Renal system

Question 1

what are the main things to assess renal function?

Answer 1

Urine smaple: colour, clarity, smell, casts, ph level
blood test: BUN, Creatine,

Question 2

what is an upper UTI infection?

Answer 2

pyelonephritis, infection of the kidneys

Question 3

what is a lower urinary tract infection?

Answer 3

urethreitis: infection of the urethra.
Cystitis: infection of the bladder.

Question 4

inflammatory disorders of the Urinary tract….

Answer 4

Glomerulonephritis: inflammation of the glomerulus in the kidneys
Nephrotic syndrome: increased permeability of the glomerulus usually secondary to diabetes.

Question 5

pathogenesis for a UTI

Answer 5

1) colonization: bacteria colonize at the periurethra, which allows for bacterial acension up the urethra
2) Uroepithelium penetration:
bacterial fimbrae allow for the attachemet & penetration of the bladder ny way of epithelial cells
3) acencsion: bacterial colonize and ascend through ureters.
4) pyelonephritits: renal parenchyma infected
5) AKI: continued inflammatory response—>interstitial edema

Question 6

Risk factors for UTIS

Answer 6

women(close proximity of vagina to anus), elderly, incontinent people, ppl w/ catheres, pregnant women, diabetics, immunocompromised, infants.

Question 7

clinical manifestations of a UTI…

Answer 7

pain when peeing, dysuria (difficult), +urgency, +frequency, nocturia, pee w/ odor and cloudy, pyuria, hematuria, +WBC

Question 8

process of UTI infection:

Answer 8

starts at the urethra then ascends to the bladder—>ureters—>kidneys
*if peeing well the infection usally does not spread
- physical barriers as well has chemical barriers (ph-) segregate infection from spreading.

Question 9

patho of pyelonephritits

Answer 9

similar manifestation to UTI, starts unilaterally–>bilateral, the pelvis & calaxes in the kidneys fill with purulent exudate which + the pressure on the ureters obstructing the flow of urine—>AKF

Question 10

Manifestation of pylonephritis:

Answer 10

• flank pain radiating to the groin, tutbular cells casts in urine, both chronic and acute infections can create scar tissue in cortex, impairs kidney functions

Question 11

inflammation:glomerunephritis etiology & Patho:

Answer 11

secondary to streptococcal infection (APSGN)
patho: type 3 hypersensitivity response that creates antibodies against bacterial antigens which enter the blood and eventually the kidneys.

Question 12

APSGN process

Answer 12

1) injury phase: AgAB complex draws tot he complex, which damages the membrane and promotes inflammation
2) proliferative phase: WBC infiltrate, pores get larger allowing bc and proteins to filtrate in urine due to damaged endothelium/BC
3) regenerative phase:
overgrowth of the podocytes impair filtration—>AKf

Question 13

Patho od APGSN

Answer 13

-strep causes the antibodies to form—> antigen antibodies deposit in the glomerus (inflammation, increased cap permeability), cell proliferation continues to +permeability–>hematuria.Glomerulus swelling –>-GFR, stimulating RAAS to +BP &edema—> AKI/chronic glomerulonephritis

Question 14

manifestation of glomerulonephritis:

Answer 14

• dark coffee ground urine, +Bp, flank pain, -Urine output, metabolic acidosis, ++edema, decreased urine function
  tx: glucocorticoids, antihtn, antibiotics

Question 15

nephrotic syndrome etiology

Answer 15

caused by; membraneous neuropathy, diabetes, amylodosis etc
- inflammation + permeability of glomerulus

Question 16

patho of nephrotic syndrome/ manifestation

Answer 16

increased permeability fo the glomerulus allows for plasma proteins to filtrate in the urine–>hypoalbuminemia–> edema/hypercortisolemia
- casts in urine, edema, weight gain, pallor, acities, pleural effusion, ++risk of infection
tx: glucocorticoids, ACE inhibitors, antihtn, antilipidemias

Question 17

what is the main cause of kidney obstructions?

Answer 17

75% from Calcium Oxalate stones 25% uric stones, insufficient water consumption. Starts as Nidus–> larger stones

Question 18

symptoms of Renal calculi (kidneys stones)?

Answer 18

asymptomcatic until the stones are large enough to impact, tachycardiac, flank+groin pain, N/V, pallor, pain when the ureters contracting around stones, unilateral primarily–>bilateral, no position of comfort

Question 19

medical term for kidney stones?

Answer 19

renal calculi, nephrolithiasis, or urolithasis) hard deposits of minerals and salts from within kidneys. main cause for Kindney OB

Question 20

Hydronephrosis patho:

Answer 20

usually secodnary cause of kidney obstruction, pee will build up in ureters and back up into the kidneys, compressing BF to the nephrons–>-GFR/necrosis of nephrons, -urine output, +bp, flank pain,

Question 21

nephrosclerosis

Answer 21

like atherosclerosis, artioles leading to the nephron narrow–>-GFR—>renal failures, +bp, -urine output, -GFR, +RAASm kidneys harden
tx: anithtn

Question 22

polycystic kidneys

Answer 22

genetic autosomal, onset age 40, cysts develop and take up space in the kidneys–>destroys nephrons by compressing vessels, symptoms are like chronic renal failure. Pt will need a kidney transplant

Question 23

renal carcinoma

Answer 23

tumour of the tubular epithelium. More common in men, smokers, ppl w/ family Hx. painless hematuria, weight loss palpable mass, anemia
- pareneoplastic syndrome: PTH/ACTH affected, not often discovered until it has metastasized

Question 24

what does ADUKPI stand for

Answer 24

causes for flank/kidney pain
A-aorta
duodenum
U-ureters
k-Kidneys
P-pancreas
I-Inferiori vena cava

Question 25

what is a normal volume of urine filtrate?

Answer 25

1.0-1.5ml/kg/hr

Question 26

Failures: AKI

Answer 26

acute renal infection/failure, has some common causes…
- toxicity: NSAID OD, ketolac etc
-Trauma to kidneys
- Reduced vol: sepsis
-obstructions

Question 27

what are the 3 ways kidneys can fail?…

Answer 27

• pre-renal: down stream problems that occur in the body before the renal system
• intra-renal: problems that occur within the renal system
• post-renal: occurs after the kidneys like an obstruction of ureters

Question 28

What is uremic frost?

Answer 28

Azotemia (build up of nitrogen in blood) that causes urea to seep out of pores and deposit on the skin surface

Question 29

Hoe does kidney failure work?

Answer 29

insult to kidneys: prodromial phase, output issues +markers in urine
oligouric phase: +uric acid, -ph, +K, -Na+, edema, HTN
Post oliguric: w/ proper care a full recovery, w/o—> longterm dialyss, dialysis, diuretics, antibodies for sepsis

Question 30

what is chronic renal failure?

Answer 30

due to a waste removal issue–>declined kidney function cuaes a loss of nephrons (Diabetes/HTN,conterm med use, cancer etc),

Question 31

at are the stages of nephron loss?

Answer 31

60% of nephrons lost: slight decrease in kidney function
75% of nephrons: -GFR, +hematuria, renal insufficiency
90% of nephrons: end stage renal disease, dialysis pt, new kidneys

Question 32

what are the different types of dialysis?

Answer 32

hemodialysis: occurs at a clinic 3-4x a weeks, cleansing of blood with a machine that recycles it.
Peritoneal dialysis: uses the peritoneal lining to filter via a tube through the belly button and an exogenous bag of isotonic solution. can be continuous, done over night through a machine or intermittent, done 2-3 times a day by injecting isotonic fluid in tube and drain back through the tube.