Patho Ch. 29: Renal

Front 1

the ratio of the density of a substance to the density of another substance accepted as a standard. The usual standard for liquids and solids is water. Thus a liquid or solid with a specific gravity of 4 is four times as dense as water at the same temperature. Hydrogen is the usual standard for gases.

Back 1

Specific Gravity

Front 2

○ a measure of the amount of urea in the blood. Urea forms in the liver as the end product of protein metabolism, circulates in the blood, and is excreted through the kidney in urine. The BUN, determined by a blood test, is directly related to the metabolic function of the liver and the excretory function of the kidney. Normal findings (in mg/dL) are 10 to 20 for adults, 5 to 18 for children and infants, 3 to 12 for newborns, and 21 to 40 for cord blood. In the elderly, the BUN may be slightly higher than the normal adult range. A critical value of 100 mg/dL indicates serious impairment of renal function.

Back 2

BUN Blood Test

Front 3

○ a substance formed from the metabolism of creatine, commonly found in blood, urine, and muscle tissue. It is measured in blood and urine tests as an indicator of kidney function. Normal adult blood levels of creatinine are 0.5 to 1.1 mg/dL for females and 0.6 to 1.2 mg/dL for males; the numbers decrease in elderly patients because of a smaller muscle mass.

Back 3

Creatinine

Front 4

○ a diagnostic test for kidney function. It measures the rate at which creatinine is cleared from the blood by the kidney. It is calculated on the basis of a urine volume in milliliters per minute times the amount of milligrams per liter of urinary creatinine excreted in 24 hours. The resulting figure is divided by the amount of serum creatinine in milligrams per deciliter.

Back 4

Creatinine Clearance Test

Front 5

Crystals, protein, or other substances
Classified by minerals comprising the stone
Most common:
Calcium oxalate or phosphate 70%
Struvite 15%
Uric acid 7%

Back 5

Renal Calculi/Stones

Front 6

Age, gender, race, geographic location (hard water), seasonal factors, fluid intake, diet, occupation

Back 6

Risk Factors for Renal Calculi/Stones

Front 7

Supersaturation of one or more salts
Precipitation of a salt from liquid to solid state
Growth into a stone via crystallization or aggregation

Back 7

Kidney stone formation

Front 8

Moderate to severe pain-flank area radiating to groin
Colic pain, urgency, frequent voiding, urge incontinence

Back 8

Clinical Manifestation of Kidney Calculi/Stones

Front 9

Stone and UA analysis
Intravenous pyelogram (IVP)
Kidney, Ureter, Bladder x-ray
Spiral abdominal CT

Back 9

Evaluation of Kidney Calculi/Stones

Front 10

5th most common malignancy
more common >60 years

Back 10

Bladder tumors

Front 11

Increased incidence with smoking
Genetic alteration in normal bladder epithelium

Back 11

Patho of bladder tumors

Front 12

Gross painless hematuria

Back 12

#1 clinical symptom of bladder tumors

Front 13

Bothersome lower urinary tract symptoms: frequency, nocturia, urgency, urge incontinence

Back 13

Clinical manifestations of bladder tumors

Front 14

Inflammation of urinary epithelium from pathogen

Back 14

Urinary Tract Infection

Front 15

Bacteria most common that causes UTI

Back 15

E. Coli

Front 16

Inflammation of the bladder

Back 16

Cystitis

Front 17

Frequency, dysuria, urgency, lower abdominal pain/suprapubic pain

Back 17

Clinical Manifestations of cystitis

Front 18

Dysuria, frequency, suprapubic and lower back pain, foul smelling, cloudy

Back 18

Young Adult Clinical Manifestations of UTI

Front 19

Confusion, abdominal discomfort, higher infection rate so microorganisms proliferate

Back 19

Older Adult Clinical Manifestations of UTI

Front 20

Inflammation of glomerulus
Most common cause of chronic and end-stage renal disease

Back 20

Glomerulonephritis

Front 21

Immunological abnormalities
Ischemia:vascular disorders
Free radicals
Drugs or toxins
Systemic diseases

Back 21

Causes of glomerulonephritis

Front 22

Deposition of circulating soluble antigen-antibody complexes, often with complement fragments
Formation of antibodies against the glomerular basement membrane
Streptococcal release of neuramidase

Back 22

Mechanisms of injury
glomerulonephritis

Front 23

Streptococcal infection
Begins abruptly; 7 to 10 days after strep infection

Back 23

Acute Glomerulonephritis

Front 24

Several diseases leading to chronic renal failure
Assoc with hypercholesterolemia and proteinuria

Back 24

Chronic Glomerulonephritis

Front 25

Dev over days to weeks
Affects adults 5 decade
Idiopathic or assoc with proliferative glomerular disease
Renal insufficiency; poor prognosis if untreated early

Back 25

Rapidly progressive
Goodpasture syndrome

Front 26

Hematuria, RBC casts, proteinuria, decreased GFR, oliguria, HTN, edema of eyes or feet/ankles

Back 26

Clinical manifestations of acute glomerulonephritis

Front 27

Hematuria and proteinuria

Back 27

Clinical manifestations of chronic glomerulonephritis

Front 28

Excretion of 3.5 g or more of protein in the urine per day
The protein excretion is caused by glomerular injury

Back 28

Nephrotic Syndrome

Front 29

Hypoalbuminemia, edema, hyperlipidemia, lipiduria, and vitamin D deficiency

Back 29

Nephrotic Syndrome
Findings

Front 30

Decline in renal function to 25% of normal

Back 30

Renal insufficiency

Front 31

Significant loss of renal function

Back 31

Renail failure

Front 32

<10% of renal function remains

Back 32

End-stage renal failure (ESRD)

Front 33

Abrupt reduction in renal function
BUN and creatinine
Oliguria; but may be normal
Most types are reversible; if treated early

Back 33

Acute Renal Failure

Front 34

Impaired renal blood flow (most common cause)
GFR declines due to ê filtration pressure

Back 34

Prerenal Acute Renal Failure

Front 35

Tubular necrosis; surgery sepsis, obstruction

Back 35

Intrarenal Acute Renal Failure

Front 36

Urinary tract obstruction (bilateral)

Back 36

Postrenal Acute Renal Failure

Front 37

Progressive and irreversible loss of nephrons
GFR; affects all organ systems
Does not become apparent until < 25% function remains

Back 37

Chronic Renal Failure
End-Stage Renal Disease (ESRD)

Front 38

Uremia/azotemia
Accumulation of toxins in plasma
HTN, anorexia, nausea, vomiting, diarrhea, weight loss, pruritus, edema, anemia, and neurologic changes

Back 38

Clinical manifestation of chronic renal failure