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Big Ol' Patho. > Renal Calculi + Incontinence + Renal Failure > Flashcards

Renal Calculi + Incontinence + Renal Failure Flashcards

1
Q

What are renal calculi?

A
  • Kidney stones
  • Within UT
  • In in men (?)
  • Form in kidney → migration -→ obstruction?
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2
Q

Renal calculi aka?

A

NEPHROLITHIASIS

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3
Q

Et of renal calculi?

A

• Complex interaction

  • Str changes in UT
  • Inc [ ] in blood/urine components
  • Dietary + metb factors
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4
Q

What two factors can cause stone formation? (outweight protective factors)

A

o If urine stasis, stones develop

o If person produces hypertonic urine, stones will develop

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5
Q

Patho of renal calculi?

What normally inhibits crystallization?

A
  • Kidney proteins inhibit crystallization (Mechanism unclear) – beneficial proteins; can be outweighed by other factors, allowing crystallization + stones to occur
  • Inc solute concentration and/or urine stasis → precipitation in urine → nucleus → crystallization
  • 4 types of stones
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6
Q

4 types of renal calculi?

A

• 4 types of stones (Get these from table 33-2 and what the major components of each)
o Calcium (oxalate and phosphate)
o Magnesium ammonium phosphate (struvite)
o Uric acid (urtrate)
o Cystine (inherited disorder of amino acid-metb)

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7
Q

Why do we want to know the type of stone?

A

• Type of stone clinically very important b/c components tells us what origin is in terms of diet…allowing us to help with prevention of future stones

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8
Q

Staghorn calculus

A

Find photo?
= shape of stone looks like head with horn on it (seen wedges within kidney calyx in photo) → if have several of these in the kidney, will impact function

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9
Q

Manifestations of renal calculi?

A

• Severe renal colic (mins to days) – acute colicky pain –
o Distended ureter (migration)
• Then non-colicky pain (also excruciating, occurs when…??)
• Nausea, vomiting, diaphoresis

  • Substantial distress as may think it’s an MI, etc…unsure of cause of pain
  • Stones can be smooth or jagged (causing hemorrhage)
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10
Q

Why is renal calculi pain colicky at first?

A

colicky as stone travels through ureterer or urethra (the contraction in the muscle of the walls of these passageways intermittently contracting, this causes pain)

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11
Q

Dx of renal caluli

A
  • Pain - Pattern of presentation
  • US, CT done in emerg, will order blood work while waiting for this
  • Urinalysis (microscopic, looking at urine under microscope…looking for signs of infection (blood cells), crystals, casts
  • IVP (was traditionally standard test, not as common now) →
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12
Q

What is an IVP?

A

Intravenous pyelogram injecting contrast medium, tracing entire urinary ystem from kidney to urethra (can visualize with xray)

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13
Q

Tx of renal calculi?

A
  • 90% passed spontaneously (won’t remove…and watch to catch stone for lab analysis)
  • Narcotics
  • Antispasmotics (ex: buscopan)
  • Cause? - BPH
  • Sx? - can use lithotripsy
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14
Q

Lithotripsy for renal calculi?

A

rarely open sx; can bombard with high intensity sound waves to break up = lithotripsy → must be careful here b/c can cause smaller fractured…will move down UT and cause problems distally

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15
Q

Is a renal stone not causing obstruction a problem? Why do we treat it?

A

• Stone is not problematic in itself unless causes obstruction – the pain is the big issue normally

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16
Q

Is urinary incontinence a disease?

A

No, mnfst of other condition

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17
Q

3 causes of stress incontinence?

A

a. Weak sphincter: If weakening of sphincter between bladder and urethra (as occurs with aging) will see incontinence
b. Inc intra-abdominal pressure: excessive P occurs with lots of laughing, sneezing, coughing…urine forced passed sphincter
c. Change in urethro-vesicular angle

18
Q

Urethrovesicular angle?

A

= angle between urethra and bladder
ii. This angle changes with childbirth

“an angle formed by the junction of the bladder wall and the urethra. Analysis of such angles was formerly considered to be a way of gauging the risk for stress incontinence.”

19
Q

3 kinds of incontinence?

A

1) Stress
2) Overflow
3) Overactive bladder

20
Q

Overflow incontinence

What occurs?

A
  • Intravesicular pressure > urethral p
  • Retention and bladder distension

Noramlly can fill bladder quite a lot before pressure will exceed the p of the sphincter → if get lazy and not empty bladder, it can exceed it however.

“Overflow incontinence is a form of urinary incontinence, characterized by the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate.”

21
Q

Overactive bladder as cause of incontinence?
What is overactive?
What kind of problem is it?

A

Hyperactive detrusor muscle

Neurogenic and/or myogenic problem (muscle in bladder itself is defective, or have inappropriate stimulation by neuro system)

22
Q

Detrusor muscle =

A

Muscle in the wall of bladder

23
Q

Tx of urinary incontinence?

A

• Drugs – treating muscle problem (to strengthen sphincter or act on detrusor muscles so able to retain more urine)
o Alpha-adrenergic agonists
• Surgery – artifical sphincter, prosthesis

24
Q

What is acute renal failure

What are the two most pressing issues that arise?

A

• Sudden L/o of renal fx – 2 most pressing problems that arise =
o Fluid-electrolyte imbal
o Azoemia

25
Q

Is acute renal failure reversible?

How quickly with GFR drop? Is urine output a reliable indicator of renal fx?

A

• Usually reversible – not always, can become chronic + person dies (ex: azotemia could progress to encephalopathy…)

  • GFR drop (could be hours or days before meaningful drop occurs)
  • Measuring urine output is NOT a good enough indicator of kidney function – not necessarily indicative of renal fx
26
Q

How much urine output is necessary to prevent azotemia?

A

• Need AT LEAST 400mL/day of urine to prevent azotemia – this is VERY borderline, want a lot more than this

27
Q

What is oliguria?
Anuria?
(in mL’s)

A
  • Oliguria = 100-400mL.day (not absolute #’s, depends on source)
  • Anuria:
28
Q

etiology of ARF?

What causes are most common?

A

(see Chart 34-1) – Ahmed says to “elaborate from this chart”
• Mostly Hypotension + hypovolemia
• 3 groups: prerenal, intrarenal (aka intrinsic), postrenal

o Can be problem within the kidneys (ex: glomerulonephritis), before or after (BPH)
o Mostly prerenal (d/t hypovolemia)
o Pre or intra = 80-90% of cases

29
Q

What % of CO usually goes to the kidneys to perfuse them?

A

Usually 20-25% of CO goes to kidneys (is renal perfusion)…if it drops below this, you run into trouble!

30
Q

Patho of prerenal ARF?

A
  • Eg: dehydration
  • Dec renal perfusion → oliguria + ischemia (even if blood flow is just about adequate, may still have ischemic damage in kidney itself
31
Q

Phases of pathophysiology of intrarenal ARF?

A

1) Initiating phase
- Precipitating events to manifestations (period bt these two events)
Ex: Immune complex or bacteria arriving until manifestations arise

2) Maintenance phase
o Drop in GFR, oliguria, Azotemia…basically kidney not doing what it’s supposed to.

3)Recovery phase
o Gradual as repair of tissue damage occurs, based on having tx for cause
o Tissue repair → gradual inc in GFR

32
Q

Postrenal ARF?

A
  • Eg BPH

* Obstruction to renal flow

33
Q

Manifestations of ARF?

Complications?

A
  • Oliguria or anuria
  • Fluid-elec imbalance - Are retaining fluids + electolytes…are many things that will come form this –
  • Azotemia (wehn less than 400cc)
  • complications: HTN, edema
  • proteinuria and hematuria
34
Q

Why would you see hematuria with ARF?

A

Hema if damage to blood vessels (d/t infection, glomerulonephritis)

35
Q

Tx of ARF?

A

• Stat interventions
• Replace fluids + electrolytes (monitor!)
• Dialysis
• Diet – normal well balanced, consideration of sodium; low proteins
o Inc calorie – ensure not coming from lots of protein….d/t nitrogenous wastes

36
Q

Dialysis
Which type is more common?
How does peritoneal work?

A

hemodialysis more common; peritoneal – using peritoneum, which is richly vascularized (so can act just like glomerulus), introduce fluid into peritoneal cavity, filters from blood into diasolate (sp?)

37
Q

Why do you have to be very vigilent in monitoring with fluid imbaalnce in ARF?

A

Be very careful Because you have failing kidneys and you’re providing fluids…don’t want to be overloading the failing kidney!)

38
Q

Chronic Renal Failure

A 
•	Progressive, perm damage
•	Via stages (numbers NOT absolute!)
1) DIMINISHED RENAL RESERVE
• Kidney function declining…GFR is decreasing 
• GFR
39
Q

Normal GFR?

A

N = 120-130ml/min

40
Q

stage 1 CRF

A

diminished renal reserve

  • GFR dec by 50% of normal (120-130ml/min)
  • no signs of dec renal fx
  • no signs of azotemia as theres enough urine output
41
Q

stafe 2 CRF

A

renal insufficiency

GFR 20-50% of normal

42
Q

stage 3 of CRF

A

renal fialure

  • GFR less than 20%
  • end stage less than 5%

Big Ol' Patho. (17 decks)

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