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Flashcards in 8 renal disease Deck (49):
1

Localized manifestations of renal disease

Flank pain
Dysuria
Colic (spasmodic pain)
Polyuria
Oliguria
Anuria

2

Oliguria definition

<30ml/hr or 400ml/day

3

Localized

Proteinuria
Glucosuria
Hematuria
Pyuria - pus in the urine

4

Systemic manifestations (vary depending on etiology)

Bacterial infection - fever, chills, general malaise
Renal failure - Uremia + other S&S of chronic renal failure
Hyperkalemia, hypercalcemia
Anemia

5

Uremia defintion

Blood excess of:
Urea (BUN)
Creatinine
Other metabolic end products
Chronic uremia can cause neuro changes and CNS depression

6

Renal insufficiency

25% of normal or GFR 25-30ml/min
Typically has mildly elevated BUN and creatinine

7

End stage renal failure

Less than 10% function

8

Renal failure

Inability of kidney to maintain normal function

9

Symptoms of uremia

Elevated creatinine and BUN
Fatigue, anorexia, N/V, pruritus and neuro changes

10

Pruritus

Severe itching of the skin as a symptom of various ailments

11

Oliguria

Reduced urine output

12

Acute renal failure

Abrupt reduction in renal function with uremia
Usually oliguria (can be normal or increased)
Both kidneys
Reversible if treated early
Extra systemic waste, less stuff normally kept by kidneys

13

Three classifications of acute renal failure

Pre, intra and post renal

14

Prerenal ARF

Most common cause of ARF
Decreased blood flow, which drops GFR because of inadequate filtration pressure

15

Causes of prerenal failure

Hypovolemia - trauma, GI bleed, childbirth, burns, peritonitis, water and lytes loss (vomiting/diarrhea/bowel obstruction/beeties/diuretics)
Hypotension - Sepsis, cardiac, PE, renal artery stenosis, vasoconstriction (PIH, hepatorenal syndrome)

16

Three types of intrarenal ARF

Acute tubular necrosis (ATN)
Acute glomerulonephritis
Acute pyelonephritis

17

Acute tubular necrosis (ATN)

Destruction of tubular epithelial cells by:
Iscehmia, nephrotoxins, intratubular obstruction, acute renal diseases
Usually multifactoral, lead to necrosis through a combination of the above causes
Least reversible as cell death is present

18

Ischemia in ARF

Surgery, sepsis, hypovolemia, trauma, burns
ATN from trauma and burns is multifactoral and can involve nephrotoxins and obstruction

19

Nephrotoxins (ATN)

Carbon tetrachloride, NSAIDS, tylenol, aminoglycoside, antibiotics (gentamycin, garamycin)
Radiocontract medium
Hemoglobin, myoglobin
Bacterial endotoxins (E.coli)

20

Intratubular obstruction (ATN)

Rhabdomyolsis or
Hemoglobinuria from anemia's and transfusion reactions

21

Acute glomerulonephritis intrarenal ARF

Inflammation of glomeruli, often from immune or autoimmune
Type 2HR (strep A)
Type 3 HR (SLE)
HTN
Diabetes
Eventually inflammation causes tissue damage and decreased function

22

Clinic manifestations of glomerulonephritis

NephrItic syndome (IN) Decreased GFR due to inflammatory occlusion - Hematuria/oliguria/ edema/HTN
NephrOtic syndrome (things go OUT)
Increased GFR due to inflammatory perm
Proteinuria
Hypoalbuinema
Hyperlipidema
Edema
Clotting disorders

23

Acute pylonephritis intrarenal ARF

UTI affecting renal pelvis and renal parenchyma
More common in women and especially preggos
Urinary catheterization, immunosuppression, the beeties, anything that obstructs flow, improper hygiene, systemic infections

24

Acute pylonephritis patho

Begins in urethra, travels to kidneys
Must affect both kidneys to be ARF
Purulent exudate fills renal pelvis and begins to obstruct surrounding structures
Abscess formation and inflamm causes tissue necrosis

25

Clinical manifestations of acute pylonephritis

Dull achy lower back/flank pain which is reproducible with palp to costoverterbral angle
Dysuria with urgency and frequency
Malaise
N/V
Fever
Urinalysis shows infection

26

Postrenal ARF

Rarest cause of ARF
Ureteral destruction (edema, tumors, stones, clots)
Bladder neck obstruction (enlarged prostate)

27

Three phases of ARF

Oliguria, Diuresis, Recovery

28

Phase 1 manifestations of ARF

Oliguria - other manifestations depend on underlying cause
Elevated BUN makes pt prone to hyperK+
Edema from fluid retention
N/V, fatigue, lyte issues
Delayed wound healing/increased risk of infection
Increased BUN and creatinine

29

Phase 2 of ARF

Diuresis
Progressive increase in urine volume as function improves. Tubular damage is still present and reabsoprtion may not recover as fast as glomerular filtration
Na+ and K+ loss - risk of hypo K+
Volume depletion may occur

30

Phase 1 of ARF

Back leak and obstruction of tubules causes lack of urine, occurs one day after hypotensive event
Lasts 1-2 weeks depending on severity
Can become anuria

31

Phase 3 of ARF

Recovery, may take 3-12 months

32

Chronic renal failure (CRF)

AKA CRD
A slow progressive loss of nephrons
Changes not evident until 25% of normal
From ARF (chronic pyelonephritis)
or congenital polycystic kidney disease
or HTN/beeties

33

CRF classifications in GFR mL/mn/1.73m2

Normal,mild,moderation,severe and failure
>90
60-90
30-60
15-30
<15

34

Clinical manifestations of CRF

Accumulation of nitrogenous wastes
High BUN and creatinine
Moves from azotemia to uremia
Fluid/lyte/pH disorders
Bone disorders
Hematologic disorders - anemia, coagulopathies (bleeding disorders and thrombotic)

35

Azotemia

Accumulation of N2 wastes

36

Chronic Renal Failure presentation

HTN, HD, pericarditis
Anorexia, n/v, ulcers
Uremic encephalopathy, decreased sensory and motor
Risk of infection
Abnormal pigment, terry nails
ED
Impaired drug elimination

37

Terry's Nails

Most of the plate turns white (not from being detached)
A sign of decreased blood supply (anemia)

38

Myoglobinuria

Life threatening - from severe muscle trauma
Renal threshold is low (0.5mg/100mL)
Released from sarcolemma membrane, along with CK and massive amounts of other serum enzymes. Prerenal ARF

39

UTIs - Cystitis

Inflammation of the bladder, usually from retrograde bacteria
Hemorrhage, suppuration, ulceration, gangrene

40

UTIs cystitis

10-20% more common in women
Frequency, urgency dysuria and suprapubic/low back pain
Hematuria and flank pain
Can be asymptomatic

41

Cystitis patho

Sexually active females
Pregnancy
Indwelling caths
Beeties, neurogenic bladder, poor hygiene and UT obstruction

42

Neurogenic bladder

Dysfunction from neuro damage (spastic or flaccid)
Incontinence, frequency, urgency, urge incontinence, retention.

43

Suppuration

The process of pus forming

44

Renal Calculi

Renal stones from metabolic disorders, common cause of UT obstruction

45

Renal Colic

Spasms of ureter, can be induced by passage of renal calculi

46

Renal Calculi - stone types

Calcium salts, often associate with hypersecretion of calcium - forms 70-80%
Struvite - magnesium ammonia phosphate (10%)
Uric acid (5-10%) related to gout
Cysteine (<1%) from errors of amino acid metabolism

47

Patho of renal calculi

Stones usually grow on papillae or, renal tubules, calcyces, renal pelvis
Mostly <3-5mm diamater
More common in men
5% of all adults

48

Clinical manifestations of renal calculi

Pain
Usually asymptomatic above ureters unless infection or obstruction occurs, or until migrates to ureter and obstructs lumen
Colicky pain occurs as ureter contracts to attempt to advance the stone
Distension and spasm follow when urine builds

49

Pain of Renal calculi

Flank pain at costovertebral angle (last rib and lumbar)
Radiation to groin if lower in ureter
N/V hematuria