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Pathophysiology > Unit 4 - Renal Diseases > Flashcards

Unit 4 - Renal Diseases Flashcards

1
Q

renal disease constitutes a syndrome of disorders that range from ___ to ___

A

vascular to traumatic

inflammatory conditions are also a large category

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2
Q

nephron

A

Functional Unit of the Kidney
About 1 million/kidney
Each has a Vascular part and a Tubular Part

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3
Q

3 processes that allow the kidney to regulate and maintain proper concentrations of electrolytes in the blood

A

reabsorption, secretion, and excretion

Filtration-occurs at the Glomerular-Bowman’s Capsule interface. Plasma (Filtrate) and Electrolytes pass from the Glomerulus into Bowman’s Capsule

Reabsorption-electrolytes pass from tubules to the renal interstitial fluid; ultimately returned to the circulation

Secretion-electrolytes pass from the renal interstitial fluid to the tubules

Excretion-electolytes pass from the kidney via the urine

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4
Q

Acute Tubular Necrosis (ATN)

A

from burns and hemorrhagic injury
fluid loss
recovery depends on degree of ischemia

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5
Q

crush injury

A

muscle damage may result in release of myoglobin (binds O2 in muscles)
mat occlude small renal vessels and produce renal ischemia

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6
Q

renal vascular disease

A 
decrease blood passes through kidneys to be filtered
renal hypertension (renin-angiotensin system)
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7
Q

renal vascular disease is usually produced by

A

Renal Arterionephrosclerosis

(hardening of small renal arteries)

also by
Peripheral Artery Disease (PAD)
Collagen Vascular Diseases
SLE, Scleroderma

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8
Q

Pyelonephritis

A

Inflammation of the Renal Pelvis

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9
Q

pyelonephritis causes

A

bacteria into kidneys from bladder (infection)

other causes: urinary calculus (kidney stone), enlarged prostate, neurogenic bladder after SCI, systemic sepsis

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10
Q

pyelonephritis etiology

A 
Females > Males
Flank Pain
High fever and chills
Hematuria (gross or occult)
Urine contains wbc’s,                                                   rbc’s, bacteria
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11
Q

dialysis and dementia

A

enhances renal function

dialysis dementia: Confused
Disoriented
Speech impaired
Fatigued

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12
Q

Glomerulonephritis

A

inflammation of the Glomeruli

Type III Hyperimmune Reaction
Antigen-Antibody Complexes
Circulate to glomerulus and become mechanically trapped in the subepithelial space
Injury/Inflammation result
Loss of glomerular filtration
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13
Q

causes of acute Glomerulonephritis

A

Approximately 70% follows beta hemolytic streptococcal pharyngitis
(APSGN)

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14
Q

Acute Glomerulonephritis facts

A

mostly in children (>50%)
Affects boys about twice as much as girls
80-90% kids fully recover
50% kids fully recover

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15
Q

those who do not recovery from glomerulonephritis may proceed to a

A

rapidly progressive stage: Glomerular crescents are proliferating cells in Bowman’s capsule that are filling Bowman’s space.

or a chronic stage

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16
Q

s/s of acute glomerulonephritis and proteins

A 
Hypertension (50%)
Proteinuria (Albumen)
Hypoproteinemia
Edema
Electrolyte (Na+, Cl+ & K+) imbalance 
Headaches 
Nausea & vomiting
Muscle spasms
Heart function disrupted
Coke colored urine (RBC’s & Casts)
Hematuria (usually gross)

Tam-Horsfall Protein
24-Hour trace protein
Normal finding

17
Q

2 stages of acute glomerulonephritis

A

Oliguric stage-decreased urine volume

Polyuric stage-increased urine volume

18
Q

Rapidly Progressive Glomerulonephritis

A

Small percentage follow APSGN (Strep Throat)
Rapidly progressive - fatal in about 2 years
Permanent glomerular subepithelial immune complexes
Fibrin accumulation around the glomeruli

19
Q

Goodpasture’s syndrome

(from rap prog glom)

A

Immune reaction to Goodpasture’s Antigen
Diffuse glomerular loss
Bilateral pulmonary alveolar lesions

Leads to:
Pulmonary Hemorrhage
Respiratory Distress
Hemoptysis (coughing up blood)

20
Q

Chronic Glomerulonephritis (CGN)

A

Small percentage follow APSGN

Slowly progressive - renal failure and uremic syndrome “end stage renal disease (ESRD)”

21
Q

Diabetic nephropathy

A

25-30% of Renal Disease and Failure
Progressive Disease-Diffuse Glomerulosclerosis
Thickening of Glomerular Basement Membrane
Glomerular Function Loss

22
Q

2 types diabetic nephropathy

A 
Diffuse Diabetic (most common)
Diffuse, pervasive thickening of the glomerular basement membrane	
Nodular Diabetic (Kimmelstiel-Wilson)
Hardening of glomeruli showing nodule
23
Q

end stage renal disease s/s

A
  • Metabolic Acidosis
  • Confusion, Lethargy
  • H+ Ions are retained, acid not excreted, pH
  • Electrolyte Imbalance
  • Renal Osteodystrophy (low vitamin D3)
  • Azotemia: retention of nitrogenous metabolic waste products (urea, creatinine, uric acid)
  • renal hypertension
  • renal induced anemia (from lack of erythroprotein)
  • pruritus (itching)
24
Q

Tx for ESRD

A

hemodialysis
peritoneal dialysis
renal transplant
physical rehab

25
Q

acute renal failure

A

“An abrupt, frequently reversible decline in renal function, with recovery expected in about 6-8 weeks.”

26
Q

causes of ARF

A
  1. Acute Prostatic hypertrophy (Prostatitis)
  2. Obstruction - kidney stone, Urinary Bladder tumor (Fast growing)
  3. Nephrotoxin consumption (Heavy metals-Lead, Mercury)
  4. Acute interstitial nephritis (Allergic)
    Inflammation-renal interstitial tissue
  5. Pigment release: accumulation of hemoglobin from disseminated intravascular coagulation (DIC)
    other: acute tubular necrosis, burns/hemorrhagic injury
27
Q

Chronic renal failure

A

“A progressive, relentless decline in the nephron population.”

28
Q

CRF causes

A

1.Chronic Glomerulonephritis
2. Chronic Hypertensive Vascular Disease
3. Collagen Vascular Diseases (Lupus Nephritis)
Chronic Pyelonephritis
4. Hereditary
Polycystic kidney disease (PKD)
5. Elevated blood uric acid-uric acid deposits in the kidneys
6. Hyperparathyroidism-calcium deposits in the kidneys
7. Amyloidosis (glycoprotein)
8. Nephrotoxins-LT exposure to lead, mercury, phenacetin
9. Chronic obstruction (long standing prostate enlargement)
Benign Prostatic Hypertrophy (BPH)
10. Neurogenic bladder
Automatic vs. Flaccid
11. Renal Cell Carcinoma
Arises from the epithelium of the proximal convoluted tubule
12. Diabetes mellitus

29
Q

Renal Dx procedures

A
  1. Blood Urea Nitrogen (BUN) (6-20 mg%)
  2. Blood Creatinine (<1.5 mg%)
  3. 24 hour Urine Volume (1200-1500 ml)
  4. Urine sticks
    Measures protein, glucose, pH, ketones etc.
  5. Intravenous Pyelography (IVP)
    - injection of radio opaque contrast agent
  6. Abdominal CT cross section
30
Q

urinary bladder disease s/s

A

cystitis (inflammation of bladder)
dysuria
nocturia
abnormal urine color

31
Q

Neoplasia of the Urinary Bladder

A

Primary or metastatic
90% of primary tumors-Transitional Cell
Smoking, airborne carcinogens, unknown etiology
Males 3:1 over females

32
Q

Urinary Bladder Incontinence causes

A 
Cystitis
Neurogenic Bladder
Reduced Bladder Volume Capacity
Hyperactive Detrusor
Reduced Pelvic Floor Support
33
Q

urethral disease - stricture and narrowing of urethra

A 
Recurrent Cystitis
Recurrent Urethritis
Pelvic fractures
Catheter insertion
Surgery performed on the prostate
Benign prostatic hyperplasia
STD’s
34
Q

Urethral Cancer

Risk Factors

A

Having a history of bladder cancer
Chronic Urethral Inflammation
Being 60 or older
Females > Males

35
Q

Hypospadias

A

Penile urethra does not close completely

Pathophysiology (27 decks)

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