Renal - UTI, Pyelonephritis, GN, Calculi, Incontinence, Failure Flashcards Preview

Kydd - Pathophysiology 2 > Renal - UTI, Pyelonephritis, GN, Calculi, Incontinence, Failure > Flashcards

Flashcards in Renal - UTI, Pyelonephritis, GN, Calculi, Incontinence, Failure Deck (169):
1

What is a lower UTI?

A urinary tract infection.

2

What are the two most common infections in the body?

Upper respiratory infections and then UTI's.

3

What causes UTIs?

A varitey of bacteria, usually E. Coli

4

How would you describe the path of infection of a UTI?

Ascending infection.

5

Urine is ____ unless there is an infection?

Sterile

6

Why are UTI's so common in women?

Women have a lot of normal flora in the vagina. When flora migrate into the urethra it causes an infection.

7

How is the inside of the bladder protected from direct contact or urine?

The mucin layer, which is a glycoprotein secretion lining the inside of the bladder which prevents direct contact of urine and epithial tissue.

8

What are the body's defences against UTIs?

Local immune response, Mucin layer, Washout, Prostatic fluid (men), Periuretheral flora (women).

9

What is washout, and how does it protect from UTIs?

Washout is daily urine output. Typically, urine stream should be forceful enough in an healthy individual to "washout" bacteria and flora that should not be there.

10

What are some risks that increase the likelyhood of developing a UTI?

Catheterization, Obstruction

11

What trick do bacteria have at their disposal to ensure proliferation on a catheterized individual?

Bacteria are able to secret a biofilm which ensure they can attach themselves to the catheter.

12

What are two examples of obstruction?

Urine statis, Reflux.

13

What are the manifestations of UTIs?

Acute onset, Frequency (need to urinate often), Dysuria (painful urination d/t inflammed tissue), Lower abdominal/back pain.

14

How are UTIs diagnosed?

Manifestations, Urinalysis

15

What will the urinalysis look for? What drugs would be given? Would they ever change?

The urinalysis will look for signs of infection, leukocytes, erythrocytes, maybe the specific bacteria. The urinalysis will be cultured if bacteria is found, but Antibiotics would be given right away. The Abx may change if they are found to be ineffective to the bacteria that is found.

16

What is treatment for UTIs?

Abx, Tx the underlying cause.

17

What is Pyelonephritis?

Pyelonephritis is an upper urinary tract infection. It is an inflammation of the renal pelvis and parenchyma. There are both acute and chronic forms of pyelonephritis.

18

What is the etiology and risk factors associated with pyelonephritis?

Pyelonephritis is cause my various bacteria, usually E. Coli. The risks of pyelonephritis are increased by suppressed immunity, catherterization, urinary reflux, and diabetes.

19

What is the Pathophysiology of Pyelonephritis?

Pyelonephritis is an ascending infection and inflammation which progesses from the urethra - bladder - ureter - kidney. Once the infection has reached the kidney the inflammation causes tissue damage through fibrosis and scar tissue causing a decrease in renal function.

20

What are the characteristics of chronic Pyelonephritis?

Recurrent inflammation leading to obstruction or reflux. Renal damage leading to renal failure.

21

What are the manifestations of pyelonephritis?

Acute onset, Lower back pain, Fever, Dysuria, Frequency, Urgency, Pyuria, Severe HTN.

22

What manifestation is seen only in chronic pyelonephritis?

Severe HTN.

23

Why is HTN a manifestation of chronic pyelonephritis?

Due to blocking passages, the body is not excreting fluid for the body experiences hypervolemia and as a result increased blood volume. This results in hypertension.

24

What is the treatment for pyelonephritis?

Antibiotics, typically for 10 - 14 days.

25

What are the five categories of Glomerular disease?

1. Nephrotic Syndromes. 2. Nephritic Syndromes. 3. Sediment disorders. 4. Rapidly professive glomerulonephritis. 5. Chronic glomerulonephritis.

26

What is Glomerulonephritis (GN)?

It is a type 3 hypersensitivity denoted by glomerular inflammation. There are several types.

27

What is the common form of Glomerulonephritis that we covered in class?

Acute Postinfectious (Proliferative) Glomerulonephritis.

28

What is Glomerulonephritis preceeded by? When does it occur?

Beta hemolytic strep infection which occurs in the pharynx or skin and last for about 7-12 days.

29

Who is typically affect by Glomerulonephritis? What is the recovery percentage?

Mostly occurs in children. There is a 95% recovery rate, provided it is identified and treated.

30

What is the percentage of occurance of glomerulonephritis in adults that become renal failure?

30%

31

What type of sensitivity is Glomerulonephritis?

It is a type 3 hypersensitivity.

32

What is an immune complex? Where do immune complexes get trapped during Glomerulonephritis? What is the effect of their entrapment?

An immune complex is when an antigen and an antibody become bound together. They become trapped in the glomerulus and impede the glomeular filtration.

33

In glomerulonephritis where do the immune complexes travel, where they then proceed to cause damage?

The immune complexes escape enzyme detection and travel to the capillairies in the glomerulus.

34

What are the two actions which occur in the capillaries once an immune complex become trapped in the capillary?

1. The immune complex plugs the wall and impeded perfusion. 2. Macrophages remove the IC but cause inflammation and damage the endothelium impeding renal function.

35

What is a type 3 hypersensitivity always preceeded by?

An infection.

36

What are two characteristics of Glomerulonephritis, specifically the Type III hypersensitivity outcomes?

Hypercellularity (Leukocytes, Mesangial, and Endothelial Cells, Glomerular enlargement.

37

What is the expected changes to a patients urinary output when suffering from glomerulonephritis?

Oliguria, followed by proteinuria and hematuria.

38

What is oliguria?

Inadequate urine volume

39

Why does a glomerulonephritis patient experience porteinuria?

Protein moves into the urine because of increased permability which results from damaged endothelium.

40

If a patient with glomerulonephritis is experiencing hematuria, what is causing it?

Damage to the capillaries in the glomerulus.

41

What renal function test will be elevated in a patient with glomerulonephritis, and why?

BUN and Creatinine will both be elevated because the kidneys will not be able to properly excrete them.

42

Why will Sodium and water retention occur in glomerulonepritis? What complications will this result in?

Retention will occur due to the kidney's inability to filter fluids. A complication of the Na and H20 retention will be HTN, and edema. Due to the increased hydrostatic pressure and decreased osmotic colloid pressure.

43

Why would a patient with glomerulonephritis have low osmotic pressure?

Due to proteinuria.

44

What is treatment for Glomerulonephritis?

Symptomatic treatment.

45

Are most cases of Glomerulonephritis self-limiting?

Yes, usually with-in a couple weeks.

46

What are Renal Calculi?

Kidney stones, which migrate into the urinary tract and can then lead to obstruction.

47

What is another name for reanl calculi?

Nephrolithiasis

48

Which sex is more likely to have nephrolithiasis? How many times more likely?

Higher incidence rates in men. 2 - 3 times higher.

49

What is the etiology of renal calculi?

Complex interaction between blood and GI nutirents in the kidney, forming calculi, which leads to structural changes in the urinary tract. There is an increased concentration of blood and urine components. There are also dietary and metabolic factors.

50

What is a "stag-horn" calculis?

A stone which takes the shape of an antler or horn. The "sharp" end inbeds into the kidney.

51

What is the pathophysiology of Nephrolithiasis?

The kidney secretes 3 different proteins which inhibit crystallization. There is an increase in the concentration of the solute and/or urine stasis which increases precipitators in the urine, a nucleus in formed leading to crystalization.

52

What are the four types of kidney stones and what are they made up of?

1. Calcium (oxalate and phosphate).
2. Magnesium ammonium phosphate (struvite).
3. Uric Acid (urate).
4. Cystine.

53

What are the manifestations of nephrolithiasis?

Sever renal colic pain associated with migration of stones (min to days). Distended ureter (hydronephrosis). Non-Colicy pain from distension of the renal pelvis and calyces. Nausea. Vomiting. Diaphoresis.

54

How is diagnosis of nephrolithiasis made?

Pain pattern (not migratory like appendicitis). Ultrasound. CT Scan. Urinalysis (microscopic - signs of infections, crystals). IVP (intravenous pylorgram).

55

What is the treatment for nephrolithiasis?

90% of stones are passed spontaneously (if

56

What is lithotripsy?

A non-invasive treatment of kidney stones using acoustic pulse to break apart kidney stones.

57

What is urinary incontinence?

Involuntary voiding or the bladder.

58

What are the three types of urinary incontinence?

1. Stress incontinence. 2. Overflow incontinence. 3. Overactive bladder.

59

What causes stree incontinence?

A weak sphincter. Increased intra-abdominal pressure (coughing-laughing). Change in urethro-vesticular angle (in women)

60

What causes overflow incontinence?

Intravesicular pressure > urethral pressure. Retention and bladder distention.

61

What causes overactive bladder incontinence?

Hyperactive detrusor muscle. Neurogenic/Myogenic problem.

62

What is the treatment for urinary incontinence?

Drugs. Surgery (artifical sphincter, prosthesis).

63

What is acute renal failure? What characteristics does it present with?

Loss of renal function, characterized by fluid-electrolyte imbalance and azotemia. There is a decrease in the GFR.

64

Is acute renal failure reversible? Self-limiting?

It is usually reversible, but it is NOT self-limiting.

65

What is the minimum amount of urine output per day to prevent azotemia?

400ml

66

What output is defined as oliguria?

100 - 400 ml/day

67

What output is defined as anuria?

68

What is anuria?

Nonpassage of urine.

69

What is the most common cause of acute renal failure?

Hypotension and Hypovolemia

70

What are the three groups of acute renal failure? (They correspond to the location in relation to the kidney).

Prerenal, Intrarenal (Intrinsic), Postrenal.

71

What are some examples of causes of prerenal acute kidney failure?

Hypovolemia, Heart failure or cardiogenic shock, Decreased renal perfusion d/t sepsis, drugs, etc.

72

What are some causes of Intrarenal kidney failure?

Renal ischemia, exposure to nephrotoxic drugs, acute renal disease (glomerulonephritis, pyelonephritis).

73

What are some causes of postrenal acute kidney failure?

bladder obstructions, benign prostatic hyperplasia.

74

What is the pathophysiology of prerenal acute renal failure?

Decreased renal perfusion causes oliguria and ischemia.

75

What is the pathophysiology of intrarenal acute renal faiure?

There are three phases. 1. Initiating phase - the precipitating event leading to manifestations. 2. Maintenance phase - the problem continues but there is a marked decrease in the GFR, and the patient experiences oliguria. 3. Recovery phase - tissue repair begins leading to a gradual increase in the GFR.

76

What is the pathophysiology of postrenal acute renal failure?

Obstruction to urine flow

77

What are the manifestations of acute renal failure?

Oliguria or anuria. Fluid-electrolyte imbalance. Azotemia. Edema, HTN, Porteinuria, Hematuria.

78

Which of the manifestations of acute renal failure are complications?

HTN and Edema.

79

What is the treatment for acute renal failure?

Stat intervention. Replace fluids and electrolytes with very careful monitoring. Dialysis. Diet (high calorie, low protein).

80

What is hemodialysis?

Filtering of the blood via a machine. Blood leaves the body, return filtered.

81

What is chronic renal failure?

Progressive, permanent damage that occurs via stages.

82

What are the three stages of chronic renal failure?

1. Diminished Renal Reserve. 2. Renal Insufficiency. 3. Renal Failure.

83

What are the characteristics of diminished renal reserve?

Kidney not functioning properly. A patient may not be exibiting manifestations, but the GFR will be

84

What are the characteristice of renal insufficiency?

GFR 20% - 50% of normal. The kidney will still be producing urine.

85

What are the characteristics of renal failure?

GFR

86

What are the two most common infections in the body?

Upper respiratory infections and then UTI's.

87

What causes UTIs?

A varitey of bacteria, usually E. Coli

88

How would you describe the path of infection of a UTI?

Ascending infection.

89

Urine is ____ unless there is an infection?

Sterile

90

Why are UTI's so common in women?

Women have a lot of normal flora in the vagina. When flora migrate into the urethra it causes an infection.

91

How is the inside of the bladder protected from direct contact or urine?

The mucin layer, which is a glycoprotein secretion lining the inside of the bladder which prevents direct contact of urine and epithial tissue.

92

What are the body's defences against UTIs?

Local immune response, Mucin layer, Washout, Prostatic fluid (men), Periuretheral flora (women).

93

What is washout, and how does it protect from UTIs?

Washout is daily urine output. Typically, urine stream should be forceful enough in an healthy individual to "washout" bacteria and flora that should not be there.

94

What are some risks that increase the likelyhood of developing a UTI?

Catheterization, Obstruction

95

What trick do bacteria have at their disposal to ensure proliferation on a catheterized individual?

Bacteria are able to secret a biofilm which ensure they can attach themselves to the catheter.

96

What are two examples of obstruction?

Urine statis, Reflux.

97

What are the manifestations of UTIs?

Acute onset, Frequency (need to urinate often), Dysuria (painful urination d/t inflammed tissue), Lower abdominal/back pain.

98

How are UTIs diagnosed?

Manifestations, Urinalysis

99

What will the urinalysis look for? What drugs would be given? Would they ever change?

The urinalysis will look for signs of infection, leukocytes, erythrocytes, maybe the specific bacteria. The urinalysis will be cultured if bacteria is found, but Antibiotics would be given right away. The Abx may change if they are found to be ineffective to the bacteria that is found.

100

What is treatment for UTIs?

Abx, Tx the underlying cause.

101

What is Pyelonephritis?

Pyelonephritis is an upper urinary tract infection. It is an inflammation of the renal pelvis and parenchyma. There are both acute and chronic forms of pyelonephritis.

102

What is the etiology and risk factors associated with pyelonephritis?

Pyelonephritis is cause my various bacteria, usually E. Coli. The risks of pyelonephritis are increased by suppressed immunity, catherterization, urinary reflux, and diabetes.

103

What is the Pathophysiology of Pyelonephritis?

Pyelonephritis is an ascending infection and inflammation which progesses from the urethra - bladder - ureter - kidney. Once the infection has reached the kidney the inflammation causes tissue damage through fibrosis and scar tissue causing a decrease in renal function.

104

What are the characteristics of chronic Pyelonephritis?

Recurrent inflammation leading to obstruction or reflux. Renal damage leading to renal failure.

105

What are the manifestations of pyelonephritis?

Acute onset, Lower back pain, Fever, Dysuria, Frequency, Urgency, Pyuria, Severe HTN.

106

What manifestation is seen only in chronic pyelonephritis?

Severe HTN.

107

Why is HTN a manifestation of chronic pyelonephritis?

Due to blocking passages, the body is not excreting fluid for the body experiences hypervolemia …. Need some editing.

108

What is the treatment for pyelonephritis?

Antibiotics, typically for 10 - 14 days.

109

What are the five categories of Glomerular disease?

1. Nephrotic Syndromes. 2. Nephritic Syndromes. 3. Sediment disorders. 4. Rapidly professive glomerulonephritis. 5. Chronic glomerulonephritis.

110

What is Glomerulonephritis (GN)?

It is a type 3 hypersensitivity denoted by glomerular inflammation. There are several types.

111

What is the common form of Glomerulonephritis that we covered in class?

Acute Postinfectious (Proliferative) Glomerulonephritis.

112

What is Glomerulonephritis preceeded by? When does it occur?

Beta hemolytic strep infection which occurs in the pharynx or skin and last for about 7-12 days.

113

Who is typically affect by Glomerulonephritis? What is the recovery percentage?

Mostly occurs in children. There is a 95% recovery rate, provided it is identified and treated.

114

What is the percentage of occurance of glomerulonephritis in adults that become renal failure?

30%

115

What type of sensitivity is Glomerulonephritis?

It is a type 3 hypersensitivity.

116

What is an immune complex? Where do immune complexes get trapped during Glomerulonephritis? What is the effect of their entrapment?

An immune complex is when an antigen and an antibody become bound together. They become trapped in the glomerulus and impede the glomeular filtration.

117

In glomerulonephritis where do the immune complexes travel, where they then proceed to cause damage?

The immune complexes escape enzyme detection and travel to the capillairies in the glomerulus.

118

What are the two actions which occur in the capillaries once an immune complex become trapped in the capillary?

1. The immune complex plugs the wall and impeded perfusion. 2. Macrophages remove the IC but cause inflammation and damage the endothelium impeding renal function.

119

What is a type 3 hypersensitivity always preceeded by?

An infection.

120

What are two characteristics of Glomerulonephritis, specifically the Type III hypersensitivity outcomes?

Hypercellularity (Leukocytes, Mesangial, and Endothelial Cells, Glomerular enlargement.

121

What is the expected changes to a patients urinary output when suffering from glomerulonephritis?

Oliguria, followed by proteinuria and hematuria.

122

What is oliguria?

Inadequate urine volume

123

Why does a glomerulonephritis patient experience porteinuria?

Protein moves into the urine because of increased permability which results from damaged endothelium.

124

If a patient with glomerulonephritis is experiencing hematuria, what is causing it?

Damage to the capillaries in the glomerulus.

125

What renal function test will be elevated in a patient with glomerulonephritis, and why?

BUN and Creatinine will both be elevated because the kidneys will not be able to properly excrete them.

126

Why will Sodium and water retention occur in glomerulonepritis? What complications will this result in?

Retention will occur due to the kidney's inability to filter fluids. A complication of the Na and H20 retention will be HTN, and edema. Due to the increased hydrostatic pressure and decreased osmotic colloid pressure.

127

Why would a patient with glomerulonephritis have low osmotic pressure?

Due to proteinuria.

128

What is treatment for Glomerulonephritis?

Symptomatic treatment.

129

Are most cases of Glomerulonephritis self-limiting?

Yes, usually with-in a couple weeks.

130

What are Renal Calculi?

Kidney stones, which migrate into the urinary tract and can then lead to obstruction.

131

What is another name for reanl calculi?

Nephrolithiasis

132

Which sex is more likely to have nephrolithiasis? How many times more likely?

Higher incidence rates in men. 2 - 3 times higher.

133

What is the etiology of renal calculi?

Complex interaction between blood and GI nutirents in the kidney, forming calculi, which leads to structural changes in the urinary tract. There is an increased concentration of blood and urine components. There are also dietary and metabolic factors.

134

What is a "stag-horn" calculis?

A stone which takes the shape of an antler or horn. The "sharp" end inbeds into the kidney.

135

What is the pathophysiology of Nephrolithiasis?

The kidney secretes 3 different proteins which inhibit crystallization. There is an increase in the concentration of the solute and/or urine stasis which increases precipitators in the urine, a nucleus in formed leading to crystalization.

136

What are the four types of kidney stones and what are they made up of?

1. Calcium (oxalate and phosphate).
2. Magnesium ammonium phosphate (struvite).
3. Uric Acid (urate).
4. Cystine.

137

What are the manifestations of nephrolithiasis?

Sever renal colic pain associated with migration of stones (min to days). Distended ureter (hydronephrosis). Non-Colicy pain from distension of the renal pelvis and calyces. Nausea. Vomiting. Diaphoresis.

138

How is diagnosis of nephrolithiasis made?

Pain pattern (not migratory like appendicitis). Ultrasound. CT Scan. Urinalysis (microscopic - signs of infections, crystals). IVP (intravenous pylorgram).

139

What is the treatment for nephrolithiasis?

90% of stones are passed spontaneously (if

140

What is lithotripsy?

A non-invasive treatment of kidney stones using acoustic pulse to break apart kidney stones.

141

What is urinary incontinence?

Involuntary voiding or the bladder.

142

What are the three types of urinary incontinence?

1. Stress incontinence. 2. Overflow incontinence. 3. Overactive bladder.

143

What causes stree incontinence?

A weak sphincter. Increased intra-abdominal pressure (coughing-laughing). Change in urethro-vesticular angle (in women)

144

What causes overflow incontinence?

Intravesicular pressure > urethral pressure. Retention and bladder distention.

145

What causes overactive bladder incontinence?

Hyperactive detrusor muscle. Neurogenic/Myogenic problem.

146

What is the treatment for urinary incontinence?

Drugs. Surgery (artifical sphincter, prosthesis).

147

What is acute renal failure? What characteristics does it present with?

Loss of renal function, characterized by fluid-electrolyte imbalance and azotemia. There is a decrease in the GFR.

148

Is acute renal failure reversible? Self-limiting?

It is usually reversible, but it is NOT self-limiting.

149

What is the minimum amount of urine output per day to prevent azotemia?

400ml

150

What output is defined as oliguria?

100 - 400 ml/day

151

What output is defined as anuria?

152

What is anuria?

Nonpassage of urine.

153

What is the most common cause of acute renal failure?

Hypotension and Hypovolemia

154

What are the three groups of acute renal failure? (They correspond to the location in relation to the kidney).

Prerenal, Intrarenal (Intrinsic), Postrenal.

155

What are some examples of causes of prerenal acute kidney failure?

Hypovolemia, Heart failure or cardiogenic shock, Decreased renal perfusion d/t sepsis, drugs, etc.

156

What are some causes of Intrarenal kidney failure?

Renal ischemia, exposure to nephrotoxic drugs, acute renal disease (glomerulonephritis, pyelonephritis).

157

What are some causes of postrenal acute kidney failure?

bladder obstructions, benign prostatic hyperplasia.

158

What is the pathophysiology of prerenal acute renal failure?

Decreased renal perfusion causes oliguria and ischemia.

159

What is the pathophysiology of intrarenal acute renal faiure?

There are three phases. 1. Initiating phase - the precipitating event leading to manifestations. 2. Maintenance phase - the problem continues but there is a marked decrease in the GFR, and the patient experiences oliguria. 3. Recovery phase - tissue repair begins leading to a gradual increase in the GFR.

160

What is the pathophysiology of postrenal acute renal failure?

Obstruction to urine flow

161

What are the manifestations of acute renal failure?

Oliguria or anuria. Fluid-electrolyte imbalance. Azotemia. Edema, HTN, Porteinuria, Hematuria.

162

Which of the manifestations of acute renal failure are complications?

HTN and Edema.

163

What is the treatment for acute renal failure?

Stat intervention. Replace fluids and electrolytes with very careful monitoring. Dialysis. Diet (high calorie, low protein).

164

What is hemodialysis?

Filtering of the blood via a machine. Blood leaves the body, return filtered.

165

What is chronic renal failure?

Progressive, permanent damage that occurs via stages.

166

What are the three stages of chronic renal failure?

1. Diminished Renal Reserve. 2. Renal Insufficiency. 3. Renal Failure.

167

What are the characteristics of diminished renal reserve?

Kidney not functioning properly. A patient may not be exibiting manifestations, but the GFR will be

168

What are the characteristice of renal insufficiency?

GFR 20% - 50% of normal. The kidney will still be producing urine.

169

What are the characteristics of renal failure?

GFR