Renal/Urologic Disorders Flashcards
Doctor that cares for the kidney system
Nephrologist
Doctor that cares for the whole kidney system (renal, kidney, nephro)
Urologist
One of the most common urologic problems
- due to stones
- enlarged prostates in male (bening prostatic hypertrophy)
- can lead to hydronephrosis and hydroureter
Obstructive urologic disorder
- can result from obstruction of urinary pathway
- instrumentation
- infection can ascend up from bladder
- symptoms: fever, chills, and pain, CVA tenderness (pain when palpating area of kidney), frequency, dysuria
- look sick because other body system are affected
Nephritis - infection of kidney
- caused: bacteria enters bladder
- common in females since urethra is shorter
- in older men due to BPH
- common bacteria: E. coli, Proteus, Pseudomonas
- more common in diabetes
- can be hospital acquired due to cauterization
- look annoyed and frequent urination
Cystitis - infection of the bladder
- involves bladder
- symptoms: dysuria, urgency, frequency, bladder pain, incontinence, hematuria
- findings: pos leukocyte esterase, nitrates, cloudy urine, bacteria in culture
Lower UTI: bladder infection
- involves the kidney
- symptoms are systemic: flank pain, chills, malaise
- findings: fever, pos CVA tenderness, pos UA, bacteria in culture
Upper UTI: Pyelonephritis
In elderly, UTIs often present with
Confusion, disorientation, and hypotension
- arise from UTI/Nephritis > bacteria spread through blood stream and affects the whole body
- seen more often in elderly or those who are physically vulnerable
- symptoms caused by bacterial endotoxins
- fever, chills, confusion, hypotension
- if not treated: death
Urosepsis - septic infection
UA findings of:
- bacteria, WBCs (pyuria), hematuria (blood present), leukocyte esterase (WBC products), nitrites (bacteria present)
UTI
- inflammation of the bladder not associated with known bacteria
- symptoms similar to UTI/Nephritis, but not associated with bacteria: painful bladder, frequency/urgency
- caused from infections (previous), autoimmunity, neurogenic sensitivity
Interstitial cystitis - painful bladder syndrome
Interstitial cystitis that shows small tears and hemorrhages of a thinning bladder wall
Non-ulcerative
Interstitial cystitis where bladder shows one or more ulcers (called Hunner ulcers)
- ulcers only seen with over-distention of the bladder
Ulcerative
Pelvic floor isn’t stable
- common with women who gave birth
- jumping = bladder leak
Stress - urinary incontinence
Muscle in bladder is spastic or overreactive
Urge or overactive bladder (OAB) - urinary incontinence
Over lapping of different types of urinary incontinence
Mixed
Can’t fully empty the bladder
Overflow - urinary incontinence
Caused by spinal cord injury and client isn’t able to hold or release urine
Neurogenic bladder - urinary incontinence
Client isn’t taking care of their needs to void, avoiding their bladder
Functional - urinary incontinence
What does kidney release
Erythropoietin and VitD
Filtration system order
Bowman’s capsule > glomerulus > proximal tube > loop of Henle > distal tubule
Blood begins process of filtration, pushed through with force of hydrostatic pressure
Bowman’s capsule
Amount of blood filtered by the glomerulus per min - gradually decreases after age 30
Glomerular filtration rate
Term indicating filtration system where waste is exchanged and fluid retained or excreted
- body is fine tuning absorption needs and getting rid of waste
- working part of kidney
Nephrons
More water is absorbed than electrolytes
Proximal tubule
- most water and salt is reabsorbed
- where urea (nitrogenous waste) is excreted
- levels of urea are measured by BUN
Loop of Henle
High BUN
Azotemia
More electrolyte absorption than water
Distal tubule
- breakdown product of muscle
- excreted by kidneys
- when blood level increase = kidneys not functioning properly
Blood creatinine
- UA
- 24 hr test decrease creatinine in urine = decrease in renal function
Urine
- breakdown of purine
- increased levels = poor kidney function
Uric acid
- amount of blood filtered by the glomerulus per minute
- decreased GFR = decrease renal function
GFR
- urea is waste product
- blood level increases = decrease renal function
BUN
- increase blood creatinine
- decrease creatinine in urine
- increase uric acid
- decrease GFR
- increase BUN
Renal function decreased and not functioning properly
Protein in urine
Proteinuria - protein shouldn’t be there
- caused by calcium struvite (caused by upper UTI), uric acid, and cystine
- severe pain from the costovertebral angel of back to abdomen and lower groin
Nephrolithiasis
- formation of stone (calculi) in the kidney
- risk for developing: dehydration, hypercalcemia, hyperparathyroidism (release more calcium), gout (precipitation of uric acid), high purine intake (can’t process uric acid)
- deep visceral pain
Nephrolithiasis
Can lead to obstruction, back up of urine in kidney (hydronephrosis), edema in renal pelvis, restricted blood flow, compression of kidney tissue, ischemia, and renal failure
Nephrolithiasis
- caused: glomerulonephritis, diabetes, autoimmune
- patho: endothelia cell and basement membrane damage leading to loss of protein (albumin), leading to edema because of decrease oncotic pressure
- clinical presentation: albuminuria, low blood albumin level, edema
- decrease albumin = dec fluid into vascular = fluid moves to tissues = edema
Nephrotic syndrome
Abrupt insult to the kidney that leads to rapid decrease in renal filtration and an accumulation of nitrogenous waste in body
- can lead to end stage renal disease
Acute kidney injury
3 major causes od AKI
pre, intra, and post renal
- issue happens before kidney
- sudden and severe drop in BP or interruption of blood flow to the kidneys from severe injury or illness
- affect perfusion to kidney
Prerenal
Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood flow
Intrarenal
- urine back flows to kidney, and kidneys don’t like urine
- sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury
Postrenal
