urinary part 5 Flashcards
what are kidney stones called
renal calculi
what are kidney stones
hard deposits that form inside the kidneys
what are kidney stones composed of
minerals and salts
when do kidney stores
when urine is concentrated and minerals crystallize and stick together
where can renal calculi occur (3)
kidneys
ureter
urinary bladder
renal calculi is the common cause of
urinary tract obstruction
what is the recurrence rate for kidney stones
30-50% within 5 years
you have a reduced risk of kidney stones if what?
adequate H2O intake and you are physically active
what are risk factors of kidney stones
men
race
geographic location
decreased fluid intake
diet
family history, PH
obesity
digestive disease/ surgery
medican conditions
vitamin/ medications
what kind of geographic locations give risk of kidney stones
warm, dry climate
what kind of diet gives risk of kidney stones
high in protein, sugar, NaCl-> xs calcium to filter
what kind of surgeries can cause kidney stones
gastric bypass, IBD, chronic diarrhea
what medical conditions can risk kidney stones
DM, HTN, metabolic syndrome, hyperparathyroidism, multiple UTIs`
what kind of vitamins and medications can cause kidney stones
vitamin c
xs laxatives
calcium based antacids
meds for migraine and depression
types of kidney stones depend on
minerals that comprise the stones or location and size
what are the four different types of kidney stones
calcium oxalate or phosphate
struvite
uric acid
cystine
what is made in the liver or absorb in diet= found in certain fruits, veggies, nuts, chocolate
oxalate
what is a metabolic condition, meds to treat migraines/ seizures
phosphate
what type of kidney stones form in response to UTI
struvite
what type is from chronic diarrhea, malabsorption, high protein, DM, metabolic syndrome, genetic factors
uric acid
what type of kidney stone is rare and is from cystinuria which means kidneys excrete too much cystine
cystine
what is the term for complex stones and are very large
staghorm calculi
what does staghorn calculi fill
minor and major calyces and renal pelvis
what does staghorn calculi cause
high morbidity
untreated staghorn calculi can lead to what
recurrent UTI’s, urosepsis, death
how do you need to treat staghorn calculi
aggresively
what is the gold standard for staghorn calculi
percutaneous nephrolithotomy- remove through skin vs surgery
in staghorn calculi, you pass a needle using what
U/S , Xray, CT to guide placement
when you insert tube sheath along needle in staghorn calculi what are you doing
breaking up the stone to remove it
what may you place in staghorn calculi
nephrostomy tube
in staghorn calculi it drains urine into bad and does what
allows it to heal
when do you remove the tube in staghorn calculi
4-6 weeks after heal
if you are unable to remove staghorn calculi with the tube what do you do
nephrectomy
if the kidney stone lodges what happens
blocked flow of urine and kidney swells and ureter spasms occur
what are the symptoms of kidney stones (5)
- Severe, Sharp pain in flank / back, below Ribs (RENAL COLIC) Radiates to Groin
- Pain radiates to Lower Abdomen & Groin, Pain in waves & Fluctuation in intensity
- Pain / Burning Sensation while Urinate
- May note Hematuria, Urge to urinate with Small amount yield, N/V; Fever & Chills (with infection)
- Cloudy with Pink, Red or Brown Urine
5 methods of diagnosing and imagine of kidney stones
history
check blood work
check urinalysis
imaging
retrieve and analyze stones
what may the history include
include diet habits, age of 1st stone/ stone analysis, complications
what do you look for in blood work for kidney stones
elevated calcium or uric acid
what do you check in your urinealysis
see if calcium oxalate
what do you look for in imaging
determine location of stone, severity of obstruction: U/S, CT
what are you looking for when you retrieve and analyze stones
passed spontaenously or via aggresive intervention
what are the treatment goals for kidney stones
manage acute pain
promote stone passage
reduce size of current stones
prevent new stone formation
how do you remove kidney stones
percutaneous nephrolithotoy, ureteroscopy, ultrasonic or laser lithotripsy
extacorporeal shock wave therapy
PT gland surgery
how do you prevent recurrence of kidney stones
increase fluid intake, avoid dark- colored soft drinks, avoid dietary oxalate, eat less animal protein
what is urinary irgency, frequency and nocturia and +/- incontinence
no uti, idopathic etiology
overactive bladder
symptoms of OAB
involuntary contraction of detrusor muscle, females> makes, increase if >65 y/0
linked to excessive caffeine or alcohol consumption, slow to get to bathroom
risk factors for OAB in females
vaginal birth, episiotomy, pelvic organ prolapse surgery, decreased estrogen
risk factors for OAB in males
enlarges prostate with urinary obstruction, surgery for prostate cancer
medications (diuretics, antidepressants, analgesics, sedatives)
how do you diagnose OAB
Detailed H&P, U/A, Questionnaires to Check Severity, Neuro exam. Rectal & Pelvic exam. Check Postvoid Residual Urine.
1st line of treatment for OAB
behavioral : Pelvic Floor Exercises, Bladder Training/Timed Voiding, Mgmt of Fluid intake.
2nd line of treatment for OAB
pharmacologic therapy: Topical Vaginal Estrogen, Drugs that increase Urethral Sphincter contract
untreated OAB can result in what
Impairs QOL, Health. Skin breakdown, Sleep issues, Falls, Depression, Nursing home admission
inflammation of bladder, due to bladder infxn
cystitis
most common site of UTI
bladder
most common infecting MO
e. coli
staphylococcus saprophyticus
symptoms of cystitis
dysuria
serious
elderly
what is dysuria
(painful urination)
frequency
urgency
suprapubic and low back pain
what are serious symptoms of cystitis
hematuria
cloudy urine
flank pain
what are elderly symptoms
asymptomatic bacteriuria= confusion, vague abdonimal discomfort
causes of cystitis
having sex, wipe back to front after going to toilet
diagnosis for cystitis
urine dipstick testing: + leukocyte esterase or nitrite reductase= uncomplicated
symptomatic= urine culture, check antibiotic sensitivity
what is the uncomplicated treatment for cystitis
treat with microorganism specific antibiotic for 3-7 days
what is complicated treatment for cystitis
7-14 days of treatment. relapse within 7-10 days= longer treatment
F/U urine culture in 1 week after initiation then monthly x3M, then every 3-4 M x 1 year
what is an infection of 1 or both upper urinary tracts (ureter, renal pelvis of kidney) women> men
acute pyelonephritits
symptoms of acute pyelonephrititis
acute onset: fever, chills, flank/ groin pain
frequency, dysuria, costovertebral tenderness prior to systemic S&S
elderly: nonspecific= low grade fever and malaise
causes of acute pyelonephritis
renal calculi, pregnant, female sexual trauma, instruments for medical procedures, neurogenic bladder
diagnosis for acute pyelonephritis
U/A, Urine Culture, Clinical S&S (WBC Casts in Urine)
uncomplicated treatment for acute pyelonephritis
Treat with MO specific Antibiotic for 2-3 weeks
Follow up Urine Cultures at 1 & 4 weeks post treatment if symptoms recur.
complicated treatment for acute pyelonephritis
blood cultures and urinary tract imaging
what is chronic pyelonephritis
persistent or recurrent renal infection-> renal scaring
does chronic pyelonnephritis affect one or both kidneys
can be either
symptoms of chronic pyelonephritis
Early HTN, Frequency, Dysuria & Flank pain. Progression Renal Failure
causes of chronic pyelonephritis
Idiopathic Etiology, may be associated with Chronic UTI’s, Renal stone obstructive uropathy. Also Drug toxicity from Analgesics, Ischemia, Irradiation & Immune complex disease
diagnosis for chronic prelonephritis
U/A, Intravenous Pyelogram (Xray of KUB using Iodinated contrast injected into veins) & U/S
treatment for chronic pyelonephritis
Treat underlying cause. Relieve Obstruction. Antibiotics, with prolonged treatment for Recurrent infection.
what is sudden decline in renal function with decrease in glomerular filtration and urinary output / accumulation of nitrogenous wastes in blood
acute kidney injury
what are the causes of acute kidney injury
due to ischemic injury, toxic injury from chemicals or sepsis-induced injury
what is the diagnosis for acute kidney injury
related to cause of disease
history of surgery, trauma or CV disorder
what are the three classifications of acute kidney injury
prerenal
intrarenal
postrenal
what is prerenal
renal hypoperfusion which is due to hemorrhage or fluid loss
prerenal is the most common reason for
AKI
what is intrarenal
disorder of renal parecnhyma/ interstitial tissue
what is intrarenal due to
DIC, allograft rejection
what is postrenal
urinary tract obstructive disorder
is postrenal common or rare
rare
when do you see postrenal
after diagnostic catheterization of ureters
what is treatment for acute kidney injury
maintain until renal function is recovered
correct fluid and electrolyte disturbances, manage BP, prevent and treat infections and maintain nutrition
what is renal replacement therapy
peritoneal dialysis or hemodialysis
uncontrolled hyperkalemia
acidosis or severe fluid overload
what does AKI turn into sometimes
CKD (chronic kidney disease)
what is the progressive loss of renal function indicated by a decline of GFR
CKF or CKD
what are symptoms of chronic kidney disease
N/V
loss of appetite
fatigue
weakness
sleep issues
dry/itchy skin
KTN
CP
SOB
causes of CKD
DM 1 or 2, PKD, prolonged obstruction of urinary tract, recurrent pyelonephritis
progress to esrd
treatment for CKD
slow progression of kidney damage, via controlling the cause. even if control cause can still progress
complications for CKD
fluid retention
hyperkalemia
anemia
HD
ED
what is CKD associated with
systemic diseases
HTN
lupus
what stage is there normal renal function with normal/ high GFR
stage I
what stage is mild renal damage with GRF 60-89 ml/min
stage 11
what is stage III
moderate renal damage with GFR 30-59 ml/min
what is stage IV
severe renal damage with GFR 15-29 ml/min
what is stage V
ESRD, renal failure with GFR <15 ml/min
