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122 Cards in this Set
- Front
- Back
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Define hematuria
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Red Blood Cells in the urine
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Define Proteinuria
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Protein in the urine
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Define Pyuria
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WBC's in the urine
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Define Glucosurea
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Glucose in the urine
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Define crystalluria
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Calcium, phosphate, magnesium crystals in the urine
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What is the role of an osteoblast?
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Takes calcium from the blood and puts it into the bones
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What is the role of an osteoclast?
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Takes calcium from the bones and puts it into the blood
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What is the role of the hormone parathormone?
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Increases blood calcium level and reduces the level of calcium in the bones
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What is the role of the hormone calcitonin?
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Increases calcium in the bones and decreases calcium in the blood? "Tones your bones"
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What is the disease involving a hormone that causes too much calcium to be released into the blood stream reducing the amount in the bones?
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Hyperparathyroidism
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What is a urinary obstruction?
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Anything that blocks the flow of urine through the urinary tract
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What does the term "lith" mean?
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Stone
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What is the term that means kidney stone?
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Nephrolith
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What is the term that means stones in the ureter?
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Ureterolith
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What is the term that means stones in the urethra?
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Urethrolith
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What is the term that means stones in the bladder?
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Cystolith
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What are the 4 factors that affect the severity of stones in the urinary tract?
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Location, duration, and partial or complete blockage
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If there is a complete blockage in the urethra how long will it before death occurs?
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3 days
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If a stone stays in place for too long, what will happen to the tissue surrounding the stone?
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Fibrosis and then possibly apoptosis of tissues which can lead to rupture
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What will happen if urine backs up into the kidney?
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Kidney failure
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Name 2 types of kidney stones
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Struvite and calcium oxilate
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What are the three steps required to build a stone?
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Supersaturation, precipitation and aggregation
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What is the term that means there is so much solute that it can no longer dissolve?
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Supersaturation
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What is the term that means solute falls out of solution and settles at the bottom?
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Precipitation
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What is the term that means solute clumps together?
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Aggregation
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What are 3 things that influence the possibility of forming stones?
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pH, decreased water consumption (dehydration), and increased intake of calcium, magnesium or phosphate (soda)
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At what pH (acidic/basic) are struvite stones prone to develop?
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Basic
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At what pH (acidic/basic) are calcium oxilate stones prone to develop?
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Acidic
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What are 5 treatments for stones?
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Avoid dehydration - drink plenty of water, alter pH accordingly, diet changes as necessary, lithotrypsy (ultrasound) to break up stones, surgery
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What is the term for the most common cause of prostatic enlargement?
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Benign Prostatic Hyperplasia
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T or F most men will have some form of BPH by the time they are 60 years of age
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TRUE
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Other than BPH what is another way that the prostate can obstruct the flow of urine?
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Prostate cancer
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What is the disease caused by filtrate backing up into the kidney, causing death of kidney tissue and creating pockets of urine where there should be none?
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Hydronephrosis
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Give an example of obstruction sequelae
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Hydronephrosis
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What is the term that means inflammation of the tubules in the nephron?
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Pyelonephritis
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If a patient has pyelonephritis is the glomerulus affected?
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NO
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What type of pyelonephritis can be cured and will have no lasting effects if treated properly?
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Acute pyelonephritis
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What type of pyelonephritis usually results in kidney failure?
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Chronic pyelonephritis
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At what point is a patient declared to have kidney failure?
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When at least 3/4 of one kidney is failing AND at least 1/2 of the other kidney is also failing
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What is an ascending UTI?
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UTI that travels from the bladder to the kidney
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What bacteria is the most common cause of a UTI?
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E-coli
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What type of pyelonephritis does one have if they have repetetive acute UTI's?
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Chronic
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Why would recurrent UTI's lead to kidney failure?
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WBC's called to area during infection - release ROS's which damage tissue and cause scarring
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What are two problems people can have with taking antibiotics for UTI's that can lead to recurring infections and possibly kidney failure?
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Not taking antibiotics as prescribed (not finishing dosage) and Rx for wrong type of antibiotic - ineffective
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Why is a person more likely to get infections if they have an obstruction in the urinary tract?
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Obstruction causes small tears in wall that can get infections
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What are the symptoms of pyelonephritis?
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Fever, flank pain, frequent urination (polyurea) dysuria
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How is pyelonephritis diagnosed?
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Pyuria, bacteriouria (should be no RBC's, WBC's, lipids or protein in urine)
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What vessel does blood pass through to enter glomerulus?
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Afferent arteriole
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What vessel does blood pass through to exit the glomerulus?
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Efferent arteriole
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Explain glomerular filtration (the structures that filtrate passes through)
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Filtrate passes through capillary pores, then filtration slits and then bowman capsule
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Why don't proteins pass through capillary clefts?
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Podocytes on capillary clefts are negatively charged as are proteins and lipids which repels them from entering unless clefts widen enough
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Is capsular onchotic pressure higher or lower than Blood onchotic pressure?
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Capsular onchotic pressure is lower because there are no proteins or lipids in filtrate
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What is the term that means there is increased levels of blood urea nitrogen and creatinine?
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Azotemia
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Why are BUN and creatinine found in the urine in someone with glomerular disorders?
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BUN and creatinine are bi-products of protein that should be removed in filtrate. Decreased GFR means Decreased filtration of both.
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What happens to capillaries early in glomerular disorders?
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Early - infection capillary clefts widen allowing proteins through as well as RBC's, WBC's, lipids
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What happens to capillaries late in glomerular disorders?
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Late - swelling and thickening of the capillaries causes decreased GFR
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Define oligouria
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Less than normal urination
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Define azotemia
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Increased levels of BUN and creatinine in blood
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Define anuria
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No urine output
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Define polyuria
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Frequent urination
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What type of bacteria is a common cause of acute glomerulonephritis?
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Post-streptococcal infection
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How long after a streptococcal infection does one typically develop glomerulonephritis if glomerular membrane is affected?
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7-10 days after infection
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Why does a streptococcal infection cause glomerulonephritis?
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Antibodies (immune complexes) get stuck in the capillary clefts and cause inflammation and thicken the glomerular membrane
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What is the prognosis for someone with acute glomerulonephritis if treated with antibiotics?
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Good - most people will recover
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What are 2 causes of chronic glomerulonephritis?
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Repeat glomerular infections, disease condition that causes you to make lots of immune complexes such as lupus
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What is the prognosis for someone diagnosed with chronic glomerulonephritis?
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Poor to Guarded 10-20 years
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What is the treatment for chronic glomerulonephritis?
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Dialysis or a renal transplant
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What is the term for the specific type of glomerulonephritis, primarily caused by having leaky capillaries?
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Nephrotic syndrome
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Does everyone that has glomerular disease get nephrotic syndrome?
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NO
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What happens to protein levels in the blood and urine with nephrotic syndrome?
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Proteinuria, extremely low BOP - proteins lost in urine
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What types of proteins are primarily lost in the urine?
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Albumins and globulins
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Define hypoalbuminemia?
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Low albumin levels in the blood
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What effect does hypoalbuminemia have on blood pressure?
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Lowers BP - hypotension
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Explain how globulins are involved in hypocalcemia in a patient with nephrotic syndrome?
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Globulins carry vitamin D from the liver where it is stored. Vit D necessary for calcium absorption
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How does nephrotic syndrome cause ricketts in children?
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No globulins = No Vit D = decreased Calcium absorption. If growth plates still present not enough Ca for strength - collagen in bones causes bones to bow
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What disease is caused in adults with nephrotic syndrome due to hypocalcemia?
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Osteomalacia - growth plates closed - fractures and reheals in odd positions because of lack of calcium
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Why might a patient with nephrotic syndrome have edema?
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Compensation to prevent hypotension
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Why might a patient with a glomerular disorder have hypertension?
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Decreased GFR
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Why might a patient with glomerular disorder have hypotension?
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Decreased BOP early in disease - proteins lost in urine - albumins control BP
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T or F Acute renal failure can occur within a few hours with have no warning signs
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TRUE
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What is the mechanism is involved in azotemia?
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Decrease in GFR
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What is a normal urine output per hour?
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125ml/hr
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At what point (ml/hr) is a patient diagnosed with oligouria?
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30ml/hr
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At what point (ml/hr) is a patient diagnosed with anuria?
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0ml/hr
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What is the prognosis for a patient with acute renal failure?
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Fair - if treated early and properly
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What is the mechanism behind proteinuria in a patient with renal disease?
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Decreased BOP
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What is the mechanism behind hypocalcemia in a patient with renal disease?
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Decreased BOP
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What is the mechanism behind edema in a patient with renal disease?
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Decreased BOP
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What is the mechanism behind hypertension in a patient with renal disease?
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Increased BHP or decreased GFR
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What type of acute renal failure is caused by decreased blood flow to the kidneys?
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Pre-renal failure
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What type of acute renal failure is caused by problems in the kidney itself?
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Intra-renal failure
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What type of acute renal failure is caused by liths or prostate enlargement?
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Post-renal failure
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What are the three types of acute renal failure?
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Pre-renal failure, intra-renal failure, post-renal failure
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What are 5 causes of pre-renal failure?
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MI, left heart failure, anesthesia (reduces BP), dehydration, anaphylactic shock
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How does ethylene glycol (anti-freeze) cause acute kidney failure?
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Ethylene glycol converted by alcohol dehydrogenase in liver to glycolic acid, filters through glomerulus, forms crystals in kidney tubules (obstruction) decrease GFR
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What type of acute renal failure is caused by ingesting ethylene glycol (anti-freeze)?
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Intra-renal failure
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What type of acute renal failure is caused by taking aminoglycosides (antibiotic) without drinking enough water?
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Intra-renal failure
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How does taking aminoglycosides (antibiotics) cause acute renal failure?
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They are secreted through kidney tubules in to urine, destroys tubule cells. If enough are destroyed can obstruct tubules if not flushed through with enough water
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How can one prevent acute renal failure when taking aminoglycosides?
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DRINK ENOUGH WATER!
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What is the treatment if you know someone has ingested antifreeze and it has bee less than 12 hours?
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LOTS OF ALCOHOL - occupies alcohol dehydrogenase in liver so that it can't convert ethylene glycol into glycolic acid
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What are the three phases of acute renal failure?
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Initiation phase, maintenance phase, recovery phase
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What happens in the initiation phase of acute renal failure?
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"Insult" happens (BP got too low, pt took amikacin or stone formed obstruction)
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What happens in the maintenance phase of acute renal failure?
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Symptoms occur because of the problem. Kidney has been harmed
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What happens in the recovery phase of acute renal failure?
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If patient gets better recovery phase is 3-12 months - polyuria & hypokalemia due to "rebound effect" increased GFR
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What is the mechanism behind hyperkalemia in a patient with renal disease?
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Decreased GFR
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What does GFR stand for?
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Glomerular Filtration Rate
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What are the three types and three phases of acute renal failure?
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Types: pre-renal failure, intra-renal failure, post-renal failure. Phases: initiation phase, maintenance phase, recovery phase.
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What type of acute renal failure is caused by reduced BHP?
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Pre-renal failure
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This term describes having an elevated BUN and Creatinine
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Azotemia
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This term describes the ability of crystals to fall out of suspension in the urine
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Precipitation
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This condition is the most common cause of pyelonephritis
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Ascending UTI
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Glomerular disorders lead to a decrease/increase in GFR because of an increase/decrease in capsular onchotic pressure
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Decrease - Increase
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Nephrotic syndrome leads to hypocalcemia because of the loss of this blood protein
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Globulin
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Explain how a decreased GFR leads to Hypertension - use terms BHP and/or BOP
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Decreased GFR increases BHP because H2O is not being filtered out
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Explain how a decreased GFR leads to edema - use terms BHP and/or BOP
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Decreased GFR leads to edema due to increase in BHP
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Explain how a decreased GFR leads to azotemia - use terms BHP and/or BOP
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Decreased GFR leads to azotemia because BUN and creatinine are not being filtered out
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Compare/contrast acute vs. chronic glomerulonephritis most common causes
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Acute glomerulonephritis cause: post-streptococcal infections. Chronic glomerulonephritis cause: auto-immune disease such as lupus
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Compare/contrast acute vs. chronic glomerulonephritis prognosis
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Acute glomerulonephritis: GOOD - most will recover with antibiotics if treated properly. Chronic glomerulonephritis: Poor-Guarded, dialysis or renal transplant cannot be completely cured
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Compare/contrast acute vs. chronic glomerulonephritis mechanisms
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Acute glomerulonephritis: immune complex deposition. Chronic glomerulonephritis: immune complex deposition
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What is the potassium status of patients during the maintenance phase and recovery phase and why are they different?
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M-Phase: hyperkalemic due to decr. GFR can't excrete K+. Also, cells are dying releasing K+. R-phase: hypokalemic due to incr. GFR & polyuria excretes too much K+
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Explain how aminoglycosides lead to acute renal failure and hypertension
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Aminoglycosides secreted through renal tubules destroy cells on the way through. Cells build up if not flushed out by drinking enough water. Filtrate backs up. Decr. GFR =increased BHP=incr. BP
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Other than an obstruction caused by lith formation, what is a common cause of post-renal failure in men?
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Prostate enlargement - prostate cancer
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