Chapter 27: Intrarenal Disorders Flashcards Preview

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Flashcards in Chapter 27: Intrarenal Disorders Deck (11):
1

Pain

- kidney and renal pain is referred to as nephralgia

- generally is felt at costovertebral angle; recorded as CVA TENDERNESS or FLANK PAIN

- due to distention/inflammation of the renal dermatomal capsule; has a dull, constant character

- Pain is transmitted to T10 and L1 by sympathetic afferent neurons; may be felt throughout dermatomes

2

Abnormal Urinalysis Findings

- provides a foundation for the differential diagnosis of renal dysfunction

- Dipstick (macroscopic) and microscopic urinalysis results provide clues to intrarenal pathologies

- Color: dark, strong smelling urine indicates decreased renal function, while cloudy pungent urine indicates an infectious process

3

Other DIagnostic Test Findings

- KUB identifies gross abnormalities related to size, position, and shape (may show renal calculi/kidney stones)

- Renogram/renal scan shows renal vasculate and tumors

- Ultrasonography differentiates tissue characteristics (MOST COMMON TEST USED)

- CT/MRI used to provide detailed info about vasculature and tissue

4

Protective Mechanisms Against Kidney Infection

- acidic pH

- Presence of urea in the urine

- Men have bacteriostatic prostatic secretions

- women have glands in the distal urethra that secrete mucous which protects against UTI

- micturation: wash out pathogens

- unidirectional urine flow which prevents reflux

5

Infection of the Kidney

- called pyelonephritis

- most common form is an ascending infection from the lower urinary tract

- the most effective preventive measure is the early removal of catheters, or just no use of catheters at all

6

Acute Pyelonephritis

- infection of the renal pelvis/parenchyma usually from an ascending UTI

- a major risk factor in pregnancy

- clinical manifestations include CVA tenderness (classic sign) accompanied by fever, chills, N/V, anorexia, and an increase in fever induced dehydration

- urosepsis: organisms in the bloodstream originating from a uti

- diagnosis is made from a presence of WBC casts which is indicative of an upper UTI

- treatment includes immediate management with antimicrobials to avoid reduced renal function

7

Chronic Pyelonephritis

- can result in chronic kidney disease

- usually associated with reflux or obstructive process leading to persistant urine stasis

- chronic inflammation causes scarring and loss of functional nephrons

- clinical manifestations include presenting with abdominal/flank pain, fever, malaise, and anorexia

- diagnosed through renal imaging

- treated by correcting the underlying processes and extending antimicrobial therapy

8

Obstruction

- conditions that interfere with the flow of urine

- may be congenital or acquired

- changes result from location and degree of obstruction as well as the duration and timing of the obstruction

9

Causes of Obstructive Processes and what they cause

- common causes include stones (most common), tumors, prostatic hypertrophy (enlarged prostate), and structures of the ureters or urethra

- Obstructive processes themselves cause urine stasis (this predisposes to infection and structural damage)

- Complete obstruction results in hydronephrosis, decreased GFR, Ischemic kidney damage because of increased intraluminal pressure. acute tubular necrosis (intrarenal acute renal failure), and chronic kidney disease

10

Renal Calculi (Nephrolithiasis)

- Kidney Stones

- crystal aggregates composed of organic and inorganic salts within the urinary tract

- urinary supersaturation is essential requirement for stone formation

- stones tend to form in the urinary tract due to solute supersaturation, LOW URINE VOLUME, and abnormal urine pH

- Most stones are composed of calcium crystals (calcium oxylate). Others include uric acid, struvite, cystine, and stones associated with certain medications

- Stationary stones are usually asymptomatic; stone migration causes intense renal colic pain abrupt in onset and may radiate; N/V, diaphoresis is common; hematuria may be present

- most stones will pass spontaneously

- Diagnosed by a CT scan

- treatment includes fluids (IV) to pass stone, lithotripsy (shockwaves that break stone) or endoscopic approaches, ureteral stenting, and ureteroscopy

- stones tend to recur; prevetion enhanced by high fluid intake to dilute the urine and dietary changes based on the type of stone

11

Nephrotic Syndrome (edema)

- occurs due to increased glomerular permeability to proteins

- urinary loss of 3 to 3.5g of protein per day (should have 0g loss)

- proteinuria leads to hypoalbuminemia and generalized edema; decreased blood colloid osmotic pressure

- increase in liver activity can cause hyperlipidemia and hypercoagulability

- most common finding is edema

- Treatment includes conservative symptom management (diuretics, lipid lowering agents, antihypertensives, and immunosuppression/immunomodulation)

- management of underlying process when identified

- may resolve spontaneously, others progress to end-stage renal disease