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31 Cards in this Set

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List some common causes of urinary tract obstruction
- developmental defects - calculi - pregnancy - benign prostatic hyperplasia - scar tissue from infection and inflammation - tumors - neurologic disorders such as spinal cord injury
Name 2 damaging effects of urinary obstruction
1. stasis of urine - predisposes to infection and stone formation 2. development of back pressure - interferes with renal blood flow and destroys kidney tissue
Urinary tract infections are often caused by what types of organisms?
urea-splitting organisms (Proteus, staphylococci)
What is hydronephrosis?
urine-filled dilatation of the renal pelvis and calices
What is the most useful noninvasive diagnostic modality for urinary obstruction?
ultrasonography
What are some factors that cause kidney stones?
- increases in blood and urinary levels of stone components - anatomic changes in urinary tract structures - metabolic and endocrine influences - dietary and intestinal absorption factors - UTI
What is two things are required for a kidney stone to form?
1. a nidus (or nucleus) 2. a urinary environment that supports continued crystallization of stone components
What are the 4 basic types of kidney stones?
- calcium stones (oxalate or phosphate) - magnesium ammonium phosphate stones - uric acid stones - cysteine stones
What is the most common type of kidney stone?
calcium stones are the most common (70% to 80%)
What are some contributing conditions that can cause calcium stones?
- immobility - bone disease - hyperparathyroidism - renal tubular acidosis
What conditions are necessary for the formation of magnesium ammonium phosphate stones?
- an alkaline environment - presence of bacteria that possess an enzyme called urease
Name and describe the 2 types of pain associated with kidney stones?
1. renal colic - accompanies stretching of the collecting system or ureter; acute, intermittent, excruciating pain in the flank and upper quadrant 2. noncolicky renal pain - caused by stones that produce distention of the renal calices or renal pelvis; dull, deep ache in flank or back
What is azotemia?
- increased levels of urea and creatinine in the plasma - usually caused by a decreased GFR
What is the difference between cystitis and pylelonephritis?
- Cystitis is a lower UTI - Pyelonephritis is an upper UTI
What is the most common cause of uncomplicated UTIs?
E. Coli
Name some non-E. Coli causes of UTIs
- Staphylococcus saprophyticus - Gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, and Enterobacter, Pseudomonas, and Serratia species) - Gram-positive cocci (Staphylococcus aureus, group B streptococci)
What are clinical presentations of cystitis?
- urinary frequency - lower abdominal pain or back discomfort, - dysuria (burning or pain during urination)
How does pyelonephritis clinically present?
- tend to produce more systemic signs of infection - shaking, chills, moderate to high fever, ache in the loin area of the back - malaise, N/V, and also lower UTI symptoms are common
What is pyuria?
- the presence of pus or WBCs in the urine - usually caused by a UTI
What are the 3 structural layers of the glomerular capillary membrane?
1. an endothelial cell layer lining the capillary 2. basement membrane 3. a layer of epithelial cells forming the outer surface of the capillary and lining Bowman's capsule
In the glomerular capillary membrane, name substances that enter the urine filtrate and name substances that remain in the blood
- Particles that enter the filtrate include glucose, amino acids, water, and electrolytes - Larger particles stay in the blood, such as plasma proteins and RBCs
What is glomerulonephritis?
- an inflammatory process that involves glomerular strucutures - characterized by hematuria with red cell casts, diminished GFR, azotemia, oliguria, and hypertension
What are causes of glomerulonephritis?
- caused by diseases that rpovoke a proliferative inflammatory response of the ednothelial, mesangial, or epithelial cells of the glomeruli - inflammatory process damages the capillary wall, allowing red blood cells to escape into the urine and producing hemodynamic changes that decrease GFR
What are the 2 types of immune mechanisms that have been implicated in the development of glomerular disease?
1. injury resulting from antibodies reacting with fixed glomerular antigens 2. injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane
Name and describe the 3 cellular changes that occur with glomerular disease
1. proliferative - an increase in the cellular components of the glomerulus 2. sclerotic - an increase in the noncellular components of the glomerulus, primarily collagen 3. membranous - an increase in the thickness of the glomerular capillary wall, often caused by immune complex deposition
What are characteristics of acute proliferative glomerulonephritis?
- follows infections caused by strains of group A ß-hemolytic streptococci - the inflammatory response is caused by an immune reaction that occurs when circulating immune complexes become entrapped in the flomerular capillary membrane - capillary membrane swells and becomes permeable to plasma proteins and blood cells - classic case of poststreptococcal glomeruloneprhitis fllows a streptococcal infection by 7-12 days
What are characteristics of the nephrotic syndrome?
- massive proteinuria - lipiduria - hypoalbuminemia - generalized edema - hyperlipidiemia
What are characteristics of Buerger's disease?
- aka immunoglbulin A nephropathy - a primary glomerulonephritis characterized by the presence of glomerular IgA immune complex deposits in the mesangium of the glomerulus
Name 3 types of tubulointerstitial disorders
1. renal tubular acidosis 2. pyelonephritis 3. drug-related nephropathies
What is renal tubular acidosis?
- a group of tubular defects in reabsorption of bicarbonate ions or excretion of H+ ions - results in acidosis
What is a Wilms' Tumor?
- aka nephroblastoma - one of the most common primary neoplasms of young children - associated with congenital anomalies, usually those affecting geitourinary structures