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Flashcards in Unit 18 Deck (132):
1

pyelonephritis

upper uti

2

what does an upper uti include

inflm of renal pelvis and parenchyma

3

et of pyelonephritis

bacteria (usually E coli)

4

Risks for pyelonephritis

supressed IR
cathetorization
urinary reflux
DM/infc in general

5

pattern of infc in pyelonephritis

ascending (urethra->bladder->uretur->kidney)

6

what does progression of bact in phyeloneph lt

kidney scaring

7

what type of tissue is responsible for kidney scaring

inc in fibrous and scar tissue

8

what is scar tissue formation in GU rt pyeloneph dependent on

duration of the infection

9

what does scar tissue to do renal fx

decreases it

10

chronic pyelonephritis

presistant infc or ongoing inflm -> obstr or reflux (str issue)

11

comp of chronic pyeloneph

renal damage -> failure

12

mnfts of pyelonep

rapid onset w/o warning
those of infc
dysuria
pain
freq/urgency
pyuria

13

where does a pt feel pain in pyeloneph

lower back

14

what other mnft occurs in chronic pyeloneph

sev htn rt retention

15

dysuria

pain rt urine passing over areas of inflm

16

tx of pyeloneph

eradicate bact with abx

17

how long is the course of abx for acute pyelonep

10-14 days PO

18

what do we add to tx if pyeloneph is chronic

anti inflm drugs

19

what 5 things are defensive factors against lower UTIs

local IR
mucin layer
washout
prostatic fluid
microbial antagonism

20

how does a mucin layer defend utis

glycoprotein that sits ontop of epith tissue forming barrier between bact and bladder wall

21

what str secs mucin

bladder

22

fx of washout in uti defense

forceful stream of urine flushes out any microbes that may have entered urethra

23

fx of prostatic fluid in uti defense

contain anti microbial properties

24

fx of microbial antagonism in uti defense

normal periurethral flora provides defense against abn flora in their niche

25

when is there inc chance for uti

when risks > defensive factors

26

risks for uti

cathertorization
obstr

27

how is cathetorization a risk for uti

bact attatch to cathedor surface and coat themselves with a biofilm that protects it from pts IR.

28

how is obstr a risk for uti

urine statsis dt no washout -> inc reflux which carries microbes

29

mnfts lower uti

acute onset
frequency, dysuria
lowerabdm/back pain

30

what is pain in lower uti related to

kidney location

31

dx of lower uti

mnfts
urinalysis

32

tx for lower uti

abx
tx underlying cause (obstr, reflux, stasis, cathedor)

33

fx of glomerulus

active sec, absorp, filtration, change permeability

34

5 categories of glomerular disease

nephrotic syndrome
nephritic syndrome
sediment disorders
rapidly progressive glomerular nephritis
chornic glomerulonephritis

35

nephrotic syndrome

inc perm. inc components move out at glom lvl -> ultra filtration, inc fluid (water and lytes) and protein loss

36

nephritic syndrome

dec in perm. dec components move thru -> fluid retention and nitrogenous waste retention

37

sediment disorders

eg hematouria, proteinuria. molecules with inc sizes percipitate out

38

how man chronic glomerulonephritis present

with mfnts of either/including nephrotic s, nephritic s, sediment disordres

39

what type of reaction is rapidly progressive glom neph (RPGN)

type 3 H rxn

40

2 main problems with rpgn

impede filtration
abn deposits and attempted removal by macrophage -> endothelial destr -> inc perm dt "holes" and inflm

41

what must be present for ic to form (rpgn

infection

42

how many weeks does infc usually proceed rpgn

1 - 1.5

43

which pts have inc risk for rpgn

peds pts who had strep throat or dermal infc dt beta hemolytic stretococcus bact

44

what percent of adult cases of rpgn lt rf

1/3

45

2 histologic components of rpgn

hypercellularity
glomerular enlargment

46

hypercellularity

inc number of cells, pathologic hyperplasia, unexplained

47

what 3 cells does hypercellularity normally affect

wbc
mesangial (between caps)
endothelial cells

48

why does glomerular enlargement occur in rpgn

inflm and swelling

49

mnfts of rpgn

impeded filt and perm
olgiuria followed by proteinuria and hematouria
inc bun, creatinin
fluid retention

50

what is olgiuria in rpgn rt

dec urine vol rt dec perm in glomerulsu

51

what is proteinuria in rpgn rt

rt tears in endothelial lining allowing large molecules to escape

52

what hematuria in rpgn rt

cap damage

53

why is there an inc in bun, creatinin in rpgn

azotemia

54

what are the 2 serious comps rt fluid retention in rpgn

sev htn rt inc vascular volume
systemic edema rt inc hsp dt fluid rtention and l/o protein lt dec OP

55

how do we tx rpgn

self limiting with monitors by inc renal fx and symptomatic tx

56

how long is recovery of rpgn

several weeks post onset

57

renal calculi

kindey stones that form in kidney and move out to any part of ut

58

who has an inc in renal calculi

men, 2-3x inc incidence

59

what plays a large role in the et of renal calculi

diet and metb

60

et of renal calculi

complex interaction rt diet and str changes of ut

61

why does diet play a role in the et of renal calculi

inc [blood] -> inc [filtrate]

62

what does the kidney normally sec to prevent crystallization of urine

3 different proteins present only in kidney

63

what do the proteins sec by kidney not prevent

urine stasis

64

what factors outweigh the benefit of proteins in the kidney (RC)

inc solute concentration and or urine stasis

65

what happens in the kidney when benefits of proteins are outweighed

percipitate in urine forms nucleus -> stone formation

66

what must be present for a kidney stone to form

nucleus

67

4 types of kidney stones

calcium
mangesium ammonium phosphate
ureic acid
cystien

68

contb factors to calcium RC

inc ca, immbolization, vit d intoxification, bone disease

69

tx for calcium rc

underlying cause, inc fluid intake, thiazide diuertics

70

cont fact to mangnesium ammonium phosphate rc

urea splitting uti's

71

tx for mg nh3 ph rc

tx uti, acidify urine, inc fluids

72

cont factors for uric acid rc

formed in acid urine with ph about 5.5
gout
high protein diet

73

tx for uric acid rc

inc fluid
alkalize urine

74

cont factors for cystine rc

cystinuria rt inhereted aa metb disorder

75

tx for cystine rc

inc fluid, alkalize urine

76

what is beneficial about knowing the type of rc that has formed

prevents it from happening aagain

77

staghorn rc

stone with a head and horn

78

mnfts of rc

sev pain with acute onset
renal colic
non colicky sev pain
n and v
diaphoresis

79

how long may renal colic last (RC)

mins - days

80

what is renal colic associated with

stone migration

81

why may uretur be distended in RC

stone migration causing obstr

82

what is non colicky sev pain in rc rt

distention of renal pelvis

83

why is somebody with rc have n and v

sev pain

84

dx for rc

cant use pain alone
US/CT (Fast)
labs - urinalysis
IVP

85

IVP

intravenous polygram

86

how does IVP work

inject dye via IV and watch it move thru circulation and into filtrate and urine. visualize blockage. not routine.

87

tx for rc

pain relief
nv releif
tx cause
sx

88

what sx may be used to treat rc

lithopsy - break down of stone using sound waves. fractures of large stones may cause problems distally

89

what do we do to stones passed spontaneosly? which stones do we pass like this

collect them

90

urinary incontinence

voiding incontinently
occurs inc with >60yo
mnft of a problem

91

et/patho of urinary incontinence (3)

stress incontinence
overflow incontience
overactive bladder

92

why is stress incontinence occur in UI

p application onto bladder + weakness/incompetence of bladder sphincter rt age.
- urethral vesicular angle change in women

93

how does P application of bladder cause stress incontinence

inc intra abdm p can inc p on weak bladder sphincter

94

why does change in urethral vesicular angle cause stress incont.

change in angle rt child birth is more susceptible to changes in P

95

overflow incontinencec

intravesicular P > urethral P or retention and bladder distention

96

overactive bladder

inc activity of bladder rt hyperactivite detuosur m. excessive contr/relax -> inc P -> incont

97

what type of problem may an overactive bladder be

n or m

98

tx for UI

drug (alpha adrenergic agonist)
sx (artificial sphincter)

99

ARF

acute onset/recovery, l/o renal fx w/o warning with dec renal fx

100

2 pressing problems with ARF

fluid/lyte imbal
azotemia

101

what is kidney fx determined by

egfr
output (not always reliable)

102

olguirua

100-400cc output a day

103

what amount of output is barely enough to prevent azotemia

400cc/day

104

anuria

no urine or

105

why does kidney receive blood

filter it
perfusion

106

when cant the kidney perfuse blood

dec blood vol or obstr

107

what perecent of CO assists with kidney perfusion

20-25

108

what happens when less then 20% of co goes to kidneys

problem

109

primary et of arf

def renal perf rt hypovoluima/perf

110

3 groups of et of arf

pre, intra, post

111

what group of et of arf is most common

pre renal

112

what et makes up 80-90 percent of arf

pre/intra

113

pre renal arf

dec renal perf dt dehydration? lt olguiria/ischemia

114

2 consequences of pre renal arf

inadeq perf -> ischema
dec filtration

115

eg of intra renal arf

glomerular nephritis

116

3 phases of intra renal arf

initiating
maintencance
recovery

117

initiating phase of intra renal arf

problem is just starting from percipitating events

118

maintenance phase of intra renal arf

dec egfr
olgiuria/azotemia

119

recovery phase of intra renal arf

inc time dt tissue repair. grad inc in egfr. address cause

120

post renal arf

eg bph
obstr to urine flow

121

mfnts of arf

olguria/anuria
lyte imbal
azotemia
proteinuria, hemouria

122

complications of arf

htn
edema

123

tx for arf

stat intervention
replace fluid and lytes with monitoring
dialysis
diet

124

why do we monitor when giving fluids to pts with arf

can they handle the inc fluid?

125

types of dialysis

hemodialyis
peritoneal dialysis

126

what diet changes do we make in pts with arf

well balanced, inc calories/carbs
dec protein to dec N waste

127

crf

prog perm damage that occurs in stages

128

stages of crf

diminshed renal reserve
renal insufficenty
rf

129

diminshed renal reserve

dec kidney fx.
dec egfr by > or equal to 50% of normal
no mfnts of dec renal fx yet

130

renal insufficency

gfr 20-50% of normal

131

renal failure

gfr

132

what is the gfr of total end stage failure