renal part 3 (obstructive disorders) Flashcards
obst. disorders are classified by what three things?
classified according to site, degree (complete or partial), and duration of obstruction (acute or chronic)
lower urinary tract vs upper urinary tract obst. disorders: where are they located? bilateral or unilateral?
Lower urinary tract obstructions are located below the UVJ and are bilateral.
Upper urinary tract obstructions are located above the UVJ and are usually unilateral.
higher or lower level of obstruction worse? why?
higher :
- stasis of urine (which predisposes to infx and stone formation)
- progressive dilation of the renal collecting ducts and renal tubular structures, which causes destruction and atrophy of renal tissue
level of obst: renal pelvis
what is the cause?
Renal calculi or papillary necrosis
level of obst: ureter
what is the cause?
Renal calculi, pregnancy, tumors that compress the ureter, ureteral stricture, congenital d/o of the UVJ and UVJ strictures
level of obst:bladder and urethera
what is the cause?
Bladder CA, neurogenic bladder, bladder stones, prostatic hyperplasia or CA, urethral strictures, congenital urethral defects
hydronephrosis: urine-filled dilation of the ______and _____ associated with …
urine-filled dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney d/t obstruction or urine outflow
hydronephrosis: clinical features of urinary obst: depend on ___, ____ and ____. symptoms reflect what?
depend on the site of obstruction, cause, and the rapidity with which the condition developed; sx will reflect the underlying process
nephrolithiasis: kidney stones: forms because of …. what can it cause?
supersaturated urine and an environment that allows the stone to grow
Can cause intrinsic and/or post-renal failure (esp. when they become ureterolithiasis)
what is the most common cause of upper urinary tract obstruction?
kidney stone
clinical features of kidney stones: two types
renal colic (more common) or noncolic renal pain
kidney stones: renal colic: due to what? what is the pain like? location?
d/t stretching of the collecting system or ureter;
intermittent,unlilateral flank pain
may radiate into groin/scrotum, N/V
what is non-colicky renal pain? causes, what is the pain like? what makes it worse?
caused by distention of the renal calyces or renal pelvis; dull, deep ache in the flank or back
worse with drinking water,
txt of kidney stones
pain meds
flomax (to dilate ureters)
what is the most common abd tumor in children? what is is assosciated with?
wilms tumor - a malignant tumor of kidney
assosciated with aniridia (absence of the iris)
3 types of malignant kidney tumors?
wilms tumor
renal cell carcinoma
bladder cancer
which accounts for 95% of kindey tumors?
renal cell carcinoma - located on cortex, common in obese women and smokers
what may be a cause of painless hematuria?
bladder cancer
most common type of bladder cancer?
Urothelial carcinoma, also known as transitional cell carcinoma (TCC)
UA finding: WBC casts
what is the renal condition?
pyelonephritis
UA finding: pigmented granular casts, myoglobin positive, dark/red/coco-cola urine
what is the renal condition?
rhabdomyalosis
UA finding: Red cell casts
what is the renal condition?
acute glomerulonephritis
UA finding: White cell casts + eiosinophils
what is the renal condition?
acute interstitial nephritis
UA finding: muddy brown casts
what is the renal condition?
acute tubular necrosis
UA finding: normal or hyaline casts
what is the renal condition?
pre-renal azotemia
UA finding: broad waxy casts
what is the renal condition?
chronic renal failure
UA finding: Tea colored urine, hematuria
RBC casts, protein <3.5 g/day
what is the renal condition?
nephritic syndrome
UA finding:Protein >3.5 g/day, oval fat bodies,
Free fat, fatty casts
what is the renal condition?
nephrotic syndrome
uncomplicated pyelonephritis: what is the initial and step down therapy for inpatient? how many days of each?
initial: ceftriaxone 1g IV every 24hr
(at least one dose IV, change to PO when able)
step-down: cephalexin (keflex) 500 mg PO BID
BOTH: 10-14 days
what to remember about step-down txt for pyelonephritis in-pt?
keflex 500mg PO BID
requires renal dose adjustment
what lab do you NEED for uncomplicated pyelonephritis?
CULTURE - then txt…
