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Patho > Renal Failure and UTI > Flashcards

Renal Failure and UTI Flashcards

1
Q

T/F acute kidney injury potentially reversible

A

True

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2
Q

During acute kidney injury, the kidney is unable to excrete ___________ and or mantain ___________

A

metabolic wastes, acid/base balance

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3
Q

What is the hallmark of acute kidney injury?

A
  1. increased SCr and BUN
  2. decreased urine output
  3. inability to maintain acid/base balance
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4
Q

In acute kidney injury, the SCR will increase > __________ from baseline in less than ________ hours OR % increase of SCr greater than or equal to __________%

A

0.3 mg/dL, 48, 50

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5
Q

In acute kidney innjury, not suppossed to let protein, RBC through but if the kidneys arent functioning, then you see ______________

A

proteinuria

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6
Q

May see oliguria in acute kidney injury. Urine output is < ___________ for more than _________ hours

A

0.5 ml/kg/hr, 6

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7
Q

What are the three classifications of acute kidney injury?

A

Prerenal, intrinsic (worst to treat), postrenal

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8
Q

ICU aquired classifications of acute kidney injury is the most ___________

A

common

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9
Q

What is the most common cause of acute kidney injury?

A

Prerenal AKI

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10
Q

What is prerenal AKI commonly associated with?

A

decreased renal perfusion, resulting in ischemia

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11
Q

What are you at an increased risk of developing in prerenal AKI ?

A

burns, septic shock, major surgery, all of which are associated with systemic hypotension

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12
Q

What is the etiology of prerenal AKI?

A

Volume depletion
Reduced cardiac output
Vascular obstruction

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13
Q

What is the presentation of prerenal AKI?

A

Hypovolemia
Highly concentrated, low-sodium urine
Serum BUN/Cr ratio: > 20:1

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14
Q

What is intrinsic AKI?

A

Actual damage is to kidney
See casts, blood, protein in urine

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15
Q

In intrinsic AKI, what are very diagnostic of renal disease? What does it consist of?

A

-casts, they only come from the kidney
-Casts consist of sedimentary urine elements red or white blood cells, lipids, necrotic tubular tissue, etc…) that lose water on way through the sluggish tubules and take on the shape of the tubule

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16
Q

___________ accounts for 75-85% of causes of intrinsic ARF

A

Acute tubular necrosis

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17
Q

In intrinsic AKI, the Most common cause of ATN is_______________

A

ischemia not perfusing. (hypotension)

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18
Q

What are the other causes of ATN?

A

Antimicrobials
Radiocontrast dyes
Endogenous toxins (myoglobin from rhabdomyolysis(muscle breakdown); multiple myeloma)

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19
Q

What is the pathiphys of ATN?

A

Necrosis of tubular epithelium, with or without basement membrane damage

Severity varies with nephrotoxins; some cases resolve quickly, others will not
-May need supportive management, dialysis

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20
Q

Other causes of intrinsic AKI?

A

inflammatory disease
-Glomerulonephritis
-Allergic interstitial nephritis (from PCNs, rifampin, sulfas, furosemide)
-Vasculitis (SLE)
Altered renal hemodynamics
-NSAIDs, ACEIs

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21
Q

What is the etiology of postrenal AKI?

A

Urethral, ureteral, bladder obstruction
Bladder, cervical, prostate cancers
BPH
Neurogenic bladder
Obstructing stones
Effect on urine output depends on degree of obstruction

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22
Q

What are the 3 stages of AKI?

A
  1. oliguric phase
  2. Diuretic phase
  3. Recovery phase
23
Q

Oliguric Phase of AKI

A

Accompanied by azotemia
-Increased BUN
May see acute-on-chronic renal failure
ARF can develop much easier in these patients

Need to determine underlying cause

24
Q

Diuretic Stage of AKI

A

Urine output slowly improves
-Sometimes several liters per day

Must watch for electrolyte abnormalities
-See osmotic diuresis secondary to high BUN, and impaired ability of tubules to conserve water and salt while healing

25
Q

Recovery Phase of AKI

A

-Typically significant improvement in 1-2 weeks
can last months while improvement occurs

-Can also have some permanent damage, depending on initial insult
Important points to remember about ARF:

-Some never recover
-Nonoliguric ARF has better prognosis

26
Q

T/F most people with chronic kidney disease are unaware because they remain asymptomatic until the disease significantly progresses

A

True

27
Q

What are most cases of chronic kidney disease due to? What are the other causes?

A

mostly due to DM and/or HTN

Other causes include glomerular or tubulointerstitial disease, vascular disease, cystic disease or obstructive nephropathies

28
Q

T/F CKD is reversible

A

False, rarely reversible

29
Q

In CKD, the destruction of ____________ leads to ______________ of the remaining nephrons, overwork injury leads to progressive ____________ and ____________

A

nephrons, compensatory hypertrophy, glomerular sclerosis and interstitial fibrosis

30
Q

What are the 5 stages of CKD?

A
  1. kidney damage with normal or increased GFR
  2. kidney damage with mild decrease in GFR
  3. Moderate decrease in GFR
  4. severe decrease in GFR
  5. Kidney Failure
31
Q

Most people with chronic kidney disease are living in stage ______

A

3

32
Q

What are the s/s of CKD?

A

-Metabolic waste products/uremic toxins can result in uremic syndrome
-Fatigue, weakness, malaise, anorexia, nausea, vomiting, insomnia, difficulty concentrating
-HYPERTENSION is the most common finding

33
Q

What is the most common finding in CKD?

A

Hypertension

34
Q

What are the infectious causes of CKD?

A

Urinary tract infection, pyelonephritis
-Chronic PN is usually the worse infectious offender in causing CRF
-E. coli most common pathogen (> 80%)
-Factors that cause infection: outflow obstruction, female gender, neurogenic bladder

35
Q

Glomerulonephritis

A

-Relatively uncommon cause of AKI or CKD
-Inflammation of the glomerulus

36
Q

What are the causes of Glomerulonephritis typically classified as?

A

Nephritic Spectrum
Nephrotic Spectrum

37
Q

Nephritic Spectrum

A

Hematuria
Sub-nephrotic proteinuria (<3 g/d)
Edema
Elevated creatinine
Hypertension
Red cell casts in the urine

38
Q

Nephritic spectrum includes many disorders that are _______, _________, _________ or _______

A

are infectious, inflammatory, autoimmune, or vascular

39
Q

What systemic diseases is Nephrotic Spectrum associated with ?

A

diabetic nephropathy, autoimmune disorders, cancers) or can be linked to medications

40
Q

Nephrotic spectrum

A

Proteinuria (nephrotic range >3 g/d)
Hypoalbuminemia( low albumin bc peeing it all out)
Edema( much more than nephiritic)
Hyperlipidemia(lipoproteins so peeing out all albumin, you’re swelling and liver will make lipoproteins to try and increase oncotic pressure but you just end up with hyperlipidemia)

41
Q

Glomerulonephritis is caused from

A

From strep infection of throat or skin; see antigen/antibody complex form and get trapped in glomerulus

42
Q

What occurs during Glomerulonephritis

A

Complex attracts immune response, makes capillary porous→proteinuria, hematuria
Also see hypertension as symptom

43
Q

In uremia, the constellatin of symptoms are seen when GFR is

A

< 10-15 ml/min

44
Q

What are the two major classifications of uremia?

A
  1. Deranged regulatory/excretory functions
    Acid/base, volume, electrolyte disturbances
  2. Multiple system abnormalities
45
Q

In uremia, you see manifestations in many organ systems such as

A
  1. CV
    Volume overload, electrolyte abnormalities
  2. Neuro
    Encephalopathy
  3. Endocrine
    Decreased insulin clearance
46
Q

In uremia, calcitrol deficiency leads to decreased ______________

A

bone mineralization (osteomalacia)

47
Q

In uremia, decreased erythropoietin production leads to _____________

A

anemia

48
Q

What is the primary key to prevention of CKD?

A

control of DM and HTN

49
Q

End stage renal disease (ESRD)

A

When GFR reaches 5-10 ml/min and symptoms can no longer be controlled

50
Q

What are the two types of UTIs

A

Acute cystitis (Bladder Infection)
Acute pyelonephritis (Kidney Infection)

51
Q

What is acute cystitis?

A

Infection of the bladder
Most commonly due to E. coli or occasionally enterococci
90% due to E. coli
Women more common than men
Complicated infections in men, pregnancy, nosocomial

52
Q

What is acute pyelonephritis

A

-Infectious inflammation of the kidney parenchyma and the renal pelvis
-Usually caused by ascension of bacterial up the urinary tract

53
Q

What is Acute pyelonephritis characterized by?

A

Irritative voiding symptoms(dysuria, etc)
Positive urine culture
Flank pain
Fever*

54
Q

What is the major difference between Acute pyelonephritis and Acute Cystitis?

A

fever and flank pain is present in Acute pyelonephritis

Patho (16 decks)

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