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Patho > Urinary tract infections (UTI), Pyelonephritis, Kidney stones, CKD, Kidney cancer > Flashcards

Urinary tract infections (UTI), Pyelonephritis, Kidney stones, CKD, Kidney cancer Flashcards

1
Q

Describe the locational difference between a lower and upper UTI?

A

Lower UTIs are commonly involved in the bladder and/or urethra.

While Upper UTIs involve the kidneys and/or ureters.

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2
Q

Describe the clinical presentation for a UTI?

A
  1. Altered mental state
  2. Nausea, vomiting
  3. SOB
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3
Q

What is a UTI’s relationship to falls?

A
  1. Pt has decreased strength

2. Increased frequency and/or urgency

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4
Q

What is the most common predisposing factor for UTIs?

A

Urinary catherization

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5
Q

Describe the pathogenesis of an UTI.

A

Usually gram-negative bacteria (E. coli) ascending into the urinary tract from the urethra.
HOWEVER, it can come from blood but this is less commonly seen.

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6
Q

Describe the clinical presentation of a UTI?

A
  1. Change in voiding habits
    a. Increased freq, urgency, dysuria, nocturia, dyspareunia
  2. Cloudy, bad-smelling urine, or hematuria (in serious cases)
  3. Pain: suprapubic, lower abdomen, groin, flank or back pain; possibility of shoulder pain
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7
Q

Describe the clinical presentation between a lower and upper UTI?

A

Lower UTI: Generally sudden onset of symptoms and will have the hallmark symptom of dysuria

Upper UTI: (silent UTI) Typically gradual onset and systemic symptoms such as fever, chills, and/or malaise.

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8
Q

When and how visceral dysfunction can present as shoulder pain?

A

Through referred pain - convergence.

Infectious agents and/or inflammatory mediators can diffuse locally and activate afferent (sensory) endings in the diaphragm. Usually from the 2nd order neuron in the dorsal horn.

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9
Q

Treatment options for UTI.

A
  1. Increased hydration

2. ABX

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10
Q

What is Pyelonephritis?

A

An infectious, inflammatory disease presumed to be caused by bacterial invasion of renal parenchyma

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11
Q

What is the most common cause of pyelonephritis?

A

One of the most common causes of pyelonephritis is backwards flow of infected urine from the bladder to the upper urinary tract. Usually called “ASCENDING UTIs”

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12
Q

Chronic pyelonephritis results from?

A

Results when kidneys become increasingly damaged due to repeated urinary infections

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13
Q

Describe both acute and chronic pyelonephritis.

A

Acute:

  1. abrupt onset of fever, chills, flank pain, and pain over the costovertebral angle
  2. Urinary frequency, dysuria, urgency, suprapubic discomfort

Chronic:
1. Weakness, loss of appetite, HTN, anemia, protein and blood in urine

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14
Q

Clinical diagnosis for stones that develop in the kidneys

A

Nephrolithiasis

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15
Q

Clinical diagnosis for stones occurring in urinary tract

A

Urolithiasis

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16
Q

Describe pathogenesis for renal calculi

A

Infection or generally due to increased blood concentration and urinary excretion of the primary component of the stone

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17
Q

Where along the urinary tract can kidney stones cause symptoms?

A
  1. Uretopelvic junction
  2. Crossing of iliac artery (midureter)
  3. Uretovesical junction
18
Q

Why is it important to know what makes up your kidney stone?

A

For prevention purposes to help facilitate good prevention

19
Q

What is the clinical presentation of kidney stones?

A

Hallmark complaint: abrupt pain associated with urinary tract obstruction = Renal colic

  1. Pain occurs once stone leaves kidney
  2. Generally is abrupt onset of excruciating pain in flank and upper abdominal quadrant, usually radiates to groin
  3. Urinary urgency and frequency
  4. Microscopic to gross hematuria
  5. Nausea/vomiting
  6. May be asymptomatic
20
Q

Treatment options for liathasis

A
  1. Time (plus pain meds and hydration)
  2. Extracorporeal shock wave lithotripsy
  3. Ureteroscopy
21
Q

Prevention for renal calculi

A
  1. Hydration

2. Dietary change, if appropriate for type of stone

22
Q

Define glomerulonephritis

A

Group of diseases that damages glomerular portions of the kidney.
Accounts for ~50% of pts requiring dialysis

23
Q

Glomerulonephritis can result from:

A
  1. Immunologic problems
  2. Drug/ toxin effects
  3. Vascular diseases
  4. Systemic disorders
24
Q

What are the risk factors for glomerulonephritis?

A
  1. Diabetes mellitus
  2. System lupus erythrematosus
  3. HTN
25
Q

What are the clinical presentations for glomerulonephritis?

A
  1. Early stages have no overt symptoms
  2. HTN
  3. Proteinuria, pyuria, hematuria
  4. EDEMA
26
Q

Why would a pt with glomerulonephritis have edema?

A

Capillaries become increasingly permeable, leading to proteinuria, hematuria, and edema. The edema occurs due to oncotic pressure.

27
Q

Define chronic kidney disease.

A

Progressive loss of renal function (permanent loss of nephrons) due to multiple causes that continues to worsen even after causes are removed.

  • Deterioration of kidney is variable
28
Q

What are the leading causes of chronic kidney disease?

A
  1. DM

2. HTN

29
Q

What are the stages of CKD defined by?

A

GFR - “Creatinine clearance”

30
Q

What does GFR have to be for CKD to be diagnosed as stage V?

A

Equal or less than 15%

31
Q

What is the general clinical presentation for CKD?

A
  1. Fatigue/weakness due to decreased H & H
  2. Weight loss/ loss of appetite
  3. Bad/ metallic taste in mouth
  4. Nausea/ vomiting
  5. Pruritus: Extreme itching that interrupts sleeping and cause increase mortality
32
Q

What are the neuromusculoskeletal clinical presentation for CKD?

A
  1. Mental dullness due to accumulation of urea
  2. Renal osteodystrophy due to bone demineralization
  3. Muscle, joint, and bone pain
  4. Extraskeletal calcification due to calcium seeding into skin
  5. Loss of DTRs and foot drop
  6. Restless leg syndrome due to peripheral neuropathy
33
Q

What are the cardiovascular clinical presentation for CKD?

A
  1. Dyspnea, orthopnea
  2. Edema
  3. HTNd
  4. Pericardial chest pain
34
Q

How is CKD diagnosed?

A
  1. Signs & symptoms
  2. BUN and Cr values
  3. Imaging to determine shrinkage of kidneys
  4. Increase of PTH serum
35
Q

What are treatment options for CKD?

A
  1. Conservative: dietary changes, HTN treatment, Fluid restriction or diuretics, and calcitriol
  2. Renal replacement: Dialysis or kidney transplant
36
Q

What does exercise training do for patients with chronic renal disease?

A
  1. Improve BP control and lipid profiles
  2. Increase GFR
  3. Improve glucose metabolism
  4. Increase hematocrit and hemoglobin levels
  5. Ameliorate muscle protein breakdown
  6. RESISTANCE TRAINING CAN HELP BONE DENSITY
  7. Improve psychological profile
  8. Increase ADLs
37
Q

In general, NO EXERCISE with this CKD pt population is permitted if:

A
  1. Serum potassium > 5 Meq/L due to risk for arrhythmias
  2. BP > 200/100 mlm Hg
  3. WBC < 5,000/ mm or > 10,000 w/ fever (if too low can indicate blood marrow infection or if too high can be indicative of infection)
  4. Hct < 25%
  5. Hb < 8 g/dl
  6. Platelets < 20,000 (4,5,6 indicative of decreased EPO)
38
Q

When exercising pts with CKD, should you place emphasis on RPE or HR and why?

A

RPE, as HR is unreliable

39
Q

Define renal cell carcinoma?

A

CANCER

- occurs in epithelial cells lining the kidneys

40
Q

What are the risk factors for renal cell carcinoma?

A
  1. Tobacco smoking
  2. Obesity
  3. Increased consumption of red meat
  4. Decreased fruit/vegetable consumption
  5. Chemical occupational exposure
41
Q

What are the clinical presentation of renal cell carcinoma?

A
  1. Hematuria
  2. Flank pain
  3. Palpable abdominal mass
42
Q

What treatment for renal cell carcinoma has the best outcome?

A

Surgery for all resectable tumors (partial or total nephrectomy)

Patho (5 decks)

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