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Pathophysiology slides; spring term (first year)
Renal and urinary pathophysiology
85
Nursing
Not Applicable
04/20/2010

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Cards

Term
Electrolytes that move out at PCT
Definition

Na+

H2O

Glucose

Amino acids

Cl

HcO3

K+

Mg

Ca

urea

 

Term
electrolytes that move in to the PCT
Definition

H+

NH4

Term
electrolytes that move out at the Loop of Henle
Definition

H2O

Cl-

K+

Na+

Term
Electrolytes that move out of DCT
Definition

Ca++

Cl-

Na+

Term
electrolytes that move in to DCT
Definition

H+

K+

 

Term
Glutamine splits to
Definition

NH4 (moves into PCT)

HCO3 (moves out of PCT)

Term
collecting duct
Definition
H2O is pulled out of urine
Term
juxtaglomerular cells
Definition
secrete rennin upon dec. GFR
Term
juxtaglomerular apparatus
Definition
afferent arterioles stretched-->inc. GFR-->macula densa cells sense(inc. GFR or stretch?)-->macula densa send signal to slow down GFR
Term
normal GFR
Definition
125 ML/Min
Term
GFR determined by
Definition

filtration pressure in glomerulus

permeability of glomerular membrane

Term
main force for filtration pressure
Definition

hydrostatic pressure in the glomerular capillaries

also plasma oncotic pressure

Term
GFR regulated by
Definition

1. SNS

2. Autoregulation

Term
autoregulation of GFR
Definition

afferent arteriole stretch-->tubuloglomerular feedback(?)-->macula dense sense inc. GFR, send signal to glomerulus to dec. GFR

 

Vasoactive prostaglandins involved

Term
SNS action
Definition
constrict/dilation of BV's
Term
juxtaglomerular cells
Definition

1) secrete rennin-->angiotensin II

2) endothelial cells in glomerular capsule have ACE capabilities-->constrict afferent or efferent arteriole

3) erythropoetin

4) activate vitamin D

Term
cystitis risk factors
Definition
chemical irritants, foreign bodies, immobility, bladder dysfunction-->urine stasis, bacteria, fungi, parasites, sexual activity, spermicides, DM, poor hygiene, dehydration, more common amond fem., age (dec. muscle tone)
Term
common UTI agents
Definition

E. Coli

proteus

enterobacter

Term
# of nephrons in human kidney
Definition
1 million
Term
cranberry juice
Definition
lowers PH
Term
no evidence of renal failure till
Definition
75% is destroyed
Term
kidney priorities (?)
Definition

1) F & E balance

2) eliminate water soluble waste

Term
Cystitis defenses
Definition

dilution of urine, voiding of urine

urea, low PH (cranberry juice)

premenopausal, prostatic secretions

Term
cystitis clinical manifestations
Definition

10% asymptomatic

frequency, dysuria, suprapubic pain, cloudy urine, hematuria

Term
cystitis pathogenesis
Definition
invasion of pathogen-->inflammation of urinary tract
Term
cystitis diagnostics
Definition

dipstick (nitrates, pos. WBC)

UA: bacteria, RBC's WBC's

culture may not be performed

Term
Tx for isolated cystitis
Definition

young fem.: 3 day course of antiBx

young male: 7-10 day course of antiBx

fem. >65: 10 day course of antiBx

male > 65: 14-28 day course of antiBx

Term
persistant bacterial infections r/t structural problems
Definition
catheters, calculi, prostatitis, congenital structure, BPH, bowel incontinence
Term
all Pt's should:
Definition

avoid caffeine, ETOH, Chocolate, spicy food, tomatoes, some berries

 

inc. fluid intake/cranberry juice

 

some fem. are given low dose prophylactic

Term
Acture pyelonephritis defenses
Definition
same as cystitis, plus vesicoureteral junction
Term
acute pyelonephritis risk factors
Definition

same as for cystitis.

vesicoureteral relfux

pregnancy

neurogenic bladder

urinary obstructions

Term
acute pyelonephritis pathogenesis
Definition
pathogens colonize in renal papilla, spreads to parenchyma-->widespread inflammation-->edema-->arterial constriction-->renal scarring
Term
acute pyelonephritis clinical manifestations
Definition

sudden onset of fever and chills

costovertebral tenderness or pain

signs of UTI

(infants children, elderly have more generalized symptoms)

Term
acute pyelonephritis dianostics
Definition

UA: WBC's, RBC's WBC casts(?)

urine culture

CBC: inc. WBC, inc. neutrophils

Term
acute pyelonephritis Tx
Definition
antibiotics, hydration
Term
acute pyelonephritis offending organism
Definition
E. coli (often)
Term
glomerulonephritis (more serious) etiologies
Definition
immune disorders, drug exposure, toxins, vascular disease, systemic disease
Term
glomerulonephritis pathogenesis
Definition
insult to body tissue-->inflammatory cells in bloodstream migrate to glomerulus-->antibody-antigen complex trapped in glomerular basement membrane-->inflamatory damage-->lysosomal enzymes released that degrade glomerular walls-->glomerulus loses selective permeability-->fibrin gets deposited in bowmans capsule-->dec. GFR-->local vasoactive compounds angiotensin, leukotrienes reduce perfusion to glomerular capillaries-->DCT inc. Na+ and H2O reabsorption .
Term
glomerulonephritis clinical manifestations
Definition

gross hematuria, red cell casts, white cell casts

proteinuria

azotemia and oliguria

edema and fluid volume excess

periorbital edema

inc. BP

 

Term
glomerulonephritis diagnostics
Definition

Hx of recent disease

UA: hematuria, proteinuria, RBC and WBC casts

inc. BUN, inc. Creatinine

antibodies to strep(?)

renal biopsy

Term
glomerulonephritis Tx
Definition

treat causative factor

dialysis

antimicrobials, antihypertensives, steroids, diuretics

restrict Na+ intake

Term
Nephrotic syndrome
Definition
collection of symptoms caused by a variety of renal disorders
Term
nephrotic syndrome clinical manifestations
Definition

edema

hyperlipidemia

hypercoagulability

dec. immunity

vit. D deficiency

hypocalcemia

Term
nephrotic syndrome pathogenesis
Definition

inc. glomerular perm.-->protienuria-->hypoalbuminemia(see below)-->dec. plasma oncotic pressure-->generalized edema. and dec. blood volume-->RAAS activation (leads to salt and water retention) and ADH secretion (water retention)

 

Hypoalbuminemia-->stimulation of liver synthesis-->hyperlipidemia(?) and excess clotting factors

Term
nephrotic syndrome Tx
Definition

Tx underlying disease

steroids

sodium restriction

rest

diuretics

Diet: low NA, low fat, adequate to high protein

Vit D, iron, calcium

Dialysis, transplant

Term
renal calculi
Definition

4x more likely in men

50-60% reccurence rate in 10 years

Term
pathogenesis of bladder obstruction
Definition
obstruction of bladder outlet-->retained urine-->trabeculae, diverticula, hypertrophy of detrusor muscle-->tortuous ureters-->hydronephrosis-->renal failure-->death
Term
renal calculi physical findings
Definition

inc. concentration of solute

abnormal urinary pH

low urine volume

lack of stone formation inhibitors (citrates and magnesium)

Term
Calcium Oxalate renal calculi etiologies
Definition

excess bone reabsorption of calcium

abnormal large intake of Ca or vit. D

impaired renal Fx

hyperabsorption of oxalate (soy prod., IBD)

bowel surgery

overdose of Vit C

genetics

fat malabsorption

Term
Struvite renal calculi
Definition
usually proteus bacteria, contains enzyme that splits urea into 2 ammonia molecules. this raises urinary pH, stones form that include phospate
Term
 cause inc. uric acid
Definition
Gout, purines, chronic diarrhea, medications that cause rapid cell destruction
Term
uric acid renal calculi
Definition

from inc. uric acid

urinary pH too low

high purine intake

Term
cystine renal calculi
Definition
hereditary, rare
Term
renal calculi pathogenesis
Definition
crystals form in renal pelvis-->migrate down ureter towards bladder-->ureter is traumatized and blocked-->hydroureter and hydronephrosis
Term
renal calculi clinical manifestations
Definition

ureteral colic pain

sudden onset

proceeds quickly to intense, severe, and sharp

starts in flank, migrates to ipsilateral groin

Term
renal calculi diagnostics
Definition

physical findings

UA: hematuria, urine pH, WBC

serum BUN and creatinine to check renal Fx

KUB or CT or IVP to locate stone

Term
renal calculi Tx
Definition

lithotripsy

prevention of future stones

calcium: consume adequate Ca and Vit D

Oxalate: peanuts, rhubarb, tea, coffee, spinach, nuts, chocolate

uric acid: limit organ meats, fish, purine rich food

struvite: prevent/treat infection

Term
prevention of future stones
Definition

dilute urine (2L or more a day)

medications

high fluid intake, reduce Na+, adequate K+, fruits and vegetables

dec. calculus forming material (calcium, oxalate, uric acid, struvite)

Term
acute renal failure
Definition

sudden severe dec. in renal Fx that is potentially reversible (deadly in the moment but better than chronic)

dec. GFR, oliguria/anuria, azotemia

Term
azotemia
Definition
nitrogenous compounds breaking down in blood. inc. BUN
Term
uremia
Definition
when azotemia becomes symptomatic
Term
risk factors for ARF
Definition
atherosclerosis, HTN, DM, CHF, liver disease(hepatorenal syndrome-->loss of perfusion to kidneys, renal vasoconstriction), advanced age
Term
ARF medications
Definition
ACE inhibitors, diuretics, ASA, NSAIDS
Term
prerenal failure is caused by
Definition

diminished perfusion to kidneys (dec. MAP):

hypovolemia

volume shifts

dec. CO (HF)

MI

inc. vascular resistance (HTN, atherosclerosis)

vascular obstruction (renal infarction)

septic shock (not enough CO?)

Term
intrarenal failure caused by
Definition

acute tubular necrosis (eventual symptom of all renal failures):

trauma

antiBx

severe muscle exertion (rhabdomyolysis-->urine very dark)

infectious disease

metabolic disorders (diabetes)

glomerulonephritis

vascular lesions

solvents

pesticides

heavy metals

Term
postrenal failure caused by
Definition

obstruction of urinary flow at renal pelvis or below:

ureteral obstruction (surgeries, hysterectomy)

bladder obstruction

urethral obstruction

stones

cancer

BPH

Term
MAP
Definition

systolic + diastolic + diastolic

3

 

(diastolic is added twice because the heart spends twice as much time in systole)

Term
prerenal failure
Definition
MAP drops below 70 (afferent arteriole won't expand), autoregulation fails, GFR drops sharply
Term
prerenal failure pathogenesis
Definition

dec. GFR-->dec. filtrate-->RAAS system activated-->Na+ and H2O retention--dec. UO-->azotemia

 

Dec. GFR-->renal endothelial ischemia-->release of vasoconstrictors and inhibition of vasodilators-->ischemia of nephron-->acute tubular necrosis

Term
macula densa
Definition

sense flow and inc. or dec. GFR

(involves vasoactive prostaglandins, ASA and NSAIDS can cause kidney disease)

Term
JG cells
Definition
Rennin
Term
angiotensin II
Definition
can enter glomerulus
Term
endothelin I
Definition
vasoconstrictor
Term
postrenal failure pathogenesis
Definition

obstruction of urine flow distal to kidney--> inc. in retrograde pressure into kidney-->inc. pressure in bowmans capsule(tubule starts degrading, ATN)-->opposition to GFR-->dec. urine formation-->azotemia

 

Build-up of retrograde urine in nephron-->ischemia of nephron-->ATN(sides of tubules start shedding, blocks tubules)

Term
intrarenal failure pathogenesis
Definition
precipitating disease process (prerenal, postrenal, transfusion reaction, nephrotoxin, inflammatory disease(pyelo and glomerulonephritis))-->ischemic renal tubules shed intracellular debris into lumen of tubule-->lumen obstructs-->filtrate backs up into tubule to form retrograde pressure-->inc. pressure in bowmans capsule-->GFR slows profoundly-->dec. renal perfusion overall-->kidney becomes hypoxic-->renal blood vessels become clogged with products of inflammation--> kidney ceases to Fx
Term
phases of acute renal failure
Definition

1. oliguric phase (1-2 wks), collection of debris in tubules, UO<500ml/24hr

2. diuretic phase (2 days-2 wks), very large diuresis, >500ml/24hr (kidneys starting to recover, many people still die becuase urine still cannot be concentrated)

3. convalescent phase (3-12 months) kidneys regain normal Fx

Term
acute renal failure diagnostics (serum)
Definition

inc. creatinine

inc. BUN (urea)

dec. Na+(normal or diluted)

inc. K+ (biggest issue)

dec. Ca++ (hypocalcemia)

inc. PO4- (hyperphosphatemia)

inc. Mg++ (do not give MOM)

dec. HCO3-

dec. arterial pH

dec. H/H (erythropoietin)

Term
ARF diagnostics (urinary)
Definition

dec. or fixed specific gravity

inc. glucose

inc. protein (degradation of bowmans)

inc. RBC

inc.WBC

dec. creatinine

(also xray US CT nuc-med to asess renal blood flow and kidney structure)

Term
Chronic renal failure
Definition

progressive loss of renal function over months to years

can be slowed but is ultimitely irreversible

ESRD if not treated with dialysis or transplant is fatal

GFR <60 for months

Term
chronic renal failure etiologies
Definition

ATN

congenital kidney conditions

polycystic kidney conditions

infections

renal cancer, benign renal tumors

systemic diseases: DM (#1 cause), HTN, lupus, others

 

Term
chronic renal failure pathogenesis
Definition
tubular atrophy-->glomerulosclerosis-->fibrosis, infiltrates
Term
Stages of Chronic renal failure
Definition

1. Dec. renal reserve (dec. GFR): <75% nephron loss, no s/s, BUN/Creatinine normal

2. Renal insufficiency: 75-90% nephron loss, slight elevation in BUN/creatinine, polyuria, nocturia, may be controlled by diet/meds

3. end stage renal disease: >90% loss, azotemia, uremia, F&E abnormalities, renal osteodystrophy (Ca-->bones become malformed), dialysis or transplant

Term
clinical manifestations of ESRD
Definition

anuria leads to fluid overload: (JVD, rales, bounding pulse, HTN, peripheral edema, "megalies"

renal diabetes (glucagon is metabolized in kidneys, so it stays in system pulling glucose into bloodstream?)

rennin causes RAAS which causes fluid overload

hormone irregularities (infertility, impotence, amenorrhea, dec. libido)

osteodystrophies

Term
chronic renal failure diagnostics
Definition

same as for acute

 

Term
chronic renal falure Tx
Definition
nutritional, meds, dialysis, transplant
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