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Renal conditions Flashcards

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1
Q

what is pyelonephritis?

A

Upper UTI, kidney infection, inflammation of the kidneys

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2
Q

what is the etiology of pyelonephritis?

A

ascending infection or bloodstream infection

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3
Q

what are the 3 risk factors associated with pyelonephritis?

A
  1. recurrent lower UTI
  2. pregnancy
  3. abx resistant strains
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4
Q

the inflammatory response with pyelonephritis leads to what?

A

kidney tissue damage

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5
Q

what are the clinical manifestations associated with pyelonephritits?

A
  • sudden onset with fever, chills, and CVA tenderness
  • lower UTI symptoms
  • hematuria
  • N/V
    -anorexia
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6
Q

what are the 3 main treatments for pyelonephritis?

A

bactrim, nitrofurantoin, and ciprofloxacin

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7
Q

what class of medication is ciprofloxacin?

A

fluoroquinolone

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8
Q

What is the MOA of ciprofloxacin?

A

destroys bacteria by altering their DNA via DNA enzymes

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9
Q

What are the major indications of ciprofloxacin?

A

UTI, anthra

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10
Q

What is the major adverse effect of ciprofloxacin?

A

arthropathy

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11
Q

is arthropathy related to ciprofloxacin reversible or irreversible?

A

irreversible

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12
Q

does ciprofloxacin cross the BBB?

A

yes

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13
Q

what is the age range for patients that can take ciprofloxacin

A

18-60

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14
Q

does ciprofloxacin work on fast or slow growing organisms?

A

both

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15
Q

what class of medication is sulfamethoxazole + trimethoprim?

A

sulfonamide

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16
Q

what is the MOA of sulfamethoxazole + trimethoprim

A

Inhibits growth by preventing the synthesis of folic acid

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17
Q

What are the general indications of sulfamethoxazole + trimethoprim?

A

UTI, some respiratory infections, salmonella, and shigellosis

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18
Q

What is the primary side effect with sulfamethoxazole + trimethoprim?

A

Photosensitivity

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19
Q

what type of allergy would be contraindicated with sulfamethoxazole + trimethoprim?

A

sulfa allergies

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20
Q

urosepsis is more likely to occur in what group of people

A

elderly

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21
Q

what are the 3 locations in which you can have a urinary obstruction?

A

renal pelvis, ureter, bladder/pelvis

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22
Q

what is the common cause of obstruction at the renal pelvis level?

A

renal calculi (stones)

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23
Q

what are the common causes of obstruction at the ureter level?

A

renal calculi, pregnancy, tumors

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24
Q

what are the common causes of obstruction at the bladder / urethra level?

A

bladder cancer, neurogenic bladder, prostatic hyperplasia, prostate cancer, urethral strictures

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25
what are the 2 primary complications with urinary blockages?
urinary stasis (which can lead to infection) or back up pressure
26
what is it called when urine backs up and causes inflammation / swelling to the kidney?
hydronephrosis
27
what is it called when urine backs up and causes inflammation / swelling to the ureters?
hydroureter
28
with urinary obstructions what primarily determines the severity of the pain?
speed of onset
29
what is nephrolithiasis?
kidney stones / renal calculi, clumps of crystals in the urinary tract
30
what is the size range of kidney stones?
can be as small as a grain of sand or as large as a golf ball
31
what are the shapes of renal calculi?
can be smooth or jagged
32
What is the most common cause of renal obstruction?
kidney stones
33
what are 3 times that crystal formation is enhanced in regards to nephrolithiasis?
1. pH changes 2. excessive concentrations of insoluble salts in the urine 3. urinary stasis
34
are men or women more likely to develop kidney stones?
men
35
what is the highest risk age range for kidney stones?
20-30's
36
what is the ethnicity that is most at risk for kidney stones?
white
37
is there a risk of family history with kidney stones?
yes
38
what weather is more likely to precipitate kidney stones? why?
hot weather - because the urine becomes more concentrated d/t fluid loss
39
what are the risk factors specific to calcium oxalate and calcium phosphate kidney stones
family history, idiopathic, increased levels of calcemia and oxaluria
40
what are the risk factors specific to struvite kidney stones?
UTI
41
what is another term for struvite kidney stones?
staghorn kidney stones
42
what are the risk factors specific to uric acid kidney stones?
gout
43
what is the typical location of pain with kidney stones?
flank pain
44
does pain r/t kidney stones radiate - if so, where?
yes - it radiates to the back and groin area
45
is the pain associated with kidney stones constant or intermittent - explain:
intermittent - they present as colicky spasms that last 20-60 minutes d/t ureter spasms
46
what would cause a sharp pain associated with kidney stones?
when / if the kidney stone scratches / scrapes the ureter walls
47
what are the typical accompanying symptoms with kidney stones?
-hematuria -dysuria -N/V -chills, fever (if infection) -foul smelling urine -diaphoresis
48
what is the typical plan of action with acute pain associated with kidney stones?
Morphine, NSAIDS, IVF
49
what is a potential preventative medication for calcium phosphate or calcium oxalate kidney stones?
thiazide diuretics
50
what is a potential preventative medication for struvite kidney stones?
abx
51
what is a potential preventative medication for uric acid kidney stones?
allopurinol
52
what are the risk factors for kidney caner (also called renal cell carcinoma)?
-smoking -male -obesity -increasing age -family hx
53
what typically determines the prognosis of kidney cancer?
metastasis
54
what are the early manifestations of kidney cancer?
none - this is why it can go undiagnosed for so long
55
what are the late manifestations of kidney cancer?
-CVA tenderness -cola-colored urine (hematuria) -palpable abdominal mass
56
What are the typical metastasis for kidney cancer?
bone and lung
57
is kidney cancer usually receptive to chemotherapy?
no, usually need to look into surgical removal
58
where are the cancer cells for bladder cancer typically found?
in the lining of the bladder
59
what are the risk factors for bladder cancer?
-smoking -male -occupations with exposure to toxins (ie rubber factory or paint) -low fluid intake (d/t not flushing kidneys)
60
what are the early manifestations of bladder cancer?
hematuria - pink/reddish color
61
what the late clinical manifestations of bladder cancer?
frequency, dysuria, urgency
62
what is the typical treatment for stage 1 bladder cancer?
BCG vaccine as intravesical chemo
63
what is the typical treatment for advanced bladder cancer?
systemic chemo
64
define glomerulonephritis:
a variety of conditions that cause inflammation of the glomeruli
65
does glomerulonephritis affect both kidneys at the same time?
not always, can be focal or diffuse in the kidneys too
66
what are the 3 layers of the capillary membrane of the glomerulus?
endothelium basement membrane podocytes (these are special cells that begin the urine formation process)
67
where is the damage to the kidneys associated with glomerulonephritis?
glomerulus and tubules
68
what are the 2 types of reactions that lead to glomerulonephritis?
type II and type III reactions
69
what is the type II reaction that leads to glomerulonephritis?
anti-GBM antibodies attach to antigens in the basement membrane of the kidneys and cause tissue injury
70
it is common for patients that have a type II reaction (r/t glomerulonephritis) to have what symptom NOT related to the urinary system?
hemoptysis
71
what is the type III reaction that can lead to glomerulonephritis?
antibodies react with circulating antigens and are deposited as immune complexes in the glomerular basement membrane
72
which reaction is most common in glomerulonephritis?
type III
73
both types of reactions that can lead to glomerulonephritis have what 2 things in common?
1. accumulation of antigens, antibodies, and complements 2. complement activation of some kind leads to tissue injury
74
what are the clinical manifestations of acute glomerulonephritis?
-hematuria -azotemia -retention (more Na+ and water retained = edema = HTN) -proteinuria
75
What are the common triggers for acute glomerulonephritis?
post-infections, primary disease (Berger's disease), or multisystem diseases (ie: goodpasture syndrome, lupus)
76
what type of reaction occurs in Berger's disease r/t to acute glomerulonephritis? Explain.
Type III - build up of antibody IgA in the kidneys that cause inflammation
77
what is chronic glomerulonephritis?
long term inflammation of the glomerulus, increased scarring decreases filtration ability
78
what are the clinical manifestations of chronic glomerulonephritis?
the same as acute glomerulonephritis: Hematuria Azotemia Retention Proteinura
79
what is the normal prognosis of chronic glomerulonephritis?
slow, progressive destruction towards ESRD
80
what occurs with nephrotic syndrome?
the glomerulus is too permeable to plasma protein
81
on average, how much protein does someone with nephrotic syndrome excrete?
> 3 g per day
82
what is the etiology of nephrotic syndrome?
glomerulonephritis and DM
83
what are the clinical manifestations of nephrotic syndrome?
- edema - HTN - hyperlipidemia - hypercoagulation - loss of antithrombin III and plasminogen
84
how does diabetic nephropathy lead to ESRD?
gross thickening of GBM that decreases GFR
85
how much urine is considered oliguria (per day)?
< 400 ml
86

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