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76 Cards in this Set
- Front
- Back
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What are the 4 different feature that can affect the glomerular function? |
1. Nephrotic sediment (massive proteinuria) 2. Glomerulonephritis. 3. Diabetic glomerulosclerosis. 4. Hypertensive glomerular disease. |
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What are the general feature of Nephrotic sediment? |
- is not a specific glomerular disease - massive proteinuria - with loss of albumin, a compensatory replacement of both albumin and lipoproteins. - usually includes a widening of the glomerular basement membrane with mesangial thickening and larger proteins escape. |
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Give more specific characteristic of nephrotic syndromes: |
- Massive proteinuria - Hypoalbuminemia and other proteins as osmotic particles. - Generalised Oedema. - Loss of immunoglobins. * Decrease resistance to infections. - Coagulation proteins increased. * thrombotic complications. - Loss of albumin carrying vitamin D and thyroxine. |
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Disorders that result in nephrotic syndrome include: |
- minimal change glomerulopathy. - Membranous glomerulopathy. - Focal segmental glomerulosclerosis. |
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What is glomerulonephritis? |
- inflammation of the glomerulus. - caused by disease that provoke a proliferative inflammatory response - immune mechanisms: * glomerular antibodies. * circulating antigen-antibody complexes. |
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Cite the characteristics of glomerulonephritis: |
- often present as nephritic syndrome. - haematuria with red cells casts. - diminished glomerular filtration rate. - Azotemia (presence of nitrogenous wastes in blood. - Oliguria - Hypertension |
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What are the causes of glomerulonephritis? |
- diseases that provoke a proliferative inflammatory response of the endothelial mesangial, or epithelial cells of the glomeruli. - the inflammatory process: * damage the capillary wall. * permits RBC to escape into the urine. * produces hemodynamics changes that decrease GFR |
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What are the specific glomerular disorders that result in a nephritic sediment? |
- IgA nephropathy. - Cresentic glomerulonephritis such as anti-glomerular basement membrane disease. - Acute post infectious glomerulonephritis. |
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Diabetic glomerulosclerosis: |
- often results in nephrotic syndrome. - diabetes can affect the arterioles causing arteriolar sclerosis. - increased susceptibility to pyelonephritis an cause tubular lesions. - Abnormal glycosylation of proteins of the basement membrane and mesangial matrix that stimulate excessive matrix production. - nodular lesions are formed. - accounts 33% of all patients on dialysis. |
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Hypertensive glomerular disease is characterised by: |
- sclerotic changes. - occurs in up to 5% of hypertensives - vascular structures thicken and perfusion diminishes. - Nocturne - Elevated BUN levels - Proteinuria |
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What are the other group of disorders that can result in end star renal disease other than glomerular disorders? |
Tubulointerstitial disorders. |
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Named the characteristic of Tubointerstitial disorders: |
- Damage to the proximal, loop, or distal portion of the nephron. |
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Named the potential causes of tubointerstitial disorders: |
- acute tubular necrosis. - renal tubular necrosis. - pyelonephritis - effects of drugs and toxins. - Obstruction or vesicoureteral reflux. - Urate. |
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What is renal tubular acidosis? |
- can be proximal or tubular disorders. - Proximal disorders affect bicarbonate reabsorption - Distal defects affect the secretion of fixed metabolic acids. |
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Definition of Renal failure: |
- A condition in which the kidneys fail to remove metabolic ends products from the blood and regulate the fluid, electrolytes, and PH balance of the extracellular fluids. |
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What are the underlying causes of Kidneys failure. |
- renal disease. - systemic disease. - Urologic defects of non renal origin |
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What are the two different types of renal failure? |
- Acute renal failure and chronic renal failure. |
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What is acute renal failure? |
- abrupt in onset. - often reversible if recognised early and treated appropriately. |
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What is the chronic kidney disease? |
- end result of irreparable damage to the kidneys. - develops slowly, usually over the course of a number of years. |
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Give three causes of acute renal failure: |
- pre renal failure - posterenal failure - internal failure |
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What is pre renal failure? |
- haemorrhage - profound Volume depletion - cardiogenic shock, heart failure. - anaphylaxis. - decreased renal perfusion due to vasoactive mediators, drugs diagnostic agents. - peripheral artery disease. Blood supply return within 30 min. |
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What is post renal failure? |
- obstruction of urine outflow - bilateral ureteral outflow. - bladder outlet obstruction. |
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Causes of this obstruction: |
- Calculi and strictures - tumours - prostatic hypertrophy. |
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What is infrarenal failure? |
- ischaemic or toxic insult. - acute tubular necrosis. - prolonged renal ischemia. - exposure to nephrotoxic drugs, metals and organic solvent. - intrabular obstruction, resulting from haemoglobinuria, myeloma light. - acute renal disease. |
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What are the phases of acute tubular necrosis? |
1. Onset or initiating (last hours or days.) 2. Maintenance (decrease in GFR) 3. recovery. (repair of renal tissue) |
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What are the manifestations and treatment of acute renal failure? |
- superimposed on the signs and symptoms of the causes. - regulate fluids. - dialysis. |
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Question: - Cognitive heart failure would be a ............................... cause of renal failure? a. pre renal b. infrarenal c. postrenal |
a. pre renal: the causative factor is before the kidney. |
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What can you do to prevent acute renal failure? |
- early diagnosis important with assessment measures to identify persons at risk for development of acute renal failure. - people with preexisting renal insufficiency and diabetes. - Eldery persons. |
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What are the common causes of chronic kidney disease? |
- Hypertension - Diabete mellitus - Glomerunephritis (autoimmune disorders) - Tubointerstitial disorders caused by hydronephrosis - Polycystic kidney disease. - Cancers - Disease of the heart. |
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What are the effects of chronic renal failure? |
- Decreased GFR - Deterioration of tubular absorption - Deterioration of endocrine function |
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What are the different stages of chronic renal failure? |
- diminished renal reserve 50% - Renal insufficiency 20-35% - Renal failure 20% - End-stage renal disease. |
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How can you determine Chronic Kidney disease? |
1. Abnormalities in fluids, electrolytes and acid base balance. 2. Abnormality in PH 3. Abnormalities of Ca, Vitamin, Phosphorus. 4. Haematologic and immune functions impaired. 5. Cardiovascular complications. |
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What are important manifestations of CKD? |
- neuropathy - atrophy and demyelination - decreased skin integrity - sexual dysfunction - alteration elimination of drugs. * major mechanism here is via the toxic effects of uraemia. |
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What is the most important factor influencing the abnormalities in fluids, electrolytes and acid-base balance? |
- sodium - generally. - glomerular origin-sodium retention - tubular dysfunction salt wasting. |
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What is the most important factor in the abnormalities of PH? |
- metabolic acidosis due to impaired mechanisms - impaired ability to secrete hydrogen ions. - bicarbonate reabsorption impaired. |
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What is the most important factor in the abnormalities of calcium, phosphorus and vitamin D. |
- serum level phosphorus levels rise, causes cascade of events - osteodystrophy. |
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What is the most important effects of the impairment of haematology and immune functions in CKD? |
- Erythropoeitein production decreased. - Platelet formation impaired. - Immunologic abnormalities. |
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What are the treatment during the renal failure insufficiency stage of renal failure? |
- using measures to retard deterioration of renal functions and assist the body in managing the effects of impaired function. - Treat urinary tract infections. - Avoid medication with renal damaging. - controlling blood pressure. - control blood sugar. - stop smoking. |
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What are the medical management in CDK? |
- Dialysis - Transplantation |
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What are the dietary management? |
- protein - CHO, fat, calories - Potassium - sodium and fluid intake. |
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What are the prevention? |
- prevention of diabetes, hypertension and other diseases. |
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What are the types of disorders that can affect the kidney? |
- developmental defects. - infections - altered immune responses. - neoplasms. |
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Fetal anomalies: |
- most common - affecting shape and position - decrease in renal mass - change in renal structure. |
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Definition of Dysgenesis: |
- failure of an organ to develop normally |
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Definition of agenesis: |
- complete failure of an organ to develop |
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Define hypoplasia: |
failure of an organ to reach normal size. |
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Cystic disease of the kidney: |
- Fluid sac or segments of a dilated nephron |
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What are the causes of CDK? |
- tubular obstructions that increase intratubular pressure. - changes in the basement membrane of the renal tubules. |
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Give examples of Cystic disease: |
- simple or acquired renal cysts. - medullary cystic disease - polycystic kidney disease. |
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What are the causes of urinary tract obstruction? |
- development defects - calculi - pregnancy - Benign prostatic hyperplasia - Scar tissue resulting from infection and inflammation - Tumors - Neurologic disorders such as spinal cord injury. - Constipation |
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What are two causes of urinary obstruction? |
- stasis of urine: predispose infection and stone formation - development of back pressure: interferes with renal blood flow and destroys kidney tissue. |
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What are the manifestations of urinary obstruction? |
- Pain - Signs and symptoms of UTI - Constant ache in the loin area. - Manifestations of renal dysfunction |
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Where is the three important factors of urinary obstruction? |
- the site of obstruction - cause - rapidity with which the condition developed. |
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Give the definition of kidney stones: |
Crystalline structures that form from components of urine. |
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Give three factors influencing kidney stones: |
- nidus formation - concentration of stone components in the urine - ability of stone components to complex and form stones. |
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Give three types of kidney stones? |
- Ca stones (oxalate phosphate - Struvite (magnesium/ ammonium phosphate stones. - Uric acid stone |
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What is the other name to Kidney stones? |
Renal calculi |
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Explain the role calcium oxalate crystals in renal calculi: |
- restrict oxalates and increases fluids. - risk factors include hypercalceamia, hyperparathyroidism and bone disease. |
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What are the most common sources of oxalates? |
- Fruits - Vegetables. - Nuts and seeds. - Legumes - Grains. |
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Explain the role of Striuvite in renal calculi: |
- happens with urinary tract infection - urine very alkaline - need to eradicate infection and acidify urine. |
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Explain the role of uric acid in renal calculi: |
- happens with gout and increased purine in diet. - decreases purines, alcohol, increase water and folic acid. |
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What are the manifestations of renal calculi? |
- Colicky pain - Haematuria - decreased urine output |
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What are the complications of renal calculi? |
- decrease in GFR - renal failure - bacterial infections - increased risk of renal cancer. |
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What are the conventional treatment? |
- appropriate alteration of urine PH - extracorporeal lithotripsy or laser therapy. - surgery if necessary. |
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Question: Which of the following conditions does not lead to stone formation? a. acidic PH b. supersaturated urine c. urine stasis. d. High Na+ concentration |
d. High Na+: Sodium concentration has nothing to do with stone formation, but all other factors listed can lead to kidney stone development. |
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Name four urinary tracts infections: |
1. Pyelonephritis 2. Cystitis 3. Ureteritis 4. Urethritis |
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What is pyelonephritis? |
infection of the kidneys and renal pelvis |
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What is cystitis? |
infection of the bladder. |
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What is urethritis? |
infection of the urethra |
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What is ureteritis |
infections of the ureters |
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What are the protective mechanism during infections? |
- washout phenomenon - mucin layer - local immune responses. - Normal flora - prostate secretions in men. |
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What is schistosomiasis? |
- a parasitic infection caused by a fluke - burrows into walls of urinary tract. - affects 200 millions people. |
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What are the risks factors for renal infections? |
- Obstruction - reflux - Genetics - Females |
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Give a specific examples of how each risk factors regarding renal infection can affect a patient: - Obstruction- reflux- Genetics- Females |
* urine acts as a medium for microbial grow. * microorganisms ascend to infect kidney * occurs in urine from the urethra moves into the bladder. * Vesicourecteral reflux occurs at the level of the bladder and the ureter. * short urethar offers less protection |
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What are the group in high risk for renal infections? |
- pregnancy: muscle relaxing effects of progesterone, bladder is displaced. - the elderly: poor bladder emptying, less protection, prostatic hyperplasia |
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Symptoms of acute cystitis: |
- frequency of urination (20 min) - Lower abs or back discomfort. - Burning pain and pain on urination. - Cloudy and foul smelling urine on occasion. |
