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Patho Final- Chap 28
renal dysfunction
36
Pathology
Undergraduate 2
12/13/2010

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Cards

Term
common sources of urinary tract obstruction
Definition

renal calculi

Neurogenic bladder

tumors

prostatic hypertrophy

strictures of ureters or urethra

Term
common types of kidney stones
Definition

1. calcium

2 types: calcium oxalate & calcium phosphate

smallest of kidney stones; most common

seen more frequently in middle-aged men

 

2. struvite

most common in women because of their
      increased risk for UTI

are called infection stones

display staghorn formation

 

3. uric acid-- gout

 

4. cystine-- cystinuria is a genetic disease characterized by excessive urinary cystine extretion

Term
Clinical Manfestations of kidney stones
Definition

hallmark: sudden-onset renal colic pain

 

gross or microscopic hematuria

 

Nausea, vomiting, urgency, dysuria

Term
Pathogen. of kidney stone formation
Definition

1. high solute concentration

2. low urine volume

3. altered urine pH

-alkaline --struvite and Ca.phosphate stone formation

-acidic- Ca.oxalate, uric acid, and cystine stone formation

Term
Neurogenic Bladder
Definition

any type of urinary incontinece caused by CNS lesions or lesions of the nerves supplying the bladder

 

is a functional obstruction; depending on the type of damage, it will either cause incontinence or retention with overflow leakage

Term
Renal cell carcinoma
Definition

most common type of renal neoplasm (90%)

 

manifests with classic triad:

hematuria

flank pain

palable flank or abdominal mass

Term
most common sites of metastasis for renal and bladder cancers
Definition

lungs

liver

lymph nodes

bone

Term
bladder cancer
Definition

most bladder cancers arise from transitional epithelium lining the urinary tract;

 

predisposing factors:

occupational exposure to carcinogenic chemicals

chronic UTI, and cigarrette smoking

Term
Clinical manifestations of bladder cancer
Definition

primary manifestation= hematuria

 

also- frequency, urgency, dysuria

Term
Uncomplicated vs Complicated UTI
Definition

Uncomplicated UTI- infection in an individual who is otherwise perfectly healthy and has a normal urinary system

 

Complicated UTI- infection in somone who has an abnormal immune system or another condition that compromises their immune system and responsiveness to treatment

Term
Cystitis
Definition

Inflammation of the bladder; a lower UTI
bladder is the most common site for UTI

 

most cases result from bacterial invasion from the urethra; Diagnosis is based on urinalysis (w/ E.Coli being most common causative agent)

Term
Clinical Manifestations of Cystitis
Definition

Triad: frequency, urgency, dysuria(painful discharge/burning upon urination)

suprapubic pain

Term
Nonbacterial Cystitis
Definition

Urethral syndrome: acute form of nonbact. cystitis; UTI symptoms without evidence of bacterial infection

Symptoms= frequency, urgency, dysuria, dyspareunia; occurs mostly in women

 

Interstitial Cystitis: chronic; S&S= frequency, urgency, pain on bladder filling; occurs mostly in women; Antiproliferative Factor is in the urine of people w/ IC; APF blocks the growth of cells lining the bladder wall

 

Term
Acute Pyelonephritis
Definition

Inflammation of the renal pelvis and interstitium;

usually d/t ascending UTI; women > men

most common causative agents: pseudomonas, E. Coli, Proteus

 

risk factors: vasicourethral reflux; urinary obstruction

 

renal tubules are the primary renal tissue affected; glomeruli are not affected; does not usually lead to renal failure

 

Term
Clinical Manifestations: Acute Pyelonephritis
Definition

hallmark= costovertebral angle tenderness on palpation

 

sudden onset of fever and chills

flank/groin pain

common triad: frequency, urgency, dysuria

Term
Diagnosis of acute pyelonephritis
Definition

need a urine culture to distinguish from bladder infection

 

presence of WBC casts in urine indicate upper bladder infection as upposed to bladder infection

Term
Chronic Pyelonephritis
Definition

chronic/recurrent kidney infection with scarring and inflammation of the kidney; 2nd leading cause of chronic renal disease

 

ongoing inflammation -->fibrosis and scarring with loss of functional nephrons

 

ultrasonography/IVP shows a small kidney with characteristic clubbing of affected calyces

Term
Glomerular disorders
Definition

result from alterations in the structure and function of the glomerular circulation; damage is mediated by the immune process but is not r/t infection; involve inflammatory processes

 

 

Term
Pathology of Glomerular Disorders
Definition

basement membrane damage causes:

hematuria

proteinuria

RBC casts

Decreased GFR

 

Glomerular damage causes a decrease in GFR d/t

-Decreased glomerular membrane surface area

-Decreased glomerular capillary BF and

-Decreased glomerular capillary hydrostatic pressure

Term
Glomerulonephritis
Definition

inflammation of the glomerulus

 

three types:

1. acute: postinfectious disease

2. rapidly progressive: cause is often unknown; may be secondar to other diseases

3. chronic: autoimmune processes

Term
Secondary manifestations of proteinuria
Definition

hypoalbuminemia

hyperlipidemia

hypercoagulability

lipiduria

altered immunity

edema

 

Term
Nephrotic Syndrome
Definition

A collection of symptoms caused by glomerular disease

 

involves increased glomerular permeability and protein leakage in urine of 3.5 g/day

Term
Acute Renal Failure
Definition

Sudden loss of renal function; usually reversible

 

may be intrarenal, prerenal, or postrenal

Term
Acute Tubular Necrosis
Definition
Acute renal failure that is intrarenal in nature; the cause is either ischemic or toxic injury to renal tubule
Term
Anuria vs. Oliguria
Definition

anuria= urine output <50 mL/ day

 

 

oliguria= urine output <400 mL/day or <30 mL/hr

Term
Azotemia vs Uremia
Definition

Azotemia= usually caused by renal failure or insufficiency and is the buildup of nitrogenous wastes in the blood  (specifically BUN)

 

Uremia= the clinical manifestations associated with azotemia; usually associated with renal failure; is known as the syndrome of renal failure

Term
Metabolic waste products
Definition
byproducts of protein metabolism that are excreted in the urine
Term

Renal insufficiency

 

vs.

 

Renal failure

Definition

renal insufficiency is a decline in renal function to about 25% of normal or to a GFR of 25-30 mL/min; levels of creatinine and urea are slightly elevated

 

renal failure is a significant loss of renal function; When less that 10% of renal functioning remains, disease is considered as end-stage renal failure

Term
Prerenal Failure
Definition

most common cause of acute renal failure;

all causes of prerenal failure involve a decrease in renal perfusion

 

1. Hypovolemia

    a. water and electrolyte loss

    b. hemorrhage

2. Hypotension

    a. septic shock

    b. cardiac failure

    c. pulmonary embolism

    d. interruption of renal artery flow

Term
Intrarenal Failure
Definition

causes most severe deviation from normal renal function; ATN is most common cause

 

other causes:

prolonged renal ischemia

glomerulopathies

nephrotoxins (pesticides, heavy metals, solvents)

malignant HTN

coagulation defects

Term
Postrenal Failure
Definition

disease is rare because obstruction must be bilateral in order to produce renal failure; caused by:

 

urethral obstruction- edema, tumors, stones, clots

ureteral obstruction- prostatic hypertrophy

bladder obstruction

(urethral strictures)

Term
Stages of Chronic Kidney Disease
Definition

1. decreased renal reserve: <75% of nephrons have been lost; findings: no signs or symptoms, BUN and creatinine levels are normal

 

2. renal insufficiency: 75-90% of nephrons have been lost; findings: polyuria, nocturia, slight elevation of BUN and creatinine, may be controlled by diet and meds

 

3. end-stage renal disease: >90% of nephrons have been lost; findings: azotemia, uremia, fluid and electolyte abnormalities, renal osteodystrophy; dialysis or transplantation needed

Term
4 categories of renal and urinary tract dysfunction
Definition

urinary tract obstruction

 

UTI

 

glomerular disorders

 

 

renal failure

Term
Conditions assoc. w/ urinary tract obstruction
Definition

kidney stones (most common obstructive disorder in adults)

 

tumors

 

prostatic hypertrophy

 

neurogenic bladder

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