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Pathophysiology > Week 4: Renal > Flashcards

Week 4: Renal Flashcards

1
Q

consequences of urinary obstruction depend on

A 
location within or outside urinary tract
unilateral or bilateral involvement
partial or complete obstruction
short-term or long-term duration
underlying cause
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2
Q

hydronephrosis

A

Fluid accumulates around the kidney
Fluid backup causes increase in hydrostatic pressure
Decreases GFR

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3
Q

chronic partial obstruction

A

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

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4
Q

kidney stones

A

Also called calculi or nephrolithiasis

Masses of crystals and protein - common cause of obstruction

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5
Q

factors that affect kidney stone formation

A

pH, high conc of stone forming substances, low urine output, tubular defects, facilitators and inhibitors of crystal growth, various diseases, drugs, diet

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6
Q

kidney stone clinical s&s

A

pain, n&v, hematuria

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7
Q

kidney stones dx

A
  • 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
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8
Q

kidney stones tx

A
  • prevent new stone formation and reduce size of ones already present
  • reduce concentration by increased fluid intake, decrease substances that cause stones
  • drugs
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9
Q

neurogenic bladder

A

caused by interruption of nerve supply to bladder - dependant on level of CNS or spinal cord injury

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10
Q

renal tumours assoc. with

A

tobacco use, obesity, and analgesic use

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11
Q

renal tumour clinical s&s

A

hematuria, flank pain, palpable, flank mass, weight loss

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12
Q

renal tumour dx

A

clinical symptoms, x ray, and ct

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13
Q

renal tumours tx

A

surgical removal by cytoscopy and chemo

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14
Q

transitional cell carcinoma

A

very frequent recurrence

must continually do surveillance

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15
Q

uti people at risk

A 
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
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16
Q

cystitis

A

inflammation of the bladder

17
Q

cystitis s&s

A

dysuria, frequency, urgency, pain, hematuria

18
Q

cystitis dx & tx

A

Most important to examine urine for bacteria
Treat with microorganism specific antibiotic
Three to five days treatment is common

19
Q

pyelonenephritis

A 
Infection of renal pelvis and interstitium
caused by: 
bacteria
kidney stones
pregnancy
neurogenic bladder
instrumentation
female sexual trauma
20
Q

acute pyelonephritis

A

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

21
Q

acute pyelonephritis cm, dx, tx

A 
- 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
22
Q

chronic pyelonephritis

A

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

23
Q

glomerulonephritis

A

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

24
Q

glomerulonephritis 3 immune mechanisms

A

deposition of circulating soluble complexes
formation of antibodies against glomerular basement membrane
streptococcal release of neuramidase

25
Q

glomerulonephritis s&s

A
  • hematuria with RBC casts
  • proteinuria exceeding 3-5g/day
  • renal insufficiency after 10-20 years
26
Q

glomerulonephritis dx, tx

A

Confirmed by urinalysis
Serum creatinine is
Creatinine clearance evaluates extent of damage
Treat primary disease (dependant on type) and accompanying problems

27
Q

renal insufficiency

A

25% normal function or a GFR of 25-30 ml/min. ( serum creatinine and urea)

28
Q

renal failure

A

ESRF = <10% renal function left

29
Q

azotemia

A

Increased serum urea levels and frequently increased creatinine levels in the blood

30
Q

acute renal failure

A

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

31
Q

prerenal ARF

A

from hypovolemia, hypotension

32
Q

intrarenal ARF

A

acute tubular necrosis

33
Q

postrenal ARF

A

obstruction

34
Q

intrarenal acute tubular necrosis

A

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)

35
Q

ATN dx & tx

A

diagnosis dependent on cause

tx goal is to maintain life until renal function resumes ie dialysis

36
Q

factors in CRF

A 
Creatinine and urea clearance
Sodium and water balance
Potassium balance
Acid-base balance
Phosphate and calcium balance
Hematocrit
Lipids
Proteins
Carbohydrates
37
Q

CRF clinical s&s

A 
anorexia
nausea
vomiting
diarrhea
weight loss
pruritus
edema
neurologic changes
38
Q

CRF dx

A 
Blood values
BUN, creatinine
Ultrasound
 IVP
Renal biopsy
Symptoms
39
Q

CRF tx

A 
Dietary management
Sodium and fluids
Potassium
Caloric intake
Erythropoietin
Dialysis
Transplant

Pathophysiology (12 decks)

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