Renal Part II Flashcards
Urine specific gravity normal
1.005-1.030
Cloudy urine
Protein, pus,
Dark urine
Bacteria
Bence-Jones proteins (Antibody fragments)
Multiple Myeloma
– Indicates multiple myeloma
Bence-Jones proteins (Antibody fragments)
– Indicates multiple myeloma
Glucose and ketones
– Carbonyl group flanked by 2 alkyl groups
– Indicate DM
Urinary casts
– Indicate inflammation of kidney tubules
Blood (hematuria)
– Small amounts
• Infection, inflammation, or tumors in urinary tract
– Large amounts (hematuria)
Increased Increased glomerular glomerular permeability permeability or hemorrhage
Elevated protein (proteinuria, albuminuria)
– Leakage of albumin or mixed plasma proteins
into filtrate, foamy urine
• Used for diagnosis of post-streptococcal
glomerulonephritis
Anti-streptolysin O or anti-streptokinase titers
Elevated renin levels –
Indicate kidney as a cause of hypertension
Urine C&S –
Identify causative organism of infection – Select appropriate drug treatment
Radiologic tests – Radionuclide imaging, angiography, ultrasound,CT, MRI, intravenous pyelography – U
sed to visualize structures and possible abnormalities, flow patterns, and filtration rates
Cast
remodeling, cut down formation of calcium oxalate stones
Cellular cast
fragments of cellular cells Acute tubular necrosis(ATN)
Clearance tests clearance – Used to Cystoscopy – Visualizes\_\_\_\_\_\_\_\_\_Tract –used for \_\_\_\_\_\_\_\_\_\_\_\_\_or to \_\_\_\_\_\_\_\_stones
Biopsy
–used for?
– e.g., creatinine or inulin
assess GFR
-lower urinary tract
biopsy or to remove kidney
-Used to acquire tissue
specimens
WBC
eosinophils (0-3 %)
Types of incontinence (3 types)
Stress
Urge
Overflow
Stress incontinence
Relax pelvic flow
increased abdominal pressure
Urge incontinence.
Bladder oversensitivity from infection
Neurologic disorders
Overflow incontinence
Urethral Blockage
Bladder unable to empty properly
Incontinence
– Loss of voluntary control of the bladder
• Enuresis
– Involuntary urination by a child age 4+ years
• Often related to developmental delay, sleep
pattern, psychosocial aspect
• Stress incontinence
– Increased intra-abdominal pressure forces
urine through sphincter
• Coughing, lifting, laughing; multiple pregnancies
Overflow incontinence
– Incompetent bladder sphincter
– Older adults weakened what muscle?
Weakened detrusor muscle may muscle may prevent prevent complete emptying of bladder – frequency and incontinence
Nuclear scan
dye is given to patient, then scan every 3 minutes
Spinal cord injuries or brain damage
Neurogenic bladder –
Neurogenic bladder: may be spastic or flaccid
• Interference with CNS and ANS voluntary controls
of the bladder
Inability to empty bladder
– May be accompanied by overflow incontinence – Spinal cord injury at sacral level blocks micturition reflex – May follow anesthesia (general or spinal)
UTI • Very common infections
Urine is an excellent growth _________
growth medium.
Lower urinary tract infections
– Cystitis and urethritis
Upper urinary tract infections
– Pyelonephritis
Common causative organism for UTI
– Escherichia coli
UTI associated with
Heavy purulence and presence of gramnegative and gram-positive organisms
More common UTI in population because
Women:
Older men:
Children:
- Shortness of urethra, proximity to anus
- Prostatic hypertrophy and urine retention
- Congenital abnormalities in children
Other common predisposing factors UTI
– Incontinence
– Retention of urine
– Direct contamination with fecal material
Cystitis
Cystitis
• Bladder wall &urethra inflamed
Dysuria Dysuria, urgency urgency, frequency frequency, and nocturia nocturia
• Systemic signs may be present – Fever, malaise, nausea, leukocytosis
• Urine often cloudy with unusual odor
• Urinalysis indicates bacteriuria, pyuria,
microscopic hematuria
Pyelonephritis
Urinary casts present.
• Reflection of renal tubule involvement
• Treatment with antibiotics
Glomerulonephritis
Usually follows strep infection Urine dark and cloud Facial and periorbitla edema elevated BP Flank and back pain Increase UO
Glomerularnephritis, lab test
Elevated Antibodies against strep
Elevated serum urea and creatinine
Low complement levels.
Tx of glomer
Sodium restriction possible – Protein and fluid intake decreased in severe cases Drug treatment • Glucocorticoids • Antihypertensives
Tx of glomerulonephritis
Sodium restriction possible – Protein and fluid intake decreased in severe cases Drug treatment • Glucocorticoids • Antihypertensives
INnflammatory Disorders – Nephrotic
Syndrome
Abnormality in glomerular capillaries, increased permeability, large amounts of plasma proteins escape into filtrate
Nephrotic syndrome seen in (conditions)
Secondary to SLE, exposure to nephrotoxins
or drugs
Nephrotic syndrome
Albumin loss, decreased osmotic pressure
Generalized edema
Increased aldosterone
high blood cholesterol
Nephrotic syndrome treatment:
Glucocorticoids
ACE
antihypertensive
Sodium intake
UROlithiasis causes
Excessive amounts of solutes in filtrate
– Insufficient fluid intake – major factor for calculi formation
– Urinary tract infection
Renal calculi (urolithiasis)
Manifestations only occur with obstruction of urine
flow.
– May lead to infection
– Hydronephrosis with dilation of calyces
– If located in kidney or ureter and atrophy of renal
tissue
Most common stones (4) to less common
Calcium stone
Urine acid stone
Struvite (infection )
Cystine stone ( high secretion of cystine)
• Stones in kidney or bladder often asymptomatic
– Frequent infections may lead to investigation.
_________possible caused by distention of renal capsule
Flank pain
• “Renal colic” caused by\_\_\_\_\_\_\_\_\_\_\_ – Intense spasms of pain in flank area • Radiating into\_\_\_\_\_\_\_\_\_\_\_ • Lasts until stone passes or is removed – Possible nausea and vomiting, cool moist skin, rapid pulse Radiologic examination confirms
-obstruction of the ureter
groin area
location of calculi.
Small stones will be passed eventually but 3 treatment
– Extracorporeal shock-wave lithotripsy (ESWL)
– Laser lithotripsy
– Drugs may be used to may be used to partially partially dissolve dissolve stones. stones.
– Surgery
Hydronephrosis
Complication of calculi – Tumors, scar tissue in kidney or ureter – Untreated prostatic enlargement – Developmental abnormalities restricting urine flow
Tumors – Renal Cell Carcinoma
primary tumor where?
Tumors – Renal Cell Carcinoma
• Primary tumor arising from the tubule epithelium
*More often in renal cortex
**Tends to asymptomatic in early stages
Often has metastasized to liver, lung, bone,
or central nervous system at time of
diagnosis
Signs of Tumors – Renal Cell Carcinoma
Painless hematuria initially – Dull, aching flank pain – Palpable mass – Unexplained weight loss – Anemia or erythrocytosis
Bladder CA early signs
Hematuria, dysuria; infection common
Bladder CA is
Tumor is invasive through wall to adjacent structures.
Metastasizes to pelvic lymph nodes, liver, and bone
Predisposing factors for Bladder CA
– Working with chemicals in laboratories and
industry Particularly analine dyes, rubber, aluminum
– Cigarette smoking
– Recurrent infections
– Heavy intake of analgesics
• Treatment of Bladder CA
– Surgical resection of tumor
– Chemotherapy and radiation
– Photoradiation successful in some early cases
Vascular Disorders – Nephrosclerosis
– Some occur normally with
- Involves vascular changes in the kidney
- aging
Vascular Disorders – Nephrosclerosis is thickening of
Thickening and hardening of the walls of
arterioles and small arteries
Vascular Disorders – Nephrosclerosis what happens then (3)
• Narrowing of the blood vessel lumen
– Reduction of blood supply to kidney
– Stimulation of renin
• Increased blood pressure: Continued ischemia
• Destruction of renal tissue and chronic renal failure
Vascular disorders: Can be primary lesion developed in kidney
• May be secondary to
• Treatment of vascular disorders
essential hypertension
Antihypertensive agents
Diuretics
Beta-blockers
Sodium intake should be reduced.
Goodpasture’s Syndrome is an ________Disorder
And what happen? Antibodies attack_______
Causes what (2)
- Autoimmune disorder
- Antibodies attack basement membrane of Kidney and Lung
- Causes hemoptysis and hematuria
Causes of Goodpasture’s Syndrome
– exposure to organic phosphates
– metal dust inhalation
– certain gene mutations HLA-DR15
Treatment of goodpasture’s syndrome
monoclonal antibodies
Wegener’s Granulomatosis
What happens to neutrophils:
• anti-neutrophil cytoplasmic antibodies (ANCA)
Cause neutrophils to adhere to endothelial cells and
degranulate, damaging blood vessels and leading to tissue damage
The glomerulonephritis in Wegener’s Granulomatosis progress to
– Glomerulonephritis progresses to chronic renal
failure
What happens in SLE:
Autoantibodies attack mesangial cells of juxtaglomerular apparatus leading to lupus nephritis
Congenital Disorders
Vesicoureteral reflux
“Horseshoe” kidney
– Fusion of the two kidneys
“Horseshoe” kidney
– Fusion of the two kidneys
Hypoplasia
– Failure to develop to normal size
PDK is
• No indications in child or young adults
• First manifestations usually
- Autosomal dominant gene on chromosome 16
- around age 40 (pain, frequent urination, uti)
In PKD there is
Multiple cysts develop in both kidneys.
Enlargement of kidneys – Compression and destruction of kidney tissue – Chronic renal failure
Diagnosis of PKD is
Diagnosis by abdominal CT scan or MRI
Alport Syndrome or “ ________”
It is a genetic defect of ____________ which is what?
Alport Syndrome “Hereditary Nephritis”
• Genetic defect in type IV collagen
• Important structural collagen in the eye, inner ear and
glomerulus
What does Alport syndrome causes
•Causes vision problems, deafness, hematuria and
proteinuria; lower extremity and periorbital edema
What does Alport syndrome causes
Causes vision problems, deafness, hematuria and
proteinuria; lower extremity and periorbital edema
• Most common tumor in children
- Wilms Tumor
Acute Renal Failure (AKI) Due to
- Acute bilateral kidney diseases
- Severe, prolonged circulatory shock or heart failure
- Nephrotoxins (Drugs, chemicals, or toxins)
- Mechanical obstruction (occasionally) Calculi, blood clots, tumors)
- Block urine flow beyond kidneys
Onset ot AKI is
sudden
Blood tests in AKI will show
– Elevated serum urea nitrogen and creatinine
- Metabolic acidosis and hyperkalemia
Treatment of AKI
– Identify and remove or treat primary problem.: To minimize risk of necrosis and permanent kidney
damage
– Dialysis: To normalize body fluids and maintain homeostasis
Causes of Renal failure nephrotoxins steps
- Filtrate becomes concentrated
- Concentrated nephrotoxin –> Tubule wall become swollen and necrotic
- Normal lumen –> Obstructed lumen
- Filtrate _-> High back pressure
- Decreased GFR
Causes of Renal failure nephrotoxins steps
- Filtrate becomes concentrated
- Concentrated nephrotoxin –> Tubule wall become swollen and necrotic
- Normal lumen –> Obstructed lumen
- Filtrate _-> High back pressure
- Decreased GFR
- Oliguria
Causes of Renal Failure: Pyelonephritis
Purulent exudate and abscesses block blood flow and urine
Causes of Renal Failure – Ischemia
- Glomerulus : severe shock –> vasonconstriction –> decreased blood flow
- Tubule: Ischemia–Swelling–necrosis–obstruction
- Filtrate : high back pressure
- Oliguria
Chronic Renal Failure
• Asymptomatic in early stages
Gradual irreversible destruction of the kidneys over a long period of time
CRF may result from
- Chronic kidney disease
– Congenital polycystic kidney disease
– Systemic disorders
– Low-level exposure to nephrotoxins over sustained period of time
Chronic Renal Failure – Stages
• Decreased renal reserve
Decrease in GFR
– Higher than normal serum creatinine levels
– No apparent clinical symptoms
CRF - STAGES
- Renal Insufficiency
• Renal insufficiency
– Decreased GFR to about 20% of normal
– Significant retention of nitrogen wastes
– Excretion of large volumes of dilute urine
– Decreased erythropoiesis
– Elevated blood pressure
CRF - STAGES ESRF
What are the 3 As:
GFR is ___________
WHat is retained in the body
End-stage renal failure
– Negligible GFR
– Fluid, electrolytes, and wastes retained in body
– AZOTEMIA, ANEMIA, ACIDOSIS (3 As)
– All body systems affected
– Marked oliguria or anuria
– Regular dialysis or kidney transplant –>To maintain patient’s life
Chronic Renal Failure
• Early signs
General signs: b
– Elevated blood pressure
– Increased urinary output
Anorexia, nausea, anemia, fatigue, unintended weight loss, exercise intolerance
Bone marrow depression and impaired cell
function
• Caused by increased wastes and altered blood
chemistry
Complete failure
- Oliguira
** Dry, pruritic, hyperpigmented skin, easy bruising
** Peripheral neurophathy
** Impotence Impotence in men, irregularities in
women
**Encephalopathy(ammonia buildup)
– Congestive heart failure, dysrhythmias
– Failure to activate vitamin D
– Possible uremic frost on the skin
– Systemic infections
Diagnostic tests
–(3) are the key indicators of chronic renal failure.
Anemia, acidosis, and azotemia
Treatment of CRF
–
all body systems are affected manage fluid electrolyes Watch acid monitor protein Treat CV problems Dialysis
Dialysis
• Provides
• Two forms –
• _______during kidney failure
• Used to treat patients with acute kidney
failure –
• For patients in end-stage renal failure –
filtration and reabsorption Hemodialysis and peritoneal dialysis Sustains life -Until primary problem reversed - Until transplant becomes available and is successful
EXPLAIN DIALYSIS
In hospital, dialysis center, or home with
special equipment and training
- Patient’s blood moves from an implanted shunt or catheter catheter in an artery to machine
- Exchange of wastes, fluid and electrolytes – Semipermeable membrane between blood and
dialysis fluid (dialysate)
3.Blood cells and proteins remain in blood. – After exchange is completed, blood is returned to patient’s vein.
Dialysis usually how often
Usually required three times a week – Each lasting about 3 to 4 hours
Cells in tubule are
metabolically active
Potential complications Hemodialysis
Shunt may become infected.
Blood clots may form. – Blood vessels involved in shunt become sclerosed or damaged. –
Patient has an increased risk of infections with hepatitis B or C or HIV if standard precautions are not followed.
Peritoneal Dialysis
• Usually done on outpatient basis
• May be done at night (during sleep) or while patient is ambulatory
Peritoneal membrane serves as the semipermeable membrane.
• Catheter with entry and exit points is implanted into the peritoneal cavity.
• Dialyzing fluid is instilled into cavity.
• Dialysate is drained from cavity via gravity
into container.
Peritoneal Dialysis
Takes more time than hemodialysis
• Requires loose clothing to accommodate bag
of fluid
Major complications of peritoneal dialysis
Infection resulting in peritonitis
With both types of dialysis
– Prophylactic antibiotics with either form of dialysis
– Any additional problem occurring in patient such
as infection may alter dialysis requirements.
– Caution is required with many drugs because toxiclevel buildup can occur.
