Unit 18 Flashcards
pyelonephritis
upper uti
what does an upper uti include
inflm of renal pelvis and parenchyma
et of pyelonephritis
bacteria (usually E coli)
Risks for pyelonephritis
supressed IR
cathetorization
urinary reflux
DM/infc in general
pattern of infc in pyelonephritis
ascending (urethra->bladder->uretur->kidney)
what does progression of bact in phyeloneph lt
kidney scaring
what type of tissue is responsible for kidney scaring
inc in fibrous and scar tissue
what is scar tissue formation in GU rt pyeloneph dependent on
duration of the infection
what does scar tissue to do renal fx
decreases it
chronic pyelonephritis
presistant infc or ongoing inflm -> obstr or reflux (str issue)
comp of chronic pyeloneph
renal damage -> failure
mnfts of pyelonep
rapid onset w/o warning those of infc dysuria pain freq/urgency pyuria
where does a pt feel pain in pyeloneph
lower back
what other mnft occurs in chronic pyeloneph
sev htn rt retention
dysuria
pain rt urine passing over areas of inflm
tx of pyeloneph
eradicate bact with abx
how long is the course of abx for acute pyelonep
10-14 days PO
what do we add to tx if pyeloneph is chronic
anti inflm drugs
what 5 things are defensive factors against lower UTIs
local IR mucin layer washout prostatic fluid microbial antagonism
how does a mucin layer defend utis
glycoprotein that sits ontop of epith tissue forming barrier between bact and bladder wall
what str secs mucin
bladder
fx of washout in uti defense
forceful stream of urine flushes out any microbes that may have entered urethra
fx of prostatic fluid in uti defense
contain anti microbial properties
fx of microbial antagonism in uti defense
normal periurethral flora provides defense against abn flora in their niche
when is there inc chance for uti
when risks > defensive factors
risks for uti
cathertorization
obstr
how is cathetorization a risk for uti
bact attatch to cathedor surface and coat themselves with a biofilm that protects it from pts IR.
how is obstr a risk for uti
urine statsis dt no washout -> inc reflux which carries microbes
mnfts lower uti
acute onset
frequency, dysuria
lowerabdm/back pain
what is pain in lower uti related to
kidney location
dx of lower uti
mnfts
urinalysis
tx for lower uti
abx
tx underlying cause (obstr, reflux, stasis, cathedor)
fx of glomerulus
active sec, absorp, filtration, change permeability
5 categories of glomerular disease
nephrotic syndrome nephritic syndrome sediment disorders rapidly progressive glomerular nephritis chornic glomerulonephritis
nephrotic syndrome
inc perm. inc components move out at glom lvl -> ultra filtration, inc fluid (water and lytes) and protein loss
nephritic syndrome
dec in perm. dec components move thru -> fluid retention and nitrogenous waste retention
sediment disorders
eg hematouria, proteinuria. molecules with inc sizes percipitate out
how man chronic glomerulonephritis present
with mfnts of either/including nephrotic s, nephritic s, sediment disordres
what type of reaction is rapidly progressive glom neph (RPGN)
type 3 H rxn
2 main problems with rpgn
impede filtration
abn deposits and attempted removal by macrophage -> endothelial destr -> inc perm dt “holes” and inflm
what must be present for ic to form (rpgn
infection
how many weeks does infc usually proceed rpgn
1 - 1.5
which pts have inc risk for rpgn
peds pts who had strep throat or dermal infc dt beta hemolytic stretococcus bact
what percent of adult cases of rpgn lt rf
1/3
2 histologic components of rpgn
hypercellularity
glomerular enlargment
hypercellularity
inc number of cells, pathologic hyperplasia, unexplained
what 3 cells does hypercellularity normally affect
wbc
mesangial (between caps)
endothelial cells
why does glomerular enlargement occur in rpgn
inflm and swelling
mnfts of rpgn
impeded filt and perm
olgiuria followed by proteinuria and hematouria
inc bun, creatinin
fluid retention
what is olgiuria in rpgn rt
dec urine vol rt dec perm in glomerulsu
what is proteinuria in rpgn rt
rt tears in endothelial lining allowing large molecules to escape
what hematuria in rpgn rt
cap damage
why is there an inc in bun, creatinin in rpgn
azotemia
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
how do we tx rpgn
self limiting with monitors by inc renal fx and symptomatic tx
how long is recovery of rpgn
several weeks post onset
renal calculi
kindey stones that form in kidney and move out to any part of ut
who has an inc in renal calculi
men, 2-3x inc incidence
what plays a large role in the et of renal calculi
diet and metb
et of renal calculi
complex interaction rt diet and str changes of ut
why does diet play a role in the et of renal calculi
inc [blood] -> inc [filtrate]
what does the kidney normally sec to prevent crystallization of urine
3 different proteins present only in kidney
what do the proteins sec by kidney not prevent
urine stasis
what factors outweigh the benefit of proteins in the kidney (RC)
inc solute concentration and or urine stasis
what happens in the kidney when benefits of proteins are outweighed
percipitate in urine forms nucleus -> stone formation
what must be present for a kidney stone to form
nucleus
4 types of kidney stones
calcium
mangesium ammonium phosphate
ureic acid
cystien
contb factors to calcium RC
inc ca, immbolization, vit d intoxification, bone disease
tx for calcium rc
underlying cause, inc fluid intake, thiazide diuertics
cont fact to mangnesium ammonium phosphate rc
urea splitting uti’s
tx for mg nh3 ph rc
tx uti, acidify urine, inc fluids
cont factors for uric acid rc
formed in acid urine with ph about 5.5
gout
high protein diet
tx for uric acid rc
inc fluid
alkalize urine
cont factors for cystine rc
cystinuria rt inhereted aa metb disorder
tx for cystine rc
inc fluid, alkalize urine
what is beneficial about knowing the type of rc that has formed
prevents it from happening aagain
staghorn rc
stone with a head and horn
mnfts of rc
sev pain with acute onset renal colic non colicky sev pain n and v diaphoresis
how long may renal colic last (RC)
mins - days
what is renal colic associated with
stone migration
why may uretur be distended in RC
stone migration causing obstr
what is non colicky sev pain in rc rt
distention of renal pelvis
why is somebody with rc have n and v
sev pain
dx for rc
cant use pain alone
US/CT (Fast)
labs - urinalysis
IVP
IVP
intravenous polygram
how does IVP work
inject dye via IV and watch it move thru circulation and into filtrate and urine. visualize blockage. not routine.
tx for rc
pain relief
nv releif
tx cause
sx
what sx may be used to treat rc
lithopsy - break down of stone using sound waves. fractures of large stones may cause problems distally
what do we do to stones passed spontaneosly? which stones do we pass like this
collect them
urinary incontinence
voiding incontinently
occurs inc with >60yo
mnft of a problem
et/patho of urinary incontinence (3)
stress incontinence
overflow incontience
overactive bladder
why is stress incontinence occur in UI
p application onto bladder + weakness/incompetence of bladder sphincter rt age.
- urethral vesicular angle change in women
how does P application of bladder cause stress incontinence
inc intra abdm p can inc p on weak bladder sphincter
why does change in urethral vesicular angle cause stress incont.
change in angle rt child birth is more susceptible to changes in P
overflow incontinencec
intravesicular P > urethral P or retention and bladder distention
overactive bladder
inc activity of bladder rt hyperactivite detuosur m. excessive contr/relax -> inc P -> incont
what type of problem may an overactive bladder be
n or m
tx for UI
drug (alpha adrenergic agonist)
sx (artificial sphincter)
ARF
acute onset/recovery, l/o renal fx w/o warning with dec renal fx
2 pressing problems with ARF
fluid/lyte imbal
azotemia
what is kidney fx determined by
egfr
output (not always reliable)
olguirua
100-400cc output a day
what amount of output is barely enough to prevent azotemia
400cc/day
anuria
no urine or
why does kidney receive blood
filter it
perfusion
when cant the kidney perfuse blood
dec blood vol or obstr
what perecent of CO assists with kidney perfusion
20-25
what happens when less then 20% of co goes to kidneys
problem
primary et of arf
def renal perf rt hypovoluima/perf
3 groups of et of arf
pre, intra, post
what group of et of arf is most common
pre renal
what et makes up 80-90 percent of arf
pre/intra
pre renal arf
dec renal perf dt dehydration? lt olguiria/ischemia
2 consequences of pre renal arf
inadeq perf -> ischema
dec filtration
eg of intra renal arf
glomerular nephritis
3 phases of intra renal arf
initiating
maintencance
recovery
initiating phase of intra renal arf
problem is just starting from percipitating events
maintenance phase of intra renal arf
dec egfr
olgiuria/azotemia
recovery phase of intra renal arf
inc time dt tissue repair. grad inc in egfr. address cause
post renal arf
eg bph
obstr to urine flow
mfnts of arf
olguria/anuria
lyte imbal
azotemia
proteinuria, hemouria
complications of arf
htn
edema
tx for arf
stat intervention
replace fluid and lytes with monitoring
dialysis
diet
why do we monitor when giving fluids to pts with arf
can they handle the inc fluid?
types of dialysis
hemodialyis
peritoneal dialysis
what diet changes do we make in pts with arf
well balanced, inc calories/carbs
dec protein to dec N waste
crf
prog perm damage that occurs in stages
stages of crf
diminshed renal reserve
renal insufficenty
rf
diminshed renal reserve
dec kidney fx.
dec egfr by > or equal to 50% of normal
no mfnts of dec renal fx yet
renal insufficency
gfr 20-50% of normal
renal failure
gfr
what is the gfr of total end stage failure
