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kol- Med Surg 320 Spring > Pyelonephritis, Glomerulonephritis > Flashcards

Pyelonephritis, Glomerulonephritis Flashcards

1
Q

4 types of UTI

A

acute
chronic
complicated
uncomplicated

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2
Q

type of UTI that is more than 2 infections in 6 months or 3 in a year

A

chronic

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3
Q

type of UTI that is Invasion of urinary tract by an infectious organism

A

acute

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4
Q

examples of complicated UTI’s

A

‣ Vesicoureteral reflux
‣ infection with multi-drug resistant organism
‣ Pregnancy
‣ CKD

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5
Q

uncomplicated vs complicated UTI

A

uncomplicated- type of uti Not associated with any anatomic or functional abnormality that complicates treatment

complicated type of uti that is associated with any anatomic or functional abnormality that complicates treatment

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6
Q

Bacterial Infection in the kidney and renal pelvis =

A

Pyelonephritis

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7
Q

acute vs chronic Pyelonephritis

A
  • Acute = active infection/ presence of bacteria

* Chronic = Repeated or continued infections (>2 infections in 6 month or >3 in 1 year)

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8
Q

chronic Pyelonephritis is often related to

A

‣ Urinary tract defect
‣ Obstruction
‣ Reflux

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9
Q

which patient population is more likely to have chronic pyelonephritis?

A

females

- males become more susceptible after the age of 65

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10
Q

Acute Pyelonephritis Infection almost always comes from…..

A

lower tract (Ascending)

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11
Q

patho of acute pyelonephritis

A

• Inflammation occurs –>Tubular cell necrosis (Abscesses may occur) –> Fibrosis and scar tissue may form

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12
Q

most common cause of chronic pyelonephritis?

A

reflux

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13
Q

patho of Chronic Pyelonephritis

A
  • Inflammation occurs
  • Repeated insults leads to more scar tissue
  • This changes vessel, glomerular and tubular structure
  • Leads to impairment of filtration, reabsorption and secretion
  • OVERALL KIDNEY FUNCTION IS IMPAIRED
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14
Q

causes of pyelonephritis?

A
  • *Bedrest and immobility (urinary stasis)
  • Structural deformities
  • Obstruction (stones, cancer, scarring)
  • Reflux (scarring, anatomic anomalies, tumor, prostate, stones, reduced bladder tone)
  • *Urinary catheter
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15
Q

which bacteria is most common cause of pyelonephritis?

A

E Coli

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16
Q

assessment for pyelonephritis?

A
  • History
  • Urinary catheter?
  • Fevers
  • Urinary problems
  • Abdominal discomfort
  • Flank pain assessment
  • Anxiety
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17
Q

diagnostics for Pyelonephritis

A
  • Urinalysis
  • Urine Culture (Clean Catch)
  • “Urinalysis, Culture if Indicated”
  • Blood Cultures
  • C-reactive protein
  • ESR
  • Xray (KUB)
  • CT
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18
Q

how do we get clean catch urine sample with foley that is already inserted? max time foley can be for collecting a sample?

A

-foley has to be less <72 hours, max time for collecting sample from indwelling Cath.

–>If >72 hours take it out, wait 1 hour and put a new one back in

19
Q

interventions for pyelonephritis?

A

• Antibiotics- Broad Spectrum vs Specific antibiotics
◦ Clean catch urine culture before start abx
• Nutrition therapy
◦ Fluid intake @ 2L/day
-Surgery

20
Q

surgery for pyelonephritis

A
  • Used to correct structural problems (causing obstruction or reflux)
  • Remove source of infection
  • IV antibiotics
  • Pyelolithotomy
  • Nephrectomy
  • Ureteroplasty
  • Ureteral Implantation
  • Ureteral diversion
21
Q

community based care for pyelonephritis?

A
  • Assess level of need
  • Assistance with adherence to antibiotics
  • Assistance with wound/incision care
  • Transportation
  • Nutrition and hydration
  • Assistance with ADL’s
22
Q

what is Glomerulonephritis? what can it lead to?

A

• Injury of the glomeruli (functional filters of the kidney) –> Proteinuria, Hematuria, Decreased GFR, Edema, Hypertension

◦ Immunologic changes injure the glomeruli
‣ Immune complexes form in the glomeruli (Antigen and antibody)

23
Q

types of Glomerulonephritis

A

Acute or Chronic, Primary or Systemic (ex:systemic lupus causes)

24
Q

patho of glomerulonephritis

A

◦ Immunologic changes injure the glomeruli
‣ Immune complexes form in the glomeruli (Antigen and antibody)
• Antigens
◦ Bacteria
◦ Viruses
◦ Toxins…

  • These complexes trigger inflammatory mediators
  • Overwhelms the glomeruli –> Injury
25
Q

most common cause of acute glomerulonephritis

A

infection- Step A! –> leads to cute post-streptococcal glomerulonephritis

26
Q

is Acute post-streptococcal glomerulonephritis a death sentence?

A

• Most people recover quickly and completely
◦ 1% of children do not recover
◦ 10% of adults do not recover

27
Q

Assessment for Acute Glomerulonephritis

A
  • History- did you recently have an infection (strep a)
  • *Edema- due to fluid overload
  • *Blood pressure
  • Fluid overload/ Sodium retention
  • Changes in urine, voiding patterns
  • Weight
  • Nausea, vomiting
  • Fatigue
28
Q

Diagnostics for Acute Glomerulonephritis

A
  • Urinalysis
  • Decreased GFR (50ml/hr)
  • Total protein assay
  • Serum albumin
  • Kidney biopsy
29
Q

Interventions for Acute Glomerulonephritis

A
  • Antibiotic therapy
  • Immune suppression
  • Fluid intake limited to 24-hr output of previous day+ 500-600 mL
  • Possible K+ and protein restrictions (oliguria)
  • Anti-hypertensives
  • Dialysis
  • Coordinate care
  • Patient Education
30
Q

how do we determine fluid restrictions for acute Glom. Nephritis?

A

• Fluid intake limited to 24-hr output of previous day+ 500-600 mL

31
Q

causes of Rapidly Progressive Glomerulonephritis

A
  • May be infection or systemic disease
  • 1% of children with AGN
  • 10% of adults with AGN
32
Q

onset of Rapidly Progressive Glomerulonephritis

A

• Develops over several weeks- months

33
Q

another name for Rapidly Progressive Glomerulonephritis

A

• Crescentic glomerulonephritis

34
Q

Rapidly Progressive Glomerulonephritis often progresses to

A

end stage renal failure

35
Q

how long does it take for chronic Glom. Nephritis to develop?

A

20-30 years

36
Q

s/s of

Chronic Glomerulonephritis

A

• Mild proteinuria, hematuria, hypertension, fatigue, edema

37
Q

patho of Chronic Glomerulonephritis

A
  • Changes in kidneys from hypertension, inflammation, infection or hypo-perfusion
  • Kidney tissue atrophies
  • Loss of functional nephrons -> reduced glomerular filtration
38
Q

chronic glom. nephritis will always lead to

A

end stage renal disease

39
Q

assessment for chronic glom. nephritis

A 
Similar to Acute:
• Fluid Overload
• Low Urinary output
• Uremia
	◦ Confusion
	◦ Itching
	◦ Fatigue
	◦ Weight loss
        -Abnormal Taste
40
Q

diagnostics for chronic glom. nephritis

A 
• Urinalysis
• GFR
• Creatinine
• BUN 
• Electrolytes (BMP)
	◦ Na
	◦ K+
• Blood gas- metabolic acidosis typically for renal failure 
• X-ray
41
Q

interventions for chronic glom. nephritis?

A
  • Slow down the progression of renal failure
  • Prevent complications
  • Diet changes
  • Sufficient fluid intake
  • Medications
  • Dialysis
42
Q

normal urine specific gravity

A

1.003 - 1.030 (higher number means higher concentration)

43
Q

normal urine pH

A

4.6- 8.0

kol- Med Surg 320 Spring (43 decks)

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