Week 3: Urology Flashcards
What is Nephrolithiasis?
Kidney Stones
Cause of obstruction in renal pelvis?
renal calculi
Causes of obstruction in ureter?
renal calculi, pregnancy, tumors
Causes of obstruction in bladder and urethra?
bladder cancer, neurogenic bladder, prostatic hyperplasia (BPH), prostate cancer, urethral strictures (narrowing)
Complications with urological obstructions?
stasis of flow, increase chance of infection, back up pressure causing hydronephrosis and hydroureter, AKI
Who is at risk for kidney stones
men, white, age 20-30, family hx, renal defect, weather (increase temp=increase risk of dehydratio), obesity
What are kidney stones?
crystallized solutes in urine
What are the 3 types of kidney stones?
calcium oxalate, struvite (staghorn), uric acid
Risks for calcium oxalate related kidney stones
family hx, hypercalcemia, oxaluria
Risk for struvite related kidney stones
UTIs
Risk for uric acid related kidney stones
gout
S/S of kidney stones
renal colic (waves of pain when ureter moves urine), nausea, flank pain, diaphoresis, tachycardia, tachypnea, and s/s of UTI
Treatment for kidney stones
help with pain, hydration (IV or PO)
Preventative meds for kidney stones
calcium oxalate= thiazide dieuretics
struvite= antibiotics
urate (uric acid)= allpurinol (med for gout)
Protective factors in urine to prevent UTI
pH, uni-directional, urea, immune system, women=urethral gland secretions, men=prostatic secretions
UTI risk factors
women, CAUTI, age, pregnancy, sexual activity, urinary obstruction, immobility, incontinent
What is pyelonephritis?
inflammation of the kidneys
Etiology of pyelonephritis
an ascending infection from lower UTI or blood infection
S/S of pyelonephritis
fever, chills, CVA tenderness, UTI
Complication of pyelonephritis
urosepsis
Treatment of pyelonephritis
bactrim, cipro, and vanco
Most common kidney cancer
renal cell carcinoma (85%)
S/S of kidney cancer
early=NONE, late= CVA tenderness, hematuria, palpable mass, and possible metastasis symptoms (lung= resp distress, etc)
Treatment of kidney cancer
surgery and chemo
Risk factors for kidney cancer
SMOKING, obesity, age, male and genetics
Most common bladder cancer
urothelial carcinoma (>90%)
Risk factors for bladder cancer
SMOKING, male, exposure to toxins, and decreased fluid intake
S/S of bladder cancer
early=hematuria, late=urinary frequency, urgency, and dysuria
Treatment for bladder cancer
stage 1 (early)= intravesical chemo
late= systemic chemo
Define intravesical chemo
chemo that is administered locally to the effected area
BCG vaccine
intravesical treatment for bladder cancer
MOA for BCG vaccine
stimulates an inflammatory response where it is injected
S/E of BCG vaccine
bladder irritation and risk of infection
Instructions for administering BCG vaccine `
empty bladder before administration, wait 2 hours and change positions q15
Azotemia definition
the s/s due to decreased kidney filtration
Oliguria definition
decreased urine output (<400mL/day)
Glomerular Fraction Rate (GFR) lab
amount of blood that is being filtered through the kidneys (mL/min)
Normal BUN value
10-20mg/dL
Normal Cr value
0.5-1.2mg/dL
Normal BUN/Cr ratio
10:1
Normal GFR value
<90mL/min
Chronic Kidney Disease (CKD) definition
kidney damage for more than 3 months with or without a GFR <60
Risk factors for CKD
family hx, age >60, male, african american, HTN, DM, smoking, and obesity
Someone with CKD cannot…
maintain acid-base balance, remove waste production from metabolism, or maintain F/E balance
Three key characteristics of CKD
glomerulosclerosis, interstitial fibrosis, and interstitial inflammation
GFR for Stage 1
> 90 (normal)
GFR for Stage 2 CKD
60-89
GFR for Stage 3 CKD
30-59
GFR for Stage 4 CKD
15-29
GFR for Stage 5 CKD (end-stage)
<15
S/S for Stage 1 CKD
asymptomatic
S/S for Stage 2 CKD
asymptomatic w/ possible HTN
S/S for Stage 3 CKD
HTN
S/S for Stage 4 CKD
Manifestations start showing, s/s of F/E imbalance, acid-base imbalance, and inability to rid of metabolic waster.
This is often when someone would get diagnosed
S/S for Stage 5 CKD
s/s of all stages and uremia (retention of metabolic waste, shown in BUN)
What s/s come from F/E imbalance in CKD?
edema, hyperkalemia, hyperphosphatemia, hypermagnesemia , acidosis
What s/s come from not urinating in CKD?
anorexia, malnutrition, itching and CNS changes
What s/s come from decreased erythropoietin in CKD?
anemia
What s/s come from decreased vitamin D in CKD?
renal osteodystrophy
Treatment for CKD
treat the HTN with an ACE or ARB, treat the HLD with a statin, and treat the symptoms/complications of CKD
Pharmacotherapy for CKD
ACE or ARB, statin, loop diuretic, sodium bicarbonate, calcium carbonate, calcitriol, and erythropoietin
Indication for Sodium Bicarbonate
metabolic acidosis
Indication for Calcium Carbonate
hyperphosphatemia
Indication for Calcitriol
renal osteodystrophy
Indication for erythropoietin
anemia
Calcium carbonate MOA
binds to phosphate, so you MUST take with meals bc majority of PO4 intake is through diet
S/E of calcium carbonate
hypercalcemia
MOA for calcitriol
activated form of Vitamin D which stimulate absorption of Ca and PO4
S/E of calcitriol
hyperCa, HyperPO4, GI upset, bone pain, cardiac arrhythmias, neuro changes
What medication are contraindicated with CKD?
Digoxin, DM meds= glyburide, metformin, antibiotics= vanco (must be renally dosed), opioids
What is the functional unit of the kidney
nephrons
Define glomerulonephritis
inflammation of glomeruli, can be local (1 kidney) or diffuse (both kidneys)
What is glomerulus?
network of arterioles within the bowmans capsule in the kidneys
What are the three layers of the glomerulus?
- endothelium
- basement membrane
- podocytes (special epithelial cells)
Etiology of glomerulonephritis
2 types
1. Type II sensitivity where anti-GBM antibodies attack basement membrane (5% of accounts)
2. Type III sensitivity where antibodies deposit complexes in the basement membrane (90% of accounts)
Triggers for glomerulonephritis
post infection, Berger (primary disease), systemic autoimmune (Lupus, Goodpasture)
S/S of glomerulonephritis
H.A.R.P= hematuria, azotemia, retention, and proteinuria
HTN, increased BUN, increased Cr, fluid retention, and oliguria
Pharmacotherapy for glomerulonephritis
steroids, diuretics, immunosuppressants, ACE and ARBS for HTN
possible dialysis if serious enough
Causes of glomerulopathy
DM nephropathy, and hypertensive glomerular disease
Pathology of glomerulopathy caused by DM nephropathy
thickening of basement membrane
Pathology of glomerulopathy caused by HTN
decreased renal prefusion causes sclerotic glomerular changes
What is nephrotic syndrome ?
the glomerulus is too permeable to plasma proteins (albumin) so there is an increase in urine (>3g/day)
S/S of nephrotic syndrome
edema, HTN, HLD, hypercoagulation (due to loss of antithrombin II and plasminogen)
What is an Acute Kidney Injury (AKI)
decreased volume and perfusion to the kidneys due to exposure to toxins or sepsis
What are the three classes on AKI
- prerenal
- intrarenal
- postrenal (RARE)
What is the prerenal class of AKI?
inadequate prefusion
What is the s/s of prerenal AKI
decreased BP, hypovolemia, sepsis, vasoconstriction, and renal artery stenosis (narrowing)
decreased GFR
What is intrarenal AKI?
acute tubular necrosis
What are the s/s of intrarenal AKI?
hypotension and volemia inflammatory response
What is postrenal AKI?
urinary tract obstructions, super rare
Lab changes for AKI
decreased GFR, decreased UOP, increased BUN, increased Cr,
Treatment for AKI
stabilize
the patient until kidney function returns and treat the cause
