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Renal patho Flashcards

1
Q

what does pyelo means?

A

renal pelvis?

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2
Q

what is pyleonephritis? where is it? Acute or chronic?

A

inflame of renal pelvis and parenchyma.

upper UTI

both

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3
Q

Et of Pyelonephritis

A

various bacteria (usually e.coli

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4
Q

what are the risks of pylenephritis?

A

suppressed immunity
catheterization
urinary reflux
diabetes

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5
Q

Patho of pylenephritis?

A

ascending infection and inflm
urethra ->bladder->ureter-> kidney
fibrosis and scar tissue?
-dec renal fx

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6
Q

patho of chronic form of pyleonephritis?

A

recurrent inflm-> obstruc or reflux

renal damage-> renal failure

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7
Q

manifestations of pyleonephritis?

A 
local and systemic of bacterial infect
acute onset
lower back pain
fever
dysuria, freq, urgency
pyuria (discharge of pus)
dec renal function (aka 1)ultrafiltration, reabsorpion, active secretion of filtrate)
Severe htn (chronic form)
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8
Q

treatment of pyleonephritis?

A

abx (10-14 days)

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9
Q

how common is a lower UTI?

A

2nd most common infect

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10
Q

are there microbes found in the lower UT?

A

no. entirely sterile. there is peri-urethral flora that can migrate from urethra into bladder?

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11
Q

what bacteria is commonly found in lower UTI?

A

e.coli

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12
Q

is it an ascending or descending infection?

A

ascending. urethra to bladder

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13
Q

what defences do we have that prevent UTI from occurring?

A

IR- systemic
local immune response
mucin layer
washout (forceful urine)
men- prostatic fluid contains components that are antimicrobial
women- periurera flora microbial antagonism

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14
Q

what is the mucin layer?

A

bladder wall comprises of transitional pith cells that secrete glycoprotein (CHO and protein) which coats the inner layer of the epith tissue (forms barrier between urine and epith) therefore prevents direct contact between act and wall of bladder

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15
Q

what are the risks of getting a lower UTI?

A

catheterization
obstr (in terms of BPH)
-stasis (or urine in bladder)
-reflux

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16
Q

why is catheterization a risk?

A

bc bacteria attach to catheter and coat themselves with biofilm and secrete this film which is above them and protects them from defences against the body

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17
Q

what are the manifestations of lower UTI?

A

acute onset
freq
dysuria
lower back/abdm pain

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18
Q

DX of lower UTI?

A

manifestations
urinalysis
-leukocytes, blood, bacteria
C and S

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19
Q

Tx of lower UTI

A

Abx and cause

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20
Q

what are the 5 categories of glomerular disease?

A 
nephrotic syndromes
nephritis syndromes
sediment disorders
rapidly progressive glomerulnephritis
chronic glomerulonephritis
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21
Q

what is nephrotic s syndrome?

A

inc in permeability aka more components mout so will have more ease of ultrafiltration - push out more fluids, lights, nitrogenous wastes
-inc glomerular permb
fluid and protein loss

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22
Q

what is nephritis syndrome?

A

dec glomeular permb (pass out less fluid ->water and lights

-fluid and n-waste retention

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23
Q

what is sediment disorders?

A

referring to component of urine that has the ability to sediment out
-hematuria, proteinuria

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24
Q

what is tricky about proteinuria and protein loss?

A

same manifestations!

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25
is glomerulnoephritis pre or post infectious? why? how soon before or after?
post because IC must form (ab and AG) and cause damage and inflamation? usually 1-1.5 wk later
26
what are the common infections in glomerulnoephritis?
B hemolytic strep infect (streptococcal infect-bacteria) beta causes hemolysis
27
where is the infection (GN) how long?
pharynx or skin (7-12 days)
28
who is usually infected in GN? age group
mostly children 95% recovery
29
if adults get GN, whats a common complication? how many get this?
renal failure | 1/3
30
what occurs in GN?
Type III hypersensitivity: IC traps in glomerulus and GF is impeded
31
Dx of GN?
eGFR, creatinine
32
what are some characteristics of GN?
histologic chat, o Hypercellularity (leukocytes, mesangial & endothelial cells) o Mesangial- in between capillaries. Don’t know why this happens o Glomerular englargement exudate forming and swelling d/t inflm process
33
what are some other symptoms of GN
oliguria followed by proteinuria, hematuria (less fluid go through so dec urie volume is oliguria and then d/t those 'holes' in the vessels you will lose protein and blood bc damage to the capillaries and it will enter the filtrate Na and water retention - HTN (vol) and edema bc of dec osmotic pressure and proteinuria
34
tx for GN?
self -limiting and symp tx
35
whats another name for renal calculi?
nephrolithisasis
36
where do renal calculi form? can they form anywhere else?
form in the kidney but can also form in the bladder--> don't usually remain there
37
who is more likely to get kidney stones? (men or woman)
men
38
Et of renal calculi?
str changes in UT (constr and stasis) -inc conc of blood/urine components dietary and metb factors (what you eat and absorb is metabolized by the cells and waste products and reabsobed into kidneys and filtrated)
39
Patho of renal calculi?
kidney proteins inhibit crystallization | -inc solute and or urine stasis-> preciptators in urine -> nucleus -> crystallization
40
mnfts of kidney stones?
severe renal colic (min to days) - usually associated with migration 0f stone distended ureter (migration) colicky pain non colicky pain (distension of renal pelvis & calyces) N +V d/t pain, diaphoresis
41
why do you have colicky pain and non colicky pain in renal stones?
colicky pain because the muscle of the kidney is contracting and relaxing to allow the stone to move non-colicky pain has to do with the distension of the renal pelvis & calyces
42
Dx of renal calculi
pain, US, CT urinalysis (is it an infection? is it BPH? looking for crystals, casts) IVP
43
what is IVP? (renal calculi)
IV pyelogram- renal pelvis “pyelo”. o Injecting a contrast medium through venous system and comes through heart and systemic circulation and kidney and will be filtered through kidney and get into renal pelvis, ureter, bladder, urethra and trace whole urinary system and take an Xray and visualize) o Not done as much
44
Tx of renal calculi?
90% passed spotaneously (
45
what is urinary incontinence?
voiding urine involuntarily, even when bladder isn't full | not a disease, more a manifestation
46
Et/Patho of urinary incontinence? 3 kinds?
stress incontinence overflow incontinence overreactive bladder
47
what occurs in stress incontinence?
weak sphincer the angle bw the bladder and the urethra is changed: 80-100degrees (change in urethra- vesicular angle) inc intra abdm pressure)
48
what is overflow incontinence?
intravesicular pressure > yrethra pressure | retension and bladder distension
49
what are the 3 pressures of the bladder/urethra
spincter, distal to sphincter and urethra pressure and sometimes the urethra pressure is greater than the bladder so pushing in or the pressure increase sin bladder to an extent that now exceeds pressure of sphincter and urine will pass through
50
what is overactive bladder?
hyperactive detrusor muscle neurogenic (nerves)/ myogenic (muscle) problem muscle is defective by excessive stimulation from nervous system or defective muscle
51
Tx for urinary incontinence?
drugs (alpha adrenergic receptors) to strengthen the spincter and ac on the muscle of the bladder Sx- artificial sphincter or prosthesis (fortifying existing sphincter)
52
what is acute in acute renal failure suggesting?
short lived and so severe they die quickly or short lived and you can reverse it
53
what is acute renal fialure
l/o renal fx -fluid- electrolyte imbal (excrete and maintain them) -azotemia (excretes nitrogenous wastes- urea, ammonia, ntrogen, gases) usually reversible GFR dec (hr or days)
54
is acute renal failure reversible?
yes
55
can you measure acute renal failure by the vol of urine?
no bc cold have lights and wastes in the urine
56
how much urine must be excreted to prevent azotemia?
400ml/day
57
how much is considered oliguria?
100-400ml/day
58
Et of acute kidney failure? 3 groups? how much % wise is each
mostly hypovolemia, hypotension prerenal (hypotension) intrarenal (GN) postrenal (BPH) 80-90% is first two
59
how much of CO goes to the kidney?
20-25%. less would be trouble
60
Patho of prerenal (acute renal failure)
eg dehydration | dec renal perfusion --> oliguria and ischemia
61
patho of internal acute renal failure?
eg) kidney infection or GN 3 phases initiating phase- problem like back causing infect -preciptating events to mfnts maintenance -dec in gfr, oliguria, azotemia recovery -tissue replair- gradual inc in GRF address cause
62
patho of post renal ?
eg. BPH. obstr to urine flow
63
manifestations of acute renal failure?
``` oliguria or anuria fluid-electrolyte imbalance azotemia proteinurai, hematuria complicaitons - htn, edema ```
64
Tx of acute renal failure?
stat interventions replace fluid and lytes dialysis diet (inc calorie, cautious about protein)
65
what is dialysis? two kinds?
hemodialysis taking the blood and channeling through the machine), peritoneal (consider the glomerulus and it’s a network of capillaries and the capsules and those two components are where filtration occurs, you use this principle within the abdm cavity and use the peritoneum (large membr) that is richly vascularized, you utilize this to do what happens in the glomerulus, introduce a fluid into peritoneal cavity and fluid is separated from blood by the membrane and what you want to filter is in the vessels and filter the components from the vessels into the dialsylate and empty that and get rid of waste and aspirate the fluid and remove it. Peritoneum is semi-permeable membrame
66
what are the stages of chronic renal failure?
diminished renal reserve -GFR drops >50% or normal no signs of dec renal fx renal insufficiency GFR 20-50% of normal Renal Failure GFR
67
is chronic rena failure permanent?
yes

patho (12 decks)

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