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SRNAanatomy > Renal Part II > Flashcards

Renal Part II Flashcards

1
Q

Urine specific gravity normal

A

1.005-1.030

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2
Q

Cloudy urine

A

Protein, pus,

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3
Q

Dark urine

A

Bacteria

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4
Q

Bence-Jones proteins (Antibody fragments)

A

Multiple Myeloma

– Indicates multiple myeloma

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5
Q

Bence-Jones proteins (Antibody fragments)

A

– Indicates multiple myeloma

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6
Q

Glucose and ketones

A

– Carbonyl group flanked by 2 alkyl groups

– Indicate DM

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7
Q

Urinary casts

A

– Indicate inflammation of kidney tubules

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8
Q

Blood (hematuria)

– Small amounts

A

• Infection, inflammation, or tumors in urinary tract

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9
Q

– Large amounts (hematuria)

A

Increased Increased glomerular glomerular permeability permeability or hemorrhage

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10
Q

Elevated protein (proteinuria, albuminuria)

A

– Leakage of albumin or mixed plasma proteins

into filtrate, foamy urine

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11
Q

• Used for diagnosis of post-streptococcal

glomerulonephritis

A

Anti-streptolysin O or anti-streptokinase titers

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12
Q

Elevated renin levels –

A

Indicate kidney as a cause of hypertension

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13
Q

Urine C&S –

A

Identify causative organism of infection – Select appropriate drug treatment

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14
Q

Radiologic tests – Radionuclide imaging, angiography, ultrasound,CT, MRI, intravenous pyelography – U

A

sed to visualize structures and possible abnormalities, flow patterns, and filtration rates

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15
Q

Cast

A

remodeling, cut down formation of calcium oxalate stones

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16
Q

Cellular cast

A

fragments of cellular cells Acute tubular necrosis(ATN)

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17
Q 
Clearance tests
clearance
– Used to
Cystoscopy
– Visualizes\_\_\_\_\_\_\_\_\_Tract
–used for \_\_\_\_\_\_\_\_\_\_\_\_\_or to \_\_\_\_\_\_\_\_stones

Biopsy
–used for?

A

– e.g., creatinine or inulin
assess GFR

-lower urinary tract
biopsy or to remove kidney

-Used to acquire tissue
specimens

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18
Q

WBC

A

eosinophils (0-3 %)

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19
Q

Types of incontinence (3 types)

A

Stress
Urge
Overflow

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20
Q

Stress incontinence

A

Relax pelvic flow

increased abdominal pressure

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21
Q

Urge incontinence.

A

Bladder oversensitivity from infection

Neurologic disorders

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22
Q

Overflow incontinence

A

Urethral Blockage

Bladder unable to empty properly

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23
Q

Incontinence

A

– Loss of voluntary control of the bladder

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24
Q

• Enuresis

A

– Involuntary urination by a child age 4+ years
• Often related to developmental delay, sleep
pattern, psychosocial aspect

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25
Q

• Stress incontinence

A

– Increased intra-abdominal pressure forces
urine through sphincter
• Coughing, lifting, laughing; multiple pregnancies

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26
Q

Overflow incontinence

A

– Incompetent bladder sphincter

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27
Q

– Older adults weakened what muscle?

A

Weakened detrusor muscle may muscle may prevent prevent complete emptying of bladder – frequency and incontinence

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28
Q

Nuclear scan

A

dye is given to patient, then scan every 3 minutes

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29
Q

Spinal cord injuries or brain damage

Neurogenic bladder –

A

Neurogenic bladder: may be spastic or flaccid
• Interference with CNS and ANS voluntary controls
of the bladder

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30
Q

Inability to empty bladder

A

– May be accompanied by overflow incontinence – Spinal cord injury at sacral level blocks micturition reflex – May follow anesthesia (general or spinal)

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31
Q

UTI • Very common infections

Urine is an excellent growth _________

A

growth medium.

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32
Q

Lower urinary tract infections

A

– Cystitis and urethritis

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33
Q

Upper urinary tract infections

A

– Pyelonephritis

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34
Q

Common causative organism for UTI

A

– Escherichia coli

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35
Q

UTI associated with

A

Heavy purulence and presence of gramnegative and gram-positive organisms

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36
Q

More common UTI in population because
Women:
Older men:
Children:

A
  • Shortness of urethra, proximity to anus
  • Prostatic hypertrophy and urine retention
  • Congenital abnormalities in children
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37
Q

Other common predisposing factors UTI

A

– Incontinence
– Retention of urine
– Direct contamination with fecal material

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38
Q

Cystitis

A

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

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39
Q

Pyelonephritis

A

Urinary casts present.
• Reflection of renal tubule involvement
• Treatment with antibiotics

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40
Q

Glomerulonephritis

A 
Usually follows strep infection 
Urine dark and cloud
Facial and periorbitla edema
elevated BP
Flank and back pain
Increase UO
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41
Q

Glomerularnephritis, lab test

A

Elevated Antibodies against strep
Elevated serum urea and creatinine
Low complement levels.

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42
Q

Tx of glomer

A 
Sodium restriction possible
– Protein and fluid intake decreased in severe
cases
Drug treatment
• Glucocorticoids
• Antihypertensives
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43
Q

Tx of glomerulonephritis

A 
Sodium restriction possible
– Protein and fluid intake decreased in severe
cases
Drug treatment
• Glucocorticoids
• Antihypertensives
44
Q

INnflammatory Disorders – Nephrotic

Syndrome

A

Abnormality in glomerular capillaries, increased permeability, large amounts of plasma proteins escape into filtrate

45
Q

Nephrotic syndrome seen in (conditions)

A

Secondary to SLE, exposure to nephrotoxins

or drugs

46
Q

Nephrotic syndrome

A

Albumin loss, decreased osmotic pressure
Generalized edema
Increased aldosterone
high blood cholesterol

47
Q

Nephrotic syndrome treatment:

A

Glucocorticoids
ACE
antihypertensive
Sodium intake

48
Q

UROlithiasis causes

A

Excessive amounts of solutes in filtrate
– Insufficient fluid intake – major factor for calculi formation
– Urinary tract infection

49
Q

Renal calculi (urolithiasis)

A

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

50
Q

Most common stones (4) to less common

A

Calcium stone
Urine acid stone
Struvite (infection )
Cystine stone ( high secretion of cystine)

51
Q

• Stones in kidney or bladder often asymptomatic
– Frequent infections may lead to investigation.
_________possible caused by distention of renal capsule

A

Flank pain

52
Q 
• “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
A

-obstruction of the ureter
groin area

location of calculi.

53
Q

Small stones will be passed eventually but 3 treatment

A

– Extracorporeal shock-wave lithotripsy (ESWL)
– Laser lithotripsy
– Drugs may be used to may be used to partially partially dissolve dissolve stones. stones.
– Surgery

54
Q

Hydronephrosis

A

Complication of calculi – Tumors, scar tissue in kidney or ureter – Untreated prostatic enlargement – Developmental abnormalities restricting urine flow

55
Q

Tumors – Renal Cell Carcinoma

primary tumor where?

A

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

56
Q

Signs of Tumors – Renal Cell Carcinoma

A 
Painless hematuria initially
– Dull, aching flank pain
– Palpable mass
– Unexplained weight loss
– Anemia or erythrocytosis
57
Q

Bladder CA early signs

A

Hematuria, dysuria; infection common

58
Q

Bladder CA is

A

Tumor is invasive through wall to adjacent structures.

Metastasizes to pelvic lymph nodes, liver, and bone

59
Q

Predisposing factors for Bladder CA

A

– Working with chemicals in laboratories and
industry Particularly analine dyes, rubber, aluminum
– Cigarette smoking
– Recurrent infections
– Heavy intake of analgesics

60
Q

• Treatment of Bladder CA

A

– Surgical resection of tumor
– Chemotherapy and radiation
– Photoradiation successful in some early cases

61
Q

Vascular Disorders – Nephrosclerosis

– Some occur normally with

A
  • Involves vascular changes in the kidney

- aging

62
Q

Vascular Disorders – Nephrosclerosis is thickening of

A

Thickening and hardening of the walls of

arterioles and small arteries

63
Q

Vascular Disorders – Nephrosclerosis what happens then (3)

A

• 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

64
Q

Vascular disorders: Can be primary lesion developed in kidney
• May be secondary to
• Treatment of vascular disorders

A

essential hypertension

Antihypertensive agents
Diuretics
Beta-blockers
Sodium intake should be reduced.

65
Q

Goodpasture’s Syndrome is an ________Disorder
And what happen? Antibodies attack_______
Causes what (2)

A
  • Autoimmune disorder
  • Antibodies attack basement membrane of Kidney and Lung
  • Causes hemoptysis and hematuria
66
Q

Causes of Goodpasture’s Syndrome

A

– exposure to organic phosphates
– metal dust inhalation
– certain gene mutations HLA-DR15

67
Q

Treatment of goodpasture’s syndrome

A

monoclonal antibodies

68
Q

Wegener’s Granulomatosis

What happens to neutrophils:

A

• anti-neutrophil cytoplasmic antibodies (ANCA)
Cause neutrophils to adhere to endothelial cells and
degranulate, damaging blood vessels and leading to tissue damage

69
Q

The glomerulonephritis in Wegener’s Granulomatosis progress to

A

– Glomerulonephritis progresses to chronic renal

failure

70
Q

What happens in SLE:

A

Autoantibodies attack mesangial cells of juxtaglomerular apparatus leading to lupus nephritis

71
Q

Congenital Disorders

A

Vesicoureteral reflux

72
Q

“Horseshoe” kidney

A

– Fusion of the two kidneys

73
Q

“Horseshoe” kidney

A

– Fusion of the two kidneys

74
Q

Hypoplasia

A

– Failure to develop to normal size

75
Q

PDK is
• No indications in child or young adults
• First manifestations usually

A
  • Autosomal dominant gene on chromosome 16

- around age 40 (pain, frequent urination, uti)

76
Q

In PKD there is

A

Multiple cysts develop in both kidneys.

Enlargement of kidneys – Compression and destruction of kidney tissue – Chronic renal failure

77
Q

Diagnosis of PKD is

A

Diagnosis by abdominal CT scan or MRI

78
Q

Alport Syndrome or “ ________”

It is a genetic defect of ____________ which is what?

A

Alport Syndrome “Hereditary Nephritis”
• Genetic defect in type IV collagen
• Important structural collagen in the eye, inner ear and
glomerulus

79
Q

What does Alport syndrome causes

A

•Causes vision problems, deafness, hematuria and

proteinuria; lower extremity and periorbital edema

80
Q

What does Alport syndrome causes

A

Causes vision problems, deafness, hematuria and

proteinuria; lower extremity and periorbital edema

81
Q

• Most common tumor in children

A
  • Wilms Tumor
82
Q

Acute Renal Failure (AKI) Due to

A
  • 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
83
Q

Onset ot AKI is

A

sudden

84
Q

Blood tests in AKI will show

A

– Elevated serum urea nitrogen and creatinine

- Metabolic acidosis and hyperkalemia

85
Q

Treatment of AKI

A

– Identify and remove or treat primary problem.: To minimize risk of necrosis and permanent kidney
damage
– Dialysis: To normalize body fluids and maintain homeostasis

86
Q

Causes of Renal failure nephrotoxins steps

A
  1. Filtrate becomes concentrated
  2. Concentrated nephrotoxin –> Tubule wall become swollen and necrotic
  3. Normal lumen –> Obstructed lumen
  4. Filtrate _-> High back pressure
  5. Decreased GFR
87
Q

Causes of Renal failure nephrotoxins steps

A
  1. Filtrate becomes concentrated
  2. Concentrated nephrotoxin –> Tubule wall become swollen and necrotic
  3. Normal lumen –> Obstructed lumen
  4. Filtrate _-> High back pressure
  5. Decreased GFR
  6. Oliguria
88
Q

Causes of Renal Failure: Pyelonephritis

A

Purulent exudate and abscesses block blood flow and urine

89
Q

Causes of Renal Failure – Ischemia

A
  1. Glomerulus : severe shock –> vasonconstriction –> decreased blood flow
  2. Tubule: Ischemia–Swelling–necrosis–obstruction
  3. Filtrate : high back pressure
  4. Oliguria
90
Q

Chronic Renal Failure

• Asymptomatic in early stages

A

Gradual irreversible destruction of the kidneys over a long period of time

91
Q

CRF may result from

A
  • Chronic kidney disease
    – Congenital polycystic kidney disease
    – Systemic disorders
    – Low-level exposure to nephrotoxins over sustained period of time
92
Q

Chronic Renal Failure – Stages

• Decreased renal reserve

A

Decrease in GFR
– Higher than normal serum creatinine levels
– No apparent clinical symptoms

93
Q

CRF - STAGES

- Renal Insufficiency

A

• 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

94
Q

CRF - STAGES ESRF
What are the 3 As:
GFR is ___________
WHat is retained in the body

A

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

95
Q

Chronic Renal Failure
• Early signs

General signs: b
– Elevated blood pressure

A

– 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

96
Q

Complete failure

A
  • 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
97
Q

Diagnostic tests

–(3) are the key indicators of chronic renal failure.

A

Anemia, acidosis, and azotemia

98
Q

Treatment of CRF

–

A 
all body systems are affected
manage fluid electrolyes
Watch acid 
monitor protein
Treat CV problems
Dialysis
99
Q

Dialysis
• Provides
• Two forms –
• _______during kidney failure
• Used to treat patients with acute kidney
failure –
• For patients in end-stage renal failure –

A 
filtration and reabsorption
Hemodialysis and peritoneal dialysis 
Sustains life
-Until primary problem reversed
- Until transplant becomes available and is successful
100
Q

EXPLAIN DIALYSIS
In hospital, dialysis center, or home with
special equipment and training

A
  1. Patient’s blood moves from an implanted shunt or catheter catheter in an artery to machine
  2. 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.
101
Q

Dialysis usually how often

A

Usually required three times a week – Each lasting about 3 to 4 hours

102
Q

Cells in tubule are

A

metabolically active

103
Q

Potential complications Hemodialysis

A

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.

104
Q

Peritoneal Dialysis
• Usually done on outpatient basis
• May be done at night (during sleep) or while patient is ambulatory

A

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.

105
Q

Peritoneal Dialysis

A

Takes more time than hemodialysis
• Requires loose clothing to accommodate bag
of fluid

106
Q

Major complications of peritoneal dialysis

A

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.

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