Renal System Pathophysiology 1

Question 1

Normal urinalysis

Answer 1

Color = yellow/amber
Trubidity - clear 
Specific gravity = 1.015 to 1.025
pH 4.6 to 8.0 (avg is 6) 
NO glucose, ketones, bile/bilirubin - No protein either but some very small amounts might be normal
NO casts, RBCs, crystals, WBCs

Question 2

Urinalysis - Casts

Answer 2

Generally formed in the proximal or distal tubules (generally distal)
Casts - product/substance that has lined the tubule and is now coming out in the urine

Question 3

Urinalysis - Casts - Common ones include

Answer 3

RBC
Granular
WBC - indicative of infection
Epi cast

Question 4

Glomerular filtration rate

Answer 4

Measures the quantity of glomerular filtrate formed each minute in the nephrons of both kidneys
Usually measured by the rate of clearance of creatinine
Indirect measure because creatinine is made by the body
Requires both blood and urine sample

Question 5

Diagnosis - Plasma creatinine (creatinine clearance test)

Answer 5

Natural substance produced by muscle and released into blood at a relatively constant rate
Small amount secreted into tubules
Decrease - reduced renal blood flow, glomerulonephritis, advanced kidney disease

Question 6

Cystatin C

Answer 6

Protein that is produced at a constant rate in all nucleated cells
Found in detectable amounts in most body fluids
Cystatin C is removed from the blood by the glomerular filtration
CLASSIC BIOMARKER
More Sn than creatinine
Most useful when there is liver pathology

Question 7

BUN

Answer 7

Aids in assessment of hydration
Evaluates renal function
Inc levels occur with dehydration, disease and urinary tract obstruction
Dec levels occur in hepatic disease and malnutrition

Question 8

Cystitis

Answer 8

Bladder inflammation
Ascending infection!!! MOST COMMON
E coli, pseudomonas, staph
F > M (typically age 20 but are recurrent)

Question 9

Second most common site of infection in terms of viscera

Answer 9

Bladder!

Resp/lungs are first

Question 10

cystitis - risk factors

Answer 10

Inc sexual activity
poor hygiene
indwelling catheter
diabetes
urinary obstruction
pregnancy 
analgesic abuse

Question 11

Clinical presentation with cystitis

Answer 11

Suprapubic pain
LBP
Frequency
Urgency
Painful urination
Flank pain 
Hematuria 
Cloudy urine

Question 12

If cystitis goes to ureter - where pain

Answer 12

Into hip now too and more flank area

Question 13

Prognosis with cystitis

Answer 13

Antibiotics
Favorable outcome
25% have reoccurence (they stop taking rx)

We want the pt to frequently void in this case because infection - we don’t want urine to become static

Question 14

Painful bladder syndrome/Interstitial cystitis

Answer 14

Unknown etiology - mucus lining in bladder degenerates - can cause pain, urgency, frequency - pain with urination (mm so contraction is painful)
Common in F 20-50 yo
Can be in M too
Chronic form may have ulceration of bladder

Question 15

Polynephritis

Answer 15

Infection is most common cause
Inflammation of pelvis of kidney (E coli most common)
Ascending usually
Unilateral or Bilateral
5x F > M 

Kidney is solid organ so will run higher grade temp

Question 16

Polynephritis risk factors

Answer 16

Kidney stones 
Pregnancy
Neurogenic bladder
Instrumentation
Sexual trauma

These are all obstructive to urinary system in some way

Question 17

Pain pattern for kidney -

Answer 17

flank pain is most common

Question 18

Polynephritis clinical presentation

Answer 18

Acute onset
Fever, chills
Fatigue
Flank pain
HA (inc BP)
Bladder irritation (changes in freq, urg)

Question 19

Polynephritis prognosis

Answer 19

Favorable if NOT chronic
Often results in some degree of scarring though
Tx - antibiotics (often need swabs to figure out how to specify it) analgesics, corticosteroids

Complication - might develop abscesses

Question 20

Chronic polynephritis

Answer 20

Progressive
Scarring and deformity of pelvis
Autoimmune reaction

Question 21

Chronic polynephritis s/s

Answer 21

Milder presentation with vague symptoms

Hypertension

Question 22

Chronic polynephritis diagnosis and prognosis

Answer 22

Intravenous pyelography (IVP)
Prognosis - accounts for 20% of dialysis pts, renal failure possible

Question 23

Urinary tract obstruction

Answer 23

Stasis and accumulation of urine occurs
Can be acute or insidious; complete or incomplete
Generally will see decrease in GFR (complete and insidious longer term - dec)

Causes - uterine prolapse, pregnancy, BPH in males

Question 24

Kidney stones

Answer 24

3rd leading cause of urinary obstruction
Accounts for 1 in 4 hospital visits
Typically in the pelvis of the kidney - large area! So stone can be large by the time it hits ureter - so small - ouch - then bladder and pain goes away - then urethra and pain comes back
Double cycle of pain!

Question 25

Kidney stone - pathophys

Answer 25

Not clearly understood
Inc in concentration of stone forming substances
Usually grow in renal tubules or renal pelvis
Most stones are less than 5 mm in diameter

Question 26

Kindey stones - types

Answer 26

Calcium (75-80%) - Family hx, immobilization
Struvite (15% - pseudomonas)
Uric acid (7% - gout, high purine diets, metabolic acidosis)

Question 27

Kidney stones - clinical s/s

Answer 27

Pain is hallmark
Colicky pain - comes and goes on a fairly regular schedule - hallmark of hollow viscera - inflammation of hollow viscera wall and when smooth mm contracts, it produces compression and pressure which produces the pain
Viscera responds most to compression and changes in pH in regards to pain
Flank pain, costovertebral angle
Radiating in groin area

N/V - Autonomic response
Hematuria
Skin cool and clammy

Question 28

Diagnosis - kidney stone

Answer 28

Medical and family hx 
Diet hx
Meds
Blood work and urinalysis 
GFR - creatinine clearance

Question 29

Treatment - kidney stone

Answer 29

Prevention
Determine and treat underlying cause 
Dec stone size 
"wait and see" is most commonly used
Pain meds, IV fluids, rest
Lithotripsy
Lasers

Question 30

Prognosis - kidney stones

Answer 30

Generally good for full recovery
Complications include infections, physical damage to the urinary tract, renal failure
Often re-occurs