Week 4: Renal

Question 1

consequences of urinary obstruction depend on

Answer 1

location within or outside urinary tract
unilateral or bilateral involvement
partial or complete obstruction
short-term or long-term duration
underlying cause

Question 2

hydronephrosis

Answer 2

Fluid accumulates around the kidney
Fluid backup causes increase in hydrostatic pressure
Decreases GFR

Question 3

chronic partial obstruction

Answer 3

Causes compression of kidney structures
Kidneys initially increase in size
Progressive atrophy follows
Tubular damage decreases ability to conserve Na+ and H2O or to excrete H- or K+
Failure to concentrate urine may cause risk of dehydration and metabolic acidosis

Question 4

kidney stones

Answer 4

Also called calculi or nephrolithiasis

Masses of crystals and protein - common cause of obstruction

Question 5

factors that affect kidney stone formation

Answer 5

pH, high conc of stone forming substances, low urine output, tubular defects, facilitators and inhibitors of crystal growth, various diseases, drugs, diet

Question 6

kidney stone clinical s&s

Answer 6

pain, n&v, hematuria

Question 7

kidney stones dx

Answer 7

• Thorough medical and family history, diet history, previous history of urinary tract disease, use of medication
• Check blood and urine (urine pH, RBC, WBC should be elevated)
• Radiographic tests: flat plate of abdomen or IV pyelogram

Question 8

kidney stones tx

Answer 8

• prevent new stone formation and reduce size of ones already present
• reduce concentration by increased fluid intake, decrease substances that cause stones
• drugs

Question 9

neurogenic bladder

Answer 9

caused by interruption of nerve supply to bladder - dependant on level of CNS or spinal cord injury

Question 10

renal tumours assoc. with

Answer 10

tobacco use, obesity, and analgesic use

Question 11

renal tumour clinical s&s

Answer 11

hematuria, flank pain, palpable, flank mass, weight loss

Question 12

renal tumour dx

Answer 12

clinical symptoms, x ray, and ct

Question 13

renal tumours tx

Answer 13

surgical removal by cytoscopy and chemo

Question 14

transitional cell carcinoma

Answer 14

very frequent recurrence

must continually do surveillance

Question 15

uti people at risk

Answer 15

premature infants
sexually active and pregnant women
women on antibiotics that disrupt vaginal flora, spermicide users
people with indwelling catheters
DM
neurogenic bladder
UT obstruction

Question 16

cystitis

Answer 16

inflammation of the bladder

Question 17

cystitis s&s

Answer 17

dysuria, frequency, urgency, pain, hematuria

Question 18

cystitis dx & tx

Answer 18

Most important to examine urine for bacteria
Treat with microorganism specific antibiotic
Three to five days treatment is common

Question 19

pyelonenephritis

Answer 19

Infection of renal pelvis and interstitium
caused by: 
bacteria
kidney stones
pregnancy
neurogenic bladder
instrumentation
female sexual trauma

Question 20

acute pyelonephritis

Answer 20

Spread via the ureters or bloodstream
Infection causes infiltration of WBC with renal inflammation and purulent urine
Release of phagocytic lysozymes and other inflammatory mediators may damage tubular cells
Glomeruli are usually spared
Healing includes scar tissue and atrophy of affected tubules

Question 21

acute pyelonephritis cm, dx, tx

Answer 21

- Present with:
fever
chills
flank or groin pain
frequency
dysuria
costovertebral tenderness
- Dx established by urine culture
- Responds to 2 weeks of microorganism specific antibiotics

Question 22

chronic pyelonephritis

Answer 22

Persistent or recurrent autoimmune infection
One or both kidneys involved
More likely seen in patients who have renal infections d/t obstructive problems
Obstruction prevents elimination of bacteria causes gradual destruction of tubules
May lead to CRF

Question 23

glomerulonephritis

Answer 23

Inflammation of the glomerulus
Caused by immunologic abnormalities, drugs/ toxins, vascular disorders, systemic disease
Immunologic alterations most frequent cause (scarring, # of glomerular cells, etc)
Glomerulonephritis is the most common cause of CRF and ESRD

Question 24

glomerulonephritis 3 immune mechanisms

Answer 24

deposition of circulating soluble complexes
formation of antibodies against glomerular basement membrane
streptococcal release of neuramidase

Question 25

glomerulonephritis s&s

Answer 25

- hematuria with RBC casts - proteinuria exceeding 3-5g/day - renal insufficiency after 10-20 years

Question 26

glomerulonephritis dx, tx

Answer 26

Confirmed by urinalysis Serum creatinine is Creatinine clearance evaluates extent of damage Treat primary disease (dependant on type) and accompanying problems

Question 27

renal insufficiency

Answer 27

25% normal function or a GFR of 25-30 ml/min. ( serum creatinine and urea)

Question 28

renal failure

Answer 28

ESRF = <10% renal function left

Question 29

azotemia

Answer 29

Increased serum urea levels and frequently increased creatinine levels in the blood

Question 30

acute renal failure

Answer 30

Abrupt reduction in renal failure Oliguria (output of <30ml/hr or <400 ml/day) Elevated BUN and creatinine Reversible if dx. & tx. early May be caused by severe hypotension, vascular obstruction, severe glomerular disease, sequela to radiocontrast media administration Classified as prerenal, intrarenal or postrenal

Question 31

prerenal ARF

Answer 31

from hypovolemia, hypotension

Question 32

intrarenal ARF

Answer 32

acute tubular necrosis

Question 33

postrenal ARF

Answer 33

obstruction

Question 34

intrarenal acute tubular necrosis

Answer 34

When caused by ischemia, most common cause is surgery, but may also be d/t sepsis, obstetric complications, severe burns or trauma (also severe hypotension with hypovolemia)

Question 35

ATN dx & tx

Answer 35

diagnosis dependent on cause | tx goal is to maintain life until renal function resumes ie dialysis

Question 36

factors in CRF

Answer 36

``` Creatinine and urea clearance Sodium and water balance Potassium balance Acid-base balance Phosphate and calcium balance Hematocrit Lipids Proteins Carbohydrates ```

Question 37

CRF clinical s&s

Answer 37

``` anorexia nausea vomiting diarrhea weight loss pruritus edema neurologic changes ```

Question 38

CRF dx

Answer 38

``` Blood values BUN, creatinine Ultrasound IVP Renal biopsy Symptoms ```

Question 39

CRF tx

Answer 39

``` Dietary management Sodium and fluids Potassium Caloric intake Erythropoietin Dialysis Transplant ```