Chapter 36 Alterations Of Renal And Urinary Tract Function

Front 1

What is obstructive Uropathy?

Back 1

Anatomical changes in the urinary system caused by obstruction

Front 2

What is the severity of Urinary Tract obstruction based on? (hint available)

Back 2

Location
Completeness
Involvement of one or both upper urinary
Duration
Cause

Hint 2

LCIDC

Front 3

What is tubulointersitial fibrosis?

Back 3

Deposition of excess amounts of extracellular matrix in kidney

(this leads to apoptosis of the nephron)

Front 4

What is the condition called right before apoptosis of the nephron in a urinary tract obstruction?

Back 4

Tubulointersitial fibrosis

Hint 4

(Involves the throwing of fibers)

Front 5

A hydroureter would likely lead to what kind of condition of urinary tract obstruction?

Back 5

Hydronephrosis

(dialation of the renal pelvis and calyces)

Front 6

What is Hydronephrosis

Back 6

dialation of the renal pelvis and calyces

Front 7

What is compensatory hypertrophy?

Back 7

When there is a unilateral blockage, the contralateral (functioning) side increases in size.
(no new nephrons)
two types of growth (compensatory and obligatory grow)

Front 8

What are the two types nephron compensatory hypertrophy?

Back 8

Obligatory (cause by somatostatin)
Compensatory (unknown pathway)

Front 9

What is postobstructive diuresis?

Back 9

Transient increase in urine production after removal of an obstruction

Front 10

What will low bladder wall compliance lead to?

Back 10

Hydroureter or hydronephrosis

Front 11

What is calculi

Back 11

kidney stones

(masses of crystals, protein or other substances that form within and may obstruct the urinary tract)

Front 12

What are some risk factors for kidney stones?

Back 12

Fluid intake, gender, occupation

Front 13

If you have renal colic, what do you have?

Back 13

Kidney stones
(it means pain originating in the flank and radiating to the groin.

Front 14

Who is more likely to get a urethral stricture? (men or women)

Back 14

Men

Front 15

WHo is more likely to get a severe pelvic organ prolapse? (men or women)

Back 15

Women

(a cystocele that pinches shut the urethra)

Front 16

Kidney stone is an example of _______ Urinary tract obstruction

Back 16

Kidney stones are an example of UPPER Urinary tract obstruction

Front 17

Neurogenic Bladder is an example of _______ Urinary tract obstruction

Back 17

Neurogenic Bladder is an example of LOWER Urinary tract obstruction

Front 18

What is Neurogenic Bladder?

Back 18

bladder dysfunction cause by neurologic disorders

(likely a result from dyssynergia = loss of coordinated neuromuscular contraction)

Front 19

What is dyssynergia

Back 19

Loss of coordinated neuromuscular contraction

(happens in nuerogenic bladder problems)

Front 20

What are the two types of Renal Tumors?

Back 20

Renal adenomas - near the cortex have a glandular origin

REnal Cell Carcinoma - arise from tubular epithelium

Front 21

Which type of urinary tumor would have a stalk?

Back 21

Papillary tumors
Stalk can be referred as pedicle!!!

A form of bladder tumor

Front 22

Which is a more invasive urinary tumor in the bladder? Papillary tumor or nonpapilarry?

Back 22

Nonpapillary (not as common in the bladder though) Stalk can be referred as pedicle

Front 23

Urinary tract infection is an inflammation of the ___________ ___________ following the invasion and colinzation of some pathogen

Back 23

Urinary tract infection is an inflammation of the URINARY EPITHELIUM following the invasion and colonization of some pathogen

Front 24

How would you have a complicated UTI?

Back 24

If you have other health problems before

Front 25

What is persistent UTI?

Back 25

Stays infected even after antimicrobial therapy for more than 3 days

Front 26

The most common Urinary tract infections:
-___________ Coli
-Staphylococcus ___________
-__________ species

Back 26

The most common Urinary tract infections:
-Escherichia Coli
-Staphylococcus Saprophyticus
-Enterobacter species

Front 27

What would effect a uropathogen's chances of being virulent as a UTI

Back 27

How well it attaches to the membranes or form biofilm

Front 28

How does a host defend against a uropathogen's attempt to attach or make a biofilm to result in a UTI?

Back 28

Urethral sphincter (barrier)
bodily secretions
Urine pH

Front 29

What is cystitis?

Back 29

an inflammation of the bladder and is the most common site of UTI

(causes dyuria = painful urination)

Front 30

How do you treat Cystitis?

Back 30

Antimicrobial therapy
increase fluid intake
avoid bladder irritants

Front 31

What is Acute pyelonephritis?

Back 31

A progession of a UTI!! Bacterial infection extends beyond urethra to bladder, ureters and renal pelvis)
An infection of one or both upper urinary tracts (ureter, renal pelvis and interstitium, renal parenchyma = (the nephrons))

(causes abdominal pain)

Front 32

How would you get chronic pyelonephritis?

Back 32

Persistent episodes of the acute condtion
(A progession of a UTI!! Bacterial infection extends beyond urethra to bladder, ureters and renal pelvis)

Risk increases w/ infections and some type of obstructive pathologic condition

Front 33

What is renal perenchyma?

Back 33

the functional tissue of the kidney, consisting of the nephrons.

Front 34

What glomerular disease has urinary sediment that contains massive amounts of protein and lipid and little to no blood?

Back 34

Nephrotic sediment

Front 35

What glomerular disease has urinary sediment that contains red cell casts, white cell casts, varying degrees of protein and has blood

Back 35

Nephritic sediment

Front 36

What will the sediment of Chronic Glomerular disease have?

Back 36

Waxy Casts, granular casts (also medium proteinuria, hematuria)

Front 37

Increase hypertension, edema and elevated blood urea nitrogen (BUN) is indicative of a renal disease most likely starting where?

Back 37

Glomerular disease

(also has decrease GFR = increase plasma protein)

Front 38

In glomerular disease Blood urea nitrogen __________(increases/decreases)

Back 38

Increases

Front 39

In glomerular disease there is _______, ______ and elevated blood urea nitrogen (BUN)

Back 39

In glomerular disease there is HYPERTENSION, EDEMA and elevated blood urea nitrogen (BUN)

Front 40

With a glomerular disorder, there is decrease GFR which means there is elevated ______________?

Back 40

With a glomerular disorder, there is decrease GFR which means there is elevated PLASMA CREATININE
(which means reduced creatinine clearance)

Front 41

With a glomerular disorder there is likely damage to 3 things, which are?

Back 41

- Glomerular membrane surface area
- Glomerular capillary blood flow
- Blood hydrostatic pressure (decreased GFR)

Front 42

With a glomerular disorder, a lose of negative ionic charge means an _________ (increase/decrease) in glomerular capillary permeability and result in _____________?

Back 42

With a glomerular disorder, a lose of negative ionic charge means an INCREASE in glomerular capillary permeability and result in PLASMA PROTEINS IN THE URINE

(This causes EDEMA)

Front 43

How do you get hypoalbuminemia with a glomerular disorder?

Back 43

There is increase glomerular capillary permeability because there is a loss of the negative ionic charge barrier.

Front 44

What is the most common way to get glomerulonephritis?

Back 44

Immunologic abnormalities

(drugs/toxins, vascular disorders and viruses are other ways)

Front 45

What are the ways that glomerulonephritis occurs? (3 ways)

Back 45

- Deposition of circulating antigen-antibody complexes
- Formation of antibodies against the glomerular basement membrane
- Streptococcal release of neuramidase

Front 46

What is Cresentic glomerulonephritis?

Back 46

- Antiglomerular basement membrane disease (Good pasture syndrome)
-Ab form against basement membrane (IgG)

- nephritis that occurs in 50-60 year olds
- proliferation of cells into bowmans space with a crescent shape
- Causes renal failure, hematuremia is common
AKA Rapidly progressive

Front 47

What is the most common form of acute glomerulonephritis?

Back 47

Bergers disease
(an IgA Nephropathy)
(20-30 year olds)
See 2-3 days after a URT or GI viral infectionGlomerulonephritis

Front 48

Can you get a nephron disorder after a throat infection?

Back 48

Yes, Acute Streptococcal Glomerulonephritis
From Skin infection is more likely
About 7-10 days after the infection

Front 49

What is nephrotic syndrome?

Back 49

excretion of 3.5 grams or more of protein in the urine per day b/c of a glomerular injury

Front 50

If you had nephrotic syndrome what other conditions would you expect to have?

Back 50

hypoalbuminemia, edema, hyperlipidemia and lipiduria

Front 51

What is renal insufficiency?

Back 51

Referes to a decline in renal function to about 25% of the normal GFR (which is 25-30ml/min)

Front 52

What is renal failure?

Back 52

"a significant loss of renal function"
A more serious case than renal insufficiency, it is when the renal function drops between 25%-10% of its normal GFR

Front 53

What is End-stage renal failure

Back 53

The most serious case, is when renal function drops below 10% of its normal GFR

(A stage after renal failure that follows renal insuffiency)

Front 54

What is uremia?

Back 54

IT IS A SYNDROME!!
includes:
- Increase blood urea
- Creatinine
- Fatigue
- Anorexia
(all this leads to neurological changes)
- Vomiting

Front 55

What is Azotemia?

Back 55

Increased levels of serum:
- Urea
- creatinine

(Not a symdrome!

Front 56

How quick does Acute Renal Failure Happen?

Back 56

WITHIN HOURS!

Front 57

What is a tale-tell sign of Acute Renal failure?

Back 57

Oliguria = low urine output!

This disease is a result of decrease in glomerular filtration

Front 58

What is oliguria?

Back 58

Low Urine output. A major sign of Acute renal failure

Front 59

Is Acute Renal Failure reversible?

Back 59

Yes, if treated

Front 60

What is the most common cause of Acute renal failure?

Back 60

Prerenal Acute Renal Failure (pARF)

mechanism = impaired renal blood flow
GFR decrease due to decrease in filtration pressure

Front 61

In Prerenal Acute Renal Failure, GFR decrease due to __________

Back 61

In Prerenal Acute Renal Failure, GFR decrease due to DECREASE IN FILTRATION PRESSURE

(most common cause of ARF because impaire renal blood flow)

Front 62

If there is renal hypofusion what renal condition would this lead to? What would you expect your BUN and creatinine levels to do?

Back 62

Prerenal Acute Renal Failure

BUN and creatinine levels would increase

Front 63

Which renal failure is rare?

Back 63

Postrenal acute renal failure

(only occurs with UTI's that effected both kidneys)
Could occur from blocking both ureters, the bladder or prostate

Front 64

What renal failure if there was an obstruction in the ureters would require a block from both ureters?

Back 64

Postrenal Acute renal failure

(could also have an obstruction caused by a UTI in the bladder or prostate)

Front 65

Acute tubular necrosis is the most common cause of what renal disease?

Back 65

Intrarenal Acute renal failure

Front 66

Which renal diease could be caused by the following conditions?
-Postichemic
-Nephrotoxic

Back 66

Intrarenal Acute Renal Failure
-Postichemic (a common post-surgery complication --> causes free radical formation when there is re-perfusion)
-Nephrotoxic (toxin induced kidney damage from antibiotics, dyes anthetics and chemo

Front 67

What are common causes of nephrotoxic conditions that cause Intrarenal Acute Renal Failure?

Back 67

antibiotics, dyes, anesthetics, chemo

Front 68

What is a common cause of postichemic condtions that cause intrarenal Acute Renal Failure?

Back 68

Free radical formation

Front 69

What is Back leak?

Back 69

When referring to Acute renal failure, tubular fluid is reabsorbed back into the body through the "denuded tubular membrane"

Front 70

What does a denuded tubular membrane cause?

Back 70

Back leak = tubular fluid is reabsorbed back into the body

Front 71

Which Acute Renal Failure is caused by a UTI?

Back 71

Postrenal Acute Renal Failure

Front 72

Which Acute Renal Failure is caused by Acute Tubular Necrosis?

Back 72

Intrarenal Acute REnal failure

Front 73

What are the 3 stages of Acute Renal Failure

Back 73

-Initiation - phase where perfusion is decreaseing, toxicity is occuring

-Maintenance Phase - when the perfusion has stabilized at its compromised state (oliguria is most pronounced

- Recover phase - when renal fucntion is established

Front 74

What encompasses the maintenance phate of Acute renal failure?

Back 74

when the perfusion has stabilized at its compromised state (oliguria is most pronounced

Front 75

___________ is the Irreversible loss of renal function. __________ and _______ are the most common causes.

Back 75

CHRONIC RENAL FAILURE is the Irreversible loss of renal function.DIABETES MELLITUS and HYPERTENSION are the most common causes.

Front 76

During renal failure, would you expect (Hypo/hyper)natermia?

Back 76

Hypernatermia

Front 77

During renal failure, would you expect (Hypo/hyper)Kalemia

Back 77

Hyperkalemia

Front 78

What does angiotension promote in the kidney after a nephrotic injury?

Back 78

Promotes glomerular hypertension (bad because it leads to increase glomerular permeability allowing protein to flow through)

Front 79

In Chronic renal Failure what happens to: Creatinine levels

Back 79

Increases (a good indicator of GFR)

Front 80

In Chronic renal Failure what happens to: Urea Levels

Back 80

Increase

Front 81

In Chronic renal Failure what happens to: Sodium

Back 81

Is delivered to the kidney in high amounts! INCREASES. Cant excrete

Front 82

In Chronic renal Failure what happens to: Water balance

Back 82

Ability to concentrate and dilute the urine decreases

Front 83

In Chronic renal Failure what happens to: Potassium Balance

Back 83

Increases because secretion in distal tubular section

Front 84

In Chronic renal Failure what happens to: Phosphate blance

Back 84

Exretion of phosphate decreases and Phosphate levels increase

Front 85

In Chronic renal Failure what happens to: Calcium balance

Back 85

Decreases, blood levels are calcemia.

Front 86

What is dysuria

Back 86

Painful urination

(a symptom of cystitis)

Front 87

There are two UTI disorders that we talked about, what are they?

Back 87

Pyelonephritis and Cystitis

Front 88

Which tumors of the urinary system can metastasize to lymph nodes, liver bone and lungs?

Back 88

Bladder Tumors

Front 89

Where can bladder tumors metastasize?

Back 89

lymph nodes
liver
bone
lungs

Front 90

If you had a manifestation of suprapubic pain, what urinary condition do u likely have?

Back 90

Cystitis

Front 91

What is Neurogenic detrusor Overactivity?

Back 91

muscle that causes bladder to contract

(part of a neurogenic bladder which is a lower Urinary tract obstruction problem)

Front 92

When would a person likely have urinary urgency?

Back 92

Neurogenic detrusor Overactivity