Renal System Pathophysiology 1 Flashcards
Normal urinalysis
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
Urinalysis - Casts
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
Urinalysis - Casts - Common ones include
RBC
Granular
WBC - indicative of infection
Epi cast
Glomerular filtration rate
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
Diagnosis - Plasma creatinine (creatinine clearance test)
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
Cystatin C
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
BUN
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
Cystitis
Bladder inflammation
Ascending infection!!! MOST COMMON
E coli, pseudomonas, staph
F > M (typically age 20 but are recurrent)
Second most common site of infection in terms of viscera
Bladder!
Resp/lungs are first
cystitis - risk factors
Inc sexual activity poor hygiene indwelling catheter diabetes urinary obstruction pregnancy analgesic abuse
Clinical presentation with cystitis
Suprapubic pain LBP Frequency Urgency Painful urination Flank pain Hematuria Cloudy urine
If cystitis goes to ureter - where pain
Into hip now too and more flank area
Prognosis with cystitis
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
Painful bladder syndrome/Interstitial cystitis
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
Polynephritis
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
Polynephritis risk factors
Kidney stones Pregnancy Neurogenic bladder Instrumentation Sexual trauma
These are all obstructive to urinary system in some way
Pain pattern for kidney -
flank pain is most common
Polynephritis clinical presentation
Acute onset Fever, chills Fatigue Flank pain HA (inc BP) Bladder irritation (changes in freq, urg)
Polynephritis prognosis
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
Chronic polynephritis
Progressive
Scarring and deformity of pelvis
Autoimmune reaction
Chronic polynephritis s/s
Milder presentation with vague symptoms
Hypertension
Chronic polynephritis diagnosis and prognosis
Intravenous pyelography (IVP) Prognosis - accounts for 20% of dialysis pts, renal failure possible
Urinary tract obstruction
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
Kidney stones
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!
Kidney stone - pathophys
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
Kindey stones - types
Calcium (75-80%) - Family hx, immobilization Struvite (15% - pseudomonas) Uric acid (7% - gout, high purine diets, metabolic acidosis)
Kidney stones - clinical s/s
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
Diagnosis - kidney stone
Medical and family hx Diet hx Meds Blood work and urinalysis GFR - creatinine clearance
Treatment - kidney stone
Prevention Determine and treat underlying cause Dec stone size "wait and see" is most commonly used Pain meds, IV fluids, rest Lithotripsy Lasers
Prognosis - kidney stones
Generally good for full recovery
Complications include infections, physical damage to the urinary tract, renal failure
Often re-occurs
