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Pathology Exam 2 > Renal and Urologic Pathology > Flashcards

Renal and Urologic Pathology Flashcards

1
Q

Where are the kidneys located?

A

posterior abdominal wall outside the peritoneal cavity

padded by fat mass for protection

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2
Q

Where are the kidneys located?

A

posterior abdominal wall outside the peritoneal cavity

surrounded by fat for protection

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3
Q

Which kidney is higher?

A

the left

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4
Q

What is the blood supply like to the kidney?

A

high vascularized by the renal artery

1000-1200 mL of blood/min

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5
Q

What are the two components of the kidney?

A

outer cortex and inner medulla

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6
Q

What is the major functions of the kidney?

A

it is the major filter of the body

  1. regulation of plasma sodium and potassium (RAAS)
  2. re-regulation of acid base balance
  3. Excretion of metabolic waste
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7
Q

What is a nephron?

A

this is the functional unit of the kidney

over 1.2 million in each kidney

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8
Q

What is the structure of a nephron?

A
  1. renal corpuscle- glomerlus and Bowman’s capsule
  2. proximal and distal convoluted loops
  3. Loop of Henle
  4. collecting duct
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9
Q

What is a GFR?

A

Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute.

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10
Q

What is kidneys function in regards to water and electrolyte balance?

A

urine formation

blood filtered through glomerlus

waste water and electrolytes are filtered out

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11
Q

What is reabsorb and secreted in proximal tube?

A

R: NaCl, glucose, K+, amino acids, HCO3-, protein, urea and water

S: H+, foreign substances and organic ions

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12
Q

What is reabsorb and secreted in Loop of Henle?

A

concentration of urine

R: water and Na+

S: urea (metabolic waste)

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13
Q

What is reabsorb and secreted in distal tube?

A

R: NaCl, water, HCO3-

S: K+, urea, H+, NH3+, drugs

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14
Q

What are functions of kidneys in regards to endocrine system?

A

gluconeogenesis and secretion of hormones

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15
Q

What is gluconeogenesis?

A

synthesis of glucose from amino acids during time of prolonged fasting

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16
Q

What hormones do the kidneys secrete?

A
  1. erythropoietin (EPO)- stimulates BM to make RBC, increases when oxygen or RBC are low (potential anemia)
  2. Vitamin D metabolism
  3. BP regulation - RAAS
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17
Q

What is the main function of RAAS?

A

regulation of BP through regulation of plasma water and sodium levels

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18
Q

Why does the kidney begin to release renin?

A

a nephron can sense:

  1. low plasma volume
  2. low NaCl concentration
  3. sympathetic stimulation (neroepinepherine)
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19
Q

What does the liver release during RAAS?

A

angiotensin which combines with Renin to make angiotensin 1

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20
Q

What is ACE?

A

angiotensin converting enzyme, coverts A1 to A2

also gets rid of bradykinin which is vasodilator

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21
Q

What are the major functions of A2?

A
  1. vasoconstrictor- increase SBP and DBP
  2. reabsorption Na+ and Cl-, excretion of K+- retain fluid and increase intravascular volume
  3. stimulates aldosterone from adrenal glands- retention of Na+ and H20
  4. stimulates ADH from post. pit. gland- increases body to drink and reabsorb H20 from distal loop
  5. increases sympathetic system- increases renin excretion
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22
Q

How is BP raised by A2?

A

more blood returns to heart via venous system, therefore more blood in LV

increased stroke volume leads to higher cardiac output

SBP= CO X SVR

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23
Q

Why are kidneys important to acid base balance in body?

A

kidneys are primary controller of pH levels in body

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24
Q

How does the kidneys buffer acid base balance?

A

during regular cell metabolism high levels of acid are generated in the plasma

kidneys buffer this acid with HCO3 (bicarbonate)

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25
Q

What is normal pH level?

A

7.35-7.45

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26
Q

What is acidosis pH?

A

under 7.35

HCO3 reabsorbed into blood and H+ excreted

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27
Q

What is alkalosis pH?

A

over 7.45

opposite of acidosis

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28
Q

What also affects acid base balance levels in blood?

A

increase or decrease of PaCO2, happens instantly

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29
Q

What happens to respiration if low PAco2 concentrations?

A

decreased minute ventilation to bring down pH levels

blow off less CO2

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30
Q

What happens to respiration if high PAco2 concentrations?

A

increased minute ventilation to bring down pH levels

blow off more CO2 (acidic) to raise pH

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31
Q

What is urea?

A

waste from amino acid metabolism

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32
Q

What is creatinine?

A

waste from muscle metab

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33
Q

What is uric acid?

A

waste or nucleic acid

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34
Q

What is bilirubin?

A

waste from RBC metabolism

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35
Q

What other wastes do kidneys excrete?

A

metabolites of hormones and drugs/chemicals

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36
Q

What are basic measurements of renal function?

A

electrolytes, BUN, creatinine, urinalysis, scans of renal arteriogram (blood flow to kidney), ultrasound, MRI, biopsy

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37
Q

What is an electrolyte crow’s foot or a Chem 7?

A

left side- Na and K (RAAS)

middle- Cl and HCO3

right- BUN and Cr (kidney)

far right- Blood sugar (pancreas)

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38
Q

What is a BUN?

A

blood urea nitrogen

end products of protein and amino acid metabolism

problem if you can’t filter these out fast enough

normal 8-25

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39
Q

What is creatinine?

A

end product of muscle metabolism

normal 0.6-1.5

could also be sign of massive skeletal muscle damage

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40
Q

What are normal sodium levels?

A

135-145

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41
Q

What are normal potassium levels?

A

3.5-5

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42
Q

What are normal chloride levels?

A

100-106

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43
Q

What are normal bicarbonate levels?

A

19-26

44
Q

What is a normal blood sugar level?

A

70-120 not fasted, random

45
Q

What is a BUN/ Cr ratio

A

measures where dysfunction is coming from

normal or postrenal- 10:1-20:1
over 20:1 prerenal dysfnx
under 10:1 intrarenal dysfnx

46
Q

What is creatinine clearance?

A

24 urine test to measure GFR

usually only performed if Cr and/or BUN is elevated

normal 5-30 ml/min

47
Q

What is a urinalysis?

A

collection and analysis of urine to examine kidneys, GI system and other systemic disorders

48
Q

What components of urinalysis are examined?

A
  1. urine color, clarity and odor
  2. pH- (4.5-8.0)
  3. gravity or osmolarity
  4. presence of abnormal substances
49
Q

What are some unusual substances in urine?

A

glycosuria- glucose in urine (DM)

proteinuria- protein in urine (dehydration, renal failure)

hematuria- blood (urinary tract bleeding, kidney dz)

bacteriuria- bacteria, will be cloudy (UTI)

ketonuria- ketones in blood (DM, n/v, starvation )

50
Q

What is glomerulonephritis?

A

inflammation of glomerulus in the nephron

can be caused by: drugs/toxins, vascular disorders, system disorders (DM, SLE), viruses ( HIV)

51
Q

What is IgA nephropathy?

A

most common form of glom-nephritis

20-50% progress to renal failure after 2025 yrs of onset

it is an immune system regulation abnormality

IgA lodged in kidneys causing inflammation that affects kidney function

52
Q

What are clinical manifestations of IgA nephro?

A

hematuria- 1-2 days post UTI or GI viral infection

proteinuria

53
Q

Medical management of IgA nephro?

A

ACE inhibitor, glucocorticoids, cytoxic agents

54
Q

What is post-infective glomerulonephritis?

A

acute inflammation of the glomerulus that occurs after an infection, clogs filter

ex: hepatitis B and C, HIV, bacteria or fungus

55
Q

Clinical manifestations of post infective glom?

A

acute onset of fluid retention and HTN

hematuria, mild. mod proteinuria, anemia

dark urine with RBC cast- cardinal sign

56
Q

Medical management of post infective glom?

A

antibiotics, fluid and electrolyte support, hemodialysis

57
Q

What is rapidly progressing glomneph?

A

glomerular inflammation that progresses rapidly into renal failure within a few days to weeks

usually in adults 50-60

can be idiopathic, related to autoimmune abnormalities or infection related

58
Q

What are clinical manifestations of RPGN?

A

rapid decline in renal function, Anuria (no production of urine)

59
Q

What is medical management of RPGN?

A

anti-inflammatories, plasmapharesis, HD, renal tx

60
Q

What is chronic glomneph?

A

a group of etiologies leads to progressive renal failure, results in scarring of glomerulus

CM- similiar to previuous diseases

MM- treat primary disease, NSAIDS, HD

61
Q

What is nephrotic syndrome (NS)?

A

increased permeability of glomerulus, results in excessive excretion of protein (especially albumin) lose it in blood and goes into 3rd space (swelling)

can be caused by- DM, SLE, infection, allergy/drug reactions, renal transplant, pregnancy

62
Q

What are clinical manifestations of NS?

A

proteinuria/hypoalbuminemia
lipiduria
vitamin D deficiency

MM- NSAIDS, albumin/protein replacement, treat underlying disease

63
Q

What is nephrolithiasis?

A

renal stones (calculi) that form in the renal pelvis, can present to clinic with LBP

caused by: high urinary content of stone producing substances, increased crystal growth, metabolic abnormalities, UTI, medications

64
Q

What are clinical manifestations of kidney stones?

A

pain in flank or groin, hematuria, n/v, fever

MM- analgesics, stone extraction, hydration

65
Q

What is pyelonephritis?

A

acute or chronic inflammatory response in the kidney

acute- usually associated with infection of renal pelvis or right before ureter

chronic- usually autoimmune dysfunction

both may lead to kidney failure

CM- flank pain and decreased urine output (renal insufficiency)

MM- antibiotics

66
Q

What is acute renal failure?

A

rapid deterioration of the kidney leading to decreased urine output (oliguria) and inability to main fluid/ electrolyte imbalance

high mortality rate

increased BUN and Cr

67
Q

What are three etiologies of ARF?

A

pre-renal 50%

Renal- 45%

post- renal 5%

68
Q

What are causes of pre-renal ARF?

A

impaired renal blood flow caused by:

dehydration (most common), shock, trauma/hemmorhage, renal artery stenosis (HTN), heart failure, CRF with sudden stressor

69
Q

What is intra-renal ARF caused by?

A

caused by damage of tissue and structures of kidneys

70
Q

What is Acute tubular necrosis?

A

most common form of intra-renal ARF

severe inflammatory response of renal cortex and outer medulla

caused by: surgery, burns, OB complications

likely to also have hypovolemic or hypoxic event

71
Q

What are other causes of intra-renal ARF?

A

nephritic syndromes: proteinuria and hematuria

nephrotic syndrome: proteinuria

72
Q

What causes post-renal ARF?

A

something is obstructing outflow from below kidney and affects both sides (rare)

could be from: kidney stone, prostatic hypertrophy, obstructed foley catheter, bladder cancer

73
Q

What are clinical manifestations of ARF?

A

hemodynamic instability- hypovolemia, HTN

acid base disorder- acidosis leads to respiratory compensation which leads to SOB

anemia- not enough EPO, peripheral edema, electrolyte imbalance

74
Q

What is medical management of ARF?

A

treat underlying cause,

gently maintain electrolyte/ fluid imbalance

manage BP

75
Q

What are the PT implications for ARF?

A

monitor vitals closely as they could have wide range of BP and RR

avoid bed rest and prevent secondary complications

edema management

76
Q

What is chronic renal failure?

A

a lot more common than ARF and it is an irreversible loss of nephrons that affects nearly all other systems

10 million americans

77
Q

What is the first stage of CRF?

A

reduced renal reserve

no sx as other nephrons can compensate for damaged ones

may see increased BUN but GFR decreased by 50%

78
Q

What is second stage of CRF?

A

Renal insufficiency

GFR- 20-35%

symptoms manifest: mild anemia, increased nitrogen waste in blood, increased BUN and Cr, HTN

79
Q

What is third stage of CRF?

A

renal failure, GFR 10-20%, starting to affect other organs

SX: acidosis, electrolyte imbalance, impaired urine output,

80
Q

What is final stage of CRF?

A

End Stage Renal disease

GFR 5-10%

everything is worsened

81
Q

What percentage of kidneys need to be working for proper function?

A

20% of one kidney

82
Q

What is etiology of CRF?

A

primary renal diseases- glomneph, pyeloneph, urinary tract obstruction

systemic diseases- DM, HTN

83
Q

What are clinical manifestations of CRF?

A
  1. Cardiovascular- fatigue (anemia), dyspnea, HTN, metabolic acidosis
  2. Neurologic- decreased alertness, memory loss, tremors
  3. MS- muscle weakness, osteoporosis
  4. integumentary- pallor, bruising, edema
84
Q

What is medical management of CRF?

A

slow the progression, electrolyte replacement, EPO for anemia, renal replacement

85
Q

What is dialysis?

A

renal replacement therapy, essentially an artificial nephron to manage fluid and electrolyte imbalance

86
Q

What is intermittent hemodialysis?

A

through the wrist, blood taken out of body into dializer which acts a kidney

usually done 3-4 days/ wk for 3-4 hours

87
Q

What are PT implications for IHD?

A

due to huge fluid shifts pts may feel exhausted before and after HD

don’t take BP in extremity with fistula in it

may be prone to OTN

monitor access site on skin

88
Q

What is CRRT?

A

same principal as IHD but this is 24/7 and for critically ill pts and cannot tolerate fluid shifts

PT: if in femoral artery no seated activities

89
Q

What is peritoneal dialysis?

A

use of peritoneal cavity as membrane to exchange fluids, bag starts high then goes low

can take 45 min to 9 hours

PT: diaphragm can be affected to due swelling of fluids can lead to SOB

can ambulate during just be careful

90
Q

Statistics about renal transplants?

A

most common organ transplanted- can last up to 72 hours post mortem

50 k on waiting list only 16 k per year

10k from cadaver, 6 k from living

91
Q

Contraindications for transplant?

A

cancer, Aids, vascular disease, liver dysfnx, chronic infection, obesity, substance abuse

92
Q

What is 10 year survival rate between cadaver and living ?

A
  1. 1%- cadaver, increased risk of ATN

76. 6%- living

93
Q

What happens to patient post transplant?

A

urine production should be immediate

BUN/Cr return to normal slowly

dialysis usually discontinued, closely watched for infection at surgery site

94
Q

What happens if organ is rejected?

A

increase of BUN and Cr

sudden increase of weight or edema (24 hours)

biopsy done to confirm

95
Q

What are PT implications post transplant

A

prevent infection

watch BP closely, to maintain good kidney SBP needs to be greater than 110

edema management

96
Q

What is upper tract urinary dysfunction?

A

involves kidney or ureter (pyelonephritis)

obstruction caused by: kidney stone or ureter stenosis

infection: UTI (more serious in upper)

97
Q

What is lower tract urinary dysfunction?

A

bladder or urethra (cystitis or urethritis)

obstruction caused by: kidney stone, prostatic hypertrophy, urethral stenosis

infection: UTI (more common than upper)

98
Q

Clinical manifestations of upper tract?

A

increased urination, pain, fever, N/V

diagnosis: high WBC, bacteruria, hematuria, pyuria

MM: antibiotics, hydration, avoid retrograde flow of urine

99
Q

Clinical manifestations of lower tract?

A

increased urination frequency, pain not till later on

diagnosis: bacteruria, pyuria

MM: same as upper

100
Q

What is a neurogenic bladder?

A

uncontrolled or premature contraction of detrusor muscle associated with neurologic disorder, loss of voluntary control of voiding

caused by: CVA, MS, Spinal cord injury, parkinson’s

101
Q

What are clinical manifestations of neurogenic bladder?

A

loss of feeling of full bladder, urine retention, UTI is common

MM: medications and catheters

102
Q

What is urinary incontinence?

A

unintentional leakage or full flow of urine

12$ billion in HC cost

24% of females at age 50 and 39% at age 80

5% of men at age 50 and 34% at age 80

can lead to depression, decreased quality of life, social isolation, sleep disturbences

103
Q

What is stress urinary incontinence?

A

leakage of urine with cough, sneeze, laugh or exertion

common in: obesity, post partum, pudendal nerve damage, overstretched pelvic floor muscles(usually when over 60)

104
Q

What is urge incontinence?

A

involuntary leakage of urine preceded by a strong urge to void that is not able to be ignored

unknown cause: maybe overactive bladder, high caffine intake and pelvic floor muscle dysfunction

105
Q

What are other forms of incontinence?

A

mixed- combination of both SUI and urge

functional- inability to get to bathroom in time to void( gait, transfers, strength)

Overflow- leakage from overfull bladder

106
Q

What is main PT way to help this problem?

A

ALWAYS ASK!

Pathology Exam 2 (4 decks)

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