Diseases and Disorders of the Urinary System Flashcards
(130 cards)
1
Q
What does urinary system do?
A
filter the blood, form and stores urine, excrete urine from the body
made of 2 kidney, ureters urinary bladder and urethera
2 kidneys to connected to urinary bladder via ureter to be drained from body via urethra
2
Q
kidney function?
A
critical for homeostasis bc they remove waste and toxins from blood, regulate water and electrolyte levels and control pH and bp
produce renin (regulates bp and eryhtopietin (stimulate RBC production)
prodces 1mL urine per min (20-25A% of body’s blood volume is in kidney at any time)
3
Q
What is the nephron?
A
functional unit of kidney (1M in each kideny)
filters metabolic waste products in blood plasma
reabsorbs 99& of water with nutreints (glucose and amino acids)
4
Q
what is excreted by kidney?
A
Extra water,
excess ions, acid, some drugs, and metabolic
wastes such as urea and creatinine
5
Q
What hormones r important in regulating nephron’s abiltiy to reabsorb salt and water?
A
aldosterone and antidiuretic hormone (ADH)
6
Q
nephron components?
A
Afferent arteriole, efferent arteriole, glomerulus, glomerular capsule, proximal convoluted tubule, renal loop (loop of Henle) and distal convoluted tubule that leads to collecting duct
7
Q
how do nephrons work?
A
carries blood to nephron and enters glomerulus (network of specialized selectively permeable capillaries) where it is filtered into the surrounding glomerular capsule
filtrate has fluid from plasma and some of its constituents
as filtrate continues through proximal renal tubules ➡ renal loop ➡ distal renal tubules water, gluvose and electrolyes is absorbed into nearby capillaires, leaving acid and urea where it enters collecting ducts, forming urine
emters renal calyces and renal pelvis, down ureters to urinary bladder
8
Q
What is checked in history for urinary system?
A
presence of other diseases (esp diabetes, hypertension and UTI), exposure to meds, antibiotics and kideny toxins or abuse of analgesics such as acetaminophen
pt reports abt fever, pain, urine volume, frequency or color
family history can indicate genetic predispotion ofr certain disease
9
Q
What can be seen in the physical exam as a result of a urinary disease?
A
edema in skin, around eyes and on ankles
toxin in blood = neurologicc abnormalities such as disorientation and changes in cosciousness and response ot stimuli
changes in electrolyes = hypertension and strong, irregular pulse
alteration in pH lelvels from acidosis = hyperventilation
10
Q
color in urine
A
color and volume (diabetes = lots of pale and diluted urine)
chronic kidney diseases = abiltiy of renal tubules to concentrate urine is absent so urine is dilute and pale + specific gravity is low
presence of RBC = red-brown color to urine
odor - abn is foul, fruity, pathologic is cysitis or uti, diabetes
chemical nautre - pH is 6.5 (slightly acidic), alkaline meakns infection cause ammonia to form
11
Q
What is studyied in urinalysis and lab tests?
A
urine speciimen (physically, chemically and microscopically)
physical factors include urine color, clarity, odor, PH and specific gravity
test for RBC, WBC, bacteria, crystals and casts (form within kidney tubules, consist of coagulated protein, blood cells and epithelial cells)
12
Q
Chem tests for urine?
A
albumin in urine (albuminuria) = inflammation of urinary tact (paticularly of glomeruli)
presence of glucose in the urine of 1 of the signs of diabetes mellitus
13
Q
What are imaging techniques for urinary diseases?
A
ultrasound and CT for visualization
cytoscopic exam to see inside of bladder and urehtera (long, lighted instrument resembling narrow hollow tube isnterted through urethrra into bladder)
14
Q
What is acute kidney injury?
A
sudden onset of impaired renal function
15
Q
3 main causes of acute kidney injury?
A
- shock (interrupts blood flow to kidney)
- tubular necrosis (= lots of diseases like systemic lupus erythematosus, sickle cell disease, renal vein thrombosis, acute pststreptococcal glomerulonephritis or exposure to toxins)
- obsutrctured urine flow (from kidney stones, inflamed prostate or tumor)
16
Q
s/s of acute kideny injury?
A
oliguria (sudden drop in urine volume)
rarely there is complete stop of urine production (anuria)
N&V
diarrhea, odor of ammonia in breath from accumulation in blood of N-containing compounds
headache, drowsiness, confusion, neuropathy, seizures, and coma
1st low bp occurs, then hypertension and heart failure and respiratory edema
17
Q
what is hyperkalemia?
A
condition of elevated blood potassium (= cardiac arrest)
18
Q
How to diagnose acute kidney failure?
A
history, blood tests for elevated blood urea nitrogen, serum creatinine, potassium, low pH (signs of kideny failure)
urnalysis for casts, low specific gravity and pssibly proteinuria,
ultrasound
19
Q
how to treat acute kidney failure?
A
diet low in protein, sodium and potassium
restricted fluid intake and dialysis (if hyperkalemia than def dialysis and IV meds to removed potassium)
20
Q
What are urinary tract infections (UTIs)
A
caused by bacteria in skin or color
bacteria that colonize urethra usually become dislodged by regular flow of urine, if not then bacteria ascend the urethra and infect urianry bladder and kidneys
can occur during low urine production, catheterization or poor hygenine
more likely in women bc they have shorter urethras
21
Q
What are the lower UTIs?
A
urethritis (inflammation of the urethra) and cystitis (inflammation of the urinary bladder)
primary cause is bacterial infection (treatment include antibiitoics)
22
Q
risk factors for lower UTIs?
A
being female, multiple sex partners and STIs
23
Q
s/s of urethritis?
A
discharge from urethra, itching sensation at opening of tge urethra and a burning sensation during urination
24
Q
cytsititis s/s
A
freqent urinary, sense of urinary urgency and dysuria (painfule burning sensation during urination)
low fever, rpessure with pain in lower back
25
how to prevent lower utis?
stay hudrated to promote urine flow, practining front-to-back wiping after urinarting and safe sex
26
What r upper UTIs?
pyelonephritis (inflammation of the kidney (renal pelvis and connective tissues))
infected abscesses form and ruptre = pyuria (pus in urine, = urine is turbid or cloudy)
caused by pyogenes (pus-forming) bacteria such as Escherichia coli, streptococci and staphylococci that ascend from lower UT
obstruction and stasis of urine by renal calcui (kidney stones), tumors, benign prostatic hypertrophy predispose kidneys to infection
27
risk factors for upper UTIs?
being female, kidney stone, urinary catheter or immunodeficiency
28
s/s pyelonephritis?
chills
high fever
N&V
sudden back (flank (lumbar)) pain
dysuria
hematuria and pyuria
tenderness in suprapubic region
abd becomes rigid
palpation may reveal tender, enlraged kidneys
abn constituents, includig urinary casts, nitrites and leukocytes
UTI w/ urinary frequency or urgency and dysuria
numerous pus cells and bacteria
abscess can fuse and fill entire kidney with pus
29
What is lupus nephritis?
inflammatory disease of kidney
occurs in 45% of ppl with systemic lupus ertheomatosus
30
s/s lupus nephritis?
hematuria, hypertension and joint pain
31
how to diagnose lupus nephritis?
pt history, physical exam, evaluation of symptom, lab tests like urinalysis, blood tests, ultrasound, kidney biopsy
32
how to treat lupus nephritis?
antiinflammatory drugs and immune-suppressants
treat hypertension must be treated with statins or ACE inhibitors and reduced-fat and low-salt diet
renal transplant
33
What is IgA nephropathy + age and what it results in?
inflammtory disease of kidney resulting IgA deposition in glomeruli
more common in men from late teens to early 30s
common cause of glomerulonephritis
34
most common s/s of IgA nephropathy?
blood in urine and later, sweelign of the hands and feet
35
how to diagnose and treat IgA nephropathy?
diagnose - test for blood urea nitrogen, urinalusis and renal biopsy
treatment - no treatment in mild cases w/ normal pbp and proteinuria but elevated bp = hypertension meds
36
What is glomerulonephritis (GN)?
inflammatory disease of glmeruli that arises from a variety of underlyind diseases and disorders
2nd leading cause of renal failure
if acute, usually affects children 1-4 wekks following streptococcal infection of skin or throat (can be endogenous as accompaniment of tumors)
chronic = after chronic kidne disease
37
risk factors for glomerulonephritis?
diabetes, hypertension, and
streptococcal infection
38
What is acute poststreptococcal glomerulonephritis?
inflammtory GN caused by antigen-antibody reaction that occurs approx 1-4 wks after streptococcal skin or throat infection
39
how does Acute poststreptococcal GN work?
antigens from streptococci and antibodies form complex in bloodstream that become trapped in glmoruli = inflammatory response and damge = impaired filtration function
40
s/s of acute poststreptococcal GN?
chills
fever
loss of appetiti
gneral feelign of weakness
edema in face and ankles
41
how to dianogse and treat acute poststreptococcal GN?
diagnose = pt history, urinalysis (grpss blood and presence of RBCs, WBCs, renal tubular cells, casts, proteinuria), phyiscal exam, renal bopsy, blood test (elevated blood urea nitrogen (BUN), hypoalbuminemia, elevated ESR, KUB radiography, ultrasonography may reveal Bilateral enlargement of kidney)
treatment - anitbiotic, rest, corticosteroids, usually anti-inflammatory drugs and immune suppressants and may need to treat hypertensoion
42
What are kidney stones?
deposits of minerals within the kidney called urinarly calcuil= urolithis
no symptoms unless larger than 1/4 in in which they become lodged in ureter
men r 4x more likely then women to get it (btwn 20-40)
may cause UTIs
43
s/s of uroliths
intense pain that radiates from kidney to groin area, hematuria, N&V, diarrhea
44
how to diagnose and treat uroliths?
diagnose - CT, renal ultrasound
treat - meds to dissolve stone, lithotripsy (prevent recurrence by increasing fluid intake to keep urine dilute and idetary calcium and protein should be reduced)
45
what is lithotripsy?
crushing of kidney stones with vibrations applied externally and focused internally
successful in 20% of kidney stone
hydrolithotripsy is when pt is submerged in water
46
What is renal failure + risk factors?
progressive loss of kidney function over time
risk factors - diabetes, glomerulonephritis, or other chronic kidney diseases, ischemia, hemorrhage, shock, toxins and large kidney stomes or tumor
47
what occurs in renal failure?
kidney r unable to clear blood of urea and creatinine (nitrogen-contaiing waste products of protein metabolism) - if these accumulate in blood they r toxi
known as uremia
48
How to diagnose and treat renal failure?
diagnose - blood tests for lood urea nitrogen and tests of the glomerular filtration rate (GFR)
treat - depends on cause of renal failure but usually renal dialysis
49
How does GFR work?
GFR determines ability of kidney to clear creatinine
if impaired serum creatinine level rises and creatinine clearance rate falls
50
What is chronic kidney disease + risk factors?
life threatening, v. poorer prognosis than acute kidney injury
gradual and progressive loss of nephroms w/ irreversible loss of renal function and graudal onset of uremia
risk factors r chronic glomerulonephritis, hypertension and diavetic nephropathy, kidney disease resulting from diabetes mellitus
also related to long-term used of ibuprofen and chronic kidney disease
51
What is diabetes nephropathy
most common cause of chronic kidney disease and end-stage renal disease in US
refers to renal changes resulting from diabetes mellitus (alled glomerulosclerosis, can be expected to occur in all pt w/ type I diabetes)
due to inflammation of glomerulus which decreases filtration rate and leaks high levels of albumin and other plasma components into urine = may develop into into diabetes
52
s/s of diabetes nephropathy
develop slowly over 5–10 years and include
fatigue
urinary retention
hypertension
nausea
proteinuria
headache
itching
frothy urine
frequent hiccups
edema, particularly in the legs
53
What is hypertensive kidney disease?
aka renovascular hypertension, hypertensive, caused by kidney injury through atherosclerosis of renal arteries and their small branches in the kidney
found in 1 in 10 ppl with system hypertension
54
What does decreased blood in kidney cause them to do?
causes kidney to release renin to convert plasma protein angiotensin into angiotensin I
in liver and lungs angiotensin I in converted to angiotensin II which triggers vasoconstriction and aldosterone secretion = hypertension
55
s/s of hypertensive kidney disease
typical features of systemic hypertension:
headache, heart palpitations, tachycardia, light-headedness and anxiety, damage to retina
risk of heart failure, myocardial infarction and stroke
56
how to diagnose renal hypertension?
pt histroy, kidney examination bc surgery may help, ultrasound, renal arteriography to view blood flow and obstruction
test blood for elevated renin to determine which kidney is affected
57
What istreatment for renal hypertension?
surgery to correct underlying renal vascular problems, endarterectomy or angioplasty
manage symptoms with antihypertensive med and diuretics and controlling sodium intake
lower risk with regular exercise, low fat, not smoking and treating hypertension, all of which help prevent atheroscleorisis
58
What is nephrotic sydnrome?
aka nephrosis
disease of basement membrane of glomerulus chronic disease with proteinuria, hypoalbuminemia, hyperlipidemia, and edema
results from glomerular injury in which there is increased permeability (from certain toxins, rugs, pregnancykindey transplant) from other kidney diseases (most common causes are glomerulpnephritis and diabetes)
59
s/s of NS?
edema of the ankle and around the eyes
loses excessive amt of pritein, mainly albumin in urine (proteinuria)
pleural and genital edema
diminished glomerular filitration = sodium and water retenion = hypertension and edema
microscopic or gross hematuris
sloughed-off fat bodies
low bp
lethargy
anorexia
high lipids (can lead to premature atherosclerosis and raise risk for infection and blood clots)
60
how to diagnose Nephhrotics sydrome?
urinalysis (for high protein levels and casts), blood tests (high lipids and low albumin), kidney biopsy (determine presence of lesions characterisitic of NS)
61
How to treat NS?
addressing uderlying cuase
adjust dietary protein accordingingly, decreased sodium
use of ACE inhibitors
coritocsteroids, hypertension meds, diuerteics, immunosuppressants, cholesterol-lowering drugs and blood-thinning meds
62
How to treat chronic kidney disease?
with anti-hypertensives, diuerteics and kidney dialysis
controllling wt, blood lipids, sodium intake, sugar levelsand engaging in regular exercise
renal dialysis, then kidney transplant
63
What is hemodialysis?
blood is removed from body and passed through dialysis membrane (artificial kidney - hemodialyzer) where access to bloodstream in arm, leg, subclavian vein w/ inernal fistula alows blood to be removed from body to remove toxic substances beforereturning blood to body
3-6 hrs long in clinic
64
What is peritoneal dialysis
dialyzing fluid is introduced into the abd cavity where the peritoneum or cavity lining acts as a dialysis filter membrane (draws toxic material out of capillaires surrounding the body cavity)
allows pt more movement and freedom bc it is collected in bag
may not work in advanced chronic kidney disease
65
about __%
of live kidney recipients survive at least 5 years
after the transplant
90
66
What is end-stage renal disease (ESRD)?
complete failure of kidney functioning and ends in death
after final stages of chronic kidney disease when dialysis and kidney tranplant havent succeeded
reduce risk by controlling bp, blood sugar levels, monitor total urine protein levels, reduce dietary protein, dont smoke
67
What is hydronephrosis?
condition of urine retention within dilated kidney tubules (in 1 out of 100 ppl) bc obstruction of urinary tract won't let it past (increases pressure)
results from urinary calculi, congenital defect, tumor, enlarged prostate gland or other obstruction of renal pelvis or ureter, enlarged uterus,
67
what are hydrourethers?
ureters dialte above obstuction
68
s/s of hydronephrosis?
hematuria, vague back pain, pyuria, fever if infection, diminshed urine output, fever, chills, kidney may be palpable
69
how to treat and diagnose hydronephrosis?
diagnose - physical exam, contrast studies of ureters and kidneys, retrograde pyelography, cystoscopy to rule out an obstruction by tumor of bladder or prostate, CT or ultrasound
treat - antibiotics, analgesics, catheterization and surgery to remove obstruction
70
What is chronic glomerulonephritis?
slow progressing inflammation of glomeruli = glomerular necrosis, chronic kideny disease and renal fialure (first is inflammation, followed by progressive desutrction of many gloumeruli)
caused by chronic kidney and glomerular diseases, systemic lupus erythematosus, renal autoimmunity, and hemolytic uremic sydrome
s/s then nephrotics sydrome then chronic kidney disease and renal failure
71
How to diagnose chrnic glomerulonephritis?
history
urinalysis
blood urea nitrogen
ultrasonogrpahy
serum creatinine levels ultrasound & CT (small kidneys)
renal biopsy = glomerular damage
electron micorscopy and immunoflourescence
72
How to treat chrnic glomerulonephritis?
irreversible, treat s/s (edema, hypertension) with antihypertensive med, low-sodium and low-protein diet, limited fluid intake, diuretic and dialysis or transplant, ACR inhibitors, prevent CHF and uremia
administer antihypertensives, diuretics, antibiotics if UTIs,
73
What is urinary incontinece?
loss of bladder control
increases with age, risk factors r being female, verweight, smokigng and prostatitis
sign of underlying disease or habits
74
What is temproary incontience caused by?
alcohol, caffeine, excess fluid intake, and medications
UTIs and constipations irritate bladder
75
What is continuing urinary incontinence associated with?
pregnancy and childbirth, bladder inflammation, infection, cancer, kidney stones and prostatitis or prostate cancer
neurologic diseases, tumors and spinal injuries
76
s/s of urinary incontinence?
dribbles of urine to complete loss
stress incontinence - unexpected flow of urine with coughing, sneezing, laughing or lifting (caused by weakening of pelvic floor miuscles and urethral structure, trauma from childborth, pressure from existing pregnacy, hormonal changes)
sense of urianry urgency followed by flow of urine
overflow inctinence (inabiltiy to empty bladder = continued leaking followign urination)
77
how to diagnose and treat urinary incontinence?
diagnose - history, phyiscal exam, lab blood tests, ultrasound and cystoscopy
treat - behavioral changes, pelvic exercises, meds, catheterization surgery or other interventions
78
What is renal cell carcinoma?
rare cancer (3% of adult cancers)
2x in men, betwen 50-60
smokers r 2x more likely
grows slowly for several yrs, painless hematuria, abd mass, flank pain (also wt loss, anemia, fever, hepatic dysfunction , hypercalcemia)
frequently spreads to lungs, liver, bones and brain
79
s/s of renal cell carcinoma?
pain, typical signs of loss of appetiti, wt loss, anemia, elevated WBC (leukocytosis)
80
What is Wilms' Tumor?
aka nephroblastona
most common kidney tumor of childhood and 4th common childhood cancer
fast growing adenosarcoma that affects children younger than 10 yrs, arising from abnormal fetal kidney tissue that is left behind duing early embryonic life (metastasizes through blood and lymph vessels)
begins after child is born
abt 20% cases r hereditary
- associated w/ several congential anomalies, such as aniridia (absnece of iris) and genitourinary anomalies (cryptorchidism and ambiguous genitalia)
most tumors r unilateral but 10% r bilateral or multicentric
81
s/s of wilms' tumor?
mass in kidney region (firm, nontender, confined to 1 side of body) hematuria, pain in abd or chest, anemia, intestinal obstruction, contstipation, wt loss, fever vomiting and hypertension
82
main influencer of wilm's tumor?
The Wilms' tumor gene (WT-1)
if gene is missing or mutated = congential defects which later becomes site of tumor
83
How to diagnose and treat Wilm's tumor?
diagnose - physical exam, seek associated congenital anomalies, signs of malignancy (increased size of liver and spleen and lypmhadenopathy), blood tests, abd ultrasonogrpahy, CT and ultrasound + kidney bipsy for confimration
treat - surgical removal, chemo, raidaiton therapy
84
What is carcinoma of bladder?
malignatn tumor in urinary bladder
3% of cancer in men 1+% in women
2 1/2x more likely if smoker
85
s/s of carcinoma of the bladder
bleeding, burning pain, crampling and inability to urinate
86
how to diagnose and treat carcinoma of the bladder?
diagnose - physical exam, urinalysis procedures, biopsy, blood analysis, cytoscope
treatment - if urinary bladder is surgicall removed than ileal conduit may be cosntrcted to store and evacutate urine
87
What is polycystic kidney disease (PKD)?
development of numerous fluid-filled pockets of tissue (cysts) within the kidney (bilateral)
cysts form from dilated nephrons and collecting ducts, kidneys become grossly enlarged w/ compression of surrounding tissue,
2 genetic forms (90% - autosomal dominant affects adults, autosomal recessive affects children)
88
s/s PKD?
development of numerous fluid-filled pockets of tissue
within the kidney
may = kidney ways 20-30 lb
lumbar or abd pain and tenderness, hypertension and hematuria
89
how to diagnose and treat PKD?
diagnose - microscopic blood, proteinuria, pus in urinalysis, radiography, abd CT, abd MRI, IVP, physical exam + renal ultrasound or CT
trat - no cure so treatment is aimed at conrtolling high bp, pain and infection, may drain srugery using surgery, need dialysis and kidney transplat eventually
90
What is medullary sponge kidney?
named for the appearance of the inner part (medulla) of an affected kidney
affects 1 in 5,000-20,000 ppl in US
present at birth but asymptomatic until adulthood
91
s/s of medullary sponge kidney?
recurrent kidney stones
hematuria
pain
92
hgow to diagnose and treat medullary sponge kidney?
diagnose - ultrasound or IV pyelogram
treatment - no treatment available except increasing fluids to reduce risk of forming stones and their complicatiosn
93
Congenital abnormalities of the ureters, bladder, and urethra occurr in about __% of births.
5
94
What are some congenital ureter disorders?
duplication
abnormal position
abnormal location of openings, abnormal dilation
constrictions
95
What are some congenital urinary bladder disorders?
malformed wall or pouches
96
What are some congenital urethra disorders?
epispadias (urethral opening develops on the dorsal side
of the penis)
hypospadias (urethral opening occurs on the ventral surface of the penis)
97
As much as _______% of
the nephrons may degenerate between ages 25
and 85.
30–40%
98
What does reduction of rennin lead to?
reduction in aldosterone actibity = ;ack of slat and water retention = more urine released by kidney
99
Why does urinary retneion occur?
urinary bladder loses muscle tone and cannot empty completely
obstructuon bc prostate enlargement
increases risk for UTIs
100
Kidney cancer
increases significantly after ____________, and the incidence of bladder cancer increases after ___________.
age 60
age 70
101
prognosis of Wilms tumor?
- has one of highest survivial rates of all childhood cancers
- low stage and favorable tumor histoloy have greater than 90% cure rate
- late stage or unfavorable histoloy has 50% cure rate
- may suffer from renal impairment, heptatoxicity, cardiotoxiciity, or second maliginancies form cancer therapy
102
what is goodpasture syndrome?
- aka anti-glomerular basement membrane (GBM antibody disease
- presence of antibodies directed against an antigen in GBM
- antibodies cause complement-mediated tissue damage in glomerular and alveolar basement membrane = glomerulonephritis
103
s/s of goodpasture syndrome?
- acute glomerulonephritis
- relatively acute renal failure with proteinuria
- anemia
- hemoptysis
- hematuria
- wt. loss
- fatigue
- fever
104
how to diagnose and treat goodpasture syndrome/
diagnose - suspected in any pt w/ acute glomerulonephritis, esp if aso pulmonary hemorrhage and acute renal failure, detect anti-GBM antibodies in serum or kidney using ELISA, immunofluorescence or renal biopsy + urinalysis
treat - plasmapheresis, immunosuppressive agents (corticosteriods and cyclophosphamide) for 6-12 months w/ hemodialysis and kidney transplantation as last resorts
105
106
s/s of acute glmerulonephritis?
proteinuria
edema
decreased urine volume
heatmuris (can range from insignificant to sudden onset of urin that is grossly bloody (gross hematuria)
= urine may appear dark or may be described as coffee color
= hypertension related to altered renal funciton
- fluid retention
- headaches
- visual distrurbance
- maliase
- anorexia
- low-grade fever
- flank or back pain frm swelling of kidney tissue
107
s/s of CGN?
at first asymptomatic
- hypertension, hematuria, proteinuria, oliguria, edema, renal failure, severe hypertension, azotemia (failure to remove urea from blood), uremic frost (excrete urea through sweat glands)
- fatigue
- malaise
- N&V
- pruritus
- dyspnea
108
what are the types of peritoneal dialysis?
- continous ambulatory peritoneal dialysis (CAPD) takes place w/o machine by allowing solution to drain by gravity into dialysis bag around waste (takes abt 15 min, repeat 3-4 times a day and once at night)
- continous cycling peritoneal dialysis (CCPD) takes place while pt sleeps w/ use of cycling machina
- intermittent peritoneal dialysis (IPD) takes several hours, performed 3-5x week in clinic
109
What is continous renal replacement therapy?
- called hemofilitration
- performed in hosptial setting
- take place typically in ICU for pt in acute renal failure (ARF)
- takes place 12-24 hrs each day, every day
110
What are some nephrotoxic agents
solvents: carbon tetrachloride, methanol, ethylene glycol
Heavy metals: lead, arsenic, mercury
pesticides
antibiotics: kanamycin, gentamicin, polymyxin B, amphotericin B, colistin neomycin, phenazopyridine
NSAIDs
iodinated radiographic contrast media
antineoplastic agents
misclelaneous compounds: acetaminophen, amphetamines, heroin, silicon, cyclosporine
poisonous mushrooms
111
What is acute renal failure? -
- aka acute kidne yinjury (AKI)
- sudden and severe reduction in renal function (few days)
- common clinical emergency bc nitrgenous waste products bein accumulate in blood quickly, causing acute uremic episodes`
112
s/s of AKI?
- oliguria
- GI disturbances
- headache
- drowsiness
- other alterations in level of consciousness
-
113
What is etiology of AKI?
- dimiisheed blood flow to ,kidneys (circulatory shock or heart failure)
- intrarrenal damage or disease
- mechanical obstruction of urine flow
- certain antibiotics (gentamicin and streptomycin can cause AKI in pt who have predisponsing factors)
114
diagnose and treat AKI?
diagnose - blood tests, urinalysis (oliguria and retention of nitrogenous wastes, elevated BUN, serum creatinine, potassium levels, renal ultrasonography, radiography (CT or MRI), IVP)
treat - cause,monitor and support all body systems through uremic crisis, may be evaluated for dialusis, fluid intake amd output r balanced, ensure protein is being replacedin right proportions to prevent metabolic acidosis, high carb/low protein diet, control sodium and potassium intakes, antihypertensives, diuretics, IV fluids, antiinfective agents
115
s/s of CKD?
- weak, tird, lethargic
- hypertension and edema result from retention of fluid
- arrhythmias
- muscle weakness
- dyspnea
- metaboic acidosis
- ulceration of GI mucosa
- hair and skin changes
116
diagnose and treat pyelonephritis?
diagnose - clinical findings, urinalysis (clean-catch urine specimen that shows increased WBCs, RBCs, presence of bacteria ,p us, protein and castes), blood caulture, radiographic studes
treat - IV or oral antibodies, increased fluid intake, bed rest, if recurrences testing (IVP, and/or renal ultrasonography), surgery to relieve an obstruction or correct anomaly
117
s/s of renal calculi?
- large stone formed in shape of renal pelvis is known as staghorm calculus
- small stones can be passed spontaneously unnoticed
- if infection or blockage caused by calculi is present the sudden severe pain in flank area known as renal colic w/ urinary urgency
- N*V
- hematuria (causedby trauma from small stones)
- fever
- chills
- abd distention
118
etiology of renal calculi?
- hereditary tendency for development of certain types of stones has been notes
- form when excess of calcium or uric acid
- men r more prone to kidney stones
- occurance from 30+ up to and including 50s
- calculi from when sources of crystals r found in urine along with absence of crystalline inhibitors and urine is supersaturated w/ poorly soluble
119
diagnose and treat renal calculi
diagnose - family history, clinical findings, urinalysis, KUB radiographic studies, IV urography, renal ultrasonography, CT, strain urine to analyize stones
treat- remove calculi, treat pain and infection, resolve causative factors, analgesic, alpha-blocker (relaxes muscle of bladder, allowing stone to pass), small calculi r treated w/ observation and fluid hydration, large r removed w/ surgical procedures w/ lithotripsy, ureteroscop, electrohydraulic lithortipsy (EHL), laser lithotripsy, ureteroscope, stent in kidney pelvis to prevent edema and spasms of ureter, cystoscopy, percutaneous nephrolithotomy (small incision is made into kidney, stone is shattered by using ultrasound or EHL), diuretics
120
diagnose and treat diabetic nephropathy?
diagnose - elevated BUN level, increase in cholesterol, urianlysis shows protein and pus in urine, urinary albumin, radiographic studies of kidneys and renal biopsy,
treat - medical control of diabetes and bp, prompt treatment of infection, ACE inhibitor for bp and prolongation of proper kidney function, balance fluid intake and ouptu, diruteics, modified low-protein and low-fat diet, dialysis or evalv for kidney transpant
121
What is neurogenic bladder?
- dysfunction of urianry bladder that consists
- caused by insult ot brain, spinal cord, nerves supplying lower urinary tract (trauma or disease), cerebrobascular accident, spinal cord trauma
122
s/s of neurogenic bladder?
- depends on cause of condition
- may have to surgically remove kidney if pt has intractable pain, renal stones or persistent infection
- hesitancy
- decreased volume of urinary streams
- urinary retnetion from decreased or absent stimuli (motor paralysis)
123
types of neurogenic bladder?
- unhibited neurogenic bladder: unable to control voiding pattern and is persistently incontient of small amts of urine
- reflex neurogenic bladder: normal sensation is absent with unctrolled bladder contractions, spontaneous voiding of spurts of urine
- autonoum neurogenic bladder: all sensations and contraction capablities r abent, resulting in inability to void w/o applying pressure ot suprapubic area
124
diagnose and treat neurogenic bladder>
diagnose - history of trauma or disease process, clinical findings, urodynamic studies that assess bladder function, urine flow rate may be evaluated by an uroflowmeter (device for continous recording of urine flow in mL per second)
treat - prevention of UTIs and attemptos t orestore some normalcy in function (means for storing urine and bladder emptying r of priamry importance), catherization, drug therapy w/ parasympathomimetic agents, surgery, external collection devices, some complications include hydronephrosis and renal failure
125
how to diagnose and treat stress incontience?
diagnose - endoscopy, voiding cystourethrography (VCUG), reveal abn bladder position
treat - exercises (kegel exercises or pelvic floor muscle tightening), estrogen replacemnt, drug hterapy, surgical repair, ocllage injections
126
diagnose and treat RCCs>
diagnose - radiologic exam, abd CT, abd ultrasonograpy, look for metastasis, bone scanning, biopsy or tumor resection
treat - surgical removal, partial nephrectomy, radical nephrectomy, metastatic RCC is usually resistant to surgical treatment and radiaiont or chemo, may use immunotherapy
127
What is bladder tumors?
- usually involves transitional epithelium (urothelium) that lines the surface of bladder (also lines the entire urinary tract from renal pelvis to prostatic urethra)
- s/s r gross, intermittent, painless hematuria, pain in flank or suprapubic area, voiding symtpoms (dysruia, urgency, increased frequency), fatigue, wt loss and anorexia
- biggest cause is environemental exposures (occupational exposure to aniline dyes, diesel exhaust, cig smoking, frequent bladder infection or prior bladder cancer, HIV)
128
diagnose bladder tumors?
diagnose - unexplained hematuria, fuull urologic evalv of entire urianry tract, cystoscopy, urinary cytology (examination of transitional cells in pt voided urine), IVP, renal ultrasonogrpahy, CT, biopsy,
129
treat bladder tumors?
treat - tumor resection via transurethral resection of bladder tumor (TURBT) (complete cystoscopic resection of any visible tumors and selected biopsies of bladder mucosa) (up to 80% of tumors will recur within 12 months)
urine cytology and cystoscopy
bacillus Calmette-Guerin (BCG) (mycobacterium modified to less patholgoic state induces local immune reaction that suppresses tuumor growth)
radical cystectomy or partial cystectomy, adjuvant chemoradiotherpay, multidrug chemo (for metastatic)
