Renal System Pathophysiology 2 Flashcards
Neurogenic bladder
Functional urinary tract obstruction caused by an interruption of the nerve supply to the bladder
Can be upper or lower motor neuron lesion
Neurogenic bladder - end result
urinary stasis - can’t void
Inc risk of infection and failure
Neurogenic bladder s/s
Smaller urine volume on voiding
Incontinence
Urgency and frequency
Higher rates of UTIs
Renal cell carcinoma
Approx 2% of cancer deaths/year
Males 50-60 yrs have highest incidence
Tobacco use is a HUGE risk factor
Renal cell carcinoma - early and late stages
Early - little to no indications
Late - Flank pain, hematuria, palpable flank mass, weight loss
Renal cell carcinoma - diagnosis
Clinical s/s X ray IVP Renal angiography CAT scan, MRI
Renal cell carcinoma - tx and prognosis
Depnends on grade and stage of tumor
Overall 5 yr survival of 60%
Bladder tumors
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!
Bladder tumors - metastassi
to lymph, liver, bones and lung (pelvis and hips usually)
High rates of metastasis (via lymph)
Bladder tumor - diagnosis and tx and prognosis
Diagnosis - cystoscopy, transurethral biopsy
Tx - surgery, immunotherapy
Prognosis stage A has 98% 5 yr, stage D is 155
Acute glomerulonephritis signs and symptoms
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
Cardinal signs of Acute glomerulonephritis
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
Acute glomerulonephritis - tx
Antibiotics, steroids, possibly short term dialysis
20% develop chronic glomerulonephritis or renal failure
Chronic glomerulonephritis
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
Chronic glomerulonephritis - diagnosis
Urinalysis
Inc BUN
Inc serum creatinine
renal biopsy (gold standard)
Chronic glomerulonephritis - hallmark
HYPERTENSION - response to Na and H20 retention
Fluid retention s.s
nephrotic syndrome develops
Chronic glomerulonephritis tx
dialysis
meds to control s/s
Nephrotic syndrome
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
Nephrotic syndrome - s/s
Edema - often in face first Hypoalbuminemia (skin and soft tissue) Hyperlipidemia Hypertension!!! Dec vit D Hypercoagulation (prone to DVT and PE)
Nephrotic syndrome - tx
Depends on cause High protein diet Management of hyperlipidemia Salt restriction may be necessary Diuretics, maybe Immunosuppressive agents or anti inflammatories
Acute renal failure
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!
Causes of acute renal failure
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
Acute renal failure - phases
THREE PHASES
Oliguria - Edema, N/V, Fatigue
Diuresis - Inc urine output, excessive electrolyte loss (could lead to cardiac arry)
Recovery - urine output stabilizes
Chronic renal failure
Progressive loss of renal function
Irreversible
No symptoms until the GFR has decreased by over 25%
Clinical picture - cominated by UREMIA
Tx - chronic renal failure
Diet
Dialysis
Transplantation
Kidney function review
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!
Uremia
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
Uremia - what do you see
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
Uremia - end stage
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
Dialysis - Hemodialysis
Blodo pumped through a series of permeable membranes
Surgically constructed AV fistula
Problems - infection, thrombosis, possible disconnection
Anticoagulation meds used
Hypotension issues
PT - dialysis
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
Dialysis - hemodialysis - things to consider
Nutritional status
Anticoagulation therapy
Hypotension during and after treatment
Condition immediately before
Peritoneal dialysis
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
Kidney transplant
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)
