Test 5 (Ch. 18&8 Flashcards
Treatment for Acute Renal Failure include:
Due to the high mortality rate, the major concern of Treatment is to identify and correct the cause
Reverse the primary problem as quickly as possible
Restrict Fluid Intake (Reduce strain on the Kidneys)
Monitor Fluid Intake and Output
Dialysis (Usually continued for 1 - 2 Weeks)
X-ray of the Urinary Tract
Contrast material is introduced directly into the Bladder and Ureters through a Cystoscope
Retrograde Pyelogram
What is the most important factor in determining prognosis?
Tumor Thickness (measured in millimeters)
The Most Common Causative Agent is:
Escherichia coli (E. coli)
Inflammation of the Urinary Bladder is called?
Most Common Site of the UTI
Cystitis
What represent 50% of the Cancers diagnosed in the U.S?
Skin Cancers
True or False
Women are far more susceptible to Ascending Urinary Tract Infections than men due to the fact that the Urethra is shorter
TRUE
Abnormal Constituents (Present in Significant Quantities) GLUCOSE AND KETONES:
Indicates when diabetes mellitus is not well controlled
What are The “ABCD” Signs That a Mole or Nevus May be a Melanoma.
Change in Appearance: “Area of the mole is increased”
Change in Border
Change in Color
Increase in Diameter
Directly introduce bacteria into the Bladder
Cystoscopy
A protective barrier between the Bladder’s Epithelium and Bacteria is called?
Mucin
Signs and symptoms of Pyelonephritis include:
Pyuria: Numerous pus filled Abscesses frequently form and rupture
Bacteruria, Hematuria and Proteinuria
Fever and Chills
Flank or lower back pain
Associated with inflammation and stretching of the Renal Capsule
Frequency or Dysuria: Usually originates as an Ascending Infection
Patients taking the above medications should increase their Fluid Intake to reduce the risk of ____________
Kidney damage
Related to Sun Exposure (UV light)
Malignant Melanoma (Severe, blistering sunburns in early childhood and intense, intermittent sun exposures)
Prostate fluid has antimicrobial properties that would function to do what?
protect the Male’s Urethra from colonization
Inherited disease
Disorder in which normal renal tissue is replaced by grapelike fluid-filled Cysts, causing them to become hugely distended
Polycystic Kidney Disease
Skin cancers that are typically associated with total cumulative UV exposure are?
Basal Cell and Squamous Cell Carcinoma
Diagnostic Tests for Pyelonephritis are:
History & Physical: Note some Tenderness during palpation of abdominal or lumbar regions
Urinalysis with C&S: Presence of bacteria, pus, protein and blood
Urinary (WBC) Casts indicate Pyelonephritis
Not always present in the urine
X-rays: Reveal Hydronephrosis - Enlarged Kidneys
Where does malignant Melanoma originate from?
Melanocytes of the base layer of the Epidermis or from a Nevus (Mole)
Due to an initial change in bicarbonate ion levels
Associated with Renal Failure, Shock, Diabetic Ketoacidosis, Severe Diarrhea. ___________
Metabolic Acidosis
ANTIBODY LEVELS:
A low titer is common in most people since ___________
Stretococcal infection is common
Microscopic Molds of the Tubules are called:
Casts
Elderly and Postmenopausal Women appear to produce
Less Mucin
Malignant Melanoma grow quickly and metastasize first to the regional __________
Lymph Nodes
Skin cancer that is more associated with intense, intermittent exposure is?
Malignant Melanomas
Shock following Operations, including Traumatic Shock
Surgical Shock
Infections are diagnosed by
Culture of specific organisms with counts of 100,000 bacteria/ml of freshly voided urine
Most Malignant Melanomas that are diagnosed clinically measure more than ___ mm in diameter
6
X-ray of the Urinary Tract after the injection of a Radiopaque material into a vein. Allows for visualization of Tumors, Obstructions, and Deformities
Intravenous Pyelogram (IVP) Intravenous Urogram
Result of Hemorrhage or Loss Fluid Volume
Hypovolemic Shock
Why is CRF irreversible?
Result of declining number of functional Nephrons over a long period of time
CRF develops when the Neprhon losses exceed 50 – 70% of the total
What is the survival rate with addition to chemotherapy and radiation therapy?
5-year survival
Abnormal Constituents (Present in Significant Quantities) URINARY CAST (microscopic molds of the tubule consisting of bacteria. protein, etc.):
Indicates inflammation of the kidney tubules
Persons with two of the 6 risk factors have a 3.5-fold increased risk of developing ___________.
Malignant Melanoma
Persons with three or more of the above risk factors have a ____________.
20-fold increased risk
Diagnostic Tests for CRF:
History: Patient history may reveal a previous renal disease
Urinalysis: Proteinurea & low Specific Gravity
Urine is very Dilute
BUN and Creatinine: Elevated
CBC: Anemia becomes severe
KUB; IVP: Done to determine the extent of Renal Damage
Serum pH: Evidence of Decompensated Metabolic Acidosis
pH less than 7.35 in the late stages
T OR F
The tubules are primarily affected but the glomeruli are not.
.True
What is a Staghorn Calculus?
a large stone that takes up more than one branch of the collecting system in the renal pelvis of the kidney.
Etiology: The Causes of Acute Renal Failure are Classified as:
- Bilateral Renal Ischemia
- Nephrotoxic Injury
- Urinary Obstruction
- Acute Bilateral Kidney Infection or Inflammation
Abnormal Constituents (Present in Significant Quantities) BLOOD:
Associated with infection, inflammation or tumors in the urinary tract. Also indicates increased glomerular permeability or hemorrhage in the tract.
Signs and Symptoms:Early Signs and Symptoms of CRF
Polyuria: Excessive water loss dominates during Early Stage Disease because the loss of reabsorptive capacity by the Tubules is greater than the reduction in Filtration in the Glomeruli Nocturia: Excessive urination at night High Blood Pressure Anemia: Caused by: Bone Marrow Depression Decrease in Erythropoietin Decreased Cellular Metabolism
Glomerulonephritis and Pyelonephritis can also cause:
Actute Renal Failure
Treatment for CRF include:
Dialysis
2. Kidney Transplant may be attempted to prolong life
Concern: Drug dosages need to carefully monitored due to poor excretion from the kidneys!
Pelvic and Low Back Pain indicate that the Infection is ____________.
Ascending toward the Kidneys
Diagnostic Tests for Acute Renal Failure include:
Urinalysis: Elevations of Protein, Glucose, Leukocytes and Casts
Decreased Specific Gravity: Earliest manifestation indicating Tubular Damage and the inability to concentrate urine
BUN and Serum Creatinine would be elevated
Electrolytes: Elevated levels of Potassium
KUB or IVP
Diagnostic Tests: Electrolytes
Hyponatremia
Hyperkalemia
Hypocalcemia
Hyperphosphatemia
The more serious Skin Cancer is what?
Malignant Melanoma
Renal Ischemia occurs whenever there is a _____________
A pronounced drop in the Systemic Blood Pressure (Could also be a result of Cardiac Damage)
Both Antistreptolysin (ASO) and Antistreptokinase (ASK) titers are used to make a Diagnosis of __________________.
Postreptococcal Glomerulonephritis
Examples of Nephrotoxins of:
Solvents: Carbon Tetrachloride Heavy Metals: Lead, Arsenic, and Mercury Pesticides Antibiotics: Ampicillin, and Penicillin Analgesics: Aspirin and Acetaminophen
Infections are diagnosed by _________
with counts of _______ bacteria/ml
Culture
100,000
Any type of blockage in the Urinary System will result in back pressure that will cause urine to accumulate into the ____________.
Kidney
Inflammation of the Renal Pelvis and the Medullary Tissue is called?
Pyelonephritis
Presence of Nitrogenous Wastes, especially Urea in increased amounts in the blood.
Azotemia
ANTIBODY LEVELS:
Elevated or increasing Titers indicate ______________
Recent or prolonged Infections.
The gradual, progressive deterioration of Kidney Function
Chronic Renal Failure (CRF)
Poor Prognosis
Later Signs and Symptoms of CRF
(End-stage Failure): Continued
Neurologic signs and symptoms as a result of Azotemia
Mental Confusion, Drowsiness, Convulsions, and Coma
Bone Marrow Depression and blood cell function is impaired
Increase bruising / bleeding
Cellular Metabolism is Impaired
Systemic Infections: Pneumonia is common
Final Comment: Anemia, Acidosis and Azotemia are the indicators of Chronic Renal Failure
Kidney Failure is usually ________, if the primary problem is treated successfully
reversible
Complications for Acute renal failure include:
Complete Kidney Failure
Death
Usually first test performed and this X-ray surveys the abdomen.
KUB (Kidneys, Ureters, and Bladder)
Diagnostic Test for Kidney Function
Creatinine Clearance (Measures the amount of Creatinine excreted in urine over a 24 hour period)
Chronic Renal Failure (CRF) is ____________
Irreversible
When would the stones typically cause clinical manifestations?
When the stone enters the Ureter and obstructs the lumen, a colicky pain occurs as the rhythmic contractions of the ureter attempt to advance the stone (renal colic)
Sometimes flank pain occurs because of distention of the Renal Capsule
Intrarenal Damage caused by exposure to Toxic Substances
Nephrotoxic Injury
Stages in Chronic Renal Failure:
End-stage Renal Failure - Uremia
Greater than 90% Nephron loss
GFR is greatly reduced
Marked Oliguria or Anuria
Fluid and Electrolytes are retained
Nitrogenous Waste Products (Urea & Creatinine) build up in the blood reaching Toxic levels
“Poisoning with Urine”
Azotemia: Presence of Nitrogenous Wastes, especially Urea in increased amounts in the blood
As Kidney function diminishes, every Organ in the body is affected, accounting for the host of symptoms presented by the individual with CRF
Complications in severe infections of Pyelonephritis include:
Acute Renal Failure
Localized abscesses may form in the Medulla and extend in the Cortex to the surface of the Capsule
Etiology: Result of Long Term Kidney Disease
Nephrosclerosis
Associated with Systemic Hypertension: Hardening of the Arteries or Arterioles
Results in a Decrease in blood supply to the Kidneys
Also stimulates Renin secretion which increases B/P
Chronic Bilateral Kidney Inflammation or Infection:
Chronic Glomerulonephritis
Severe Pyelonephritis
Diabetes Mellitus causing Diabetic Nephropathy
Indicate a problem from higher up in the Urinary Tract
Casts
Early Stage - Decreasing Renal Reserve
60% of Nephron loss
Decrease in GFR
Creatinine Levels are consistently higher but within Normal limits
BUN is Normal
Asymptomatic: Remaining Nephrons are able to adapt and increase their capacity for Filtration
Used to determine the position of the Kidneys, Ureters and Urinary Bladder
Also utilized to check for gross abnormalities
KUB (Kidneys, Ureters, and Bladder)
What would an urine unpleasant order indicate?
infection or resulting from dietary components or medications.
May enter the Kidneys through the blood stream and may cause Pyelonephritis
Blood-borne Infection
Indicates decreased Erythropoietin secretion and/or Bone Marrow Depression
Anemia
Nitrogenous waste and is constantly being released from Muscle
Excreted primarily by the Kidneys
Serum Creatinine
Common Causative Factors of UTI’s in Both Sexes are:
Incontinence: Inability to control urination and results in Bladder Retention of Urine
Stasis of Urine: Any Obstruction to the flow of Urine
Infection may also be the result of Immunosuppression: Decreased Host Resistance
Diabetes Mellitus: Vascular impairment or Glycosuria
Glucose in urine provides a good media to support bacteria growth
Food for Microbes
Recurrent or Chronic Infections can lead to Fibrous Scar Tissue forming over a Calyx, resulting in loss of Tubule Function
Chronic Pyelonephritis
In Renal Failure, plasma levels Increase as the Glomerular Filtration Rate (GFR) ________.
Decrease
This can compromise excretion and directly damage _________.
Renal Tissues (Examples: Renal Calculi, Blood Clots or Tumors)
Hemoglobin is Toxic to the Tubule Epithelium and results in ___________ and ___________
Inflammation and Necrosis
Examination inside the Urinary Bladder with an lighted instrument
May be used in performing a Biopsy
Cystoscopy
Makes up the normal flora of the periurethral area of women
Lactobacillus (Typically provide defense against pathogens)
Damaged RBC’s release their _________ which accumulates in the Tubules
Hemoglobin
Signs and Symptoms of Inflammation of cystitis include:
Lower Abdominal Pain Urinary Frequency and Urgency Dysuria Bacteriuria, Hematuria and Pyuria Urine appears Cloudy because of the presence of Leukocytes Foul Smelling Urine Spasms of the Bladder
What is the prognosis of malignant melanoma?
variable depending on tumor thickness, location, type of lesion, and level of invasion.
The kidney function test is also called:
Blood Urea Nitrogen (BUN)
Signs and Symptoms of Acute Renal Failure are:
Elevation of the Blood Urea Nitrogen (BUN) and Serum Creatinine
Oliguria: Reduction in urine output
Less than 500 ml/24 Hours
May continue for several weeks, depending on the severity of damage and on regeneration capacity of the Epithelium of the Tubules
Anuria: Failure of Kidneys to produce urine
Hyperkalemia
Gastrointestinal Disturbances
Neurologic Changes
General S&S of CRF Include:
Anorexia, Nausea, Fatigue, Weight Loss, Weakness and Exercise Intolerance
Decreased blood flow to the Kidneys and results in damage to the Basement Membrane of the Nephron Tubules.
Bilateral Renal Ischemia
Onset of pyelonephritis is usually ______
Acute
TRUE OR FALSE:
Both the presence of RBC’s and WBC’s in the Urine Specimen?
TRUE
Causes muscle weakness and can slow the heart to the point of Cardiac Arrest
Hyperkalemia
Basal Cell and Squamous Cell Carcinoma are typically associated with what?
Total cumulative UV exposure
Treatment for Pyelonephritis include:
Antibiotics
Increased fluid intake
Surgery to relieve a possible Obstruction
Hospitalization may be required during initial treatment
What is the end product of protein metabolism?
Urea (Normally found in blood)
Later Signs and Symptoms of CRF
(End-stage Failure):
Oliguria and Anuria: As Glomerular Function is even further reduced
Low / Fixed Specific Gravity: Urine that is produced is characteristically Dilute as a result of failing tubular concentration mechanisms
Congested Heart Failure with Pulmonary Edema
Arrhythmias: Due to high levels of serum Potassium
Urine-like Breath Odor: May develop in the terminal stage or if an infection is present
Failure of the Kidneys to activate Vitamin D (needed for Calcium absorption from the GI tract and metabolism), combined with urinary retention of Phosphate ions, results in:
Hypocalcemia and Hyperphosphatemia
Stimulates the Parathyroid Gland to release PTH and causes Osteoclasts to release Calcium ions from Bone tissue
Leads to the development of Osteodystrophy
What is the pathophysiology of Pyelonephritis
Purulent exudate fills the Renal Pelvis and Calyces and the Medulla becomes Inflamed
Decreased blood flow to the Kidneys and results in damage to the Basement Membrane of the Nephron Tubules
Bilateral Renal Ischemia (The severity of the damage to the Tubules varies)
TRUE OR FALSE:
Shock after an Incompatible Blood Transfusion
True
What type of men can develop a UTI
Older Males With Prostatic Hypertrophy and Retention of Urine
Pathogens enter via the Urethra Bladder Ureter Kidney
Ascending Infection
Treatment for malignant melanomas include:
Surgical Excision
Extensive amount of tissue around and below the lesion is excised to ensure that all malignant cells are removed
Possible Skin Grafts
Radiation and Chemotherapy
Used to treat tumors that have distant metastases
Interferon (alfa-2b)
The “E” stands for an ______________.
evolving lesion over time (Elevated or raised appearance)
Streptococcal Antibody Test is called:
Antibody test Antistreptolysin O (ASO):
What would cloudy urine indicate?
presence of large amounts of protein, blood cells, bacteria or pus
Failure of the Cardiovascular System to meet tissue needs and this would result in a diminished blood flow to the Kidneys
Shock
Usually damage the Basement Membrane of the Tubular Epithelium
Nephrotoxins
Abnormal Constituents (Present in Significant Quantities) SPECIFIC GRAVITY:
Indicates the ability of the tubules to concentrate the urine; usually related to renal faliure
6 risk factors that make certain individuals more prone to the development of Malignant Melanoma include:
- Family history of Malignant Melanoma
- Presence of blond or red hair
- Presence of marked freckling on the upper back
- History of 3 or more blistering sunburns prior to age 20
- History of 3 or more outdoor jobs as a teenager
- Presence of Actinic Keratosis
What type of the diagnostic test would John’s physician order to confirm his diagnosis of Kidney stones?
KUB, IVP, CAT Scan: Presence of stone on x-ray and demonstrate an obstruction
Regeneration of the Tubular Epithelium and Restoration of function depends on ___________
The degree of damage
Rapid, usually Reversible decline of Renal Function is _________
Acute Renal Failure (Develops rapidly)
Middle Stage - Renal Insufficiency
75% Nephron loss
GFR is decreased approximately 20% of normal
Elevated levels of BUN and Creatinine
Blood Pressure is Elevated
Osmotic Diuresis:
Decreased Renal Tubule Function
Tubules fail to Concentrate the Urine
Osmotic Diuresis occurs as the remaining Nephrons filter an increased Solute load
End Result: Large Volumes of dilute urine with a Low Specific Gravity
What is the range in percentage that of woman have relapsing Infections within 7 - 10 Days?
20-25%
What would all contribute to the development of UTI
Pregnancy, Scar Tissue, Congenital Defects, Renal Calculi and Vesicoureteral Reflux
Treatment for Cystitis include:
Antibiotics (Sulfa Drugs)
Fluids may be Increased to promote urinary outflow
Prophylactic Measures: Cranberry juice may be recommended because it’s tannin content (Acid Substance) appears to decrease the ability of E. coli to adhere to the Bladder Mucosa and/or Proanthrocyanidins (PACs), an anteribacterial substance
Certain Kidney Diseases may interfere with the ability to Excrete the Urea properly. What would be the result of this?
Increased level of Urea in the blood
Headaches, Drowsiness and CNS Depression
Due to accumulation of Nitrogenous Wastes
May progress to a Coma
Neurologic Changes
WHAT HAPPENS TO THE EXCRETION OF URINE IF THE BLOOD PRESSURE DECREASES AS WITH SHOCK?
It also Decreases
Acute Renal Failure is ___________
Reversible
What type of Complications may develop when the Calculi are located in the Kidney or Ureter?
Hydronephrosis with dilation of the Calyces and Atrophy of Renal Tissue as a result of increase back pressure of urine.
Later Signs and Symptoms of CRF
(End-stage Failure):
Uremic Frost on the skin
Pale, frostlike deposit of white crystals on the skin
Urea and other Metabolic Waste Products that cannot be excreted by the Kidneys are eliminated through the small superficial capillaries into the Skin and they collect on the surface
Dry, pruritic, and hyperpigmented skin, easy bruising
What are most stones composed of?
Calcium salts
What is the normal urine pH?
4.5.-8.0
Abnormal Constituents (Present in Significant Quantities) BACTERIA AND PUS:
Associated with infection in the urinary tract
Complications of CRF include:
Increase in Systemic Infections such as Pneumonia
Due to poor tissue resistance related to Anemia, Fluid Retention and Low Protein Levels
Children with Kidney Failure have Retarded Growth
Death
What would dark colored urine indicate?
may indicate hematuria, excessive billirubin or highly concentrated urine
Etiologic Factors include of MM:
Immunosuppression
UV Light Exposure, including exposure at Tanning Salons
Nausea, Vomiting and Diarrhea
Gastrointestinal Disturbances
(Renal Calculi Formation) in order:
a. Usually grow on papillae or in a renal tubule
* Some develop in renal pelvis
b. Begins with a nidus
* First crystal
c. Nidus becomes trapped within the urinary tract
* Lodged in a renal calyx
d. Nidus attracts other crystals
* Grows into a stone
When damage is severe or infection or other complications are present the prognosis is _____.
Fatal
