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115 Cards in this Set
- Front
- Back
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To localize cause of urinary tract pain, you must assess:
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location, onset, quality, quantity, and pattern
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Bladder pain presents in the area of -_____, whereas ureteral pain is in the ______, and renal pain in the ____
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1. suprapubic to upper thigh - bladder
2. ureteral = groin/genitals 3. renal = constovertebral angle in back |
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Renal and ureteral pain are/not changed by body position
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Are NOT
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The word that describes pain from the kidneys themselves
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nephralgia
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Pain from the kidneys is due to _______, because the kidneys themselves have no pain receptors.
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inflammation that irritates the capsule
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Pain in lower parts of urinary tract suggests ____/
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obstruction
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Urine is assessed for what things initially?
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color, odor, turbidity, odor
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A dark, strong-smelling urine suggests
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decreased renal function
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What are two congenital disorders of the urinary tract?
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Renal agenesis and polycystic kidney disease.
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What is PKD?
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Polycystic kidney disease
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What is renal agenesis?
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absence of one or both kidneys, may be random or hereditary.
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Bilateral agenesis is usually ____ and ____/
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fatal, and associcated with other disorders
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In unilateral renal agenesis, a person will have ___ kidneys and will display compensatory ___
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one, and display compensatory hypertrophy of that kidney.
- sometimes the single kidney is deformed. |
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____% of bilateral renal agenesis are male.
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75%
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What is Potter's syndrome?
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The combination of bilateral renal agenesis, facial anomalies, and early death from respiratory distress.
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PKD is the result of multiple _______ of collecting ducts.
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dilations, which appear as fluid-filled cysts
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ARPKD stands for ____ and is diagnosed in _____
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1. Autosomal recessive PKD
2. infants and young children |
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ADPKD is ____ and is diagnosed in ____/
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1. Autosomal dominant PKD
2. diangosed in adulthood |
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ARPKD begins ___ as a result of mutation to chromosome ___.
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in utero, chromosome 6
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ARPKD is commonly accompanied by ____.
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Hepatic fibrosis
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In ARPKD, worse damage to kidney results in ____ damage to liver.
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less
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ADPKD results in ___ of dialysis patients after renal failure.
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9-10%
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Describe the known pathology of ADPKD.
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tubular epithelial cells are hyperplasic, cysts involve the entire nephron
(overgrowth of tubule cells = obstruction = fluid backup = cysts) |
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ADPKD is commonly (95%) a mutation of chromosome ____
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16
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ADPKD symptoms commonly begin between ages __ and __
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30-50 years old
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Common secondary problems seen in ADPKD include:
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UTI, back/flank pain, hematuria, HTN, renal failure in later years
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Presence of ADPKD indicates an increased risk of developing ____ anywhere in the body, or ___.
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aneurysm, diverticuli
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The urinary tract is usually protected from infection by ___, ____, or __.
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acidic pH, prevention of reflux, or prostatic secretions.
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What is typically the cause of induction of agents in bacterial infection of the urinary tract?
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Retrorade flow of urine
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Urinary tract infections are more common in ____ due to ____, but are more serious among __.
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females due to shorter urethra and ease of introducing bacteria from GI to Urinary; more serious among men
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What is pyeloneprhitis
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infection of the renal pelvis and interstitium
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Risk factors for pyelonephritis include?
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pregnancy, neurogenic bladder, instrumentation (catheters), obstruction, sexual trauma, or vesicoureteral reflux (reflux from bladder up to ureters and back to kidney)
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Two forms of pyelonephritis.
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acute and chronic
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Severity of acute pyelonephritis increases with ___
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age
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Describe the pathology of acute pyelonephritis.
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inflammatory mediators damage tubule cells, necrosis of renal papillae occur, scar tissue is deposited and atrophy the affected tubules
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Describe the pathology of chronic pyelonephritis.
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persistent or recurring episodes of acute pyelo that lead to shrunken, fibrotic kidney. (infection may not be persistent, the problem is a deposition of scar tissue)
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What causes increased likelihood of development of chronic pyelonephritis?
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Infection related to obstruction.
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complete obstruction of urinary tract causes ___
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hydroureter
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What is hydroureter?
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build up of fluid in one or bothe ureters. This causes increased pressure in renal pelvis/tubules that causes dilation and flattening of renal papilla
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Hydroureter results in ___ of the GFR?
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drop
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Discuss the pathway of events resulting from hydroureter.
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GFR drops due to increased pressure in capsule, activates RAA, BP elevates, blood flow in kidney drops, kidney becomes ischemic, results in medulary desruction and tubular atrophy in 4-6 weeks
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Partial obstruction of the urinary tract results in
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little disruption. Bilateral may result in symptoms of fluid retention
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What is postobstructive diuresis?
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after correcting an obstruction, the body plays "catch up" to get rid of excess sodium, water, urea, etc.
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What are complications of partial urinary obstruction
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infection, sepsis, progressive loss of renal function, renal failure.
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renal calculi are ____ and are most commonly composed of ___
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crystals of combined organic material that develop within the kidneys, usually consist of calcium
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What is nephrolithiasis?
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Presence of a stone (calculus) anywhere in the urinar tract.
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What factors influence formation of renal calculi?
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supersaturation (esp calcium)
abnormal urine pH (urinary or respiratory problem) low urine volume (dehydration) |
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What is ureteral colic?
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Pain in the ureter, especially with renal calculi
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Renal calculi most commonly cause pain only when lodged in the ___ because ___
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ureter, because the ureter distends behind the stone.
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What are the three groups of renal tumors?
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Benign, primary neoplasms, secondary neoplasms.
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What is an oncocytoma?
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Slow-growing, generally asymptomatic benign tumor of the kidney
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What is a mesoblastic nephroma?
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benign congenital tumor of the kidney in infancy
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What is a renal angiomyolipoma (hemartoma)?
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strange looking benign tumors on the kidney, especially made of fats but a "catch all" - blood vessel, muscle, fat, etc.
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What is a renal adenoma?
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A common benign tumor of the kidney. May be pre-malignant adenocarcinoma.
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Renal adenocarcinoma typically affects ____ ages ___, especially ____.
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adults, ages 50-70, especially males
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Risk factors of renal adenocarcinoma include:
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occupational exposures, high protein diet, smoking, obesity, hypertension, family history.
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Renal adenocarcinoma develop from what tissue?
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Epithelium of PCT
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Renal adenocarcinoma is commonly due to a defect of chromosome ___
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3
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Symptoms of renal cell carcinoma include __
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hematuria, flank pain, mass
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What is a urothelial tumor?
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a malignant lining of the renal pelvis, calices, ureter, or bladder
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Urothelial tumors in the bladder are typically _
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transitional cell carcinomas and squamous cell carcinoma and adenocarcinomas
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Risk factors of urothelial tumors include:
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smoking, excessive caffine, aromatic and amine exposure (nitrates in diet - i.e. bacon), UTI history, family history, etc.
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What is the most common abdominal tumor in children?
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Nephroblastoma (Wilms tumor)
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A nephroblastoma is also called.
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wilms tumor
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Nephroblastomas occur most commonly in children ages 3-5, and is due to a defect on chromosome _____
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11
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Nephroblastoma results in ____
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no normal differentiation of tubules and glomeruli, tumor in flank or abdomen, abdominal pain, HTN, hematuria, difficulty concentrating urine and maintining water balance.
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What is the difference between primary and secondary glomerulopaties.
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primary - kindey is only organ affected.
secondary - glomerular injury with multisystem or vascular abnormalities (i.e. drug exposure/ infection) |
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What is the most common cause of chronic renal disease and ESRD?
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glomerulonephritis
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Group A post-streptococcal infection is a common source of inflammation causing ___
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acute glomerulonephritis. inflammation thickents the glomerular membrane and results in fluid retention
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How is acute glomerulonephritis treated?
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it self-resolves with resolution of strep infection
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What are symptoms of acute glomerulonephritis?
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hematuria, red cell casts, proteinuria, decreased GFR, oliguria, edema, HTN
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Describe rapidly-progressing glomerulonephritis.
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subacute, crescentic, extracapillary glomerulonephritis
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What is the primary syndrome in which rapidly-progressing glomerulonephritis occurs?
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Goodpasture's syndrome
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What is goodpasture syndrome?
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anti-glomerular basement membrane disease. Results in antibody formation against capillaries and results in crescentic lesions resulting in renal insufficiency.
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What does "crescentric" refer to in rapidly progressing glomerulonephritis.
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Proliferation of cells into bowman's space that create crescent-shaped lesions
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Rapidly progressing glomerulonephritis commonly affects ___
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adults
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What are the pathological changes present in chronic glomerulonephritis?
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proliferation of mesangial cells (cells inside bowman's space on glomerular capillary)
tubular dilation and atrophy, tubulointerstitial injury |
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In chronic glomerulonephritis, antigen-antibody complexes ____
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deosity or form within glomerular capillary filtration membrane
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The severity of chronic glomerulonephritis depends on:
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size, number, location, duration, type of antigen-antibody complexes
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What is nephrotic syndrome?
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Excretion of 3.5g or more of protein in urine daily, characteristic of glomerular injury.
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What are the 4 basic symptoms of nephrotic syndrome?
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hypoalbuminemia, edema, hyperlipidemia, lipiduria
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Primary nephrotic syndrome is usually ___ and has other types of nephropaties with it, whereas secodary is usually due to ____
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1. genetic
2. some other process such as diabetes, lupus, etc |
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Define renal insuffficency
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decline in renal function to 25% of normal.
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Define renal failure
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Significant loss of renal function only 10-25% of normal
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Define end-stage renal failure
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minimal renal function <10% of normal
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What is uremia
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increased blood urea level -part of the syndrome of renal failure that includes azotemia as well as nausea, neuro problems, etc
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What is azotemia?
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increased serum urea levels (without neuro, nausea, etc). alos usually has elevated creatinine.
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What is acute renal failure?
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abrupt reduction in renal function, usually associated with oliguria & elevated BUN and Creatinine levels
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Acute renal failure is ____ reversible.
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Usually
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What are the three categories of acute renal failure?
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pre-renal, intra-renal, and post-renal
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What is pre-renal ARF?
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most common, can be caused by ANYTHING that decreases cardiac output that reduces blood flow to kidneys.
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Describe intra-renal ARF
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intrinsic renal azotemia, caused by something within the kidney
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What is the most common cause of ARF?
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acute tubular necrosis. may be postischemic or nephrotoxi. Blood flow causes ischemia and eventually necrosis within the kidney.
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What is the cause of nephrotoxic Acute tubular necrosis?
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antibiotic use, drugs accumulate in cortex and result in a uniform style of ischemia.
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What are 3 theories on the cause of reduced GFR in intra-renal ARF?
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tubular obstruction, tubular back-leak, and alterations in renal blood flow.
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Postrenal ARF is ___ and occurs with urinary tract obstructions that affect kidneys ____/
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rare, bilaterally
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What are the three phases of acute renal failure?
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initiation phase, maintenance phase, and recovery phase
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What occurs during the initiation phase of ARF?
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reduced perfusion or toxicity (evolving injury)
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What occurs during the maintenance phase of ARF?
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estabilshed injury and dysfunction occur & urine output i the lowest
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What occurs during the recovery phase of ARF?
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renal injury is repaired
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Define chronic renal failure?
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Irreversible loss of renal function, it affects nearly all organ systems, and readily progresses to ESRD.
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What are the most common causes of chronic renal failure?
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Diabetes mellitus and hypertension.
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What establishes the reduced renal reserve in chronic renal failure?
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GFR is reduced to 50%, no clinical symptoms, BUN elevated
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What occurs during renal insufficiency of chronic renal failure?
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GFR is severely reduced to 25%-30% normal, mild clinical symptoms of renal dysfunction
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What consists of the renal "failure" stage of chronic renal failure?
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azotemia, acidosis, impaired urine dilution, severe anemia, electrolyte imbalances, and GFR <20%
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What occurs in the ESRD phase of chronic renal failure?
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near complete absence of GFR <10%. Severe alteration in water, electrolyte, and acid/base balance
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What electrolyte and acid/base problems occur in renal disease?
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- creatinine and urea
- sodium and water - phosphate and calcium - potassium - acid base |
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Renal failure causes what problems in the skeletal system?
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hypocalcemia and bode disease due to lack of active vitamin D
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Renal failure causes what problems in the cardiovascular system?
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HTN may lead to CHF, also arrhythmias due to electrolyte problems.
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Why does renal failure cause HTN?
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Decreased blood flow in kindeys activates RAA, triggers HTN.
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What effects does renal failure have on the neural system?
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progressive and non-specific. mild sleep disorders, impaired concentration, memory loss, impaired judgement, hiccups, muscle cramps, twitching, asterixis, seizures, coma, peripheral neuropathy.
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Renal failure has what effects on the endocrine/reproductive systems?
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drop in circulating sex steroids and hyperinsulinemia
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___% of patients also have _____ problems with RF including ___ and ___
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25%, GI problems, gastroenteritis and uremic fetor
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Immunologic dysregulation in renal failure includes:
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suppression of chemotaxis, phatgocytosis, antibody production, and cellular immunity
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Renal failure resultsi in acceleration of ____ due to altered ratio of ___:___
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atherosclerosis, HDL to LDL
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