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Urinary System Flashcards

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1
Q

Assess kidney function.

A

Filtration
Reabsorbtion
Secretion

Waste excretion
Water level balancing
Blood pressure regulation
Red blood cell regulation
Acid regulation
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2
Q

Describe obstructive disorders of the urinary tract.

A

Ureter (hydroureter)
– Calculi
– Pregnancy
– Tumour

Bladder and urethra
– Tumour
– Neurogenic bladder
– Enlarged prostate
– Urethral strictures

Neurogenic bladder
– Bladder dysfunction caused by neurological
disorders
– Types of dysfunction related to location of
nervous system lesion
- Detrusor hyperreflexia (brain & SC nerves)
- Flaccid bladder (sacral or peripheral nerves)

Obstruction to urine flow
– Urethral stricture, prostate enlargement (men)
– Pelvic organ prolapse (women)

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3
Q

Compare and contrast glomerular diseases (nephritic and nephrotic syndromes).

A 
Nephrotic syndrome involves the loss of a lot of protein, whereas nephritic syndrome involves the loss of a lot of blood.
Tip: Nephrotic & Protein both have an “O” which may help you remember!
Nephritic:
"PIG ARM"
Poststreptococcal gn
IgA nephropathy
Goodpasture's syndrome
Alport's syndrome
Rapidly Progressive GN (RPGN)
Membranoproliferative GN
Nephrotic:
"Mum* Fights*** with Me** and i'm SAD"
Membranous GN
Focal segmental glomerulosclerosis
Minimal change glomerulonephritis
SLE nephropathy
Amyloidosis
Diabetic nephropathy
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4
Q

Distinguish between acute kidney injury and chronic kidney disease.

A

CAUSE
a - Event leading to kidney malfunction (dehydration,
blood loss, medications), often reversible
c - Long-term disease (high BP, DM) that damages kidney
and reduces function

SYMPTOMS
a - Fluid build up
Electrolyte imbalance
Dehydration, light-headedness, weak rapid pulse.
Symptoms reflect actual cause (eg – urinary tract
obstruction = haematuria, reduced urine output)
Sudden creatinine increased
c - May not develop until little kidney function remains.
Anaemia
Increased phosphates in blood

TREATMENT
a - Discontinue nephrotoxic meds Renal replacement
therapy (dialysis, haemofiltration).
c - First: dietary control, restrict protein, Na & fluid control,
Restrict K, manage lipids and EPO, ACE inhibitors
Later: Supportive, dialysis, transplantation
Treat anaemia: Epoetin alfa Vit D activation

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5
Q

Explain structural and functional abnormalities in children.

A

Enuresis – involuntary passage of urine beyond age of bladder control (4-5).
- Primary enuresis – Child has never been continent
- Secondary–Diurnal, nocturnal, or both
- Treatment: fluid measurement, diett herapy, drugs
(desmopressin), treat obstructive sleep apnoea,
behavioural modification therapy

Wilms’s Tumour (Nephroblastoma)
- Common primary neoplasm (3-6years)
- Affects transitional/squamous renal pelvis cells
- Solid mass–Rapid growth. Distorts kidney. Presents as
abdominal mass.
- Treatment: Surgery, chemo/radio therapy

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6
Q

List drugs used to treat UTIs.

A

Trimethoprim/Sulfamethoxazole (Bactrim) preferred treatment
Cephalexin (Keflex)
Ceftriaxone

• Location/nature of UTI determines treatment duration
• Most treated with oral medication
• Severe infections may require IV delivery
• HAI may be associated with resistance to Bactrim therefore
requires use of other drugs

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7
Q

Discuss neoplasia of the kidney.

A
  • Two most common types: Renal cell carcinoma (RCC) - ~80% primary renal cancers, and transitional cell carcinoma (TCC)
  • Common signs/symptoms: Haematuria, tiredness, loss of appetite, high temperature, weight loss, heavy sweating, abdominal pain.
  • Causes: smoking, regular NSAIDs, obesity, family history, Hepatitis C, renal calculi, high BP
  • Pathophysiology: Originates in renal tubule and renal pelvis.
  • Treatment: Surgery, Chemotherapy, Radiotherapy, Immunotherapy
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8
Q

Discuss glomerular diseases and the differences between nephritic and nephrotic syndromes.

A

.

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9
Q

Discuss the relationship between the cardiovascular and renal systems.

A

Dosing should be minimal and slowly ↑ to avoid HTN and
adverse cardiovascular events associated with ↑ blood
viscosity due to excessively high haematocrit

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10
Q

Discuss the relationship between urinary tract infections and acute kidney injury.

A

.

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11
Q

Explain the connection between the GFR and progression to end-stage kidney disease.

A

GRF decreases as CKD progresses.
Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)

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12
Q

Explain the connection between urinary tract infection and confusion in the elderly.

A

.

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13
Q

Review RAAS

A

.

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14
Q

Review ACE inhibitors

A

.

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15
Q

List and explain the action of different types of diuretics.

A

.

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16
Q

Define kidney stones

A

Masses of crystals, protein or other substances that form within and may obstruct the urinary tract.

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17
Q

Renal Calculi Formation

A

Supersaturation of one or more salts
– Salt in a higher concentration than the volume able to
dissolve the salt

Precipitation of a salt from liquid to solid state

Growth into a stone via crystallization or aggregation

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18
Q

Type of kidney stones

A

Calcium oxalate or calcium phosphate, struvite, uric acid stones

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19
Q

Manifestations of kidney stones

A

– Renal colic (pain +++)
– Haematuria
– Nausea & vomiting

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20
Q

Treatment of kidney stones

A

– High fluid intake
– Decreasing dietary intake of stone-forming substances
– Stone removal
– Drug treatment

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21
Q

Manifestations of LUT infection

A

– Frequent voiding
– Nocturia
– Poor force of stream
– Intermittent urinary stream
– Urinary urgency, often combined with hesitancy
– Feelings of incomplete bladder emptying despite
micturition

22
Q

Define UTI

A

Inflammation of the urinary epithelium caused by bacteria

23
Q

Types of UTI

A

Lower urinary tract: bladder and urethra
Upper urinary tract: kidney (acute pyelonephritis)
Complicated UTIs: infection associated with underlying complication (calculi, IV line, prostatic hypertrophy etc)
Recurrent infections: > 3/yr, re-infection often due to sexual activity

24
Q

Risk factors of UTIs

A 
• Gender
• Age
• Intercourse
• Indwelling urinary catheters
• Obstruction and stagnation
• Impaired host defences
• Postmenopausal
• Special populations: diabetes, pregnancy, children,
   elderly
25
Q

Define acute cystitis

A

Cystitis is an inflammation of the bladder

26
Q

Manifestations of acute cystitis

A 
Frequency
Dysuria
Urgency
Lower
Abdominal and/or suprapubic pain
27
Q

Treatment of acute cystitis

A

Antimicrobial therapy
Increased fluid intake
Avoidance of bladder irritants
Urinary analgesics

28
Q

Define acute pyelonephritis

A

Acute infection of the renal pelvis & interstitium

29
Q

Define chronic pyelonephritis

A

Persistent or recurring episodes of acute pyelonephritis that leads to scarring

Risk of chronic pyelonephritis increases in individuals with renal infections and some type of obstructive pathologic condition

30
Q

Effect of nephrotoxic drugs

A

Kidney damage occurs as kidneys are often exposed to drugs because of their filtering and excretion role

Damage may occur due to:
• Reduced renal blood flow
• Obstructions
• Hypersensitivity reactions

31
Q

What are some drug-related nephropathies

A

Reduced renal blood flow:
NSAIDs (aspirin) block prostaglandin synthesis→ reduce blood flow to tubules → tubule cell damage and necrosis

Obstruction:
Older sulphonamide drugs form crystals in renal structures, lesser problem w/ current drugs, hydration important

Hypersensitivity:
Synthetic antibiotics, thiazide diuretics, frusemide can lead to nephritis w/sensitivity. Signs- fever, haematuria, proteinuria. Drugs withdrawn promptly to encourage recovery

32
Q

Define renal failure

A

Condition in which kidneys fail to remove metabolic products from blood and regulate fluid, electrolyte and pH
balance

33
Q

What are the underlying causes of renal failure

A

– Renal disease
– Systemic disease
– Other urological defects

34
Q

Types of renal failure

A

Acute kidney injury

Chronic kidney disease

35
Q

Outline acute kidney injury

A

– Abrupt onset; often reversible if detected early
– Progressive kidney alterations lead to failure, classified
using RIFLE staging system
– Prerenal, intrarenal, postrenal causes

36
Q

Outline chronic kidney injury

A

– Irreparable kidney damage
– Develops slowly, usually over number of years
– Mirrors: diabetes, hypertension, obesity (rising)

37
Q

What is Prerenal Acute Kidney Injury

A

Decreased blood flow to kidneys resulting in kidney injury

Hypovolemia

- haemorrhage
- burns
- heart failure/ cardiogenic shock

Decreased renal perfusionsepsis

- vasoactive mediators/drugs
- diagnostic agents
38
Q

Clinical manifestations of Prerenal Acute Kidney Injury

A

Oligurea, azotaemia (+BUN, creatinine, uric acid)

39
Q

Intrarenal Acute Kidney Injury

A

.

40
Q

Postrenal Acute Kidney Injury

A

.

41
Q

5 categories of acute kidney injury

A 
Risk
Injury
Failure
Loss
End-stage
42
Q

Phases of acute kidney injury

A
  • Onset (hrs - days)
  • Oliguric/Anuric (8-14 days)
  • Diuretic (7-14 days)
  • Recovery (months-yr)
43
Q

Outline the onset stage of acute kidney injury

A

Injury through cell death period (hrs - days).

Characteristics:
– Tissue oxygenation at 25% of normal
– Renal flow 25% of normal
– Urine output 30 ml/hr (or less)
– 50% of patients are oliguric. With prompt treatment, 
    damage can be reversed
44
Q

Outline the oliguric/anuric stage of acute kidney injury

A

Damage to tubular walls (8-14 days)

Characteristics:
– < BUN/Creatinine
– Electrolyte abnormalities (hyperkalemia, 
   hyperphosphatemia and hypocalcemia)
– Metabolic acidosis
45
Q

Outline the diuretic stage of acute kidney injury

A

Pathology resolved, scarring/edema of tubules remain (7-14 days)

Characteristics:
– >GFR
– Urine output 2-4 L/day
– Renal tubules cannot concentrate urine
– Increased GFR linked to loss of electrolytes; (requires IV 
   crystalloids to maintain hydration)
46
Q

Outline the recovery stage of acute kidney injury

A

Tubules begin to function adequately (months-yr)

Characteristics:
–

47
Q

Define chronic kidney disease

A

Irreversible loss of renal function that affects nearly all organ systems

48
Q

Stages of CKD

A

1 - normal kidney function or high GFR
2 - mild kidney damage + mild reduction in GFR
3 - moderate kidney damage + moderate reduction in GFR
4 - severe kidney damage + severe reduction in GFR
5 - end stage kidney disease + kidney failure

49
Q

Signs of CKD

A

• Proteinuria and uraemia

•

50
Q

Risk factors of CKD

A
  • Hypertension, smoking, family history
  • Obesity, Type II Diabetes mellitus
  • Over 50 years old, Indigenous
  • Polycystic kidney disease
  • Obstructions of the urinary tract
  • Glomerulonephritis
  • Cancers
  • Autoimmune disorders (SLE)
  • Diseases of the heart or lungs
  • Chronic use of pain medication
51
Q

Effect of aging on renal function

A
  • Decrease in renal blood flow and GFR
  • Number of nephrons decrease
  • Increased risk for drug toxicity
  • Alterations in thirst and water intake
52
Q

How is renal function assessed

A

Blood tests-
• Creatinine: 0.6–1.2mg/dL (50–100mmol/L)
• Creatinine Clearance: 115–125 mL/min
• Blood Urea Nitrogen (BUN): 8.0–20.0 mg/dL (3–8mmol/L)
• Potassium: 3.5–5 mEq/L (3.5–5.0 mmol/L)
• Cystoscopy, Ultrasound, Radiological & Other Imaging

z Clinical Science (4 decks)

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