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Exam 3 Pathophysiology > Renal System and disorders > Flashcards

Renal System and disorders Flashcards

1
Q

Average urine production of a healthy adult

A

= 1-2 L/day

o Dependent on state of hydration, activity levels, environmental factors, weight, individuals health

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2
Q

Micturition

A

urination

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3
Q

Urinalysis

A

an array of tests performed on urine, and one of the most common methods of medical diagnoses

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4
Q

Possible appearances to see in urinalysis

A
  • Normal: Straw colored with mild odor. specific gravity 1.010 to 1.050 (varies by UA strips, do not memorize)
  • Cloudy: May indicate the presence of large amounts of protein, blood, bacteria, and pus
  • Dark color: May indicate hematuria, excessive bilirubin, or highly concentrated urine
  • Unpleasant or unusual odor : Infection or result from certain dietary components (asparagus) or medication
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5
Q

What is the most common cause of proteinuria?

A

Diabetes (d/t damaged nephrons)

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6
Q

Urinary casts

A

cylindrical structures produced by kidneys; present in certain disease states
o Indicates inflammation of kidney tubules
o Present in environments favoring protein denaturation + precipitation – low blood flow to kidney, concentrated salts, low pH

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7
Q

Specific gravity

A

Indicates ability of tubules to concentrate urine (toxic + metabolic wastes); role of kidney is to concentrate urine so waste products can be excreted with minimal loss of water + nutrients
o If low specific gravity – dilute urine (with normal hydration)
o If high specific gravity – concentrated urine (with normal hydration)
• Related to renal failure

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8
Q

What are blood tests to check for kidney function?

A

• Check for elevated serum urea and serum creatinine
o Indicates failure to excrete nitrogen wastes, due to decreased GFR

• ABGs - Metabolic acidosis* (in absence of other problems)
o Indicates decreased GFR
o Failure of tubules to control acid-base balance

• CBC – to assess for Anemia* (in absence of other problems)
o Indicates decreased erythropoietin secretion and/or bone marrow depression

• Look at person’s electrolytes (but these also depend on related fluid balance)
– Na+, K+

• Antibody level
– Anti-streptolysin O or anti-streptokinase titers

• Used for diagnosis of post-streptococcal glomerulonephritis

• Elevated renin levels (RAAS)
– Can indicate kidney as a cause of hypertension

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9
Q

What are other tests (in addition to blood tests) that can be done to test kidney function?

A

• Culture and sensitivity studies on urine specimens
– Identify any causative organism of infection and to select appropriate drug treatment
• Radiologic tests
– Radionuclide imaging, angiography, ultrasound, CT, MRI, intravenous pyelography
– Used to visualize structures and possible abnormalities, flow patterns, and filtration rates
• Creatinin or inulin clearance tests (used to assess GFR)
• Cystoscopy: inserting scope into urethra (Visualizes lower urinary tract)
– May be used in performing biopsy or to remove kidney stones
• BiopsyUsed to acquire tissue specimens to be studied microscopically

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10
Q

Which substance directly controls the reabsorption of water from the collecting ducts?

A

ADH (retains water & constricts blood vessels)

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11
Q

Under what circumstances do cells in the kidneys secrete renin?

A

– Renin is secreted by the afferent arterioles of the kidney in response to 3 stimuli. 1) a decrease in arterial pressure as detected by the baroreceptors. 2) a decrease in NaCl levels in the ultrafiltrate of the nephron. 3) w/ sympathetic nervous system activity, which also controls blood pressure, acting through the beta1 adrenergic receptors.

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12
Q

When a respiratory infection with high fever is present in the body, how would the kidney tubules maintain normal pH of body fluids?

A

Secrete more acids + absorb more bicarb

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13
Q

Functions of kidneys

A

The kidneys regulate pH, levels of metabolites, electrolytes, blood volume and pressure; eliminates wastes, synthesis, release and/or activation of hormones like erythropoietin, renin and vit D.

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14
Q

Urinary Tract Obstruction

A

It can occur anywhere along the urinary tract but most commonly are in the kidneys or the ureters): blockage of urine flow within the urinary tract (by typically a stone, could also be caused by a tumor)

• Severity based on:
o Location
o Completeness (incomplete or complete, little/no flow)
o Involvement of one or both upper urinary tracts
o Duration
o Cause

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15
Q

Calculi or urinary stones/ urolithiasis

A

Masses of crystals, protein, or other substances that form within and may obstruct the urinary tract

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16
Q

Risk factors for Calculi or urinary stones/ urolithiasis

A

Risk factors
• Gender, race, geographic location, seasonal factors, fluid intake, diet, and occupation
• Family hx or stone disease, 1st urinary stone by age 25
• Urinary stasis, retention, immobility, dehydration
• Dehydration from low fluid intake is a MAJOR FACTOR!!!
• High dietary intake of protein, sodium, refined sugars (ESP. high fructose corn syrup), grapefruit, apple juice
• More common in Crohn’s disease (high levels of oxalate + malabsorption of Mg)

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17
Q

What are the types of renal calculi (renal lithiasis)

A

4 Types of Kidney Stones

1) Calcium oxalate or calcium phosphate (MOST COMMON)
• Hyperparathyroidism, increased dairy intake

2) Struvite stones (15% cases)
• Magnesium-ammonium-phosphate
• 2x more common in women

3) Uric acid stones (8%): high urine acidity
• Gout

4) Cystinuric stones (3%): sulfur containing amino acid stones; rare
• Genetic disorder

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18
Q

Manifestations of kidney stones

A

Manifestations (NO FEVER)
• MOST COMMON: Flank pain (excruciating, debilitating) – located in kidney or upper ureter; extends to scrotum or vulva, stone is in ureter or bladder
• Hydration often makes pain worse
• Pain most intense when stone is moving or ureter obstructed
• Stones form in the kidney and move to ureter lodge in areas where ureter bends of slightly changes shape
• Hydroureter: Ureter dilates
• Hydronephrosis: fluid buildup into kidney
• Nausea/Vomiting

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19
Q

What are the complications we worry about with kidney stones?

A
  • Hydronephrosis
  • Pyelonephritis: kidney infection
  • Acute renal failure (ARF)
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20
Q

Diagnosis and treatment of kidney stone

A

Evaluation
• Urinalysis: blood, WBCs
• Kidney, Ureter, Bladder (KUB) Xray
• Intravenous Pyelogram (IVP): using contrast to visualize any obstruction
• Abdominal CT
• Stone analysis: once stone passes; analyze components of stone

Treatment Goals
• Removal of stones
• Prevent formation of new stones

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21
Q

Urinary tract infection

A

UTI is inflammation of the urinary epithelium following invasion and colonization by some pathogen within the urinary tract (bacteria, fungus)

  • More common in Women – lifetime risk is 30%
  • Bc of close proximity of urethra to anus
  • Men – lifetime risk is 1% (increases to 10% after age 65)
  • Most common cause of sepsis in hospitalized patients d/t use of urinary catheters for prolonged periods of time
22
Q

What’s the most common pathogen that causes UTI

A

E coli (80% of cases)

23
Q

Risk factors for UTI

A
  • Urinary stasis: d/t immobility, urinary retention, medication (i.e. beta-blockers) that cause urinary retention, BPH (benign prostatic hyperplasia – prostate obstructing urethra + urinary output)
  • Renal stones

CATHETERS*
• Within 48 hrs of catheter insertion, bacteria colonization begins
• 50% of indwelling catheters become infected within 1 week of insertion

  • Fistula exposing urinary stream to skin – vagina, GI tract
  • Sexual intercourse
  • Immunocompromised
  • Constipation, difficulty voiding
24
Q

What is the most common UTI

A

Infectious cystitis

(• UTI causes Cystitis (inflammation of the bladder)
• Cystitis can also be caused by trauma, autoimmune disease, or certain medications (this is non infectious cystitis))

25
Q

Clinical manifestations of UTI

A

Low urinary tract symptoms, “LUTS”:
• Frequency, dysuria, urgency, and lower abdominal and/or suprapubic pain
• In the elderly, patients will often present with none of the normal LUTS symptoms, but instead with delirium (confusion, agitation)

26
Q

Treatment of UTI

A
  • Treatment
  • Antimicrobial therapy (Culture + sensitivity: type + antibiotic)
  • Increased fluid intake (flushing bladder)
  • Avoidance of bladder irritants (caffeine)
  • Cranberry capsules have been shown to reduce risk in those with chronic infection, as has consistent hydration
27
Q

Pyelonephritis

A

UPPER urinary tract infection

28
Q

Acute pyelonephritis

A
  • Acute infection of the ureter, renal pelvis, and/or renal parenchyma
  • Bacterial infection that has spread up urinary tract from urethra OR traveled through the blood stream to kidney
  • E. coli (70-80%)
  • HAI (Hospital Acquired Infection): Coliform bacteria, enterococci, pseudomonas, klebsiella
  • Usually start as lower UTIs (cystitis, prostatitis)

Manifestations:
• Rapid onset of a fever, chills, malaise and flank pain (this would mean a serious infection). May have hematuria, polyuria, pyuria. May be different in the elderly

29
Q

Treatment for acute pyelonephritis

A

Treated with antibiotics, generally resolves within 10-14 days

30
Q

Chronic pyelonephritis

A
  • Persistent or recurring episodes of acute pyelonephritis
  • Risk of chronic pyelonephritis increases in individuals with renal infections and some type of obstructive pathologic condition
  • Can lead to loss of tubular function and ability to concentrate urine
  • Leads to polyuria, nocturia, and proteinuria
  • Can lead to end stage renal failure in 10-20% of cases
31
Q

What are autoimmune diseases that can lead to GN

A

Lupus, diabetic nephropathy

32
Q

Glomerulonephritis (GN)

A

Refers to several kidney diseases; usually affecting both kidneys. Inflammation of glomeruli or small vessels of the kidney, usually affecting both kidneys.

33
Q

Most forms of GN appear with a collection of immune complexes in glomeruli made up of antigens and antibodies. What hypersensitivity reaction is this?

A

Type 3 hypersensitivity (antigen-antibody complex)

34
Q

Clinical manifestations of GN

A
  • An infection often occurs before the kidney manifestations of acute GN
  • Onset of symptoms: 10 days from time of infection; common after upper resp strep infections
  • GN after strep more common in men
  • Usually patients recover quickly from GN, and most cases are infectious or are related to a secondary condition such as lupus or diabetic nephropathy

SIGNS AND SYMPTOMS:
• Urine becomes dark and cloudy (protein, RBCs in urine; kidneys are now allowing large molecules to pass through)
• Facial and preorbital edema – initially (d/t retention of fluids)General edema follows
• Elevated blood pressure
• Due to increased renin secretion and decreased GFR
• Flank or back pain
• D/T dema and stretching of renal capsule
• General signs of inflammation
• Decreased urine output

35
Q

Treatment of GN

A
  • Sodium restriction possible (bc pt is already retaining Na + water)
  • Protein and fluid intake decreased in severe cases
  • Drug treatment
  • Glucocorticoids to reduce inflammation
  • Antihypertensives (bring down BP)
36
Q

Polycystic kidney disease (PKD)

A

The most common life threatening genetic disorders.

  • Multiple cysts are typically present in both kidneys, however, 17% of cases have cysts in only 1 kidneys w/ most cases progressing to bilateral disease in adulthood
  • Damage liver + pancreas; more rare: heart + brain

• Growth of fluid filled cysts bilaterally in kidneys; cause massive enlargement of kidneys

37
Q

Categories of PKD

A
  • Genetic, autosomal dominant (ADPKD)
  • Genetic, autosomal recessive (ARPKD)
  • Acquired
38
Q

Clinical manifestations of PKD

A
  • Enlarged kidneys (usu bilaterally)
  • Hypertension
  • Flank pain (d/t enlarged kidneys)
  • Altered fluid, electrolyte balance
  • Renal calculi
  • Diverticular disease
  • Urinary tract infection
  • Additional organ involvement
  • Liver, pancreatic cysts
  • Cardiac valvular disease
  • Cerebral aneurysms
39
Q

You are caring for a patient with post-streptococcal glomerulonephritis. What would youexpect to see of the following on lab tests?

A

Low GFR, low C4 complement (decreased bc they are used in renal inflammation), proteinuria

40
Q

Acute kidney injury (AKI)

A

Pathophysiology (may be reversible w/ prompt attention)
• Rapid decrease in kidney function, leading to the collection of metabolic wastes in the body.
• Effects: Reduce GFR, damage nephron cells, obstruct urine flow

41
Q

Types of AKI

A
  • Types:
  • Prerenal: reduced blood flow to kidney
  • Intrarenal: damage to glomeruli, interstitial tissue, tubules
  • d/t Infections (pyelonephritis, glomerulonephritis)
  • Postrenal: obstruction of urine flow
  • d/t stones in ureters, BPH
42
Q

Possible causes of AKI

A 
Possible causes
•	Reduced blood flow (poor perfusion) – hypovolemic shock
•	 Toxins
•	Infections
•	Urinary tract obstruction
43
Q

Phases of AKI

A 
Phases:
o	Onset
o	Oliguric
o	Diuretic
o	Recovery
44
Q

Azotemia

A

retention + build up of nitrogenous waste in blood

45
Q

Chronic renal failure

A

Progressive, irreversible disorder; kidney function does not recover

Chronic Renal Failure (CRF), occurs when the kidney is no longer able to effectively maintain homeostasis and remove wastes.

Leads to end stage renal disease: when kidneys function becomes too poor to sustain life.

46
Q

Primary cause of chronic renal failure

A
  • Acute Renal Failure (untreated)
  • Diabetes (d/t macrovascular changes of kidney)
  • Hypertension (d/t end organ damage of kidney)
  • Glomerulonephritis
  • Systemic Lupus Erythematous
  • Polycystic Kidney Disease
47
Q

How is chronic renal failure staged?

A

Staged using GFR (The lower the GFR, the worse kidney failure)

48
Q

What are the most vital clinical complications in CKD?

A

HTN & edema (d/t Na+/H2O imbalance). Can lead to CHF, pulmonary edema or peripheral edema

  • Hyper kalemia
  • uremia (high serum urea) can lead to bleeding disorder and eventual encephalitis)
  • Anemia (d/t/ dec erythropoietin production)
  • metabolic acidosis
  • hypocalcemia d/t unactivated Vit D
  • Hyper phosphatemia
49
Q

Why does renal disease frequently cause HTN?

A

Congestion and ischemia are stimulated by release of renin

CKD causes HTN d/t fluid + sodium overload + dysfunction of RAAS. Retention of Na + water causes circulatory overload, elevating BP. Kidneys respond to decrease in kidney blood flow or low serum sodium levels by improving blood flow to kidney. Release of renin triggers production of more angiotensin + aldosterone

50
Q

What is the basic cause of osteodystrophy associated with chronic renal failure?

A

Failure of the kidneys to activate vitamin D

Exam 3 Pathophysiology (9 decks)

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