immune complexes in the GBM - 90% = Type III reaction
48
Acute Glomerulonephritis: Onset and Symptoms
-Abrupt HARP -Hematuria -Azotemia (to much waste in blood) -Retention (sodium and water) (Edema and In BP) -Proteinuria
49
Acute Glomerulonephritis Triggers
Post infections Primary Disease Multisystem Disease
50
Acute Glomerulonephritis Triggers: Post infections
-Postreptococcal infections -Nonstreptococcal infection (bacterial viral parasitic)
51
Acute Glomerulonephritis Triggers: Primary disease
Berger disease Antibodi IGA builds up in the kidney
52
Acute Glomerulonephritis Triggers: Multisystem Disease
-Goodpasture's syndrome, systemic lupus erythematosus (SLE), vasculitis These can attack the kidneys
53
Anti-GBM Antibodies
These are similar to the ones the lungs so patients typically have respiratory problems and cough up blood Goodpasture syndrome
54
Acute Glomerulonephritis: Pathogenesis
1. Trigger 2. Immune complexes form 3. Complement activated 4. Release of mediators 5. Tissue injury 6. HARP
55
Chronic Glomerulonephritis
-Long term inflammation = scar tissue Scar tissues can not filter correctly and as the build up scar tissue occurs the kidneys are able to maintain less
56
Nephrotic Syndrome
The glomerulus is too permeable to plasma proteins Eliminations of 3 grams of protein per day
57
Nephrotic Syndrome: Etiology
-Glomerulonephritis -Diabetes mellitus
58
Nephrotic Syndrome: Pathogenesis
Increased glomerular permeability Proteinuria Hypoalbuminemia (start to 3rd space)
59
Nephrotic Syndrome: Clinical Manifestations
-Edema -Hyper tension Liver problems: -Hyperlipidemia -Hypercoagulation -Loss of antithrombin and plasminogen
60
Glomerulopathy: Diabetes and HTN complications
DM: -Major complications -Gross thickening of the GBM -Ultimately leading to --> ESRD HTN: -Decrease renal perfusion --> sclerotic glomerular changes
61
Glomerulopathy: Manifestations
Hematuria Oliguria Fluid retention Increase BUN/Cr ratios Proteinuria Low albumin (hypoproteinemia)

NUR 326 (Patho 1) (62 decks)

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