Urinary Tract Diseases & Filtration

Question 1

Urinary Tract Obstruction

Answer 1

A blockage of urine flow within the urinary tracts
This may be caused by an anatomic problem or a function problem
The result is urinary stasis, dilated structures, increased risk of infection and compromised function
Long term or permanent impairment can be caused by prolonged obstruction

Question 2

Urinary Tract Obstruction: Pathophysiology

Answer 2

The severity of an obstruction is based on:
The location
The completeness of the blockage
Involvement of one or both of the upper urinary tracts
Duration
The cause

Question 3

Filtration

Answer 3

Renal artery receive about 1, 000mL per minute
About 180L of filtrate per day
About 178L reabsorbed
About 2L excreted as urine

Question 4

Etiology of Alteration in Filtration

Answer 4

Infection
Autoimmune Disease
Hypertension
Tubular necrosis due to ischemia

Question 5

Dysuria

Answer 5

burning, tingling, or stinging of the urethra and meatus associated with voiding.

Question 6

Hematuria

Answer 6

the presence of blood or blood cells in the urine.

Question 7

Nocturia

Answer 7

condition in which you wake up during the night because you have to urinate. Causes can include high fluid intake, sleep disorders and bladder obstruction.

Question 8

Oliguria

Answer 8

urinary output less than 400 ml per day or less than 20 ml per hour and is one of the earliest signs of impaired renal function.

Question 9

Proteinuria

Answer 9

increased levels of protein in the urine. This condition can be a sign of kidney damage.

Question 10

Glycosuria

Answer 10

presence of reducing sugars in the urine,

Question 11

UTI

Answer 11

UTI is inflammation of the urinary epithelium caused by bacteria
Acute cystitis
Painful bladder syndrome/interstitial cystitis
Acute and chronic pyelonephritis
- Most common pathogens:Escherichia coli
- Virulence of uropathogens
:Host defense mechanisms

Question 12

UTI: Acute Cystitis (def, cm, T)

Answer 12

Cystitis is an inflammation of the bladder
-Manifestations
Frequency
Dysuria
Urgency
Lower abdominal and suprapubic and low back pain 
-Treatment
Antimicrobial therapy
Increased fluid intake
Avoidance of bladder irritants
Urinary analgesics

Question 13

UTI: Painful bladder syndrome/interstitial cystitis

Answer 13

Nonbacterial infectious cystitis; noninfectious
-Manifestations
Most common in women 20 to 30 years old
Bladder fullness, frequency, small urine volume, chronic pelvic pain
-Treatment
No single treatment effective, symptom relief

Question 14

UTI: Pyelonephritis (acute & chronic)

Answer 14

*Acute pyelonephritis
Acute infection of the ureter, renal pelvis, interstitium
Vesicoureteral reflux, E. coli, Proteus, Pseudomonas

*Chronic pyelonephritis
Persistent or recurring episodes of acute pyelonephritis that lead to scarring
Risk of chronic pyelonephritis increases in individuals with renal infections and some type of obstructive pathological condition

Question 15

Renal Failure

Answer 15

Inability of the nephrons within the kidneys to:
Excrete wastes
Maintain fluid- electrolyte, acid-base balance
Perform regulatory functions

Question 16

Acute Renal Failure

Answer 16

Sudden & rapid decrease in renal function

Reversible with early treatment

If left untreated > chronic renal failure

Question 17

Chronic Renal Failure

Answer 17

Progressive & irreversible damage to the nephrons

End result- loss of kidney function

Progresses to end-stage renal disease

Question 18

PATHOPHYSIOLOGY: Prerenal acute renal failure

Answer 18

the most common cause of acute renal failure
**Caused by impaired renal blood flow
If blood pressure or blood volume are not restored, it can lead to acute tubular necrosis or acute cortical necrosis

Question 19

PATHOPHYSIOLOGY: Intrarenal acute renal failure

Answer 19

Can be caused by acute tubular necrosis, cortical necrosis, acute glomerulonephritis, vascular disease, allograft rejection or interstitial diseases
May be related to tubular obstruction

Question 20

PATHOPHYSIOLOGY: Postrenal acute renal failure

Answer 20

Least common type
Occurs with urinary tract obstruction that affects both kidneys
This leads to an increase in the pressure upstream from the obstruction
Several hours of anuria along with flank pain followed by polyuria is characteristic

Question 21

PATHOPHYSIOLOGY: Chronic kidney disease

Answer 21

Alterations seen in following systems:
Cardiovascular
Pulmonary
Hematological
Immune
Neurological
Gastro-intestinal
Endocrine and reproductive
Integumentary

Question 22

Chronic kidney disease

Answer 22

Progressive loss of renal function that affects nearly all organ systems
Associated with HTN, diabetes, systemic lupus erythematosus, intrinsic kidney disease

Question 23

Chronic kidney disease

Answer 23

Stages: (The kidney’s filtration rate, called the glomerular filtration rate (GFR), shows how well the kidneys are filtering. )

Normal (GFR >90 mL/min)
Mild (GFR 60 to 89 mL/min)
Moderate (GFR 30 to 59 mL/min)
Severe (GFR 15 to 29 mL/min)
End stage (GFR <15)

Question 24

CKD: Proteinuria and uremia

Answer 24

Due to glomerular hyperfiltration

Damages interstitial tissue of kidney via inflammation

Question 25

CKD: Creatine and urea clearance

Answer 25

GFR falls (glomerular filtration rate)= shows how well the kidneys are filtering. 
Plasma creatinine increases

Question 26

CKD: Fluid and Electrolyte balance

Answer 26

*Sodium and water balance
Sodium excretion increases with obligatory water excretion leading to sodium deficit and volume loss
Concentration and dilution ability diminishes
*Potassium balance
Tubular secretion increases early
Once oliguria sets in, potassium retained
*Acid–base balance
Metabolic acidosis when GFR 30 to 40%
*Calcium, phosphate, bone
Reduced renal phosphate excretion, decreased renal synthesis of 1,25-(OH)2 vitamin D3, and hypocalcemia
Fractures
*Protein, carbohydrate, fat metabolism
-Anemia
Lethargy, dizziness, and low hematocrit are common