Renal/Urologic patho Flashcards
Transport maximum (Tmax)
molecules such as glucose need transport proteins for reabsorption
when Tmax for glucose is exceeded it can not be reabsorbed and is excreted thru the urine
glucosuria is a sign that blood glucose levels excees Tmax
urinalysis
↑ specific gravity: concentrated w/ other molecules
↓ specific gravity: diluted urine
ketones: diabetes
blood/protein in urine means glomeruli issue
nitrate and leukocyte: UTI
crytals: dehydrated
epithelial cells: urinary tract cells sloth off
RBC “Ghost”
will just see membrane because the cell is broken down
urine odor
ammonia present
casts
molds of renal tubules (composed of proteins)
urine electrolytes
sodium
potassium
urine cytology
cytologist assess abnormal cells shed from urinary tract
get done if hematuria and dont knwo cause
creartinine clearance
not used as much
test reflects glomerular filtration rate (GFR)
requires 24hr urine spec and one blood specimen for plasma creatinine
↓creatinine clearance = ↓Glomerular function
serum creatinine level
serum creatinine level rises as renal function declines
blood urea nitrogen (BUN)
as BUN rise renal function declines
Estimated GFR (eGFR)
obtainee with a single blood sample:
measures plasma creatinine and adjusted for:
*age
*sex
*confounding population factors
↓eGFR = ↓glomerular function
CO2
70% bi carb
10% disolve in plasma
bicarb is a base so its mainly base so it can cause alkalosis if increased
consequences of urinary tract obstructions
hydroureter
(ureter dilated due to hydrostatic pressure)
hydronephrosis
(kidney dilated due to hydrostatic pressure
UTI
Renal failure
urinary tract obstructions
Inherited polycystic kidney disease
2 forms of genetic transmission
autosomal dominant (adult onset)
autosomal recessive (infant onset)
urinary tract obstruction
urethralvesical reflux
vesicoureteral reflux
urethralvesical reflux
*from urethra into bladder
vesicoureteral reflux
*from bladder into ureter
flap isnt there and pressure pushed back up
urinary tract obstruction
Neurogenic bladder (tone issue)
spastic bladder (overactivity)
*failure to relax and store urine
flaccid bladder
*failure to contract to empty urine
nonrelaxing external sphincter
urinary tract obstruction
specific to men
benign prostactic hyperplasia
prostatic cancer
urinary tract obstruction
kidney stones
calcium stones:
*calcium oxalate or phosphate
struvite stones:
*mg, phos, ammonium
uric acid stones
urinary tract obstruction
kidney stones
clinical manifestations
pain
hematuria
N/V/D
urinary tract cancer in adults
prostatic cancer
bladder
renal carcinoma
urinary tract cancers in children
wilms tumor (nephroblastoma)
*embryonic origin
urinary tract infections
cystitis
pyelonephritis
cystitis (bladder)
pyelonephritis (kidney)
urinary tract infections
hemolytic uremic syndrome (HUS)
how we get
causes
ingesting undercooked meats contaminated with bacteria:
E coli
causes:
acute renal failure
hemolytic anemia
thrombocytopenia
preceded byt a GI infection (starts out and looks like that but its really urinary tract infection)
immune mechanisms in glomerular disease
type 2 immunoglobulin-mediated hypersensitivity response
type 3 immune complex hypersenstivity response
type 2: IgA usually and they antigen and antibody bind and cause inflammation
type 3: antigen-antibody complex get out of the basement membrane and cause damage
alterations in glomerular function
acute glomerulonephritis (acute nephritic syndrome)
acute postinfectious glomerulonephritis:
*post-streptococcal infection
rapidly profressive glomerulonephritis:
*autoimmune response to antibodies in glomerular basement membrane ad they also attack lungs
alterations in glomerular function
chronic glomerulonephritis
risk factors
DM
HTN
IgA nephropathy
systemic lupus erythematosis
alterations in glomerular function
nephrotic syndrome
glomerular damage—
protien leak out—
hypoproteinemia (bc its in urine now)—
↓plasma pressure due to less proteins and
hyperlipidemia
causes of acute kidney injury
prerenal
decrease renal perfusion
cause:
hypovolemia
shock
causes of acute kidney injury
intrarenal
some type of acute injury originating within the kidney itself
EX: acute tubular necrosis
causes of acute kidney injury
postrenal
obstruction to outflow from kidney
stages of chronic kidney disease
1-5
1: normal function
5: end stage (dialysis or transplant)
chronic kidney disease
clinical manifestations:
altered fluid electrolyte balance
altered:
*sodium and water: lead to HTN and cardiac dysfunction
*postassium: hyperkalemia
*acid-base balance: metabolic acidosis
*phosphate and calcium: metabolic bone diasease
chronic kidney disease
clinical manifestations:
urine output
decline in GFR:
*oliguria
*↓creatinine clearance
*↑plasma creatinine
*↑BUN
azotemia: elevation of nitrogenous wastes only
uremia: urine in blood
(molecules normally eliminated in urine accumulate in blood and become toxic)
chronic kidney disease
clinical manifestations:
skin
hematologic status
drug elimination
altered skin integrity:
*formation of phos and ca crystals
altered hematologic status:
*circulating toxings contribute to:
-chronic anemia
-coagulopathies
-altered immune function
altered drug elimination
*renal eliminition is decreased leading to prolonged half life of drug in blood (reduce dose)
