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Pathophysiology > Week 15: Urinary system > Flashcards

Week 15: Urinary system Flashcards

1
Q

Urinary System: Review

  • Removes metabolic ________
  • Removes ____________ from the body
  • Removes drugs other foreign material from body
  • Regulates water, electrolyte, acid-base balance
  • Secretes erythropoietin
  • Activates vitamin D
  • Regulate _______________ through the renin-angiotensin-aldosterone system
A
  • Removes metabolic wastes
  • Removes hormones from the body
  • Removes drugs other foreign material from body
  • Regulates water, electrolyte, acid-base balance
  • Secretes erythropoietin
  • Activates vitamin D
  • Regulate blood pressure through the renin-angiotensin-aldosterone system
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2
Q

Kidneys
↓
Ureters
↓
_____________
↓
Urethra

A

Kidneys
↓
Ureters
↓
Urinary bladder
↓
Urethra

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3
Q

Nephrons—functional units of the kidneys

Each kidney has over ___________ nephrons.

Renal ____________
- Glomerulus
- Bowman capsule

Renal __________
- Proximal convoluted tubules
- Loop of Henle
- Distal convoluted tubules
- Collecting duct

A

Each kidney has over a million nephrons.

Renal corpuscles
- Glomerulus
- Bowman capsule

Renal tubules
- Proximal convoluted tubules
- Loop of Henle
- Distal convoluted tubules
- Collecting duct

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4
Q

Filtration
-In renal ____________
-Large volume of fluid passes from glomerular ___________ into the tubule (Bowman capsule)

A

-In renal corpuscles
-Large volume of fluid passes from glomerular capillaries into the tubule (Bowman capsule)

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5
Q

Reabsorption

Transport mechanisms for reabsorption
- ________ transport
- Co-transport
- Osmosis—water

Proximal convoluted tubules
-Most of water ______________
- Glucose reabsorption
- Nutrients and electrolytes to maintain homeostasis

A

Transport mechanisms for reabsorption
- Active transport
- Co-transport
- Osmosis—water

Proximal convoluted tubules
-Most of water reabsorption
- Glucose reabsorption
- Nutrients and electrolytes to maintain homeostasis

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6
Q

Hormones Involved in reabsorption
- ___________ hormone (ADH)
- Aldosterone
- ________ natriuretic hormone

A
  • Antidiuretic hormone (ADH)
  • Aldosterone
  • Atrial natriuretic hormone
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7
Q

Blood Flow through the Kidney - Specialized pattern:

Renal ________ → interlobar artery → arcuate artery → interlobular artery → afferent arteriole
→ glomerular ______________ → efferent arteriole → peritubular capillaries → interlobular vein → arcuate vein → interlobar vein → renal _______

A

Renal artery → interlobar artery → arcuate artery → interlobular artery → afferent arteriole
→ glomerular capillaries → efferent arteriole → peritubular capillaries → interlobular vein →
arcuate vein → interlobar vein → renal vein

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8
Q

Glomerular Filtration Rate - control of arteriolar constriction by three factors:

____________
- Local adjustment in diameter of arterioles
- Made in response to changes in blood flow in kidneys

_____________ nervous system
- Increases vasoconstriction in both arterioles

____________
- Secreted by juxtaglomerular cells when blood flow to afferent arteriole is reduced
- Renin-angiotensin mechanism

A

Autoregulation
- Local adjustment in diameter of arterioles
- Made in response to changes in blood flow in kidneys

Sympathetic nervous system
- Increases vasoconstriction in both arterioles

Renin
- Secreted by juxtaglomerular cells when blood flow to afferent arteriole is reduced
- Renin-angiotensin mechanism

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9
Q

Retention
- Inability to ___________ bladder
- May be accompanied by overflow incontinence
- Spinal cord injury at sacral level blocks micturition reflex
- May follow anesthesia (general or spinal)

A
  • Inability to empty bladder
  • May be accompanied by overflow incontinence
  • Spinal cord injury at sacral level blocks micturition reflex
  • May follow anesthesia (general or spinal)
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10
Q

Urinalysis: Urinary Infection
- Heavy purulence and presence of _______________________________ organisms

A

gram-negative and gram-positive

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11
Q

Urinalysis: Abnormal Constituents of Urine
- _______ (hematuria)
- Elevated _________ level (proteinuria, albuminuria)
- _________ (bacteriuria)

A
  • Blood (hematuria)
  • Elevated protein level (proteinuria, albuminuria)
  • Bacteria (bacteriuria)
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12
Q

Urinary casts
- Indicate inflammation of ______________

Specific gravity
- Indicates ability of tubules to ____________ urine
- Low specific gravity—dilute urine (with normal hydration)
- High specific gravity—concentrated urine (with normal hydration)
- Related to renal failure

Glucose and ketones
- Found when _____________ mellitus is not well controlled

A

Urinary casts
- Indicate inflammation of kidney tubules

Specific gravity
- Indicates ability of tubules to concentrate urine
- Low specific gravity—dilute urine (with normal hydration)
- High specific gravity—concentrated urine (with normal hydration)
- Related to renal failure

Glucose and ketones
- Found when diabetes mellitus is not well controlled

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13
Q

Elevated renin levels Indicate _______ as a cause of hypertension

A

kidney

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14
Q

Diuretic Drugs
- Used to remove excess _________ ions and _______ from the body
- Increased excretion of water though the kidneys
- Reduces fluid volume in tissues and blood
- Prescribed for many disorders
-Renal disease, hypertension, edema, congestive heart failure, liver disease, pulmonary edema
- Several different mechanisms to increase urine _________ based on specific drug
- Some drugs are potassium-wasting and some are potassium-sparing.

A
  • Used to remove excess sodium ions and water from the body
  • Increased excretion of water though the kidneys
  • Reduces fluid volume in tissues and blood
  • Prescribed for many disorders
    -Renal disease, hypertension, edema, congestive heart failure, liver disease, pulmonary edema
  • Several different mechanisms to increase urine volume based on specific drug
  • Some drugs are potassium-wasting and some are potassium-sparing.
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15
Q

Dialysis
-Provides ____________ and reabsorption

Two forms
- Hemodialysis
-Peritoneal dialysis

  • Sustains life during __________ failure
    -Used to treat patients with acute kidney failure
  • For patients in end-stage renal failure
A

Dialysis
-Provides filtration and reabsorption

Two forms
- Hemodialysis
-Peritoneal dialysis

  • Sustains life during kidney failure
    -Used to treat patients with acute kidney failure
  • For patients in end-stage renal failure
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16
Q

Hemodialysis
- In hospital, dialysis center, or home with special equipment and training
- Patient’s blood moves from an implanted shunt or catheter in an artery to ____________
- Exchange of wastes, fluids, and electrolytes
- Semipermeable membrane between blood and dialysis fluid (dialysate)
-Blood cells and proteins remain in blood.
- After exchange is completed, blood returned to _________________

A
  • In hospital, dialysis center, or home with special equipment and training
  • Patient’s blood moves from an implanted shunt or catheter in an artery to machine
  • Exchange of wastes, fluids, and electrolytes
  • Semipermeable membrane between blood and dialysis fluid (dialysate)
    -Blood cells and proteins remain in blood.
  • After exchange is completed, blood returned to patient’s vein
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17
Q

Hemodialysis (Cont.)
- Usually required ______ times a week
- Each lasts about 3 to 4 hours.

Potential complications
- Shunt may become infected.
- Blood ______ may form.
- Blood vessels involved in shunt may become sclerosed or damaged.
-Patient has an increased risk of infection with hepatitis B, hepatitis C, or HIV if Standard Precautions are not followed.

A
  • Usually required three times a week
  • Each lasts about 3 to 4 hours.

Potential complications
- Shunt may become infected.
- Blood clots may form.
- Blood vessels involved in shunt may become sclerosed or damaged.
-Patient has an increased risk of infection with hepatitis B, hepatitis C, or HIV if Standard Precautions are not followed.

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18
Q

Peritoneal Dialysis
- Usually done on outpatient basis
- Peritoneal membrane serves as the semipermeable membrane.
- Catheter with entry and exit points is implanted into the __________________
- Dialyzing fluid is instilled into cavity
- Dialysate is drained from cavity via gravity into container

A
  • Usually done on outpatient basis
  • Peritoneal membrane serves as the semipermeable membrane.
  • Catheter with entry and exit points is implanted into the peritoneal cavity
  • Dialyzing fluid is instilled into cavity
  • Dialysate is drained from cavity via gravity into container
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19
Q

Peritoneal Dialysis (Cont.)
- Takes more _____ than hemodialysis
- Requires loose clothing to accommodate bag of fluid
- Major complication - ___________ resulting in peritonitis - With both types of dialysis

A
  • Takes more time than hemodialysis
  • Requires loose clothing to accommodate bag of fluid
  • Major complication - Infection resulting in peritonitis - With both types of dialysis
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20
Q

Urinary Tract Infections (UTIs)
- Very common infections
- Urine is an excellent ________ medium.

Lower urinary tract infections
- Cystitis
- Urethritis

Upper urinary tract infections
- Pyelonephritis

Common causative organism
_____________

A

Urinary Tract Infections (UTIs)
- Very common infections
- Urine is an excellent growth medium.

Lower urinary tract infections
- Cystitis
- Urethritis

Upper urinary tract infections
- Pyelonephritis

Common causative organism
- Escherichia coli

21
Q

Urinary Tract Infections (UTIs) (Cont.)

More common in women because of:
- Shortness of _________
-Proximity to ______

Older men
- Prostatic hypertrophy
- Urine retention

Congenital abnormalities in children

Other common predisposing factors
- Incontinence
-Retention of urine
- Direct contamination with fecal material

A

More common in women because of:
- Shortness of urethra
-Proximity to anus

Older men
- Prostatic hypertrophy
- Urine retention

Congenital abnormalities in children

Other common predisposing factors
- Incontinence
-Retention of urine
- Direct contamination with fecal material

22
Q

Cystitis and Urethritis
-Bladder wall (cystitis) and urethra (urethritis) are _________.
- _____________ bladder and reduced capacity
-Pain is common in pelvic area
- Dysuria, urgency, frequency, and nocturia
-Systemic signs may be present.
- Fever, malaise, nausea, leukocytosis
- Urine often _________, with unusual odor
- Urinalysis indicates bacteriuria, pyuria, microscopic hematuria

A

More common in women because of:
- Shortness of urethra
-Proximity to anus

Older men
- Prostatic hypertrophy
- Urine retention

Congenital abnormalities in children

Other common predisposing factors
- Incontinence
-Retention of urine
- Direct contamination with fecal material

23
Q

Pyelonephritis
- One or both kidneys involved
- From ureter into kidney
- Purulent __________ fills pelvis and calyces
- Recurrent or chronic infection can lead to scar tissue formation.

A
  • One or both kidneys involved
  • From ureter into kidney
  • Purulent exudate fills pelvis and calyces
  • Recurrent or chronic infection can lead to scar tissue formation.
24
Q

Pyelonephritis (Cont.)
- Signs of cystitis plus pain associated with renal disease
- Dull, aching pain in lower _____ or flank area
- Systemic signs include high temperature

Urinalysis
- Similar to cystitis
- Urinary _____ are present.
- Reflection of renal tubule involvement
- Treatment with antibacterials

A
  • Signs of cystitis plus pain associated with renal disease
  • Dull, aching pain in lower back or flank area
  • Systemic signs include high temperature

Urinalysis
- Similar to cystitis
- Urinary casts are present.
- Reflection of renal tubule involvement
- Treatment with antibacterials

25
Q

Inflammatory Disorders: Glomerulonephritis
-Many forms

Presence of antistreptococcal (ASO) _________
- Formation of an antigen-antibody complex
- Activates complement system
- Inflammatory response in glomeruli

  • Severe ______________ response - Congestion and cell proliferation
A

Presence of antistreptococcal (ASO) antibodies
- Formation of an antigen-antibody complex
- Activates complement system
- Inflammatory response in glomeruli

  • Severe inflammatory response - Congestion and cell proliferation
26
Q

Inflammatory Disorders—Glomerulonephritis (Cont.)
- Urine becomes _____ and cloudy
- Facial and periorbital _______ —initially
- General edema follows
- Elevated blood pressure
-Caused by increased ______ secretion and decreased GFR
- Flank or back pain
- Edema and stretching of renal capsule
- General signs of inflammation
- Decreased urine output

A
  • Urine becomes dark and cloudy
  • Facial and periorbital edema—initially
  • General edema follows
  • Elevated blood pressure
    -Caused by increased renin secretion and decreased GFR
  • Flank or back pain
  • Edema and stretching of renal capsule
  • General signs of inflammation
  • Decreased urine output
27
Q

Inflammatory Disorders: Glomerulonephritis Treatment
- Sodium restriction possible
- Protein and fluid intake decreased in severe cases
- Drug treatment
- ____________ to reduce inflammation
- Antihypertensives

A
  • Sodium restriction possible
  • Protein and fluid intake decreased in severe cases
  • Drug treatment
  • Glucocorticoids to reduce inflammation
  • Antihypertensives
28
Q

Inflammatory Disorders: Nephrotic Syndrome
- Abnormality in ______________________ , increased permeability, large amounts of plasma proteins escape into filtrate
- May be idiopathic in children 2 to 6 years old
- May be secondary to SLE, exposure to nephrotoxins or drugs

A
  • Abnormality in glomerular capillaries, increased permeability, large amounts of plasma proteins escape into filtrate
  • May be idiopathic in children 2 to 6 years old
  • May be secondary to SLE, exposure to nephrotoxins or drugs
29
Q

Nephrotic Syndrome: Pathophysiology
- Hypoalbuminemia with decreased plasma osmotic pressure
- Subsequent generalized edema
-Blood pressure remains low or normal.
- May be elevated depending on angiotensin II levels
-Increased ___________ secretion in response to reduced blood volume
-More severe edema
-High blood cholesterol, lipoprotein in urine, lipiduria with milky appearance to urine

A
  • Hypoalbuminemia with decreased plasma osmotic pressure
  • Subsequent generalized edema
    -Blood pressure remains low or normal.
  • May be elevated depending on angiotensin II levels
    -Increased aldosterone secretion in response to reduced blood volume
    -More severe edema
    -High blood cholesterol, lipoprotein in urine, lipiduria with milky appearance to urine
30
Q

Inflammatory Disorders: Nephrotic Syndrome (Cont.)

Treatment
- ____________ to reduce inflammation
- ACE inhibitors may decrease protein loss in urine
- Antihypertensives
- ________ intake may be restricted.

A
  • Glucocorticoids to reduce inflammation
  • ACE inhibitors may decrease protein loss in urine
  • Antihypertensives
    -Sodium intake may be restricted.
31
Q

Urolithiasis (Calculi)
- Can develop anywhere in _______ tract
- Stones may be small or very large.
- Tend to form with:
- Manifestations only occur with obstruction of urine flow.
-May lead to infection
- Hydronephrosis with dilation of calyces
- If located in kidney or ureter and atrophy of renal tissue

A
  • Can develop anywhere in urinary tract
  • Stones may be small or very large.
  • Tend to form with:
  • Manifestations only occur with obstruction of urine flow.
    -May lead to infection
  • Hydronephrosis with dilation of calyces
  • If located in kidney or ureter and atrophy of renal tissue
32
Q

Urolithiasis (Calculi) (Cont.)
- Calculi composed of _______ salts
- High urine calcium levels
-Form readily with highly alkaline urine
- Uric acid stones
- Hyperuricemia
- Gout, high-purine diets, cancer chemotherapy
- Especially with acidic urine
- Struvite and cystine stones
- Stone formation depends on predisposing factor

A
  • Calculi composed of calcium salts
  • High urine calcium levels
    -Form readily with highly alkaline urine
  • Uric acid stones
  • Hyperuricemia
  • Gout, high-purine diets, cancer chemotherapy
  • Especially with acidic urine
  • Struvite and cystine stones
  • Stone formation depends on predisposing factor
33
Q

Urolithiasis (Calculi) (Cont.)
- Stones in kidney or bladder often asymptomatic
- Frequent infections may lead to investigation.
- Flank pain possible caused by distention of renal capsule
- Renal colic caused by ________ of the ureter
- Intense spasms of pain in flank area
- Possible nausea and vomiting, cool moist skin, rapid pulse
- Radiological examination confirms _________ of calculi

A
  • Stones in kidney or bladder often asymptomatic
  • Frequent infections may lead to investigation.
  • Flank pain possible caused by distention of renal capsule
  • Renal colic caused by obstruction of the ureter
  • Intense spasms of pain in flank area
  • Possible nausea and vomiting, cool moist skin, rapid pulse
  • Radiological examination confirms location of calculi
34
Q

Urolithiasis (Calculi) (Cont.)

Treatment
-Small stones will be ________ eventually.
- Extracorporeal shock wave lithotripsy (ESWL)
- Laser lithotripsy
- Drugs may be used to ________ stones partially.
- Surgery

Prevention
- Treatment of underlying condition
- Adjustment of urine pH through _________ modifications
- Consistent increased fluid intake

A

Treatment
-Small stones will be passed eventually.
- Extracorporeal shock wave lithotripsy (ESWL)
- Laser lithotripsy
- Drugs may be used to dissolve stones partially.
- Surgery

Prevention
- Treatment of underlying condition
- Adjustment of urine pH through dietary modifications
- Consistent increased fluid intake

35
Q

Tumors: Renal Cell Carcinoma
- Primary tumor arising from the tubule epithelium
- More often in renal cortex
- Tends to symptomatic in early stages
- Often has metastasized to liver, lung, bone, or CNS at time of diagnosis
- Occurs more frequently in men and smokers
- Treatment is _______________ .
- Immunotherapy may be used in some cases.
- Tumor is radioresistant, and chemotherapy is not used in most cases

A
  • Primary tumor arising from the tubule epithelium
  • More often in renal cortex
  • Tends to symptomatic in early stages
  • Often has metastasized to liver, lung, bone, or CNS at time of diagnosis
  • Occurs more frequently in men and smokers
  • Treatment is removal of kidney.
  • Immunotherapy may be used in some cases.
  • Tumor is radioresistant, and chemotherapy is not used in most cases
36
Q

Tumors: Renal Cell Carcinoma Manifestations
- Painless _________ initially
- Gross or microscopic
- Dull, aching flank pain
- Palpable mass
- Unexplained weight loss
- Anemia or erythrocytosis
- Paraneoplastic syndromes
- Hypercalcemia or Cushing’s syndrome

A
  • Painless hematuria initially
  • Gross or microscopic
  • Dull, aching flank pain
  • Palpable mass
  • Unexplained weight loss
  • Anemia or erythrocytosis
  • Paraneoplastic syndromes
  • Hypercalcemia or Cushing’s syndrome
37
Q

Tumors: Bladder Cancer
- Most bladder tumors are ___________ & commonly arise from transitional epithelium of bladder.
- Often develops as multiple tumors
- Diagnosed by urine cytology and biopsy

Early signs
- Hematuria, dysuria
- Infection common

Tumor is invasive through wall to adjacent structures.
- Metastasizes to pelvic lymph nodes, liver, and bone

A
  • Most bladder tumors are malignant & commonly arise from transitional epithelium of bladder.
  • Often develops as multiple tumors
  • Diagnosed by urine cytology and biopsy
38
Q

Tumors: Bladder Cancer (Cont.)

Predisposing factors
- Working with __________ in laboratories and industry
- Particularly aniline dyes, rubber, aluminum
- ________ smoking
- Recurrent infections
- Heavy intake of _________

Treatment
- Surgical resection of tumor
- Chemotherapy and radiation
- Photoradiation successful in some early cases

A

Predisposing factors
- Working with chemicals in laboratories and industry
- Particularly aniline dyes, rubber, aluminum
- Cigarette smoking
- Recurrent infections
- Heavy intake of analgesics

Treatment
- Surgical resection of tumor
- Chemotherapy and radiation
- Photoradiation successful in some early cases

39
Q

Vascular Disorders: Nephrosclerosis

Involves ________ changes in the kidney
- Some occur normally with aging.

Thickening and __________ of the walls of arterioles and small arteries

Narrowing of the blood vessel lumen
- Reduction of ______ supply to kidney
- Stimulation of renin
- Increased blood pressure

Continued ischemia
- Destruction of renal ________
- Chronic renal failure

A

Involves vascular changes in the kidney
- Some occur normally with aging.

Thickening and hardening of the walls of arterioles and small arteries

Narrowing of the blood vessel lumen
- Reduction of blood supply to kidney
- Stimulation of renin
- Increased blood pressure

Continued ischemia
- Destruction of renal tissue
- Chronic renal failure

40
Q

Nephrosclerosis (Cont.)
- Can be primary _______ developed in kidney
- May be secondary to essential hypertension

Treatment
- ___________ agents
- Diuretics
- Beta blockers
- ________ intake should be reduced.

A
  • Can be primary lesion developed in kidney
  • May be secondary to essential hypertension

Treatment
- Antihypertensive agents
- Diuretics
- Beta blockers
- Sodium intake should be reduced.

41
Q

Congenital Disorders
- Vesicoureteral reflux

Agenesis
-Failure of one kidney to ________

Hypoplasia
- Failure to develop to normal _____

Ectopic kidney
- Kidney and ureter displaced out of normal position

“Horseshoe” kidney
- _________ of the two kidneys

A

Congenital Disorders
- Vesicoureteral reflux

Agenesis
-Failure of one kidney to develop

Hypoplasia
- Failure to develop to normal size

Ectopic kidney
- Kidney and ureter displaced out of normal position

“Horseshoe” kidney
- Fusion of the two kidneys

42
Q

Adult Polycystic Kidney
- Autosomal dominant gene on chromosome 16
-No indications in child and young adults
- First manifestations usually around age 40 years
- Multiple cysts develop in both kidneys.
- Enlargement of kidneys
-Compression and destruction of kidney tissue
- Chronic renal failure
- Diagnosis by abdominal CT scanning or MRI

A
  • Autosomal dominant gene on chromosome 16
    -No indications in child and young adults
  • First manifestations usually around age 40 years
  • Multiple cysts develop in both kidneys.
  • Enlargement of kidneys
    -Compression and destruction of kidney tissue
  • Chronic renal failure
  • Diagnosis by abdominal CT scanning or MRI
43
Q

Wilms’ Tumor
-Most common tumor in ________
- Defects in tumor suppressor genes on chromosome ____
- May occur in conjunction with other congenital disorders
- Usually unilateral
- Large encapsulated mass
- Pulmonary metastases may be present at diagnosis.

A

-Most common tumor in children
- Defects in tumor suppressor genes on chromosome 11
- May occur in conjunction with other congenital disorders
- Usually unilateral
- Large encapsulated mass
- Pulmonary metastases may be present at diagnosis.

44
Q

Acute Renal Failure Causes
- Acute bilateral kidney diseases
- Severe, prolonged circulatory shock or heart failure
- ___________
- Drugs, chemicals, or toxins
-Mechanical __________ (occasionally)
- Calculi, blood clots, tumors
- Block urine flow beyond kidneys

A
  • Acute bilateral kidney diseases
  • Severe, prolonged circulatory shock or heart failure
    -Nephrotoxins
  • Drugs, chemicals, or toxins
    -Mechanical obstruction (occasionally)
  • Calculi, blood clots, tumors
  • Block urine flow beyond kidneys
45
Q

Acute Renal Failure (Cont.)
-Sudden onset

Blood tests
- Elevated serum urea nitrogen and creatinine levels
- Metabolic acidosis and hyperkalemia

Treatment
- Identify and remove or treat primary problem to minimize risk of necrosis and permanent kidney damage
- ________ to normalize body fluids and maintain homeostasis

A

Blood tests
- Elevated serum urea nitrogen and creatinine levels
- Metabolic acidosis and hyperkalemia

Treatment
- Identify and remove or treat primary problem to minimize risk of necrosis and permanent kidney damage
- Dialysis to normalize body fluids and maintain homeostasis

46
Q

Chronic Renal Failure
-Gradual ____________ destruction of the kidneys over a long period of time
-Asymptomatic in early stages

May result from
- Chronic __________ disease
-Congenital polycystic kidney disease
- Systemic disorders
- Low-level exposure to nephrotoxins over sustained period of time

A

-Gradual irreversible destruction of the kidneys over a long period of time
-Asymptomatic in early stages

May result from
- Chronic kidney disease
-Congenital polycystic kidney disease
- Systemic disorders
- Low-level exposure to nephrotoxins over sustained period of time

47
Q

Chronic Renal Failure: Stages

Decreased renal reserve
- Decrease in ______
- Higher than normal serum creatinine levels
- No apparent clinical symptoms

Renal insufficiency
- Decreased GFR to about 20% of normal
- Significant retention of nitrogen wastes
- Excretion of large volumes of dilute urine
- Decreased erythropoiesis
- Elevated blood pressure

End-stage renal failure
- Negligible ______
- Fluid, electrolytes, and wastes ___________ in body
-Azotemia, anemia, and acidosis (three As)
- All body systems affected
- Marked oliguria or anuria
- Regular dialysis or kidney transplantation
- To maintain patient’s life

A

Decreased renal reserve
- Decrease in GFR
- Higher than normal serum creatinine levels
- No apparent clinical symptoms

Renal insufficiency
- Decreased GFR to about 20% of normal
- Significant retention of nitrogen wastes
- Excretion of large volumes of dilute urine
- Decreased erythropoiesis
- Elevated blood pressure

End-stage renal failure
- Negligible GFR
- Fluid, electrolytes, and wastes retained in body
-Azotemia, anemia, and acidosis (three As)
- All body systems affected
- Marked oliguria or anuria
- Regular dialysis or kidney transplantation
- To maintain patient’s life

48
Q

Chronic Renal Failure (Cont.)

Early signs - Increased __________ output

General signs
- Bone marrow depression and impaired cell function
- Caused by increased wastes and altered blood chemistry
- Elevated blood pressure

Complete failure
- __________
- Dry, pruritic, hyperpigmented skin, easy bruising
- Peripheral neuropathy
- Impotence in men, menstrual irregularities in women
- Encephalopathy
- Congestive ________ failure, dysrhythmias
-Failure to activate vitamin D
- Possible uremic frost on the skin
- Systemic infections

A

Early signs - Increased urinary output

General signs
- Bone marrow depression and impaired cell function
- Caused by increased wastes and altered blood chemistry
- Elevated blood pressure

Complete failure
- Oliguria
- Dry, pruritic, hyperpigmented skin, easy bruising
- Peripheral neuropathy
- Impotence in men, menstrual irregularities in women
- Encephalopathy
- Congestive heart failure, dysrhythmias
-Failure to activate vitamin D
- Possible uremic frost on the skin
- Systemic infections

49
Q

Chronic Renal Failure (Cont.)

Diagnostic tests
- Anemia, acidosis, and azotemia are the key indicators of chronic renal failure.

Treatment—all body systems are affected.
- Difficult to maintain _______________ of fluids, electrolytes, and acid-base balance
- Drugs to stimulate erythropoiesis
- Drugs to treat cardiovascular problems
- Intake of fluid, electrolytes, protein must be ___________
- Dialysis or transplantation

A

Diagnostic tests
- Anemia, acidosis, and azotemia are the key indicators of chronic renal failure.

Treatment—all body systems are affected.
- Difficult to maintain homeostasis of fluids, electrolytes, and acid-base balance
- Drugs to stimulate erythropoiesis
- Drugs to treat cardiovascular problems
- Intake of fluid, electrolytes, protein must be restricted
- Dialysis or transplantation

Pathophysiology (23 decks)

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