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Flashcards in Class #4 Deck (44):
1

How do the kidneys maintain bone calcium levels?

By Activating vitamin D

2

What is Glomerulonephritis?

2nd leading cause of kidney failure

3

What causes Glomerulonephritis?

-Hereditary
-Other disease process
-Injury from antibodies reacting with antigens in the glomeruli
injury from circulating antibody/antigen complexes that lodge in the glomeruli

4

What are the 4 types of glomerularnephritis?

Proliferative
Infiltration of WBCs and proliferation of glomerular cells
Membranous
Thickening of glomerular capillary wall
Sclerotic
Increased extracellular matrix
Diffuse/focal/segmental
Ex: Mesangial (involves only these cells)

5

Manifestations of Acute Nephritic Syndrome

Hematuria** HALLMARK SIGN
Decreased GFR
Azotemia (build up of nitrogenous waste)
Oliguria
Fluid retention (edema, HTN)
*Shortness of Breath from the buildup of fluid*

6

What is Acute Nephritic Syndrome?

Inflammatory response that damages the glomerular capillary wall

7

How can nephritic syndrome be treated?

-children have spontaneous recovery
-Adults--treat the symptoms
-antibiotics
-fluids

8

What is rapidly progressive glomerulonephritis? Explain the patho.

signs of severe glomerular injury without a specific cause.
*Proliferation of glomerular cells, with monocytes & macrophages destroy Bowman space

9

Name a rare type of rapidly progressive glomerulonephritis

Goodpastures Syndrome

10

What is Nephrotic Syndrome?

Damage to the integrity of the glomerular membrane caused by medications, neoplasms, inflammation

11

Symptoms of Nephrotic Syndrome?

*Increased GFR, but you are losing things into your urine that you shouldnt
*Massive proteinuria
*Hypoalbuminemia
*Edema (anasarca) : When you lose the protein in your urine, the blood doesn’t have the osmotic pressure to hold fluid in your vascular space
*Lipiduria--Lose lipids in your urine
*Hyperlipidemia--compensatory action when you lose proteins and lipids and your liver synthesis more proteins to increase lipids

12

What is acute pyelonephritis? What causes it?

Caused by Bacterial infection of upper UT with infrarenal reflux, or movement of urine in the wrong direction

13

TRUE OR FALSE
Nephritic syndromes are characterized by blood in the urine?

TRUE

14

What are contributing factors to acute pyelonephritis?

Outflow obstruction
Catheterization
Vesicoureteral reflux (urine moves backwards from the ureters into the bladder and into the kidney)
Pregnancy
-Neurogenic Bladder

15

Manifestations of acute pyelonephritis

Rapid chills and fever
Ache/pain unilateral or bilateral
*Costovertebral Angle
-Dysuria, frequency, urgency
-N/V, abdominal pain radiating to the back

16

Treatment of acute pyelonephritis

Symptomatic pain relief
Fluids to aid dysuria
Antibiotics

17

Chronic pyelonephritis. What does it usually affect?

Scarring and deformation of renal calyces and pelvis, with atrophy and thinning of cortex
Usually affects the proximal and distal tubules

18

What causes chronic pyelonephritis?

-Recurrent or persistent infection
-Intrarenal reflux

19

What does the effect of toxin-related nephropathies dependent on?

-Action of drugs/toxins
-Number of toxins involved
-Existence of pre-renal issues that decrease blood flow to kidney
-Formation of crystals
-Hypersensitivity response

20

What is polycyctic Kidney Disease?

Inherited autosomal dominant
Generally older population; progresses slowly
Fluid-filled cysts in kidney and liver

Deformity of epithelial cell interfere with fluid absorption/cellular maturation resulting in cyst formation
-Inflammatory mediators accumullate, and renal tubular cells are destroyed
Kidneys are enlarged

21

Manifestations of PKD

Pain
Hematuria
Infected cysts—UTI
HTN

22

Complications of PKD

-Nephrolithiasis (REALLY COMMON! kidney stones)
-Valvular deformities (inflammation, bacterial involvment)
-Cerebral artery aneurysm

23

What can obstruct flow in the ureters?

Calculi, pregnancy, tumors, stricture, congenital origins

24

obstructions in the bladder & the ureter

Calculi, neurogenic bladder, cancer, Benign prostatic hypertrophy, strictures

25

What are the 2 main causes of stasis of urine?

UTI, stone formation

26

What is hydronephrosis?

anything that causes urine buildup in in renal pelvis and calyces d/t obstruction of outflow, leading to atrophy of kidney

27

Manifestations of urinary obstruction

-Recurrent UTI
-Minimal to severe pain dependent of level and degree of obstruction
-Complete obstruction with oliguria/anuria and renal failure

28

Look at pg 633 for types of stones

NOW!

29

What causes calcium kidney stones

-immobilization
-hyperparathyroidism
-diffuse bone disease

30

What causes Magnesium ammonium phosphate kidney stones?

UTIs

31

Manifestations of Kidney stones

-pain (Ureter stone: severe flank/upper abdominal pain that radiates
Renal pelvis stone: less severe)
-nausea and vomiting
-Pallor, diaphoresis
-Frequency and burning
-Fever and chills
-Hematuria

32

How can you treat kidney stones?

-Analgesics, Anti-spasmotics
-Allopurinol (GOUT) that
changes pH to decrease acidity
-Increased fluids to produce 2 liter/day
-Strain urine
-Diet modification
-Extrancoporeal shockwave lithotripsy (ESWL)
-Ureteroscopic removal
-Percutaneous nephrolithotomy

33

What is Wilms Tumor?

Most common malignant abdominal tumor in children
-usually encapsulated, therefore it can usually be removed

34

Symptoms of Wilms Tumor?

Abdominal mass, HTN, Abdominal pain, vomitting

35

What is renal cell carcinoma? Symptoms?

Kidney cancer
-Hematuria, flank pain, mass

36

What puts you at high risk for renal cancer?>

Smoking

37

What is pre-renal failure

problems in the kidney that result from decreased blood flow to the kidney

38

How is pre-renal kidney failure caused?

hypovolemia
heart failure
cardiogenic shock
sepsis
certain medications or toxins

39

Manifestations of pre-renal kidney failure?

-decreased urinary output
-elevation of BUN proportionally to creatinine 20:1
-Azotemia (Build up of nitrogenous waste in blood)

40

Most common indicator for acute renal failure?

AZOTEMIA

41

If your patient has pre renal failure, would you expect the delivery of intravenous fluids to help the patients outcome?

YES! because "not enough blood flow to the kidneys" is the problem, and fluids can help that!

42

What is Intrinsic Renal Failure? What can it be caused by?

Disorder within the kidney structure
-Prolonged ischemia
-injury to tubular structures
-intratubular obstruction
-Infection
-nephrotoxic agent (IRON)

43

3 Phases of Acute Tubular Necrosis

1. Onset- development up to time of ischema
2. Maintenance- Decreased GFR and urinary output (Edema, pulmonary congestion, HTN)
-Retention of urea/K/Sulfate, creatinine
3. RECOVERY
-gradually increased output

44

How can you treat Renal Failure?

PREVENTION
EARLY DIAGNOSIS
-fluids (be careful!)
-Electrolytes
-calories
-dialysis
-continuous renal replacement therapy