renal and urologic systems

Question 1

S&S of polycystic kidney disease

Answer 1

cysts found in liver and spleen, gross hematuria, pain, infected cysts (ascending UTIs), hypertension, aneurysms (late)

Question 2

diagnosis and treatment of polycystic kidney disease

Answer 2

total kidney volume (TKV) to measure cyst expansion, manage hypertension and make lifestyle modifications (low sodium, no NSAIDS, hydrate, no smoking)

Question 3

S&S of hydronephrosis

Answer 3

UTI (microorganism overgrowth), pain, complete bilateral obstruction, partial obstruction (polyuria, nocturia), hypertension

Question 4

diagnosis and treatment of hydronephrosis

Answer 4

early diagnosis is key, use ultrasound, treatment is cause dependent

Question 5

S&S of renal calculi

Answer 5

pain; renal colic (acute/intermittent, flank pain upper right quadrant), noncolic (dull, deep, flank, back, mild-severe, exaggerated by drinking large amounts of fluids). pain and vomiting

Question 6

diagnosis and treatment of renal calculi

Answer 6

based on symptoms, run diagnostic tests such as urinalysis and nonspiral contrast CT, strain urine and test stone

Question 7

S&S of UTIs

Answer 7

frequent urinations, lower abdominal/back discomfort, burning and pain (dysuria), cloudy/foul smelling urine.

SPECIAL POPULATIONS: symptoms absent to typical UTI, change in mental status, anorexia, fatigue, weakness, classic signs (fever, chills, flank pain) may be absent!!

Question 8

what renal and urologic conditions are caused by disease or injury?

Question 9

describe manifestations of acute kidney injury

Answer 9

sharp decrease in urine output (early sign), elevation BUN related to serum creatinine levels

Question 10

prerenal AKI

Answer 10

hemorrhage reduces golmerular filtration rate which leads to tissue ischemia, impaired perfusion due to heart failure/cardiogenic shock, decreased vascular filling due to increased vascular capacity, vasoactive mediators/drugs/diagnostic agents stimulate intrarenal vasoconstriction

Question 11

intrarenal AKI

Answer 11

ischemia from prerenal AKI leads to intrarenal vasoconstriction, decreased hydrostatic pressure in glomeruli, toxic/ischemic insult to tubular structures of nephron, acute pyelonephritis, acute glomerulonephritis

Question 12

postrenal AKI

Answer 12

obstruction of urine outflow from kidneys, retrograde pressure in tubules/nephrons leads to damage, prostatic hyperplasia

both ureters must be obstructed to induce renal failure

Question 13

postrenal obstruction

Answer 13

ureter; stones and strictures
bladder; neurogenic bladder, cancer
urethra; prostatic hyperplasia

Question 14

describe the azotemia and fluid/acid base balance manifestations of chronic kidney disease

Answer 14

-BUN elevates with progression (normal is 20mg/dl)
-uremia leads to weakness/fatigue/nausea which leads to vomiting/lethargy/confusion, leading to coma
and death without dialysis/transplant
-dehydration or fluid overload leads to altered Na+/H20 balance and progressive inability to regulate Na+ excretion
-salt wasting
- hyperkalemia through increased excretion in remaining nephrons and GI
-impaired hydrogen ion secretion
-impaired Na+ and HCO3- reabsorption
-loss of ammonia production results in metabolic acidosis

Question 15

describe the skeletal manifestations of CKD

Answer 15

PO4- levels rise with impaired kidney excretion

PO4- rise and Ca++

Ca++ decreases, stimulating PTH and increasing bone resorption, compromising the bone structure over time

reduced calcitriol and active viamin D elevates PTH, less vitamin D means less Ca++ absorbed from GI

secondary hyperparathryroidism develops

Question 16

describe the blood and cardiac manifestations of CKD

Answer 16

-anemia
-epistaxis, menorrhagia, GI bleeding, subcutaneous bruising, platelet function impaired
-hypertension
-left ventricular hypertrophy
-congestive heart failure and pulmonary edema
-pericarditis (ckd stage 5)

Question 17

describe the GI and neuromuscular manifestations of CKD

Answer 17

• anorexia
• nausea, vomiting, early morning nausea
• ulcerations/bleeding GI mucosa
• PNS function impaired (peripheral neuropathy, sensory and motor function is impaired, restless leg syndrome at rest)
• CNS system function impaired (uremic encephalopathy, reduced alert/aware, loss of recent memory, can’t ID people/objects, reduced fine motor movements and asterixis)

Question 18

describe the skin and immune manifestations of CKD

Answer 18

• high levels or urea/metabolic wastes
• decreased granulocyte count
• impaired humoral/cell mediated immunity
• active inflammatory and delayed hypersensitivity responses impacted
• may not have fever
• pallor skin
• sallow, yellow brown skin
• dry skin
• subcutaneous bruising
• pruritis

Question 19

describe CKD treatment

Answer 19

• treat UTIs quickly
• avoid nephrotoxic medications
• treat OG cause
• manage BP
• no smoking
• manage blood sugar
• dialysis/transplantation if appropriate
• diet management (restrict protein, fluid and electrolyte balance, restrict K+ when needed, limit dietary phosphorus)

Question 20

describe the pathophysiological mechanisms of chronic kidney disease

Answer 20

GFR < 60mL/min/1.73m squared >or= 3 months

permanent loss of nephrons leads to the progressive decreased ability to filter, concentrate urine, and fulfill endocrine function

causes include diabetes, hypertension, glomerulonephritis, SLE, polycystic kidney disease

nephron changes to compensate, leading to structural and functional hypertrophy to meet the need

stage 1: 90% function
stage 2: 60-89% function
stage 3: 30-59% function
stage 4: 15-29% function
stage 5: <15% function, kidneys can no longer keep up with removing waste products and extra water