Week 4: Renal Flashcards
consequences of urinary obstruction depend on
location within or outside urinary tract unilateral or bilateral involvement partial or complete obstruction short-term or long-term duration underlying cause
hydronephrosis
Fluid accumulates around the kidney
Fluid backup causes increase in hydrostatic pressure
Decreases GFR
chronic partial obstruction
Causes compression of kidney structures
Kidneys initially increase in size
Progressive atrophy follows
Tubular damage decreases ability to conserve Na+ and H2O or to excrete H- or K+
Failure to concentrate urine may cause risk of dehydration and metabolic acidosis
kidney stones
Also called calculi or nephrolithiasis
Masses of crystals and protein - common cause of obstruction
factors that affect kidney stone formation
pH, high conc of stone forming substances, low urine output, tubular defects, facilitators and inhibitors of crystal growth, various diseases, drugs, diet
kidney stone clinical s&s
pain, n&v, hematuria
kidney stones dx
- Thorough medical and family history, diet history, previous history of urinary tract disease, use of medication
- Check blood and urine (urine pH, RBC, WBC should be elevated)
- Radiographic tests: flat plate of abdomen or IV pyelogram
kidney stones tx
- prevent new stone formation and reduce size of ones already present
- reduce concentration by increased fluid intake, decrease substances that cause stones
- drugs
neurogenic bladder
caused by interruption of nerve supply to bladder - dependant on level of CNS or spinal cord injury
renal tumours assoc. with
tobacco use, obesity, and analgesic use
renal tumour clinical s&s
hematuria, flank pain, palpable, flank mass, weight loss
renal tumour dx
clinical symptoms, x ray, and ct
renal tumours tx
surgical removal by cytoscopy and chemo
transitional cell carcinoma
very frequent recurrence
must continually do surveillance
uti people at risk
premature infants sexually active and pregnant women women on antibiotics that disrupt vaginal flora, spermicide users people with indwelling catheters DM neurogenic bladder UT obstruction
cystitis
inflammation of the bladder
cystitis s&s
dysuria, frequency, urgency, pain, hematuria
cystitis dx & tx
Most important to examine urine for bacteria
Treat with microorganism specific antibiotic
Three to five days treatment is common
pyelonenephritis
Infection of renal pelvis and interstitium caused by: bacteria kidney stones pregnancy neurogenic bladder instrumentation female sexual trauma
acute pyelonephritis
Spread via the ureters or bloodstream
Infection causes infiltration of WBC with renal inflammation and purulent urine
Release of phagocytic lysozymes and other inflammatory mediators may damage tubular cells
Glomeruli are usually spared
Healing includes scar tissue and atrophy of affected tubules
acute pyelonephritis cm, dx, tx
- Present with: fever chills flank or groin pain frequency dysuria costovertebral tenderness - Dx established by urine culture - Responds to 2 weeks of microorganism specific antibiotics
chronic pyelonephritis
Persistent or recurrent autoimmune infection
One or both kidneys involved
More likely seen in patients who have renal infections d/t obstructive problems
Obstruction prevents elimination of bacteria causes gradual destruction of tubules
May lead to CRF
glomerulonephritis
Inflammation of the glomerulus
Caused by immunologic abnormalities, drugs/ toxins, vascular disorders, systemic disease
Immunologic alterations most frequent cause (scarring, # of glomerular cells, etc)
Glomerulonephritis is the most common cause of CRF and ESRD
glomerulonephritis 3 immune mechanisms
deposition of circulating soluble complexes
formation of antibodies against glomerular basement membrane
streptococcal release of neuramidase
glomerulonephritis s&s
- hematuria with RBC casts
- proteinuria exceeding 3-5g/day
- renal insufficiency after 10-20 years
glomerulonephritis dx, tx
Confirmed by urinalysis
Serum creatinine is
Creatinine clearance evaluates extent of damage
Treat primary disease (dependant on type) and accompanying problems
renal insufficiency
25% normal function or a GFR of 25-30 ml/min. ( serum creatinine and urea)
renal failure
ESRF = <10% renal function left
azotemia
Increased serum urea levels and frequently increased creatinine levels in the blood
acute renal failure
Abrupt reduction in renal failure
Oliguria (output of <30ml/hr or <400 ml/day)
Elevated BUN and creatinine
Reversible if dx. & tx. early
May be caused by severe hypotension, vascular obstruction, severe glomerular disease, sequela to radiocontrast media administration
Classified as prerenal, intrarenal or postrenal
prerenal ARF
from hypovolemia, hypotension
intrarenal ARF
acute tubular necrosis
postrenal ARF
obstruction
intrarenal acute tubular necrosis
When caused by ischemia, most common cause is surgery, but may also be d/t sepsis, obstetric complications, severe burns or trauma (also severe hypotension with hypovolemia)
ATN dx & tx
diagnosis dependent on cause
tx goal is to maintain life until renal function resumes ie dialysis
factors in CRF
Creatinine and urea clearance Sodium and water balance Potassium balance Acid-base balance Phosphate and calcium balance Hematocrit Lipids Proteins Carbohydrates
CRF clinical s&s
anorexia nausea vomiting diarrhea weight loss pruritus edema neurologic changes
CRF dx
Blood values BUN, creatinine Ultrasound IVP Renal biopsy Symptoms
CRF tx
Dietary management Sodium and fluids Potassium Caloric intake Erythropoietin Dialysis Transplant
