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NURS 2514 > Week 4 - Renal & Urological Problems > Flashcards

Week 4 - Renal & Urological Problems Flashcards

1
Q

list the immunological disorders of the kidney (4)

A
  • glomerulonephritis
  • goodpasture’s syndrome
  • IgA nephropathy
  • nephritic & nephrotic syndrome
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2
Q

what is glomerulonephritis

A
  • inflammation of the glomerulus
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3
Q

how can glomerulonephritis be classified?

A

according to clinical presentation

  1. nephritic syndrome
  2. nephrotic syndrome
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4
Q

what is nephritic sybdrome?

A
  • the typical presentation of glomerulonephritis

Note: when just glomerulonephritis is used, it is referring to nephritic syndrome

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5
Q

what causes nephritic or nephrotic syndrome (2)

A
  • disorders of the kidney (pimary)

- systemic diseases that affect the kidney (secondary)

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6
Q

what is the typical cause of nephritic syndrome/glomerulonephritis

A
  • nearly all causes are immune mediated
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7
Q

what are exmaples of immune mediated causes of glomerulonephritis (6)

A
  • post-infectious disease
  • sepsis
  • endocarditis
  • lupus
  • rheumatic disease
  • idiopathic autoimmune
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8
Q

what are some examples of post-infectious diseases that can cause glomerulonephritis (7)

A
  • streptococci
  • penumococci
  • hep B
  • mononucleosis
  • measles
  • mumps
  • malaria
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9
Q

what are the 4 common manifestations of glomerulonephritis

A
  • hematuria
  • proteinuria
  • reduced GFR
  • hypertension
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10
Q

what are the 3 paths of glomerulonephritis

A
  1. acute glomerulonephritis
  2. rapidly progressive glomerulonephritis
  3. chronic glomerulonephritis
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11
Q

what is acute glomerulonephritis? what does it result in?

A
  • an abrupt onset of syndrome

- results in acute renal failure, followed by full recovery of renal function

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12
Q

what is rapidly progressive glomerulonephritis? what does it result in?

A
  • an abrupt onset of symptoms
  • results in acute renal failure which does not recover
  • over weeks to months it progresses to chronic renal failure
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13
Q

what is chronic glomerulonephritis? what does it result in?

A
  • acute glomerulonephritis which progresses slowly (5-20 years) to chronic renal failure
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14
Q

what is APSGN

A

acute poststreptococcal glomerulonephritis

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15
Q

what causes APSGN

A
  • after someone is infected with streptococcus, the immune attack on the streptococcus antigen results in immune complex deposits in the glomerular capillaries
  • the deposits of these immune complexes activates the complement system & causes the inflammatory response
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16
Q

how long does it take for nephritic manifestations to occur in APSGN

A
  • ~7-10 days after the onset of infection
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17
Q

what 2 types of infection with streptococcus occur? which is more common?

A
  1. pharyngeal
  2. cutaneous
  • cutaneous is more common
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18
Q

what type of bacteria causes APSGN

A
  • group A streptococcus = streptococcus pyogenes
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19
Q

how long does it take for APSGN to resolve?

A
  • will resolve over a period of weeks
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20
Q

who does APSGN effect? who is it more common in?

A
  • usualy children between ages 3-7

- more common in boys

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21
Q

what can we do to prevent APSGN

A
  • treat the streptococcal infection w antibiotics
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22
Q

how does APSGN effect the structure of the glomerulus (3)? what does this cause?

A
  • the endothelial cells swell & lose their fenestrations
  • the podocytes are altered & lose their slits
    = RBC and proteins can leak thru
  • get subendothelial & subepithelial deposits of WBC and immune complexes
    = glomerular congestion = difficult to make filtrate
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23
Q

what are the manifestations of APSGN (9)

A
  • hematuria
  • proteinuria
  • erythrocyte casts
  • decreased GFR = oliguria & azotemia
  • pain in the flank & lower back
  • HTN & edema
  • blood analysis results
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24
Q

what causes hematuria & proteinuria in APSGN

A
  • due to damage of the glomerular capillaries = theyr are more permeable
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25
Q

what causes a decreased GFR in APSGN? how does it cause oliguria & azotemia?

A
  • GFR reduces due to the congestion in the capillary with WBC and the immune complexes
  • oliguria = decreased GFR = decreased flitrate = decreased urine
  • azotemia = can’t filter out the metabolits
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26
Q

how does APSGN cause flank and lower back pain

A
  • due to swelling/distension of the renal capsule which presses on nerves (?)
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27
Q

what type of edema is seen in APSGN

A
  • facial

- preorbital

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28
Q

what causes HTN and edema in APSGN (3)

A
  • due to fluid & salt overload from decreased GFR
  • also hyperreninemia
  • decreased colloid osmotic P (due to proteinuria)
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29
Q

what does a blood analysis in APSGN show?

A
  • elevation of antibodies to streptococcal antigens

- metabolic acidosis

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30
Q

what 2 types of antibodies will be seen for streptococcal antigens

A
  1. antistreptolysin O

2. antistreptokinase ASK

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31
Q

what does a urine analysis in APSGN show?

A
  • proteinuria
  • hematuria
  • erythrocyte casts
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32
Q

describe the resolution of APSGN; describe it for kids & adults; what can it result in?

A
  • most cases resolve with a diuretic phase after treatment for the infection (esp after kids)
  • in adults, not as easily resolved
  • some cases may progress to chronic renal failure
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33
Q

what causes nephrotic syndrome

A
  • occurs secondary to a number of disorders
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34
Q

what are some disorders that cause nephrotic syndrome (6)

A
  • infection
  • lupus
  • exposure to nephrotoxins
  • neoplasia
  • diabetic nephropathy
  • immune-mediate
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35
Q

what is the difference between nephritic and nephrotic syndromw

A
  • both = inflammation of the glomerulus

- nephrotic = no presence of cellular immune cells (WBC)

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36
Q

what are the symptoms of nephrotic syndrome (6)

A
  • marked proteinuria (lots) –> which leads to…
  • hypoalbuminemia & hypoproteinuria
  • hyperlipidemia
  • lipid in the urine
  • generalized edema
  • no HTN and hypovolemia
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37
Q

how does lipid in the urine present as?

A
  • milky appearance with increased specific gravity
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38
Q

what causes edema in nephrotic syndrome

A
  • loss of proteins = reduced colloid osmotic pressure (which usually pulls fluid in)
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39
Q

where do we see edema in nephrotic syndrome (3)? what does edema cause?

A
  • dependent areas (ex. feet)
  • ascites
  • effusions (heart or lungs)
  • causes weight gain
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40
Q

how does the edema in nephrotic syndrome effect bp?

A

bp is not usually elevated due to:

  • third-spacing (so it is not in vascular space)
  • hypovolemia
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41
Q

what are the manifestations of hypovolemia (3)

A
  • syncope
  • circulatory shock
  • acute kidney azotemia
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42
Q

how does nephrotic syndrome cause hyperlipidemia

A
  • the decreased colloid osmotic pressure stimulate the liver to produce proteins, including lipoproteins
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43
Q

what does hyperlipidemia in nephrotic syndrome result in? (2)

A

= elevated plasma LDL and VLDL

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44
Q

besides decreased colloid pressure, what does loss of plasma proteins (other than albumin) cause? (5)

A
  • deficient phagocytosis & opsonization
  • hypercoagulability
  • secondary parathyroidism
  • iron deficiency
  • abnormal thyroid function
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45
Q

loss of which proteins result in phagocytosis & opsonization

A
  • loss of antibodies and complement proteins
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46
Q

loss of which proteins result in hypercoaguability

A
  • loss of plasma anticoagulants

ex. antithrombin

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47
Q

loss of which protein results in secondary hyperparathyroidism

A
  • loss of vitamin D binding proteins
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48
Q

loss of which protein results in iron deficiency

A
  • loss of transferrin
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49
Q

loss of which protein results in abnormal thyroid function

A
  • loss of thyroid binding protein
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50
Q

some cases of nephrotic syndrome are considered…

A
  • a minimal change disease
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51
Q

what is meant by minimal change disease

A
  • all manifestations are due to proteinuria

- progression to uremia does not occur

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52
Q

is the difference between nephrotic & nephritic syndrome always distinct?

A
  • no, sometime it is difficult or impossible to make
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53
Q

how is nephrotic syndrome treated

A
  • with anti-inflammatory drugs like glucocorticoids to reduce glomerular inflammation
  • lasix & spironolactone for fluid & electrolyte control
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54
Q

what are 3 types of infectious & inflammatory disorders of the urinary system

A
  1. cystitis
  2. acute pyelonephritis
  3. chronic pyelonephritis
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55
Q

what are the 2 categories of UTIs

A
  1. upper tract

2. lower tract

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56
Q

what is considered upper tract urinary system?

A

anything that involves:

  • ureter
  • kidney
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57
Q

what is considered lower tract urinary system?

A

anything that involves:

  • bladder
  • urethra
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58
Q

what is the second most common infection seen by HCP?

A
  • UTIs
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59
Q

what is the most common cause a UTI?

A
  • an ascending infection = microbes enter the urethra as the portal of entry & work their way up
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60
Q

what is the body’s major defense against ascending infection

A
  • the flushing effect of urine flow
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61
Q

why is it that when we take urine samples for UTIs, is it done mid-stream>

A

-bc at first, there will always be bacteria in urine`

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62
Q

what type of bacteria is the most common cause of UTI? what type of infections does it cause

A
  • escherichia coli

= opportunist infection or nosocomial infection

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63
Q

what type of bacteria is the second most common cause of UTI

A
  • proteus bacteria
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64
Q

what are 6 causes/contributing factors to an UTI?

A
  • ascending infection
  • immobility = stasis of urine
  • blood-borne organism
  • obstruction : ex. prostatic hypertrophy
  • vesicoureteral reflux
  • incomplete bladder emptying
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65
Q

what is the vesicoureteral reflux?

A
  • congenital defect that causes a defective valve

- this causes backflow of urine into the kidneys

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66
Q

what about e.coli creates its ability to cause UTIs? what typically prevents this?

A
  • its pilli which causes its ability to bind to urinary epithelial cells
  • urine flow tends to prevent this
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67
Q

how does glucosuria/diabetes effect E.coli’s ability to cause UTIs?

A
  • the glucose provides an additional energy source
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68
Q

describe the relation between proteus bacteria & urea

A
  • it can use urea as an energy source, liberating free ammonium
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69
Q

who is more susceptible to UTIs? (2)

A
  1. young females

2. older men

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70
Q

why are younger females more susceptible to UTIs?

A

due to anatomical vulnerability:

- short, wide urethra with closer proximity to the anus

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71
Q

why are older males more susceptible to UTIs?

A
  • they suffer from an enlarged prostate

= obstruction & retention of urine = frequent UTIs

72
Q

what can cause incomplete bladder emptying & obstruction of urine flow (6)

A
  • incontinence
  • pregnancy
  • scar tissue
  • congenital defects of the ureter
  • impaired blood supply to the bladder
73
Q

what are 2 other risk factors for UTIs

A
  • catheterization

- sexual intercourse

74
Q

describe the relationship between UTIs and renal calculi (kidney stones)

A
  • calculi can obstruct the urine = infection

- while ammonium formed by UTIs makes the urine more alkaline & predisposes calculi formation

75
Q

what are the 4 main manifestations of cystitis

A
  1. pain
  2. frequency & uregency
  3. systemic signs of infection
  4. urinalysis
76
Q

what type of pain is common in cystitis (2)

A
  • abdominal pain

- dysuria –> pain during micturition

77
Q

what are the frequency and urgency symptoms of UTI called?

A
  • irritative symptoms
78
Q

what causes frequency and urgency in UTIs

A
  • inflammation & swelling of the bladder = reduced capacity of the bladder
79
Q

what are systemic signs of infection seen in UTIs?

A
  • fever
  • malaise
  • nausea
  • leukocytosis
80
Q

what is leukocytosis

A
  • increased WBC
81
Q

what is seen during urinalysis for cystitis (3)? what does this cause?

A
  • bacteriuria
  • pyuria
  • microscopic hematuria

= creates cloudy urine with unusual odour

82
Q

what is the treatment for UTIs (2)

A
  • antibiotic therapy
  • increased fluid intake

both to help eliminate evading organisms

83
Q

what 2 types of juice are useful for UTIs? why?

A
  • cranberry & blueberry

- contain tannins that interfere w the pili of e.coli & prevent binding to urinary epithelia

84
Q

what is the cause of pyelonephritis (2)

A
  • an ascending infection from the bladder

- bacteremia

85
Q

what does pyelonephritis often involve (2)

A
  • the renal pelvis

- medullary tissue

86
Q

what does pyelonephritis often result in

A
  • inflammation

- possibly necrosis

87
Q

if pyelonephritis is severe, would happens?

A
  • exudate & pus compress the renal vessels
    = ischemia & HTN
  • or it can compress the ureter = obstructs urine flow
88
Q

what are the manifestations of pyelonephritis(4)

A
  • pain
  • LUTS
  • urinalysis abnormalities
  • failure to conc the urine
89
Q

what symptom might you see if pyelonephritis includes bilateral obstruction

A
  • azotemia
90
Q

what does chronic or repeat infection of pyelonephritis result in?

A
  • chronic kidney failure
91
Q

what is chronic pyelonephritis

A
  • term used to describe a kidney that has become shrunken & has lost function due to scarrin & fibrosis
92
Q

what causes chronic pyelonephritis

A
  • usually occurs as the outcome of recurring infections involving the upper urinary tract
93
Q

what type of pain is experiences during pyelonephritis? what causes it?

A
  • dull & aching lower back/flank pain
  • CVA tenderness

due to distension of the renal capsule

94
Q

describe the urinalysis for pyelonephritis

A
  • pyuria
  • bacteruria
  • hematuria
  • casta (WBC & epithalial)
95
Q

what are urinary calculi

A
  • kidney stones
96
Q

what is the most common cause of urinary tract obstruction?

A
  • kidney stones (nephrolithiasis)
97
Q

what does stone formation require? (2)

A
  • a nucleus to initiate formation ex. cell debris

- an enviro that encourages precipitation ex. pH

98
Q

what are stones made of?

A
  • various solutes the kidney normally excretes
99
Q

how many types of stones are there? list them

A

4

  1. calcium
  2. struvite
  3. uric acid
  4. cystine
100
Q

what are 2 types of calcium stones?

A
  • oxalate ( an organic acid found in plants)

- phosphate

101
Q

what are struvite kidney stones made of

A
  • ammonium
  • magnesium
  • phosphate
102
Q

what is the most common type of kidney stone?

A
  • approx 75% contain calcium
103
Q

what are most calcium stones due to? (3)

A
  • idiopathic hypercalciuria
  • hyperparathyroidism
  • immobility
104
Q

uric acid stones account for ___% of stones

A
  • 10
105
Q

what are the contributing factors to uric acid stones (6) what pH?

A
  • hyperuricosuria
  • gout
  • chemo
  • obesity
  • diet high in organ meats, red meat
  • acidic urine
106
Q

struvite stones represent nearly __% of stones

A

15

107
Q

what causes struvite stones (2) what pH

A
  • chronic or recurrent UTIs with urea metabolizing bacteria (proteus), where the pH is alkaline
108
Q

how common are cystine stones?

A
  • very rare
109
Q

what causes cystine stones?

A
  • inherited disorders of amino acid metabolism
110
Q

list 4 causes of renal calculi

A
  • precipitation of organic salts in the urinary tract
  • dehydration
  • high Na and protein diets
  • HTN
111
Q

what is meant by precipitation of salts?

A
  • deposited in a solid form
112
Q

what two things can cause precipitation of salts in the urinary tract?

A
  • saturation (too much solute, not enough solvent)

- change in solubility (change in pH)

113
Q

which type of stone prefers acidic enviro? alkaline?

A
  • struvite, calcium phosphate = alkaline

- uric acid, calcium oxylate, cystine = acid

114
Q

how does dehydration contribute to renal calculi formation

A
  • increases urine concentration (saturation)

- decreases Ca transit time

115
Q

list the symptoms of kidney stones (7)

A
  • renal colic = lower back & flank pain
  • ureteral colic = pain radiating to groin, perineum, scortum
  • lower abdominal pain
  • oliguria
  • hematuria
  • with or without fever
  • signs of hydronephrosis & hydroureter
116
Q

what does it mean if kidney stones are obstructing both kidneys

A
  • there is underlying disease
117
Q

what occurs if a person only has 1 kidney and they have a kdiney stone (2)

A
  • azotemia

- anuria

118
Q

what 3 things are often required to allow passage of a stone (3)

A
  • fluids
  • best rest
  • analgesics
119
Q

what is the specific treatment for oxalate stones (3)

A
  • thiazide diuretics
  • alkali therapy
  • cholestyramine
120
Q

what is the specific treatment for struvite stones

A
  • antibiotics (to kill the proteus bacteria)
121
Q

what is the specific treatment for oxalate, uric acid, and cystine stones?

A
  • alkali
122
Q

what is the specific treatment for uric acid stones

A
  • allopurinol treatment (inhibits uric acid formation)

- alkali treatment

123
Q

what is used to chalate calcium?

A
  • cellulose phosphate (calcibind)
124
Q

what is used to bind oxalate?

A
  • cholestyramine
125
Q

what dietary changes can be used to treat kidney stones (2)

A
  • low sodium & protein intake
126
Q

what type of diet change is not very effective for stones? why?

A
  • decreasing calcium intake

- can accelerate oxalate stones

127
Q

what are 2 types of treatment for kidney stones?

A
  • lithotripsy

- surgery

128
Q

what are 2 common causes of urinary obstruction

A
  • renal calculi

- prostate disease

129
Q

what are the 2 most damaging effects of obstruction? why?

A
  • stasis of urine = predisposes to infection

- increased backpressure = can impair renal blood flow & damage renal tissue

130
Q

obstruction can be either.. (2)

A
  • complete

- or partial

131
Q

how can increased backpressure damage renal tissue?

A
  • increased pressure in the renal pelvis & calices can obstruct blood flow to the medulla which can cause ischemic damage & necrosis
132
Q

how long does it take for irreversible nephron damage to occur after complete obstruction?

A
  • within a few days
133
Q

how long can it take for recovery after obstruction?

A
  • can take weeks
134
Q

how does prolonged obstruction effect the ureters and renal pelvis??

A
  • causes dilation = hydroureter & hydronephrosis
135
Q

does pain occur with urinary obstruction? why?

A
  • renal colic occurs due to distension of the bladder, ureter, or renal capsule
136
Q

when is pain usually more severe with urinary obstructions>?

A
  • in acute obstructions
137
Q

describe the effect of urinary obstruction on GI

A
  • can cause disruption of visceral innervation
    = can impair GI mobility
    = abdominal distension & paralytic ileus
138
Q

why is early treatment & diagnosis of urinary obstruction important?

A
  • failure to restore the urinary flow can result in permanent renal damage
139
Q

what can be bilateral obstruction result in?

A
  • can result in renal failure
140
Q

what is BPH

A
  • benign prostate hyperplasia

- nonmalignant growth of the prostate

141
Q

what is the cause of BPH? what contributes to it?

A
  • cause unknown

- age & hormonal factors play a role

142
Q

what specifically increases during BPH

A
  • increase cell number

- not cell size (which is hypertrophy)

143
Q

the normal prostate contains…(2)

A
  • epithelial & smooth muscle cells
144
Q

describe the role os testosterone in the maintenance of normal prostate size

A
  • acts to produce protein growth factors (FGF, IGF) which help maintain the normal size
145
Q

describe testosterone & estrogen as the male ages, and how this effects the prostate

A
  • testosterone decreases while serum estrogen rises

- estrogen increases the number of testosterone receptors & increase prostate sensitivity

146
Q

what type of receptors does prostate smooth muscle contain? what does this cause?

A
  • contains alpha 1 receptors that stimulate them to contract
147
Q

what 2 things are responsible for the manifestations of BPH

A
  • obstruction to urine outflow

- bladder dysfunction

148
Q

what are the 2 categories of BPH symptoms?

A
  • irritative

- obstructive

149
Q

what causes irritative symptoms in BPH

A
  • bladder hypertrophy & dystrophy
150
Q

what are irritative symptoms in BPH

A
  • frequency
  • urgnecy
  • nocturia
151
Q

what causes obstructive symptoms in BPH

A
  • narrowing of the bladder neck & urethra
152
Q

what is included in obstructive symptoms of BPH? (5)

A
  • difficulty initiating urination
  • decreased urinary flow (both force & caliber)
  • intermittency
  • hesitancy
  • dribbling
153
Q

what are 4 complications of BPH? what causes them?

A
  • UTIs
  • hematuria
  • post-renal azotemia
  • chronic renal failure

from bilateral hydroureter & hydronephrosis

154
Q

what is used to reveal enlargement of the prostate? how well does this correlate with symptoms

A
  • digital rectal exam

- does not correlate well w symptoms

155
Q

what 2 other things do digital rectal exams reveal during BPH ?

A
  • bladder distension & hypertrophy
156
Q

list treatment for BPH (4)

A
  • alpha-1 blockers
  • androgen blockade
  • prostate stents
  • surgery
157
Q

describe how alpha-1 blockers are effective in tx of BPH

A
  • as noted earlier, alpha 1 receptors are found in the sm. m of the prostate to stimulate contraction
  • alpha 1 blockers causes the sm. m to relax, which can make urine flow better & take tension off
158
Q

describe how androgen blockade is effective in tx of BPH?

A
  • blocks testosterone production
159
Q

what is a prostate stent?

A
  • a stent used to keep the male urethra open & allow passage of urine during BPH
160
Q

what is the cause of prostate cancer? what plays a role (2)

A
  • unknown

- enviro & genetic factors play a role

161
Q

what are risk factors for prostate cancer (6)

A
  • first or second degree-relative woth prostate cancer = 8x the risk
  • over age 50 but occurs earlier in men of African descent
  • testosterone
  • dietary fat & red meat
  • obesity & inactivity
  • prostatitis
162
Q

why is it believed that testosterone is a risk factor for prostate cancer?

A
  • men who have been castrated do not develop prostate cancer
163
Q

is BPH or infectious disease linked to prostate cancer?

A
  • no
164
Q

what are manifestations of prostate cancer (3)

A
  • most are asymptomtic
  • depending on size of tumour, may be changes in urination similar to BPH
  • production of a protein called prostate-specific antigen
165
Q

what is prostate specific antigen (PSA)

A
  • function unknown

- but it is a protein that becomes elevated in the serum during prostate disease (cancer, BPH, prostatitis)

166
Q

why is screening for prostate cancer so important?

A
  • bc most cases are asymptomatic
167
Q

list common screening tests for prostate cancer

A
  • serum PSA
  • rectal exam
  • ultrasound
168
Q

what can a rectal exam detect during screening on prostate cancer?

A
  • hard nodular tumours
169
Q

what can an ultrasound detect during screening for prostate cancer?

A
  • can detect small tumours, as small as 5 mm
170
Q

how is the diagnosis of prostate cancer confirmed?

A
  • prostate biopsy
171
Q

list 3 treatments for prostate cancer?

A
  • surgery
  • radiotherapy
  • androgen-deprivation therapy
172
Q

what are 2 types of hereditary renal disease

A
  • polycystic kidney disease

- medullary cystic disease

173
Q

what is polycystic kidney disease

A
  • A genetic disorder in which numerous fluid-filled cysts develop in the kidney.
    = increased size of kidney
174
Q

list various metabolic & CT disease processes that have an effect on renal function

A
  • diabetic nephropathy
  • gout
  • amyloidosis
  • systemic lupus erythematosus
  • systemic sclerosis (scleroderma)
175
Q

how does gout effect renal function

A
  • causes excess uric acid

NURS 2514 (75 decks)

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