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Practice Topics/PID Exam 7 > Renal System Pathophysiology 2 > Flashcards

Renal System Pathophysiology 2 Flashcards

1
Q

Neurogenic bladder

A

Functional urinary tract obstruction caused by an interruption of the nerve supply to the bladder
Can be upper or lower motor neuron lesion

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2
Q

Neurogenic bladder - end result

A

urinary stasis - can’t void

Inc risk of infection and failure

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3
Q

Neurogenic bladder s/s

A

Smaller urine volume on voiding
Incontinence
Urgency and frequency
Higher rates of UTIs

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4
Q

Renal cell carcinoma

A

Approx 2% of cancer deaths/year
Males 50-60 yrs have highest incidence
Tobacco use is a HUGE risk factor

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5
Q

Renal cell carcinoma - early and late stages

A

Early - little to no indications

Late - Flank pain, hematuria, palpable flank mass, weight loss

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6
Q

Renal cell carcinoma - diagnosis

A 
Clinical s/s
X ray
IVP
Renal angiography
CAT scan, MRI
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7
Q

Renal cell carcinoma - tx and prognosis

A

Depnends on grade and stage of tumor

Overall 5 yr survival of 60%

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8
Q

Bladder tumors

A 
MOST COMMON urinary tract neoplasm 
More likely to be diagnosed early than renal cell carcinoma because is more obstructive 
Peak 60-80 yo
M more than F (3:1) 
Most significant risk factor is SMOKING!
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9
Q

Bladder tumors - metastassi

A

to lymph, liver, bones and lung (pelvis and hips usually)

High rates of metastasis (via lymph)

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10
Q

Bladder tumor - diagnosis and tx and prognosis

A

Diagnosis - cystoscopy, transurethral biopsy
Tx - surgery, immunotherapy
Prognosis stage A has 98% 5 yr, stage D is 155

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11
Q

Acute glomerulonephritis signs and symptoms

A 
HA (hypertensive)
Edema, primarily around eyes
Lumbar pain
Dark urine - foul smelling too
Hematuria CARDINAL SIGN
Proteinuria CARDINAL SIGN
Hypertension
Oliguira - Decreased urinary output
Azotemia - inc nitrogenous waste in blood which leads to ANOREXIA
Low grade temp
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12
Q

Cardinal signs of Acute glomerulonephritis

A

Hematuria
Preoteinuria

The basement membranes open up and let large molecules go through - now filtering the proteins and RBCs and they get dumped into the urine

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13
Q

Acute glomerulonephritis - tx

A

Antibiotics, steroids, possibly short term dialysis

20% develop chronic glomerulonephritis or renal failure

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14
Q

Chronic glomerulonephritis

A

Variety of causes
Chronic inflammation with scarring
Insidious progressive course leads to renal failure
Can lose up to 25% of kidney function before see impact of it

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15
Q

Chronic glomerulonephritis - diagnosis

A

Urinalysis
Inc BUN
Inc serum creatinine
renal biopsy (gold standard)

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16
Q

Chronic glomerulonephritis - hallmark

A

HYPERTENSION - response to Na and H20 retention

Fluid retention s.s
nephrotic syndrome develops

17
Q

Chronic glomerulonephritis tx

A

dialysis

meds to control s/s

18
Q

Nephrotic syndrome

A

Excessive permeability of glomerular membrane
Excretion of more than 3.5 g of protein a day
It is an outcome of disease of the kidneys
Sign of excessive permeability of glomerular membrane

19
Q

Nephrotic syndrome - s/s

A 
Edema - often in face first
Hypoalbuminemia  (skin and soft tissue)
Hyperlipidemia 
Hypertension!!!
Dec vit D
Hypercoagulation (prone to DVT and PE)
20
Q

Nephrotic syndrome - tx

A 
Depends on cause
High protein diet
Management of hyperlipidemia
Salt restriction may be necessary
Diuretics, maybe
Immunosuppressive agents or anti inflammatories
21
Q

Acute renal failure

A

Increased BUN and increased plasma creatinine
Usually associated with oliguria (output less than 30 ml/hr or 400 ml/day)

Decreased urine output
Most commonly seen with trauma!

22
Q

Causes of acute renal failure

A

Prerenal - Most common (will see with MVA or other trauma)
Intrarenal - direct damage to kidney - inflammation, toxins, drugs, infection, dec blood
Postrenal - obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury

23
Q

Acute renal failure - phases

A

THREE PHASES
Oliguria - Edema, N/V, Fatigue
Diuresis - Inc urine output, excessive electrolyte loss (could lead to cardiac arry)
Recovery - urine output stabilizes

24
Q

Chronic renal failure

A

Progressive loss of renal function
Irreversible
No symptoms until the GFR has decreased by over 25%
Clinical picture - cominated by UREMIA

25
Q

Tx - chronic renal failure

A

Diet
Dialysis
Transplantation

26
Q

Kidney function review

A

Primary site of erythropoetin production
Renin angiotensin system (BP)
Vit D activated in kidney (skeletal system)
Degrades insulin
Should be noted - Inc nitrogen byproducts irritate the GI tract

Kidney function and disorder impacts multiple systems!

27
Q

Uremia

A

The result of pathology - it itself is not pathology
A cluster of clinical s/s related to the inability of the kidneys to clear nitrogenous waste products
Effects ALL systems

28
Q

Uremia - what do you see

A 
Mental status changes
Neuropathies
HA
Insomnia
Anorexia
OP
CHF
Anemia
Sallow (brown/yellow waxy) color, bruise easily 
Emaciated appearance
Mm wasting, cramps
"burning" feet and hands
Metallic taste 
Mucous membranes dry
Smells of urine (uremic frost)
Change in respiration mild dyspnea
29
Q

Uremia - end stage

A

The frost will appear - crystals made of urine on their skin
Once pt goes into uremia they will likely not be making it much longer

30
Q

Dialysis - Hemodialysis

A

Blodo pumped through a series of permeable membranes
Surgically constructed AV fistula
Problems - infection, thrombosis, possible disconnection
Anticoagulation meds used
Hypotension issues

31
Q

PT - dialysis

A

Day of dialysis they are tired, fatigued, not feeling well
Go in for dialysis and feel a little better
After dialysis feel fatigue again
Within half a day or 1 day they will have more energy - this is when need to do PT

32
Q

Dialysis - hemodialysis - things to consider

A

Nutritional status
Anticoagulation therapy
Hypotension during and after treatment
Condition immediately before

33
Q

Peritoneal dialysis

A

Uses peritoneal cavity as the semipermeable membrane that filters the blood
Tube placed into cavity through abdominal wall
Dialysate is placed into the cavity
Fluid is then removed after a period of time

They are on this longer then hemodialysis
More of a continuous thing but they can move while getting the dialysis

34
Q

Kidney transplant

A

The transplanted one is usually taken and transplanted into the pelvis to protect it (not into the place where the other was) - so important to keep in mind because the kidney will be in a different place than normal (It will be in the pelvis)

Practice Topics/PID Exam 7 (9 decks)

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