Renal - UTI, Pyelonephritis, GN, Calculi, Incontinence, Failure Flashcards
What is a lower UTI?
A urinary tract infection.
What are the two most common infections in the body?
Upper respiratory infections and then UTI’s.
What causes UTIs?
A varitey of bacteria, usually E. Coli
How would you describe the path of infection of a UTI?
Ascending infection.
Urine is ____ unless there is an infection?
Sterile
Why are UTI’s so common in women?
Women have a lot of normal flora in the vagina. When flora migrate into the urethra it causes an infection.
How is the inside of the bladder protected from direct contact or urine?
The mucin layer, which is a glycoprotein secretion lining the inside of the bladder which prevents direct contact of urine and epithial tissue.
What are the body’s defences against UTIs?
Local immune response, Mucin layer, Washout, Prostatic fluid (men), Periuretheral flora (women).
What is washout, and how does it protect from UTIs?
Washout is daily urine output. Typically, urine stream should be forceful enough in an healthy individual to “washout” bacteria and flora that should not be there.
What are some risks that increase the likelyhood of developing a UTI?
Catheterization, Obstruction
What trick do bacteria have at their disposal to ensure proliferation on a catheterized individual?
Bacteria are able to secret a biofilm which ensure they can attach themselves to the catheter.
What are two examples of obstruction?
Urine statis, Reflux.
What are the manifestations of UTIs?
Acute onset, Frequency (need to urinate often), Dysuria (painful urination d/t inflammed tissue), Lower abdominal/back pain.
How are UTIs diagnosed?
Manifestations, Urinalysis
What will the urinalysis look for? What drugs would be given? Would they ever change?
The urinalysis will look for signs of infection, leukocytes, erythrocytes, maybe the specific bacteria. The urinalysis will be cultured if bacteria is found, but Antibiotics would be given right away. The Abx may change if they are found to be ineffective to the bacteria that is found.
What is treatment for UTIs?
Abx, Tx the underlying cause.
What is Pyelonephritis?
Pyelonephritis is an upper urinary tract infection. It is an inflammation of the renal pelvis and parenchyma. There are both acute and chronic forms of pyelonephritis.
What is the etiology and risk factors associated with pyelonephritis?
Pyelonephritis is cause my various bacteria, usually E. Coli. The risks of pyelonephritis are increased by suppressed immunity, catherterization, urinary reflux, and diabetes.
What is the Pathophysiology of Pyelonephritis?
Pyelonephritis is an ascending infection and inflammation which progesses from the urethra - bladder - ureter - kidney. Once the infection has reached the kidney the inflammation causes tissue damage through fibrosis and scar tissue causing a decrease in renal function.
What are the characteristics of chronic Pyelonephritis?
Recurrent inflammation leading to obstruction or reflux. Renal damage leading to renal failure.
What are the manifestations of pyelonephritis?
Acute onset, Lower back pain, Fever, Dysuria, Frequency, Urgency, Pyuria, Severe HTN.
What manifestation is seen only in chronic pyelonephritis?
Severe HTN.
Why is HTN a manifestation of chronic pyelonephritis?
Due to blocking passages, the body is not excreting fluid for the body experiences hypervolemia and as a result increased blood volume. This results in hypertension.
What is the treatment for pyelonephritis?
Antibiotics, typically for 10 - 14 days.
What are the five categories of Glomerular disease?
- Nephrotic Syndromes. 2. Nephritic Syndromes. 3. Sediment disorders. 4. Rapidly professive glomerulonephritis. 5. Chronic glomerulonephritis.
What is Glomerulonephritis (GN)?
It is a type 3 hypersensitivity denoted by glomerular inflammation. There are several types.
What is the common form of Glomerulonephritis that we covered in class?
Acute Postinfectious (Proliferative) Glomerulonephritis.
What is Glomerulonephritis preceeded by? When does it occur?
Beta hemolytic strep infection which occurs in the pharynx or skin and last for about 7-12 days.
Who is typically affect by Glomerulonephritis? What is the recovery percentage?
Mostly occurs in children. There is a 95% recovery rate, provided it is identified and treated.
What is the percentage of occurance of glomerulonephritis in adults that become renal failure?
30%
What type of sensitivity is Glomerulonephritis?
It is a type 3 hypersensitivity.
What is an immune complex? Where do immune complexes get trapped during Glomerulonephritis? What is the effect of their entrapment?
An immune complex is when an antigen and an antibody become bound together. They become trapped in the glomerulus and impede the glomeular filtration.
In glomerulonephritis where do the immune complexes travel, where they then proceed to cause damage?
The immune complexes escape enzyme detection and travel to the capillairies in the glomerulus.
What are the two actions which occur in the capillaries once an immune complex become trapped in the capillary?
- The immune complex plugs the wall and impeded perfusion. 2. Macrophages remove the IC but cause inflammation and damage the endothelium impeding renal function.
What is a type 3 hypersensitivity always preceeded by?
An infection.
What are two characteristics of Glomerulonephritis, specifically the Type III hypersensitivity outcomes?
Hypercellularity (Leukocytes, Mesangial, and Endothelial Cells, Glomerular enlargement.
What is the expected changes to a patients urinary output when suffering from glomerulonephritis?
Oliguria, followed by proteinuria and hematuria.
What is oliguria?
Inadequate urine volume
Why does a glomerulonephritis patient experience porteinuria?
Protein moves into the urine because of increased permability which results from damaged endothelium.
If a patient with glomerulonephritis is experiencing hematuria, what is causing it?
Damage to the capillaries in the glomerulus.
What renal function test will be elevated in a patient with glomerulonephritis, and why?
BUN and Creatinine will both be elevated because the kidneys will not be able to properly excrete them.
Why will Sodium and water retention occur in glomerulonepritis? What complications will this result in?
Retention will occur due to the kidney’s inability to filter fluids. A complication of the Na and H20 retention will be HTN, and edema. Due to the increased hydrostatic pressure and decreased osmotic colloid pressure.
Why would a patient with glomerulonephritis have low osmotic pressure?
Due to proteinuria.
What is treatment for Glomerulonephritis?
Symptomatic treatment.
Are most cases of Glomerulonephritis self-limiting?
Yes, usually with-in a couple weeks.
What are Renal Calculi?
Kidney stones, which migrate into the urinary tract and can then lead to obstruction.
What is another name for reanl calculi?
Nephrolithiasis
Which sex is more likely to have nephrolithiasis? How many times more likely?
Higher incidence rates in men. 2 - 3 times higher.
What is the etiology of renal calculi?
Complex interaction between blood and GI nutirents in the kidney, forming calculi, which leads to structural changes in the urinary tract. There is an increased concentration of blood and urine components. There are also dietary and metabolic factors.
What is a “stag-horn” calculis?
A stone which takes the shape of an antler or horn. The “sharp” end inbeds into the kidney.
What is the pathophysiology of Nephrolithiasis?
The kidney secretes 3 different proteins which inhibit crystallization. There is an increase in the concentration of the solute and/or urine stasis which increases precipitators in the urine, a nucleus in formed leading to crystalization.
What are the four types of kidney stones and what are they made up of?
- Calcium (oxalate and phosphate).
- Magnesium ammonium phosphate (struvite).
- Uric Acid (urate).
- Cystine.
What are the manifestations of nephrolithiasis?
Sever renal colic pain associated with migration of stones (min to days). Distended ureter (hydronephrosis). Non-Colicy pain from distension of the renal pelvis and calyces. Nausea. Vomiting. Diaphoresis.
How is diagnosis of nephrolithiasis made?
Pain pattern (not migratory like appendicitis). Ultrasound. CT Scan. Urinalysis (microscopic - signs of infections, crystals). IVP (intravenous pylorgram).
What is the treatment for nephrolithiasis?
90% of stones are passed spontaneously (if
What is lithotripsy?
A non-invasive treatment of kidney stones using acoustic pulse to break apart kidney stones.
What is urinary incontinence?
Involuntary voiding or the bladder.
What are the three types of urinary incontinence?
- Stress incontinence. 2. Overflow incontinence. 3. Overactive bladder.
What causes stree incontinence?
A weak sphincter. Increased intra-abdominal pressure (coughing-laughing). Change in urethro-vesticular angle (in women)
What causes overflow incontinence?
Intravesicular pressure > urethral pressure. Retention and bladder distention.
What causes overactive bladder incontinence?
Hyperactive detrusor muscle. Neurogenic/Myogenic problem.
What is the treatment for urinary incontinence?
Drugs. Surgery (artifical sphincter, prosthesis).
What is acute renal failure? What characteristics does it present with?
Loss of renal function, characterized by fluid-electrolyte imbalance and azotemia. There is a decrease in the GFR.
Is acute renal failure reversible? Self-limiting?
It is usually reversible, but it is NOT self-limiting.
What is the minimum amount of urine output per day to prevent azotemia?
400ml
What output is defined as oliguria?
100 - 400 ml/day
What output is defined as anuria?
