Week 11 AKI & UTD patho Flashcards
1
Q
If we see Casts in someone’s urine, it indicates that they have what
A
Damage to their tubules (Intra-tubual damage). The epithelial cells have sloughed off and are collecting in the filtrate.
2
Q
How do you aleviate pre-renal injury?
A
Fix blood pressure
3
Q
How do you aleviate post renal injury?
A
remove/fix the obstruction
4
Q
What types of AKI can be reversed easily?
A
- pre-renal injury
- Post -renal injury
5
Q
What do delays in intervention lead to with pre-renal injury and post-renal injury?
A
Intra-renal injury (bad)
6
Q
What are the 3 stages of Intra-renal Injury?
A
- initiation
- Maintenance
- recovery
7
Q
What are the 5 urinary tract disorders?
A
- Immunological kidney disorders
- Urinary tract infections
- Kidney stones (Calculi)
- Polycystic kidney disease
- Cancer
8
Q
Is mortality high or low with AKI?
A
Low
9
Q
Do people with AKI sometimes need dialysis?
A
Yes
10
Q
What disease can AKI lead to?
A
CKD
11
Q
What are the 3 risk factors for developing AKI?
A
- Infection - sepsis is most common cause
- low BP
- Nephrotoxins
12
Q
What is the most common cause of infection that leads to AKI?
A
Sepsis
13
Q
What are 3 reasons people have low BP that can lead to AKI?
A
shock, surgery, heart failure
14
Q
What are 3 examples of nephrotoxins that can lead to AKI?
A
medication
radiocontrast
chemical exposure
15
Q
What are 3 pre-renal factors that lead to AKI?
A
- hypovolemia
- altered peripheral vascular resistance
- cardiac disorders
16
Q
What are 5 intra-renal factors that lead to AKI?
A
- renal ischemia that lasts a while
- nephrotoxic drugs
- organic solvents - ethylene glycol
- acute hemolysis and rabdo
- acute glomerulonephritis
17
Q
What are examples of nephrotoxic drugs that lead to AKI?
A
antibiotics - *aminoglycosides the “-cins”
NSAIDS
CT dye/contrasts
18
Q
What are 3 post-renal factors that lead to AKI?
A
- stones/tumours
- enlarged prostrate
- urethral scarring/infection (STIs)
19
Q
What does azotemia mean?
A
Lots of waste product in the urine
20
Q
What happens in the nephron during pre-renal AKI?
A
- decreased renal blood flow
- Hypoperfusion
- decreased GFR
- In the proximal tubule more Na and H2O are absorbed to help compensate
- Aldosterone and ADH increase to help compensate for low BP
- in the distal tubule more Na and H2O to help compensate
- 3 compensations = Oliguria & Azotemia
21
Q
What happens in the nephron during intrarenal injury?
A
- There is injury to the tubule (necrosis)
- Casts form from cells sloughing off
- Causes intratubular obstruction
- So then increase in intratubular pressure
- causes backflow and leaking of proteins
- This reduces GFR
- Oliguria
22
Q
What is happening in the nephron during post-renal AKI?
A
blockage causes back up in the glomerulus so GFR goes down because of changes to the delicate pressure balance
23
Q
What are the 2 reasons that AKI happen?
A
- renal system circulatory issue - so a drop in GFR
- Damage to the actual glomerulus or tubule
24
Q
What issue in the heart contributes to low perfusion to the kidneys?
A
CO
25
How do the glomerular pressures change in pre and post renal injuries?
-the hydrostatic pressure lowers in pre-renal injury
-the hydrostaic pressure rises due to back flow in post renal injury ?
26
During the initiation stage of Intrarenal AKI what are the 2 major things we will see?
1. increase serum creatinine & BUN- waste due to GFR issues
2. decreased urine output (due to compensatory mechanisms)
27
During the maintenance stage of Intrarenal AKI what are the major things we will see?
1. *Oliguric* - B/c proteins are coming out and water is following
2. Anuric, nonoliguric
3. Fluid retention - edema- hypertension - weight gain
4. metabolic acidosis - Kussmaul's respirations b/c kidney can't regulate acid/bicarb adjustments
5. Na goes down, Ca goes down (lost in urine)
6. K+ goes up (b/c opposite Na), phosphate goes up
7. Anemia - b/c RBC problem /EPO
8. Waste accumulation (Uremia) - affects major organs
28
During the Recovery stage of Intrarenal AKI what are the major things we will see?
1. Bun, creatinine and eGFR move back towards normal ranges - cuz nephrons are reapairing
2. possible Diuretic phase b/c nephrons aren't 100% yet so protein still getting out
3. can excrete waste
4. Possible hypovolemia and hypotension
5. Risk for low Na, Low
6. Risk for dehydration
29
What are the 5 Urinary Tract Disorders
1. Immunological Kidney disorder
2. UTI
3. Kidney Stones - renal calculi
4. Poly cystic kidney disease
5. cancer
30
What is an example of an immunological Kidney Disorder?
Glomerulonephritis
31
What are the 4 stages of Glomerulonephritis?
1. Acute
2. Rapidly progressive
3. Chronic
4. Nephrotic syndrome
32
What is Glomerulonephritis ?
1. Immune- mediated inflammation of *glomerulus and some urinary tract
33
What are characteristics of Glomerulonephritis?
1. Both kidneys affected equally
2. Proteinuria
3. hematuria (blood)
4. less urine
5. oliguria
34
What causes Glomerulonephritis?
1. Immune disorders
2. Drugs
3. infection
35
What bacteria most commonly leads to glomerulonephritis and why?
Streptococcal (Strep)
- antigen-antibody complexes form during the fight and damage the glomerulus
36
How many days after strep do we see nephritic presentation?
5-21 days after
37
What age does poststreptococcal glomerulonephritis affect most often?
ages 3-7
38
What are the symptoms of post glomerulonephritis?
1. *periorbital edema *
2. Edema
3. Hypertension (think SNS response )
4. Urine has things it shouldn't like WBC, RBC, protein, erythrocyte casts (smoky urine)
5. Urea and creatinine will be increased
6. Oliguria
39
Does a healthy urinary tract have bacteria or is it free from bacteria?
free from bacteria
40
Where do most UTIs start?
Urethra and travel up - from bacteria
41
What is the most common pathogen leading to UTI?
E. coli
42
What is the best defense in getting rid of bacterial threat at the urethra?
Urinating
43
What is the major cause of bacteria getting into the urethra?
Stasis
44
Who is at risk for UTIs?
1. Female
2. not emptying bladder fully
3. obstruction of urine outflow (BPH - enlarged prostate)
4. Scar Tissue from frequent STIs
5. born with issue - congenital
6. blood supply to bladder not good
7. renal calculi (stones)
8. Incontinence
45
What are the 2 manifestations of UTIs?
1. Cystitis (upper/lower)
2. Pyelonephritis
46
What 4 things is cystitis characterized by?
LUTS (lower urinary tract symptoms)
1. Dysuria
2. frequent/urgent urination
3. *suprapubic pain
4. cloudy urine
47
What will we see in the urinalysis of someone with Cystitis?
cloudy urine
1. Bacteriuria
2. Pyuria
3. microscopic hematuria
48
What are the 6 characteristics of Pyelonephritis?
1. LUTS
2. fever
3. Chills
4. Malaise
5. N&V
6. kidney tenderness (back)
49
What can Pyelonephritis lead to?
CKD due to chronic episodes
50
What will we see in the urinalysis of someone with Pyelonephritis?
1. Bacteriuria
2. pyuria
3. microscopic hematuria
4. leukocyte casts
51
What is the most common type of Renal Calculi and causes?
Calcium (phosphate or oxalate)
1. we don't know but they get hypercalciuria
2. hyperthyroidism
3. immobile
4. oxalate from food like green and root veggies
52
What is the second most common Renal calculi and causes?
Struvite
1. Magnesium, ammonium, phosphorus
2. recurrent UTI
53
What is the third most common Renal calculi and causes?
Uric acid
1. waste product with lots of nitrogen from breakdown of DNA and RNA
2. animal meat, coffee, alcohol, obesity
3. Gout
54
What is the least common cause of renal calculi and causes ?
Cytine
1. genetic
2. hard to metabolize amino acids
55
What are the clinical manifestations of renal calculi?
1. abdominal/flank pain (severe)
2. Renal colic (severe pain from urinary tract block)
3. Hematuria
4. Fever, chills
5. N&V
56
What is polycystic kidney disease?
cortex and medulla filled with cysts that get big and destroy tissue through compression (ischemia)
57
What is the most common genetic disease in Canada?
polycystic Kidney disease
58
Does polycystic kidney disease affect one or both kidneys?
both
59
What are the symptoms of polycystic kidney disease?
1. abdominal/flank pain
2. hematuria (ruptured cyst)
3. UTI
4. Hypertension
60
What does polycystic kidney disease ultimately lead to ?
CKD
61
What are the risk factors for Kidney cancer?
1. smoking
2. obesity
62
What are the clinical manifestations of kidney cancer?
1. lots of hematuria
2. flank pain
3. palpable mass
63
What are the risk factors of bladder cancer?
1. smoking
2. industrial dyes
3. chronic kidney stones
3. chronic cystitis
64
What can chronic cystitis lead to?
Bladder cancer
65
What are the clinical manifestations of bladder cancer?
1. *lots of blood/ hematuria
2. painless
3. irritative bladder symptoms
66
What is a major risk factor for developing cancer in the urinary tract?
1. chronic cystitis
2. chronic kidney stones (renal calculi)
