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31 Cards in this Set
- Front
- Back
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List some common causes of urinary tract obstruction
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- developmental defects - calculi - pregnancy - benign prostatic hyperplasia - scar tissue from infection and inflammation - tumors - neurologic disorders such as spinal cord injury
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Name 2 damaging effects of urinary obstruction
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1. stasis of urine - predisposes to infection and stone formation 2. development of back pressure - interferes with renal blood flow and destroys kidney tissue
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Urinary tract infections are often caused by what types of organisms?
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urea-splitting organisms (Proteus, staphylococci)
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What is hydronephrosis?
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urine-filled dilatation of the renal pelvis and calices
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What is the most useful noninvasive diagnostic modality for urinary obstruction?
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ultrasonography
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What are some factors that cause kidney stones?
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- 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
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What is two things are required for a kidney stone to form?
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1. a nidus (or nucleus) 2. a urinary environment that supports continued crystallization of stone components
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What are the 4 basic types of kidney stones?
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- calcium stones (oxalate or phosphate) - magnesium ammonium phosphate stones - uric acid stones - cysteine stones
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What is the most common type of kidney stone?
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calcium stones are the most common (70% to 80%)
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What are some contributing conditions that can cause calcium stones?
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- immobility - bone disease - hyperparathyroidism - renal tubular acidosis
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What conditions are necessary for the formation of magnesium ammonium phosphate stones?
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- an alkaline environment - presence of bacteria that possess an enzyme called urease
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Name and describe the 2 types of pain associated with kidney stones?
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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
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What is azotemia?
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- increased levels of urea and creatinine in the plasma - usually caused by a decreased GFR
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What is the difference between cystitis and pylelonephritis?
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- Cystitis is a lower UTI - Pyelonephritis is an upper UTI
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What is the most common cause of uncomplicated UTIs?
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E. Coli
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Name some non-E. Coli causes of UTIs
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- Staphylococcus saprophyticus - Gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, and Enterobacter, Pseudomonas, and Serratia species) - Gram-positive cocci (Staphylococcus aureus, group B streptococci)
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What are clinical presentations of cystitis?
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- urinary frequency - lower abdominal pain or back discomfort, - dysuria (burning or pain during urination)
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How does pyelonephritis clinically present?
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- 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
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What is pyuria?
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- the presence of pus or WBCs in the urine - usually caused by a UTI
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What are the 3 structural layers of the glomerular capillary membrane?
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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
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In the glomerular capillary membrane, name substances that enter the urine filtrate and name substances that remain in the blood
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- Particles that enter the filtrate include glucose, amino acids, water, and electrolytes - Larger particles stay in the blood, such as plasma proteins and RBCs
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What is glomerulonephritis?
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- an inflammatory process that involves glomerular strucutures - characterized by hematuria with red cell casts, diminished GFR, azotemia, oliguria, and hypertension
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What are causes of glomerulonephritis?
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- 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
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What are the 2 types of immune mechanisms that have been implicated in the development of glomerular disease?
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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
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Name and describe the 3 cellular changes that occur with glomerular disease
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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
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What are characteristics of acute proliferative glomerulonephritis?
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- 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
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What are characteristics of the nephrotic syndrome?
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- massive proteinuria - lipiduria - hypoalbuminemia - generalized edema - hyperlipidiemia
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What are characteristics of Buerger's disease?
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- aka immunoglbulin A nephropathy - a primary glomerulonephritis characterized by the presence of glomerular IgA immune complex deposits in the mesangium of the glomerulus
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Name 3 types of tubulointerstitial disorders
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1. renal tubular acidosis 2. pyelonephritis 3. drug-related nephropathies
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What is renal tubular acidosis?
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- a group of tubular defects in reabsorption of bicarbonate ions or excretion of H+ ions - results in acidosis
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What is a Wilms' Tumor?
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- aka nephroblastoma - one of the most common primary neoplasms of young children - associated with congenital anomalies, usually those affecting geitourinary structures
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