week 11 acute kidney injury & injury tract disorders Flashcards
(113 cards)
1
Q
how is acute kidney injury ( AKI ) characterized ?
A
characterized by abrupt decline in kidney function
2
Q
what are the 2 major symptoms of AKI ?
A
elevated serum creatine
reduction in urine output
3
Q
true or false. When a pt has AKI, increase in Cr to 1.5 times ( or more ) baseline
A
true, this is reversible but can affect other life threatening levels
4
Q
what is the onset of AKI
A
it is sudden , varies from mild to severe and RRT may be require
5
Q
true or false. acute kidney injury, does not lead into CKD .
A
false, it does!
6
Q
what is the ICU level renal replacement therapy referred to ?
A
continuous renal replacement (CRRT)
7
Q
what are the 3 categories that are in risk for developing AKI ?
A
pts with infections
pts with low blood pressure
pts exposed to nephrotoxins
8
Q
what is the most common cause of AKI ?
A
sepsis is the most common cause of AKI ( Hypotension and antibiotics ) –> but anyone with infections
9
Q
recall that pt with low blood pressure is at risk for developing AKI name what undergoes this
A
shock, surgery, heart failure
10
Q
Recall that pts exposed to nephrotoxins is at risk for developing AKI, name what undergoes this
A
medication, radiocontrast
11
Q
true or false. Heart failure impacts cardiac output by low blood pressure which makes the kidney suffers.
A
true
12
Q
patients with infection is at risk for developing AKI , does this cause wide spread of vaso constrict or dilation?
A
dilation
13
Q
AKI etiology : divided into 3 categories, what are they ?
A
Pre-renal
Intra-renal
Post- renal
14
Q
define the description
pre-renal
intra-renal
post-renal
A
pre-renal ( before) decrease glomerular filtration and profusion
intra-renal ( during )- direct damage to renal tissue
ATN- most common in renal causes of AKI
post - renal ( after )- mechanical obstruction of urinary outflow
15
Q
examples of pre- renal factors
related to decreased renal perfusion :
A
hypovolemia
altered peripheral vascular resistance
cardiac disorders
16
Q
give an example for hypovolemic
altered peripheral vascular resistance
cardiac disorders
A
1) this might be actual loss of blood volume : accident, or surgery loss of water ( content in the blood - dehydrated - vomiting or diarrhea )
2) heart conditions ( result reduced in cardiac output, heart attack )
** whenever ur pt blood pressure drop suddenly be worried about that potential cause for pre-renal acute kidney injury
17
Q
true or false. the reason : when bp drops, the body is going to do whatever is necessary to keep the most vital organs like the heart, lungs, the brain perfused even if that means shutting down circulation to those other still important it not immediately.
A
true
18
Q
examples of intra-renal factors
direct damage to kidney itself leads to intra renal injury
name the 5 characteristics
A
1) prolonged renal ischemia
2) nephrotoxic drug ( Abc, NSAIDs, radio contrast agents )
3) organic solvents ( ethylene glycol )
4) acute hemolysis and rnhabdomylosis
5) acute glomerulonephritis
19
Q
examples of intra- renal factors
nephrotoxic drugs ( ABx, NSAIDS, Radiocontrast agents ) what are some examples?
A
amino-glycosides
gentamycin
tobramycin
streptomycin
20
Q
true or false. Ethylene Glycol , very toxic to the kidneys.
A
true
21
Q
true or false. Rhabdomyolysis cause can be by traumatic accident ( collision ).
example : syncopole episode, orthostatic, meds, unable to get themself up
A
true
22
Q
what is hemolysis
A
break down of rbc
23
Q
finish the sentence:
break down of muscle tissue : Being broken down releases a component called ______ and this is small particle that is filtered through the glomerulus into the tubules and cause now some possible reasons for _______
A
heme
hemolysis
24
Q
examples of post renal factors
re-call this is related to obstruction of urine outflow : define the characteristics
A
related to obstruction of urine outflow
- stones/tumours ( type of physical obstruction )
- enlarged prostate ( external force by blocking urinary flow )
- urethral scarring/infection STIs
25
what is happening in the Nephron During Pre- Renal AKI
low blood flow into the kidney has disrupted what ?
what happens when GFR drops ? and how will our body respond to that ?
disrupted that normal balance of pressures that push the glomerulus
bp will drop, and our body will correspond by having overall drop in that filtration rate
26
nephron during pre-renal aki what is the kidney doing here due to that low blood pressure?
kidney will attempt to compensate for this change by activating the RAAS system, but often this is not enough to maintain for that normal GFR
27
what is happening nephron in an intra-renal injury what is occuring here ?
lack of blood flow enter the epithelial cells entering the tubules resulting in losing tubular function
28
recall : lack of blood flow enter the epithelial cells entering the tubules resulting in losing tubular function
2) causes increase in tubular pressure against which the glomerular hydrostatic pressure has to push
this filtration pressures will have to what ?
this filtration pressures will have the act result of dropping in urine output and the development of azotemia.
29
Wha is happening in the Nephron in an intra renal injury?
Dead cells have sloughed off in the endothelium, through the tubules and become a part f the filtrate they will clump together to from what we call ____ excreted in the urine intra tubular damage
casts
30
what is happening in the nephron during post- renal AKI
due to physical obstruction of flow to the kidneys intra tubular pressure rises - work in obstruction and GFR is dropped
post renal - is not damage initially
31
clinical course of pre and post renal AKI
pre- renal injury, what would early recognition of this and intervention result
return to normal kidney function
32
post renal injury what would early cognition conclude if we had time to intervene quickly?
return to normal kidney function
33
pre- renal could eventually lead to intra renal injury ? true or false.
true
34
post renal injury could lead to intra renal injury ? true or false.
true
35
clinical course of AKI with intra- renal injury
three phases : what are they?
1) initiation
2) maintenance
3) recovery
36
what is initiation phase ?
precipitous event, characterized by increased serum creatine & BUN decreased urine output
37
What does increased serum creatine and BUN, decreased urine output indicate ?
one of the causes are ( hemolytic reaction, ischemia to the kidneys, exposure to nephrotoxins )
38
what does maintenance phase indicate ?
lasts days to weeks
anuric, oliguric, nonoliguric ( still producing the same urine production ) , normally 10-14 days
fluid retention, edema, htn, weight gain
39
maintenance phase re call we know that it lasts days to weeks ( anuric , oliguric, nonoliguric, --> still producing the same urine production )
normally 10-14 days and fluid retention, edema, HTN , weight gain could occur
what else could we see?
metabolic acidosis, kussmaul's respirations
fluid & electrolyte imbalance - decrease Na, increase K, decrease CA, and increase in PO4
40
is anemia seen, with maintenance?
yes this is seen.
41
Waste product accumulation --> can affect major organs and this occurs in maintenance?
yes this is true
42
True or false. Waste product accumulation --> can affect major organs ( so we must look for changes, this is the same as chronic )
true
43
what is non oliguric ?
still producing the same urine production
44
recovery phase ( intra-renal injury )
name the characteristics under this
return of BUN, creatine, eGFR toward normal ranges
may have diuretic phase ( lasts 1-3 weeks )
recovered ability to excrete waste
risk for hypovolemic and hypotension
45
what are the risk for recovery phase ?
risk for hyponatremia, hypokalemia, dehydration
46
How long does recovery phase take to stabilize ?
12 hours
47
true or false. Improvement in the blood work is the occurence during recovery phase
true
48
true or false. Kidneys have not regain to concentrate that urine imbalance still occur
true
49
electrolytes- potassium and sodium is lost during recovery phase. is this true or false.
true
50
urinary tract disorders
name the categories
immunological kidney disorders
urinary tract infections
kidney stones ( calculi )
polycystic kidney disease
cancer
51
what is immunological disorders of the kidneys mean ?
immune mediated inflammation of the urinary tract ( primarily the glomerulus )
52
how is immunological disorders of the kidneys characterized
proteinuria, hematuria, decreased urine production and oliguria
53
true or false. Immunological disorders of the kidneys, both kidneys equally affected.
true
54
immunological disorders of the kidneys , causes include:
drugs, infection , immune disorders
55
Re-call that immunological disorders of the kidneys, causes include drugs, infection, immune disorders. Now name examples
this can develop after strep infection, pneumonia, hepatitis associated with lupus rheumatic ( autoimmune )
this will affect the kidney equally
56
'immunological disorders of the kidneys'
types of glomerulonephritis
acute glomerulonephritis
rapidly progressive glomerulonephritis
nephrotic syndrome
57
true or false. Rapidly progressive glomerulonephritis, some people don't recover after the initial injury ?
yes this is true
58
what type of glomerulonephritis is this ?
acute injury seems to resolve, low levels of inflammation persist over years, nephrons slowly die and leads to this
chronic glomerulonephritis
59
Acute post streptococcal glomerulonephritis
this immune attack on the strep infection causes what ?
this immune attack on the strep infection causes antigen antibody complexes to form (damage glomerulus)
60
when does nephritic presentation begin after initial infection ( ** this is talking about acute post streptococcal glomerulonephritis )
nephritic presentation will begin 5-21 days
61
true or false. Acute post streptococcal glomerulonephritis most often occurs in adult.
false. mostly occurs in children in the age of 3-7
62
what are the symptoms of Acute Post streptococcal Glomerulonephritis
smoky urine
oliguria
edema ( often periorbital )
HTN
urinalysis: WBC, RBC, protein, erythrocyte casts
blood work : increase in creatinine, and urea
63
true or false.Acute Poststreptococcal Glomerulonephritis mostly attack on the throat and the skin?
yes this is true
64
what does erythrocyte casts indicate ?
damage to the tubules
65
recall that during Acute Poststreptococcal Glomerulonephritis , some of these capillaries can rupture and cells will leak out into the urine, leading to hematuria.
the urine in Glomerulonephritis is described as what ?
smoky, tea colored, coca cola color
66
true or false. Acute Poststreptococcal Glomerulonephritis causes activation of WBC to rush to the area, and the combiantion of inflammation in WBC fills the lumen and leaves very little room to enter to be filtered. DROPPED GFR over time
true
67
Urinary tract infections
what does ascending infections mean ?
they start with bactering entering the urethra , moving up into the bladderm and if this bacteria is not recognized or treated it can move up further to the ureters and the kidneys.
68
true or false. Very rarely, infections can enter the kidney directly from the blood, but this is
not often and the vast majority of infections will be the ascending type stemming
from the urethra.
true ( urinary tract infections is what this is describing )
69
true or false. healthy urinary tract is free from bacteria ?
true
70
MOST_____ ascend and occur from bacteria entering the urethra
UTIs
71
what is the type of pathogen leading to UTI ?
E.coli
72
what is the major defense to ascending bacteria ?
flushing effect of urine flow ( stasis major cause of UTIs )
73
most people have feces in close proximity to
the urethra so how we don't all have UTIs all the time. Explain the reason
our body protects against infection is called the flushing effect and
this means that on a regular basis when the bladder is emptied any bacteria sitting
in or near the entrance of the bladder is flushed away by the process of urinating.
74
what happens when flushing effect is damaged or disrupted?
increased risk for infection
75
who is at risk for UTIs
anatomically ???
females are more susceptible ( anatomical )
76
who is at risk for UTIS
Urinary stasis ( what undergoes this category )
incomplete bladder emptying ( incontinence )
obstruction of blood flow ( BPH )
scar tissue ( frequent STIs)
congenital defects
impaired blood supply to bladder
renal calculi ( obstructs )
stroke and MI
77
true or false. when urine is not flushed out regularly and sits in the bladder and festering this is putting yourself at risk for UTIs
true
78
true or false. Anything can cause incomplete bladder emptying
true
79
There are two categories of physical manifestations of UTIs, what is it ?
Cystitis, pyelonephritis
80
what are the symptoms for cystitis
what are the urinalysis of cystitis
dysuria, urinary frequency and urgency, suprapubic discomfort , cloudy urine ( aka LUTS )
urinalysis : bacteriuria, pyuria, microscopic, hematuria
81
what are the symptoms for pyelonephritis ( affects lower and upper tract )
LUTS and have fever, chills, malaise, vomitting, tenderness over kidney
urinalysis : bacteriuria, pyuria, microscopic, hematuria, leukocyte casts
can become chronic and lead to CKD
82
what is the first symptom called in cystitis ?
dysuria, which means discomfort with urination
83
why is discomfort happening during cystitis ( the term dysuria ) go more in depth
urine is in contact with those inflamed tissues. The next is urinary frequency which means that patients can often have to void more often and the reason for this is when the bladder is full of inflamed tissue there's going to be less room for urine to accumulate and so the
patient needs to empty their bladder more often.
84
true or false. with the UTI, again related to that inflammation of that tissue. When you're
assessing the patient's urine, you may note that it's really cloudy or has a white tissue. Sometimes it can be described as a milky or really foul smelling and this has to do with that presence of bacteria as well as pus in the urine.
true
85
what is another word for renal calculi ?
kidney stones
86
describe what kidney stones are
renal calculi: occurs when the mineral salts in the urine become so concentrated that they cant stay in the solute anymore and they start to participate out and form solid little stone structure.
87
where do most kidney stones start ?
renal pelvis, they fill this out, but it could also branch out into the helix
88
True or false. When kidney stones is so large it could actually obstruct the outflow from the kidney.
true
89
re-call: When the kidney stones are so large it could actually obstruct the outflow from the kidney . And as a result this kidney would develop something called _____ what does it mean explain?
Hydronephrosis, meaning the kidney has become swollen due to all of that back pressure and backup of fluid..
90
the term calculus refers to the _____ and _____ refers to stone formation
stone
lithiasis
91
what are the four different types of stones
calcium ( phosphate or oxalate )
struvite
uric acid
cystine
92
name the most to least common of stones
calcium ( phosphate or oxalate )
struvite
uric acid
cystine
93
describe what calcium ( phosphate or oxalate ) what are the characteristics
this is the most common, idiopathic hypercalciuria
hyperparathyroidism and immobility
oxalate from diet ( green veg and root veg )
94
describe what struvite and its characteristics
second most common
made of mg, ammonium, phos
recurrent UTis ( proteus bacteria )
95
describe what uric acid and its characteristics
nitrogen containing waste product from breakdown of DNA and RNA, accumulates with large amount of animal meat, coffee, alcohol, obesity
** GOUT
96
describe what cystine is as a stone and its characteristics
( least common )inherited disorder when people have difficulty metabolizing amino acid
97
true or false. dehydration has not been associated with kidney stones, it usually associates with physical obstruction.
false, dehydration has been associated with kidney stonea
98
manifestations of renal calculi
symptoms incldude:
abdominal/flank pain ( severe )
renal colic
hematuria
fever, chills
nausea & vomitting
99
Describe if this statement is true or false. The intensity and location of the pain of renal calculi is going to differ depending on the location.
TRUE
100
If the kidney stone is located in the renal pelvis, patients may complain of what type of pain
flank pain
flank pain is
the pain in the back directly over top of where the kidneys would sit kind of below
that rib cage there.
101
Now as the stone moves out into the ureters, patients may
describe the pain as intensifying and it follows a pattern that we refer to as
_____ , why do u think this is the pain they are experiencing ?
renal colic, this is really excruciating pain that tends to come and go and
waves and the reason for this pain is that the ureters are trying to move that
stone down.
102
renal colic pain does it radiate anywhere else for men and women ?
yes it does, it can radiates down the groin
for men : radiate towards the scrotum
for women : radiate towards the labia
103
true or false. if the stone makes it down to the
bladder, the pain will shift again and this time it shifts into the abdomen.
true
104
what is the most common genetic disease in canada?
polycystic kidney disease in canada
105
polycystic kidney disease only involves one kidneys, this is why it is the less severe urinary tract disorders
false, it involves both kidneys and no that doesnt mean its the less severe bommbooooclat
106
Describe what cortex and medulla becomes filled with in polycysitc kidney disease
filled with cysts that enlarge and destroy surrounding tissue by compression
107
what are symptoms when someone has polycystic kidney disease
abdominal or flank pain, hematuria ( ruptured cysts), UTI, hypertension
eventually can lead to renal failure, as it presses on the renal capsule
108
true or false. polycystic kidney disease does not lead to CKD
false, it does!
109
Just a summary not an question u need to answer: Polycystic kidney disease gets taken over by cysts, Gradually these cysts take over and compress the healthy tissue and we end up with loss of renal function. Now patients with polycystic kidney disease experience pain associated with the growing kidney.
YUUUUUUPPPPPPP TYPE SHI
110
what are the two types of cancer we are talking in urinary tract disorders
kidney and bladder
111
characteristics abt kidney cancer
what are the risk factors
what are the early symptoms
what are THE SYMPTOMS
*Risk factors: smoking, obesity
*No early symptoms
*Gross hematuria, flank pain, palpable mass
112
characteristics abt bladder cancer
what are the risk factors
what are the early symptoms
what are THE SYMPTOMS
*Risk factors: smoking, exposure to industrial dyes, chronic kidney stones, chronic cystitis
*Gross, painless hematuria is most common finding ( visible blood in the urine )
*Irritative bladder symptoms
113
recall : not a question u need to answer , just a bit more detail of bladder cancer
bladder cancer include a history of smoking and in fact tumors
occur four times more frequently in cigarette smokers than non-smokers. Exposure to chemicals can be dangerous
for the urinary tract and increase that risk for bladder cancer.
And finally a history of frequent injury or infection to the bladder can also
increase that risk for bladder cancer development.
TYYYYPEE SHIII
