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Pt.2 PHRM/PHYS/NS > week 11 acute kidney injury & injury tract disorders > Flashcards

week 11 acute kidney injury & injury tract disorders Flashcards

1
Q

how is acute kidney injury ( AKI ) characterized ?

A

characterized by abrupt decline in kidney function

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2
Q

what are the 2 major symptoms of AKI ?

A

elevated serum creatine
reduction in urine output

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3
Q

true or false. When a pt has AKI, increase in Cr to 1.5 times ( or more ) baseline

A

true, this is reversible but can affect other life threatening levels

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4
Q

what is the onset of AKI

A

it is sudden , varies from mild to severe and RRT may be require

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5
Q

true or false. acute kidney injury, does not lead into CKD .

A

false, it does!

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6
Q

what is the ICU level renal replacement therapy referred to ?

A

continuous renal replacement (CRRT)

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7
Q

what are the 3 categories that are in risk for developing AKI ?

A

pts with infections
pts with low blood pressure
pts exposed to nephrotoxins

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8
Q

what is the most common cause of AKI ?

A

sepsis is the most common cause of AKI ( Hypotension and antibiotics ) –> but anyone with infections

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9
Q

recall that pt with low blood pressure is at risk for developing AKI name what undergoes this

A

shock, surgery, heart failure

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10
Q

Recall that pts exposed to nephrotoxins is at risk for developing AKI, name what undergoes this

A

medication, radiocontrast

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11
Q

true or false. Heart failure impacts cardiac output by low blood pressure which makes the kidney suffers.

A

true

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12
Q

patients with infection is at risk for developing AKI , does this cause wide spread of vaso constrict or dilation?

A

dilation

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13
Q

AKI etiology : divided into 3 categories, what are they ?

A

Pre-renal
Intra-renal
Post- renal

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14
Q

define the description
pre-renal
intra-renal
post-renal

A

pre-renal ( before) decrease glomerular filtration and profusion

intra-renal ( during )- direct damage to renal tissue
ATN- most common in renal causes of AKI

post - renal ( after )- mechanical obstruction of urinary outflow

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15
Q

examples of pre- renal factors
related to decreased renal perfusion :

A

hypovolemia
altered peripheral vascular resistance
cardiac disorders

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16
Q

give an example for hypovolemic
altered peripheral vascular resistance
cardiac disorders

A

1) this might be actual loss of blood volume : accident, or surgery loss of water ( content in the blood - dehydrated - vomiting or diarrhea )

2) heart conditions ( result reduced in cardiac output, heart attack )

** whenever ur pt blood pressure drop suddenly be worried about that potential cause for pre-renal acute kidney injury

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17
Q

true or false. the reason : when bp drops, the body is going to do whatever is necessary to keep the most vital organs like the heart, lungs, the brain perfused even if that means shutting down circulation to those other still important it not immediately.

A

true

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18
Q

examples of intra-renal factors
direct damage to kidney itself leads to intra renal injury
name the 5 characteristics

A

1) prolonged renal ischemia
2) nephrotoxic drug ( Abc, NSAIDs, radio contrast agents )
3) organic solvents ( ethylene glycol )
4) acute hemolysis and rnhabdomylosis
5) acute glomerulonephritis

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19
Q

examples of intra- renal factors
nephrotoxic drugs ( ABx, NSAIDS, Radiocontrast agents ) what are some examples?

A

amino-glycosides
gentamycin
tobramycin
streptomycin

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20
Q

true or false. Ethylene Glycol , very toxic to the kidneys.

A

true

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21
Q

true or false. Rhabdomyolysis cause can be by traumatic accident ( collision ).

example : syncopole episode, orthostatic, meds, unable to get themself up

A

true

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22
Q

what is hemolysis

A

break down of rbc

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23
Q

finish the sentence:
break down of muscle tissue : Being broken down releases a component called ______ and this is small particle that is filtered through the glomerulus into the tubules and cause now some possible reasons for _______

A

heme
hemolysis

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24
Q

examples of post renal factors
re-call this is related to obstruction of urine outflow : define the characteristics

A

related to obstruction of urine outflow
- stones/tumours ( type of physical obstruction )
- enlarged prostate ( external force by blocking urinary flow )
- urethral scarring/infection STIs

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25
Q

what is happening in the Nephron During Pre- Renal AKI

low blood flow into the kidney has disrupted what ?

what happens when GFR drops ? and how will our body respond to that ?

A

disrupted that normal balance of pressures that push the glomerulus

bp will drop, and our body will correspond by having overall drop in that filtration rate

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26
Q

nephron during pre-renal aki what is the kidney doing here due to that low blood pressure?

A

kidney will attempt to compensate for this change by activating the RAAS system, but often this is not enough to maintain for that normal GFR

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27
Q

what is happening nephron in an intra-renal injury what is occuring here ?

A

lack of blood flow enter the epithelial cells entering the tubules resulting in losing tubular function

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28
Q

recall : lack of blood flow enter the epithelial cells entering the tubules resulting in losing tubular function

2) causes increase in tubular pressure against which the glomerular hydrostatic pressure has to push

this filtration pressures will have to what ?

A

this filtration pressures will have the act result of dropping in urine output and the development of azotemia.

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29
Q

Wha is happening in the Nephron in an intra renal injury?
Dead cells have sloughed off in the endothelium, through the tubules and become a part f the filtrate they will clump together to from what we call ____ excreted in the urine intra tubular damage

A

casts

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30
Q

what is happening in the nephron during post- renal AKI

A

due to physical obstruction of flow to the kidneys intra tubular pressure rises - work in obstruction and GFR is dropped

post renal - is not damage initially

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31
Q

clinical course of pre and post renal AKI

pre- renal injury, what would early recognition of this and intervention result

A

return to normal kidney function

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32
Q

post renal injury what would early cognition conclude if we had time to intervene quickly?

A

return to normal kidney function

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33
Q

pre- renal could eventually lead to intra renal injury ? true or false.

A

true

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34
Q

post renal injury could lead to intra renal injury ? true or false.

A

true

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35
Q

clinical course of AKI with intra- renal injury
three phases : what are they?

A

1) initiation
2) maintenance
3) recovery

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36
Q

what is initiation phase ?

A

precipitous event, characterized by increased serum creatine & BUN decreased urine output

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37
Q

What does increased serum creatine and BUN, decreased urine output indicate ?

A

one of the causes are ( hemolytic reaction, ischemia to the kidneys, exposure to nephrotoxins )

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38
Q

what does maintenance phase indicate ?

A

lasts days to weeks
anuric, oliguric, nonoliguric ( still producing the same urine production ) , normally 10-14 days
fluid retention, edema, htn, weight gain

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39
Q

maintenance phase re call we know that it lasts days to weeks ( anuric , oliguric, nonoliguric, –> still producing the same urine production )
normally 10-14 days and fluid retention, edema, HTN , weight gain could occur
what else could we see?

A

metabolic acidosis, kussmaul’s respirations
fluid & electrolyte imbalance - decrease Na, increase K, decrease CA, and increase in PO4

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40
Q

is anemia seen, with maintenance?

A

yes this is seen.

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41
Q

Waste product accumulation –> can affect major organs and this occurs in maintenance?

A

yes this is true

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42
Q

True or false. Waste product accumulation –> can affect major organs ( so we must look for changes, this is the same as chronic )

A

true

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43
Q

what is non oliguric ?

A

still producing the same urine production

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44
Q

recovery phase ( intra-renal injury )
name the characteristics under this

A

return of BUN, creatine, eGFR toward normal ranges
may have diuretic phase ( lasts 1-3 weeks )
recovered ability to excrete waste
risk for hypovolemic and hypotension

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45
Q

what are the risk for recovery phase ?

A

risk for hyponatremia, hypokalemia, dehydration

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46
Q

How long does recovery phase take to stabilize ?

A

12 hours

47
Q

true or false. Improvement in the blood work is the occurence during recovery phase

A

true

48
Q

true or false. Kidneys have not regain to concentrate that urine imbalance still occur

A

true

49
Q

electrolytes- potassium and sodium is lost during recovery phase. is this true or false.

A

true

50
Q

urinary tract disorders
name the categories

A

immunological kidney disorders
urinary tract infections
kidney stones ( calculi )
polycystic kidney disease
cancer

51
Q

what is immunological disorders of the kidneys mean ?

A

immune mediated inflammation of the urinary tract ( primarily the glomerulus )

52
Q

how is immunological disorders of the kidneys characterized

A

proteinuria, hematuria, decreased urine production and oliguria

53
Q

true or false. Immunological disorders of the kidneys, both kidneys equally affected.

A

true

54
Q

immunological disorders of the kidneys , causes include:

A

drugs, infection , immune disorders

55
Q

Re-call that immunological disorders of the kidneys, causes include drugs, infection, immune disorders. Now name examples

A

this can develop after strep infection, pneumonia, hepatitis associated with lupus rheumatic ( autoimmune )
this will affect the kidney equally

56
Q

‘immunological disorders of the kidneys’
types of glomerulonephritis

A

acute glomerulonephritis
rapidly progressive glomerulonephritis
nephrotic syndrome

57
Q

true or false. Rapidly progressive glomerulonephritis, some people don’t recover after the initial injury ?

A

yes this is true

58
Q

what type of glomerulonephritis is this ?

acute injury seems to resolve, low levels of inflammation persist over years, nephrons slowly die and leads to this

A

chronic glomerulonephritis

59
Q

Acute post streptococcal glomerulonephritis

this immune attack on the strep infection causes what ?

A

this immune attack on the strep infection causes antigen antibody complexes to form (damage glomerulus)

60
Q

when does nephritic presentation begin after initial infection ( ** this is talking about acute post streptococcal glomerulonephritis )

A

nephritic presentation will begin 5-21 days

61
Q

true or false. Acute post streptococcal glomerulonephritis most often occurs in adult.

A

false. mostly occurs in children in the age of 3-7

62
Q

what are the symptoms of Acute Post streptococcal Glomerulonephritis

A

smoky urine
oliguria
edema ( often periorbital )
HTN
urinalysis: WBC, RBC, protein, erythrocyte casts

blood work : increase in creatinine, and urea

63
Q

true or false.Acute Poststreptococcal Glomerulonephritis mostly attack on the throat and the skin?

A

yes this is true

64
Q

what does erythrocyte casts indicate ?

A

damage to the tubules

65
Q

recall that during Acute Poststreptococcal Glomerulonephritis , some of these capillaries can rupture and cells will leak out into the urine, leading to hematuria.

the urine in Glomerulonephritis is described as what ?

A

smoky, tea colored, coca cola color

66
Q

true or false. Acute Poststreptococcal Glomerulonephritis causes activation of WBC to rush to the area, and the combiantion of inflammation in WBC fills the lumen and leaves very little room to enter to be filtered. DROPPED GFR over time

A

true

67
Q

Urinary tract infections
what does ascending infections mean ?

A

they start with bactering entering the urethra , moving up into the bladderm and if this bacteria is not recognized or treated it can move up further to the ureters and the kidneys.

68
Q

true or false. Very rarely, infections can enter the kidney directly from the blood, but this is
not often and the vast majority of infections will be the ascending type stemming
from the urethra.

A

true ( urinary tract infections is what this is describing )

69
Q

true or false. healthy urinary tract is free from bacteria ?

A

true

70
Q

MOST_____ ascend and occur from bacteria entering the urethra

A

UTIs

71
Q

what is the type of pathogen leading to UTI ?

A

E.coli

72
Q

what is the major defense to ascending bacteria ?

A

flushing effect of urine flow ( stasis major cause of UTIs )

73
Q

most people have feces in close proximity to
the urethra so how we don’t all have UTIs all the time. Explain the reason

A

our body protects against infection is called the flushing effect and
this means that on a regular basis when the bladder is emptied any bacteria sitting
in or near the entrance of the bladder is flushed away by the process of urinating.

74
Q

what happens when flushing effect is damaged or disrupted?

A

increased risk for infection

75
Q

who is at risk for UTIs
anatomically ???

A

females are more susceptible ( anatomical )

76
Q

who is at risk for UTIS
Urinary stasis ( what undergoes this category )

A

incomplete bladder emptying ( incontinence )
obstruction of blood flow ( BPH )
scar tissue ( frequent STIs)
congenital defects
impaired blood supply to bladder
renal calculi ( obstructs )
stroke and MI

77
Q

true or false. when urine is not flushed out regularly and sits in the bladder and festering this is putting yourself at risk for UTIs

A

true

78
Q

true or false. Anything can cause incomplete bladder emptying

A

true

79
Q

There are two categories of physical manifestations of UTIs, what is it ?

A

Cystitis, pyelonephritis

80
Q

what are the symptoms for cystitis

what are the urinalysis of cystitis

A

dysuria, urinary frequency and urgency, suprapubic discomfort , cloudy urine ( aka LUTS )

urinalysis : bacteriuria, pyuria, microscopic, hematuria

81
Q

what are the symptoms for pyelonephritis ( affects lower and upper tract )

A

LUTS and have fever, chills, malaise, vomitting, tenderness over kidney

urinalysis : bacteriuria, pyuria, microscopic, hematuria, leukocyte casts

can become chronic and lead to CKD

82
Q

what is the first symptom called in cystitis ?

A

dysuria, which means discomfort with urination

83
Q

why is discomfort happening during cystitis ( the term dysuria ) go more in depth

A

urine is in contact with those inflamed tissues. The next is urinary frequency which means that patients can often have to void more often and the reason for this is when the bladder is full of inflamed tissue there’s going to be less room for urine to accumulate and so the
patient needs to empty their bladder more often.

84
Q

true or false. with the UTI, again related to that inflammation of that tissue. When you’re
assessing the patient’s urine, you may note that it’s really cloudy or has a white tissue. Sometimes it can be described as a milky or really foul smelling and this has to do with that presence of bacteria as well as pus in the urine.

A

true

85
Q

what is another word for renal calculi ?

A

kidney stones

86
Q

describe what kidney stones are

A

renal calculi: occurs when the mineral salts in the urine become so concentrated that they cant stay in the solute anymore and they start to participate out and form solid little stone structure.

87
Q

where do most kidney stones start ?

A

renal pelvis, they fill this out, but it could also branch out into the helix

88
Q

True or false. When kidney stones is so large it could actually obstruct the outflow from the kidney.

A

true

89
Q

re-call: When the kidney stones are so large it could actually obstruct the outflow from the kidney . And as a result this kidney would develop something called _____ what does it mean explain?

A

Hydronephrosis, meaning the kidney has become swollen due to all of that back pressure and backup of fluid..

90
Q

the term calculus refers to the _____ and _____ refers to stone formation

A

stone
lithiasis

91
Q

what are the four different types of stones

A

calcium ( phosphate or oxalate )
struvite
uric acid
cystine

92
Q

name the most to least common of stones

A

calcium ( phosphate or oxalate )
struvite
uric acid
cystine

93
Q

describe what calcium ( phosphate or oxalate ) what are the characteristics

A

this is the most common, idiopathic hypercalciuria
hyperparathyroidism and immobility
oxalate from diet ( green veg and root veg )

94
Q

describe what struvite and its characteristics

A

second most common
made of mg, ammonium, phos
recurrent UTis ( proteus bacteria )

95
Q

describe what uric acid and its characteristics

A

nitrogen containing waste product from breakdown of DNA and RNA, accumulates with large amount of animal meat, coffee, alcohol, obesity

** GOUT

96
Q

describe what cystine is as a stone and its characteristics

A

( least common )inherited disorder when people have difficulty metabolizing amino acid

97
Q

true or false. dehydration has not been associated with kidney stones, it usually associates with physical obstruction.

A

false, dehydration has been associated with kidney stonea

98
Q

manifestations of renal calculi
symptoms incldude:

A

abdominal/flank pain ( severe )
renal colic
hematuria
fever, chills
nausea & vomitting

99
Q

Describe if this statement is true or false. The intensity and location of the pain of renal calculi is going to differ depending on the location.

A

TRUE

100
Q

If the kidney stone is located in the renal pelvis, patients may complain of what type of pain

A

flank pain
flank pain is
the pain in the back directly over top of where the kidneys would sit kind of below
that rib cage there.

101
Q

Now as the stone moves out into the ureters, patients may
describe the pain as intensifying and it follows a pattern that we refer to as
_____ , why do u think this is the pain they are experiencing ?

A

renal colic, this is really excruciating pain that tends to come and go and
waves and the reason for this pain is that the ureters are trying to move that
stone down.

102
Q

renal colic pain does it radiate anywhere else for men and women ?

A

yes it does, it can radiates down the groin
for men : radiate towards the scrotum
for women : radiate towards the labia

103
Q

true or false. if the stone makes it down to the
bladder, the pain will shift again and this time it shifts into the abdomen.

A

true

104
Q

what is the most common genetic disease in canada?

A

polycystic kidney disease in canada

105
Q

polycystic kidney disease only involves one kidneys, this is why it is the less severe urinary tract disorders

A

false, it involves both kidneys and no that doesnt mean its the less severe bommbooooclat

106
Q

Describe what cortex and medulla becomes filled with in polycysitc kidney disease

A

filled with cysts that enlarge and destroy surrounding tissue by compression

107
Q

what are symptoms when someone has polycystic kidney disease

A

abdominal or flank pain, hematuria ( ruptured cysts), UTI, hypertension
eventually can lead to renal failure, as it presses on the renal capsule

108
Q

true or false. polycystic kidney disease does not lead to CKD

A

false, it does!

109
Q

Just a summary not an question u need to answer: Polycystic kidney disease gets taken over by cysts, Gradually these cysts take over and compress the healthy tissue and we end up with loss of renal function. Now patients with polycystic kidney disease experience pain associated with the growing kidney.

A

YUUUUUUPPPPPPP TYPE SHI

110
Q

what are the two types of cancer we are talking in urinary tract disorders

A

kidney and bladder

111
Q

characteristics abt kidney cancer

what are the risk factors
what are the early symptoms
what are THE SYMPTOMS

A

*Risk factors: smoking, obesity
*No early symptoms
*Gross hematuria, flank pain, palpable mass

112
Q

characteristics abt bladder cancer

what are the risk factors
what are the early symptoms
what are THE SYMPTOMS

A

*Risk factors: smoking, exposure to industrial dyes, chronic kidney stones, chronic cystitis
*Gross, painless hematuria is most common finding ( visible blood in the urine )
*Irritative bladder symptoms

113
Q

recall : not a question u need to answer , just a bit more detail of bladder cancer
bladder cancer include a history of smoking and in fact tumors
occur four times more frequently in cigarette smokers than non-smokers. Exposure to chemicals can be dangerous
for the urinary tract and increase that risk for bladder cancer.
And finally a history of frequent injury or infection to the bladder can also
increase that risk for bladder cancer development.

A

TYYYYPEE SHIII

Pt.2 PHRM/PHYS/NS (14 decks)

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