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Unit 18 Flashcards

1
Q

pyelonephritis

A

upper uti

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2
Q

what does an upper uti include

A

inflm of renal pelvis and parenchyma

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3
Q

et of pyelonephritis

A

bacteria (usually E coli)

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4
Q

Risks for pyelonephritis

A

supressed IR
cathetorization
urinary reflux
DM/infc in general

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5
Q

pattern of infc in pyelonephritis

A

ascending (urethra->bladder->uretur->kidney)

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6
Q

what does progression of bact in phyeloneph lt

A

kidney scaring

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7
Q

what type of tissue is responsible for kidney scaring

A

inc in fibrous and scar tissue

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8
Q

what is scar tissue formation in GU rt pyeloneph dependent on

A

duration of the infection

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9
Q

what does scar tissue to do renal fx

A

decreases it

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10
Q

chronic pyelonephritis

A

presistant infc or ongoing inflm -> obstr or reflux (str issue)

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11
Q

comp of chronic pyeloneph

A

renal damage -> failure

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12
Q

mnfts of pyelonep

A 
rapid onset w/o warning
those of infc
dysuria
pain
freq/urgency
pyuria
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13
Q

where does a pt feel pain in pyeloneph

A

lower back

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14
Q

what other mnft occurs in chronic pyeloneph

A

sev htn rt retention

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15
Q

dysuria

A

pain rt urine passing over areas of inflm

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16
Q

tx of pyeloneph

A

eradicate bact with abx

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17
Q

how long is the course of abx for acute pyelonep

A

10-14 days PO

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18
Q

what do we add to tx if pyeloneph is chronic

A

anti inflm drugs

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19
Q

what 5 things are defensive factors against lower UTIs

A 
local IR
mucin layer
washout
prostatic fluid
microbial antagonism
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20
Q

how does a mucin layer defend utis

A

glycoprotein that sits ontop of epith tissue forming barrier between bact and bladder wall

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21
Q

what str secs mucin

A

bladder

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22
Q

fx of washout in uti defense

A

forceful stream of urine flushes out any microbes that may have entered urethra

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23
Q

fx of prostatic fluid in uti defense

A

contain anti microbial properties

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24
Q

fx of microbial antagonism in uti defense

A

normal periurethral flora provides defense against abn flora in their niche

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25
when is there inc chance for uti
when risks > defensive factors
26
risks for uti
cathertorization | obstr
27
how is cathetorization a risk for uti
bact attatch to cathedor surface and coat themselves with a biofilm that protects it from pts IR.
28
how is obstr a risk for uti
urine statsis dt no washout -> inc reflux which carries microbes
29
mnfts lower uti
acute onset frequency, dysuria lowerabdm/back pain
30
what is pain in lower uti related to
kidney location
31
dx of lower uti
mnfts | urinalysis
32
tx for lower uti
abx | tx underlying cause (obstr, reflux, stasis, cathedor)
33
fx of glomerulus
active sec, absorp, filtration, change permeability
34
5 categories of glomerular disease
``` nephrotic syndrome nephritic syndrome sediment disorders rapidly progressive glomerular nephritis chornic glomerulonephritis ```
35
nephrotic syndrome
inc perm. inc components move out at glom lvl -> ultra filtration, inc fluid (water and lytes) and protein loss
36
nephritic syndrome
dec in perm. dec components move thru -> fluid retention and nitrogenous waste retention
37
sediment disorders
eg hematouria, proteinuria. molecules with inc sizes percipitate out
38
how man chronic glomerulonephritis present
with mfnts of either/including nephrotic s, nephritic s, sediment disordres
39
what type of reaction is rapidly progressive glom neph (RPGN)
type 3 H rxn
40
2 main problems with rpgn
impede filtration | abn deposits and attempted removal by macrophage -> endothelial destr -> inc perm dt "holes" and inflm
41
what must be present for ic to form (rpgn
infection
42
how many weeks does infc usually proceed rpgn
1 - 1.5
43
which pts have inc risk for rpgn
peds pts who had strep throat or dermal infc dt beta hemolytic stretococcus bact
44
what percent of adult cases of rpgn lt rf
1/3
45
2 histologic components of rpgn
hypercellularity | glomerular enlargment
46
hypercellularity
inc number of cells, pathologic hyperplasia, unexplained
47
what 3 cells does hypercellularity normally affect
wbc mesangial (between caps) endothelial cells
48
why does glomerular enlargement occur in rpgn
inflm and swelling
49
mnfts of rpgn
impeded filt and perm olgiuria followed by proteinuria and hematouria inc bun, creatinin fluid retention
50
what is olgiuria in rpgn rt
dec urine vol rt dec perm in glomerulsu
51
what is proteinuria in rpgn rt
rt tears in endothelial lining allowing large molecules to escape
52
what hematuria in rpgn rt
cap damage
53
why is there an inc in bun, creatinin in rpgn
azotemia
54
what are the 2 serious comps rt fluid retention in rpgn
sev htn rt inc vascular volume | systemic edema rt inc hsp dt fluid rtention and l/o protein lt dec OP
55
how do we tx rpgn
self limiting with monitors by inc renal fx and symptomatic tx
56
how long is recovery of rpgn
several weeks post onset
57
renal calculi
kindey stones that form in kidney and move out to any part of ut
58
who has an inc in renal calculi
men, 2-3x inc incidence
59
what plays a large role in the et of renal calculi
diet and metb
60
et of renal calculi
complex interaction rt diet and str changes of ut
61
why does diet play a role in the et of renal calculi
inc [blood] -> inc [filtrate]
62
what does the kidney normally sec to prevent crystallization of urine
3 different proteins present only in kidney
63
what do the proteins sec by kidney not prevent
urine stasis
64
what factors outweigh the benefit of proteins in the kidney (RC)
inc solute concentration and or urine stasis
65
what happens in the kidney when benefits of proteins are outweighed
percipitate in urine forms nucleus -> stone formation
66
what must be present for a kidney stone to form
nucleus
67
4 types of kidney stones
calcium mangesium ammonium phosphate ureic acid cystien
68
contb factors to calcium RC
inc ca, immbolization, vit d intoxification, bone disease
69
tx for calcium rc
underlying cause, inc fluid intake, thiazide diuertics
70
cont fact to mangnesium ammonium phosphate rc
urea splitting uti's
71
tx for mg nh3 ph rc
tx uti, acidify urine, inc fluids
72
cont factors for uric acid rc
formed in acid urine with ph about 5.5 gout high protein diet
73
tx for uric acid rc
inc fluid | alkalize urine
74
cont factors for cystine rc
cystinuria rt inhereted aa metb disorder
75
tx for cystine rc
inc fluid, alkalize urine
76
what is beneficial about knowing the type of rc that has formed
prevents it from happening aagain
77
staghorn rc
stone with a head and horn
78
mnfts of rc
``` sev pain with acute onset renal colic non colicky sev pain n and v diaphoresis ```
79
how long may renal colic last (RC)
mins - days
80
what is renal colic associated with
stone migration
81
why may uretur be distended in RC
stone migration causing obstr
82
what is non colicky sev pain in rc rt
distention of renal pelvis
83
why is somebody with rc have n and v
sev pain
84
dx for rc
cant use pain alone US/CT (Fast) labs - urinalysis IVP
85
IVP
intravenous polygram
86
how does IVP work
inject dye via IV and watch it move thru circulation and into filtrate and urine. visualize blockage. not routine.
87
tx for rc
pain relief nv releif tx cause sx
88
what sx may be used to treat rc
lithopsy - break down of stone using sound waves. fractures of large stones may cause problems distally
89
what do we do to stones passed spontaneosly? which stones do we pass like this
collect them
90
urinary incontinence
voiding incontinently occurs inc with >60yo mnft of a problem
91
et/patho of urinary incontinence (3)
stress incontinence overflow incontience overactive bladder
92
why is stress incontinence occur in UI
p application onto bladder + weakness/incompetence of bladder sphincter rt age. - urethral vesicular angle change in women
93
how does P application of bladder cause stress incontinence
inc intra abdm p can inc p on weak bladder sphincter
94
why does change in urethral vesicular angle cause stress incont.
change in angle rt child birth is more susceptible to changes in P
95
overflow incontinencec
intravesicular P > urethral P or retention and bladder distention
96
overactive bladder
inc activity of bladder rt hyperactivite detuosur m. excessive contr/relax -> inc P -> incont
97
what type of problem may an overactive bladder be
n or m
98
tx for UI
drug (alpha adrenergic agonist) | sx (artificial sphincter)
99
ARF
acute onset/recovery, l/o renal fx w/o warning with dec renal fx
100
2 pressing problems with ARF
fluid/lyte imbal | azotemia
101
what is kidney fx determined by
egfr | output (not always reliable)
102
olguirua
100-400cc output a day
103
what amount of output is barely enough to prevent azotemia
400cc/day
104
anuria
no urine or
105
why does kidney receive blood
filter it | perfusion
106
when cant the kidney perfuse blood
dec blood vol or obstr
107
what perecent of CO assists with kidney perfusion
20-25
108
what happens when less then 20% of co goes to kidneys
problem
109
primary et of arf
def renal perf rt hypovoluima/perf
110
3 groups of et of arf
pre, intra, post
111
what group of et of arf is most common
pre renal
112
what et makes up 80-90 percent of arf
pre/intra
113
pre renal arf
dec renal perf dt dehydration? lt olguiria/ischemia
114
2 consequences of pre renal arf
inadeq perf -> ischema | dec filtration
115
eg of intra renal arf
glomerular nephritis
116
3 phases of intra renal arf
initiating maintencance recovery
117
initiating phase of intra renal arf
problem is just starting from percipitating events
118
maintenance phase of intra renal arf
dec egfr | olgiuria/azotemia
119
recovery phase of intra renal arf
inc time dt tissue repair. grad inc in egfr. address cause
120
post renal arf
eg bph | obstr to urine flow
121
mfnts of arf
olguria/anuria lyte imbal azotemia proteinuria, hemouria
122
complications of arf
htn | edema
123
tx for arf
stat intervention replace fluid and lytes with monitoring dialysis diet
124
why do we monitor when giving fluids to pts with arf
can they handle the inc fluid?
125
types of dialysis
hemodialyis | peritoneal dialysis
126
what diet changes do we make in pts with arf
well balanced, inc calories/carbs | dec protein to dec N waste
127
crf
prog perm damage that occurs in stages
128
stages of crf
diminshed renal reserve renal insufficenty rf
129
diminshed renal reserve
dec kidney fx. dec egfr by > or equal to 50% of normal no mfnts of dec renal fx yet
130
renal insufficency
gfr 20-50% of normal
131
renal failure
gfr
132
what is the gfr of total end stage failure

PAtho (31 decks)

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