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SRNAAnatomy II > POST-RENAL FAILURE > Flashcards

POST-RENAL FAILURE Flashcards

1
Q

What is post renal failure?

A

Obstruction of urinary outflow tract at any point from

renal pelvis to distal urethra

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2
Q

The likelihood of functional impairment depends on:

A

– duration of the obstruction
– Whether it is partial or complete
– Whether it involves one or both kidneys

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3
Q

Nephrolithiasis

A

Kidney Stones in minor or major Calyces of the kidney

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4
Q

Ureterolithiasis

A

Kidney stones in the Ureter

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5
Q

In renal calculi there is

A

Supersaturation of stone constituents in urine

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6
Q

Renal calculi: male to Female ratio

A

3:1

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7
Q

What stone is more common in women

A

Stones due to infection (struvite)

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8
Q

Most urinary calculi develop between

A

20-50 years

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9
Q

Initial stone attack after_______ relatively

uncommon

A

age 50

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10
Q

2 imaging for renal stones

A
  • KUB

* Spiral CT

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11
Q

Renal Calculi Tx:

A

aimed at prevention.

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12
Q

Medication for stone less than 5mm

A

Tamsulosin (if < 5mm)

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13
Q

Four Types of stones and their occurrence %

A

Calcium oxalate (70%) - most common
Uric acid (15%) - High purines
Struvite (15%) - Occur with infection ↑pH
Cystine (15%)- Genetic disorder

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14
Q

Calcium Oxalate Stones

• Start with _____plaques which is

A

Randall’s plaques – predisposing factor for stone formation

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15
Q

Calcium oxalate is a

A

subepithelial calcification of the renal papilla

Act as anchor for calcium oxalate crystals

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16
Q

Randall’s plaques (CET)

A
  1. Calcium phosphate precipitates in basement membrane of loops of Henle
  2. erodes into the interstitium, and then accumulates
    in the subepithelial space of the renal papilla
  3. The subepithelial deposits eventually erode through the papilla into minor calyces
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17
Q

Most common metabolic abnormality

A

Hypercalciuria

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18
Q

3 causes of Calcium Oxalate stone

A

Absorptive
Resorptive
Renal-leak

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19
Q

Explain Absoprtive cause of Calcium oxalate

A

↑dietary Ca++ = ↑intestinal absorption

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20
Q

Explain Resoprtive cause of Calcium oxalate

A

↑resorption from bone (hyperparathyroidism)

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21
Q

Explain Renal-leak cause of Calcium oxalate

A

Renal-leak: tubules fail to properly reclaim Ca++

Assoc’d. w/ 2o hyperparathyroidism & Chronic Renal Failure

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22
Q

Excessive dietary calcium restriction is IT ADVANTAGEOUS?

A

NOT advantageous, it can cause hyperoxaluria

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23
Q

Increases free dietary dietary ______ =

A

↑oxalate absorption

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24
Q

Calcium oxalate crystals

A

Dianion, binds with many metals to form insoluble

precipitates.

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25
Q

Also increase risk of Oxalate stones

A

Excessive amounts of Vitamin C (> 2000 mg/day)

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26
Q

Preventative Treatment for Calcium oxalate

A

Calcium citrate is recommended supplement

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27
Q

Calcium citrate work as an

A

Works as an oxalate binder, reducing oxalate absorption from the intestinal tract.

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28
Q

Calcium citrate decreases

A

Decreases risk of stone formation

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29
Q

Calcium should be administered with

A

meals, especially those that contain high-oxalate foods

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30
Q

Uric Acid Stones in blood

A

• Hyperuricemia

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31
Q

Uric acid is a by-product of

A

purine metabolism via xanthine oxidase pathway

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32
Q

Normal uric acid

A

• Normal: 2-7 mg/dl (blood); 600 mg/d (urine)

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33
Q

_____people with ↑ uric acid are

A

• 95%; asymptomatic

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34
Q

Uric acid deposit in joint

A

GOUT

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35
Q

In urine = uric acid crystals if pH

A

< 5.5 obstruct tubules and/or form uric acid stones

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36
Q

High _______diet especially -____Associated with gout

A

PURINE; Excess alcohol ingestion (especially Beer)

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37
Q

Increased risk factors for URIC ACID (CPD, BHCD)

A 
Chronic renal insufficiency
PKD
DM2 
Bartter’s Syndrome 
Hemolysis
Chemotherapy (Tumor Lysis Syndrome)
Dehydration
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38
Q

Medications risk for Uric acid (NACH)

A

HCTZ, ASA, Cyclosporine, Niacin

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39
Q

Uricostatic drugs Example

A

allopurinol

40
Q

What does uricostatic drugs do ?

A

– reduces uric acid production through competitive

inhibition of xanthine oxidase

41
Q

Uricosuric drugs Example

A

ex. probenecid

42
Q

What does Uricosuric drug do?

A

increases urinary uric acid excretion by blocking tubular

re-absorption of urate

43
Q

Struvite stones Form in

A

chronic upper urinary tract infection due to a urease-producing organism

44
Q

Struvite stones composition

A

Are composed of magnesium ammonium phosphate (struvite) & calcium carbonate.

45
Q

Normal urine is undersaturated with ammonium

phosphate – struvites occur when___

A

ammonium phosphate
ammonia production is increased & urine pH is elevated which decreases the solubility of phosphate causing stones to form.

46
Q

Cystine Stone is what kind of disorder?

A

Autosomal recessive disorder caused by a tubular

defect in amino acid transport

47
Q

Cystine Stone causes

A

Excessive excretion of cystine, ornithine, lysine and arginine

48
Q

Cystine is only soluble in

A

urine up to 24 - 48 mg/dl.

49
Q

In Cystine stone, In affected pts, excretion is about _______/day

A

480 - 3500 mg/day.

50
Q

Cystine stone formed in

A

4th decade

51
Q

2 types of Bladder calculi

A

Primary and Secondary

52
Q

Most common types of bladder calculi

A

Primary (most common) – Occurs from urinary stasis. Incomplete emptying results in concentration of solutes which crystalize

53
Q

Secondary bladder calculi when does it occur

A

Secondary – Result from migrated urinary calculi – Concretions on foreign material (ie. catheters)

54
Q

Causes of Primary stones (CUNB)

A

– Cystocoele
– Urethral obstruction
– Neurogenic bladder
– Bladder outlet obstruction

55
Q

Cystocoele, what occurs?

A

Pubocervical fascia torn by childbirth, allows bladder to herniate into the vagina.

56
Q

Tx of cystocoele

A

Tx: surgical correction if severe.

57
Q

Neurogenic Bladder is

A

Bladder dysfunction secondary to injury of central or

peripheral nerves controlling urination

58
Q

Neurogenic bladder can be the result of

A

Nerve injury caused by infection, trauma, CA or

vascular insult.

59
Q

Additional causes of neurogenic bladder can be

A

– MS
– Parkinson disease
– Spinal cord injury
– stroke complications

60
Q

On cystogram with neurogenic bladder you see

A

Cystogram with “pine cone” or “Christmas tree” bladder

61
Q

Tx of neurogenic bladder depends on

A

Etiology

62
Q

Bladder Outlet Obstruction caused by 3 (BCO)

A
  • BPH
  • CA – Prostate, Bladder, Cervical
  • Outflow tract obstructed
63
Q

Bladder Outlet obstruction Treatment:

A

Tx: Treat underlying condition

– Relive obstruction and Prevent UTI

64
Q

Urethral Obstruction :Most commonly affects

A

males

65
Q

Urethral Strictures caused by:

A

– Infection
– Inflammation
– Trauma
– Iagtrogenic

66
Q

Inflammation cause of urethral strictures

A

Balanitis Xerotica Obliterans

67
Q

Infectious cause of urethral stricutres

A

Gonococcal

68
Q

Traumatic cause of urethral strictures

A

Straddle injury or pelvic Fractures

69
Q

Iatrogenic cause of urethral strictures

A

Prolonged cath., or surgical procedures)

70
Q

Urethral Valves: what are they?

A

– Congenital obstructive lesion of proximal urethra.

–Obstruction during active nephrogenesis results in cystic renal dysplasia.

71
Q

Bladder diverticuli Treatment

A

surgical correction

72
Q

What is Urethral Diverticulum?

A

• Abnormal outpouching of urethral wall

73
Q

Urethral Diverticulum affects_____more than ____

A

Affects females more often than males

74
Q

Urethral Diverticulum occurs between ages of

A

40 – 70

75
Q

Urethral diverticulum caused by

A

Caused by trauma or repeated infections of periurethral ducts

76
Q

In urethral diverticulum ,Periurethral glands

A

secrete mucins which protect urethra from irritative, potentially toxic effects of urine

77
Q

Multiple Myeloma Uropathy is what kind of disease?

A

Cancer of plasma cells.

78
Q

Multiple Myeloma Uropathy produces

A

monoclonal immunoglobulin.

79
Q

Multiple Myeloma Uropathy Causes

A

renal insufficiency ,bone pain, hypercalcemia, anemia, and recurrent infections.

80
Q

In Multiple Myeloma uropathy overproduction of?

A

Overproduction of Ig light chains (Bence Jones proteins) filtered by glomeruli

81
Q

What happens to light chains in Multiple Myeloma?

A

Light chains saturate reabsorptive capacity of PCT
and **combine with filtered proteins & Tamm-Horsfall
mucoprotein to form obstructive casts

82
Q

Signs/Symptoms of Multiple Myeloma Uropathy

PPHR

A 
Signs/Symptoms:
Persistent unexplained bone pain, particularly at night or at rest
• Proteinuria
• Hypercalcemia
• Renal insufficiency
83
Q

Multiple Myeloma Uropathy occurence

A

Occurs > 40 yrs. of age; m:f 1.6:1

84
Q

Treatment of Multiple Myeloma Uropathy

A

– Dialysis

– Chemotherapy/radiation, poss. marrow transplant

85
Q

Other Congenital Obstructive Uropathy

– most common prenatally detected obstructive ds.

A
  • Ureteropelvic Junction Obstruction (UPJ)

* Ureterovesical Junction Obstruction (UVJ)

86
Q

What is Ureteropelvic Junction Obstruction (UPJ)

A

most common prenatally detected obstructive ds.

87
Q

What is Ureterovesical Junction Obstruction (UVJ)

A

– second most common prenatally detected obstructive ds.

88
Q

Ureteropelvic Junction Obstruction (UPJ)

• Two types

A

Intrinsic obstruction and Extrinsic obstruction:

89
Q

UPJ INTRISIC obstruction

A

stenosis secondary to scarring or presence of

ureteral valves

90
Q

UPJ EXTRINSIC obstruction

A

compression secondary to vessel or fibrous band passing anterior to pelvis & ureter

91
Q

TX of UPJ obstruction

A

Surgical correction

92
Q

Cystine stone Treatment

Water why?

A

• Water, water and more water

Maintain solubility.

93
Q

Cystine Stone and pH tx

A

• Increase urine pH > 7.5

– increases cystine solubility

94
Q

Cystine stone treatment Medication

A

D-penicillamine

– binds cystine and reduces urine supersaturation

95
Q

Tx of Hyperurecemia other than meds

A
  • Hydration
  • Diet modifications
  • Cessation of offending medication

SRNAAnatomy II (16 decks)

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