Renal Medical Conditions Flashcards
Describe the condition- RENAL STONES (Renal Calculi)
Think about- The pathophysiology of the condition, risk factors for developing it, signs/symptoms, & hospital treatment
1- Minerals + salts build up in urinary tract, #2- Minerals + salts form crystals/stones which bind together to become larger, #3- Stone gets stuck on surrounding skins cells, or it travels through urinary system until it obstructs the passage of urine
RENAL STONES
Pathophysiology=
Risk Factors= calcium supplements, high protein diet (protein is high in uric acid which can form into stones), Hyperparathyroidism (increases calcium in blood), UTIs (affects pH), warm environments (cause ^sweating, ^dehydration, ^concentration of urine)
Signs & Symptoms= Renal colic (intermittent pain), Haematuria (blood in urine from sharp edges tearing), UTI symptoms (urgency, frequency)
Treatment= <5mm (will pass spontaneously w/pain), >5mm (lithotripsy- shock wave breaks up stone; Surgery)
Describe the condition- Urinary Tract Infections (UTIs)
Think about- what it is, risk factors for developing it, signs/symptoms, treatment, what 2 conditions a UTI can lead to
URINARY TRACT INFECTIONS
What is a UTI- A Bacterial infection in the bladder
Risk Factors- being female (shorter urethra), poor hygiene, recent sexual intercourse, diabetes (neuropathy= inadequate bladder emptying), older age (suppressed immunity, unable to completely empty bladder
Signs & Symptoms- Dysuria (difficulty urinating), urination urgency & frequency, pain on urination, haematuria (blood in urine)
Treatment- Antibiotics
Conditions UTIs can lead to- Urosepsis, Pyelonephritis (kidney infection caused by UTI moving up into kidney)
Describe the condition Acute Urinary Retention
Think about-
a) what it is,
b) the pathophysiology (there are 3 mechanisms that can cause urinary retention),
c) which age/gender is most likely to experience it
d) treatment
ACUTE URINARY RETENTION
a) What is it? → An inability to completely empty the bladder
b) Pathophsyiology:
Mechanism #1- Obstruction in outflow→ from kidney stone
Mechanism #2- Neurologic impairment (eg. from diabetes causing neuropathy)
Mechanism #3- Distended (enlarged) Bladder
c) Common Patients: Older males (prostatic enlargement is the most common cause of urinary retention)
d) Treatment: Indwelling catheter, suprapubic catheter
Describe the condition- Acute Kidney Injury
Think about- What it is, what it can progress to,
Pathophysiology (starts with- Acute Tubular Necrosis)
ACUTE KIDNEY INJURY
What is it? An abrupt reduction in kidney function from kidney damage/failure (hours-days)
Stages= AK Injury→ AK Failure→ AK Disease (kidney loss)→ End Stage Renal Disease (kidney failure)
Pathophysiology= #1- Acute Tubular Necrosis reduces blood & oxygen flow to kidneys, #2- reduced GFR, #3- Kidneys cant balance solutes, #3- waste accumulates in blood
Describe the condition- CHRONIC KIDNEY DISEASE
Think about- what it is, what kidney condition usually leads to it, signs and symptoms, treatment in early stages, treatment in late stages (when it becomes kidney failure)
CHRONIC KIDNEY DISEASE
What is it? When kidney damage and decreased kidney function lasts for 3 or more months
_Condition that leads to i_t- Acute Kidney Injury (if it has caused irreversible damage)
Signs & Symptoms- Pulmonary Oedema (from fluid retention), Shortness of breath (from acidosis), Arrhythmias (from high potassium, low sodium, pressure in brain (encephalopathy)
Treatment in early stages= fluid restrictions, diuretic meds, low potassium/protein diet
Treatment in late stages= haemodialysis or peritoneal dialysis
There are 6 types of renal stones (kidney stones). What is the one called which is “formed due to an excess of a mineral called oxalate”?
CALCIUM STONES are “formed due to an excess of a mineral called oxalate”?
There are 6 types of renal stones (kidney stones). What is the one called which is “caused by infection in the urinary tract”?
STRUVITE STONES are “caused by infection in the urinary tract”
There are 6 types of renal stones (kidney stones). What is the one called which “forms due to chronic dehydration”?
URIC ACID STONES “form due to chronic dehydration”
There are 6 types of renal stones (kidney stones). What is the one called which “forms in people with an inherited disorder that causes the kidneys to excrete an excess of a certain amino acid?”
CYSTINE STONES “form in people with an inherited disorder that causes the kidneys to excrete an excess of a certain amino acid”
There are 6 types of renal stones (kidney stones). What is the one which is “caused by an enzyme deficiency that causes the build up of xanthine deposits”?
XANTHINE STONES are “caused by an enzyme deficiency that causes the build up of xanthine deposits”?
There are 6 types of renal stones (kidney stones). What is the one which is “caused by certain medications or herbal supplements”?
SILICA STONES are “caused by certain medications or herbal supplements”?
Acute Kidney Injury often occurs in stages. This is often remembered using the acronym R.I.F.L.E. What does this stand for?
R.I.F= severity of damage; L.E= outcome of the damage
KIDNEY DAMAGE:
severity:
(R)- Risk [of acute kidney injury]
(I)- acute kidney INJURY [rapid, sudden deterioration of kidney function]
(F)- acute kidney FAILURE [when dialysis is required secondary to AKI]
outcome:
(L)- LOSS of kidney function for >4wks
(E)- END stage kidney failure (ESKF)- loss of kidney function for >3months [long term dialysis required]
Chronic Kidney Disease often occurs into 2 stages. What are these stages & what characterises each stage?
Chronic Kidney Disease- progressive, irreversible destruction of kidney function that occurs over months-decades (can occur secondary to acute kidney injury, or from chronic health conditions)
End Stage Kidney Failure (ESKD)- complete loss of kidney function, requires dialysis
What are the 3 classifications of causes of Acute Kidney Injury?
Pre-renal factors [above kidney]- external factors such a sudden & severe reduction in blood flow to the kidneys & subsequent sudden reduction in glomerular blood flow & then reduction in GFR- often secondary to severe/prolonged hypovolaemia [dehydration/ haemorrhage/ vomiting/] or decreased cardiac output [hypotension, myocardial infarction, dysrythmias] over hrs-days
Intra-renal factors (direct injury to kidney [acute tubular necrosis] from prolonged ischaemia caused by pre-renal factors, or exposure to nephrotoxins [NSAIDs, contrast dye, crush injury/rhabdomyolysis, heavy metals, antibiotics], diabetes)
Post-renal factors (below kidney issue)- obstruction of urine outflow- kidney stone, tumour reduces blood flow
What are some causes of Chronic Kidney Disease?
CHRONIC KIDNEY DISEASE (progressive, irreversible destruction of kidney function for >3months)
Causes:
Chronic conditions (Diabetes [chronic hyperglyacemia damages blood vessels in nephron], Hypertension [narrows kidney vessels- weakens them & reduces blood flow)
Glomerulonephritis (damage/inflammation of glomerulus)
Occurs secondary to AKI (& therefore the result of pre-renal factors [hypovolaemia, reduced cardiac output, nephrotoxins] or post renal [urine outflow obstruction]
Explain some key metabolic & electrolyte issues that can occur from acute kidney injury
[Hint- think about what would happen if filtrate can’t move through the nephrons at an adequate rate/at all]
Reduced flow of filtrate through the nephron:
- Reduced production of urine= fluid build up/overload, congestive heart failure, pulmonary oedema
- Excess potassium can’t be put into the filtrate to be excreted in urine= hyperkalaemia- cardiac dysrhythmias
- Hypotension (initially) due to low sodium/lack of ability to balance fluid levels, but then Hypertension occurs (secondary to fluid overload)
- Low sodium as it usually increases in levels by being reabsorbed OUT of the filtrate, but the GFR is so low, there is such minimal reabsorption of sodium= dysrhythmias
- Ammonia and urea usually get taken OUT of the blood and put INTO the filtrate to be excreted. So low GFR means this can’t happen & this causes Encephalopathy (^toxins in brain)= lethargy, seizures
