Renal Conditions

Question 1

Pyelonephritis clinical manifestations

Answer 1

CVA Tenderness
Dysuria
Hematuria
N/V
Anorexia
Fever
Chills

Question 2

Pyelonephritis Treatment

Answer 2

Trimethoprim/Sulfemethaxole (Bactrim)
Ciprofloxacin

Question 3

Pyelonephritis Risk Factors

Answer 3

Pregnancy
Recurrent lower UTIs
Antibiotic resistant strains

Question 4

Complications of Pyelonephritis

Answer 4

Urosepsis (sepsis d/t UTI)

More systemic response
High mortality rate
More likely in elderly

Question 5

Causes of Nephrolithiasis in the renal pelvis

Answer 5

Renal Calculi

Question 6

Causes of nephrolithiasis in the ureter

Answer 6

Renal Calculi
Pregnancy
tumors

Question 7

Causes of nephrolithiasis in the bladder/urethra

Answer 7

Bladder cancer
Neurogenic bladder
Prostate hyperplasia
Prostate cancer
Urethral strictures

Question 8

Complications of nephrolithiasis

Answer 8

Stasis of blood flow
Back-up pressure

Back-up pressure can lead to hydroureter, hydronephrosis, postrenal acute kidney injury

Question 9

What factors can enhance crystal formation in the kidneys?

Answer 9

1. PH changes d/t UTIs
2. Excessive concentration of insoluble salts in the urine d/t dehydration, bone disease, gout, renal disease
3. Urinary stasis - Immobility/sedentary lifestyle

Question 10

Risk factors for nephrolithiasis

Answer 10

Men
20-30s
White
Obesity
Family Hx
Congenital defects
Hot weather (dehydration)

Question 11

Prevalence and risk factors for Struvite kidney stones

Answer 11

15%
UTIs

Question 11

Prevalence and risk factors for calcium oxalate/phoshpate kidney stones

Answer 11

70-80%
Family Hx
Idiopathic
Increased calcemia
Increased oxaluria

Diet factors: Increased protein, Increased sodium, Increased oxalate

Question 12

Prevalence and risk factors for Uric acid kidney stones

Answer 12

7%
Gout

Question 13

Clinical manifestations of nephrolithiasis

Answer 13

Acute renal colic
Chills, fever (only if infection is present)
Dysuria
Hematuria
Foul smelling urine
Diaphoresis

Question 14

Pharmacologic treatment for different kidney stones

Answer 14

Calcium = Thiazide diruetics
Struvite = abx
Urate = Allopurinol

Question 15

Risk factors for renal cell carcinoma

Answer 15

Smoking
Obesity
Age
Male
Genetics

Question 16

When does diagnosis of renal cell carinoma usually happen

Answer 16

Once the cancer cells have metastized

Question 17

Renal cell carcinoma clinical manifestations

Answer 17

Early - NONE
Late -
1. CVA tenderness
2. Hematuria
3. Possible palpable abdominal mass

Question 18

Where does renal cell carcinoma usually metastize to

Answer 18

Bones or lungs

Question 19

How is renal cell carcinoma treated

Answer 19

Surgery to remove kidney

renal cell carcinoma is usually resistant to chemotherapy

Question 20

Risk factors for urethelial carcinoma

Answer 20

Smoking
Male
Occupations with exposure to toxins
Low fluid intake

Question 21

Clinical manifestation of urethelial carcinoma

Answer 21

Early - Hematuria
Late -
1. Frequency
2. Urgency
3. Dysuria

Question 22

Types of chemo treatments for urethelial Carcinoma

Answer 22

Stage 1 - Intravesical chemo
Advanced stages - Systemic chemo

Question 23

BCG vaccine

Indications, MOA, and adverse effects

Answer 23

Indications: 1st stage of urethelial carcinoma
MOA: Stimulates inflammatory response to the bladder
Adverse effects: Bladder irritation, systemic infection

Question 24

BCG Vaccine | Patient instructions

Answer 24

1. Empty bladder 2. Instill BCG vaccine into the bladder through I/O Catheter (Dwells for 2 hours) 3. Change positions q 15 minutes

Question 25

BCG vaccine | safety precautions

Answer 25

Live vaccine - Contraindicated in immunocompromised | HIV, AIDS, etc

Question 26

Type 2 vs Type 3 Sensitivity Reactions

Answer 26

Type 2: Reactions occur on the cell surface and result in cell death or malfunction Type 3: Immune complexes are deposited into tissues and the resulting inflammation destroys the tissue

Question 27

2 Types of injuries resulting in glomerulonephritis

Answer 27

1. Antibodies attach to antigens of the glomerular basement membrane ("Anti-GBM Antibodies) - 5% 2. Antibodies react with circulating antigens and are deposited as immune complexes in the GBM - 95%

Question 28

Clinical manifestations of acute glomerulonephritis

Answer 28

Hematuria Azotemia Retention of Na+ and water (decreased uOP leads to HTN and edema) Proteinuria | HARP

Question 29

Causes of acute glomerulonephritis

Answer 29

**Poststreptococcal infection** Berger disease Goodpasture syndrome Systemic lupus erythematosus (SLE) Vasculitis

Question 30

Pathogenesis of acute glomerulonephritis

Answer 30

1. Trigger 2. Immune complexes form 3. Complement activated 4. release of mediators 5. tissue injury 6. Hematuria, proteinuria, decreased GFR

Question 31

Prognosis for chronic glomerulonephritis

Answer 31

Slow progressive desruction of glomerulus leading to ESRD

Question 32

What is nephrotic syndrome?

Answer 32

The glomerulus is too permeable leading to plasma proteins leaking into the urine | Elimination of >3g of protein per day into the urine

Question 33

What diseases cause nephrotic syndrome

Answer 33

Glomerulonephritis Diabetes mellitus

Question 34

Pathogenesis of nephrotic syndrome

Answer 34

1. Increased glomerular permeability 2. Proteinuria 3. Hypoalbuminemia

Question 35

Clinical manifestations of nephrotic syndrome

Answer 35

1. Edema 2. HTN 3. Liver problems - * Hyperlipidemia * Hypercoagulation * Loss of antithrombin III and plasminogen (DVTs and PE)

Question 36

DM complications r/t nephrotic syndrome

Answer 36

Diabetic neuropathy * Major complication * Gross thickening of GBM * Ultimately leads to ESRD

Question 37

HTN complications r/t nephrotic syndrome

Answer 37

Hypertensive glomerular disease Decreased renal perfusion leads to scarring of glomerulus

Question 38

Clinical manifestations of glomerulopathy

Answer 38

FLuid retention increased BUN/Cr ratio Proteinuria Decreased albumin (blood protein)