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Patho Renal Bladder
Definitions, symptoms of renal and bladder pathophys: copstead, banasik
| Question | Answer |
|---|---|
| dysuria | difficult or painful urination |
| incontinence | loss of control of urination due to a variety of factors |
| stress incontinence | increased intraabdominal pressure in the presence of lax urinary sphincters |
| urge incontinence | strong and immediate urge to void brought about by involuntary detrusor overactivity |
| functional incontinence | loss of urine as a result of factors external to the urinary tract, ie physical or cognitive impairment, that inhibits continence |
| overflow incontinence | loss of bladder control associated with urinary retention and a bladder overextension due to obstruction, detrusor under/inactivity, or sphincteric malfunction |
| urinary retention | inability to empty the bladder |
| enuresis | involuntary voiding (usually w/ children) |
| primary enuresis | involuntary voiding due to structural abnormalities |
| secondary enuresis | involuntary voiding due to other causes |
| cystitis | inflammation of the bladder urothelium from infection, irritants, foreign bodies, trauma |
| urgency | sudden need to void the bladder |
| frequency | need to void the bladder more than usual |
| hesitancy | difficulty beginning the flow of urine |
| UTI | urinary tract infection: usually lower tract, ie cystitis |
| Where does dilation (hydroureter, hydronephrosis)occur in urinary tract due to an obstruction? | proximal to the obstruction |
| What are the effects on kidneys of hydroureter or hydronephrosis? | GFR, renal perfusion decline, portions become ischemic. Tubular atrophy, destruction of medulla can follow, resulting in scar tissue and poor function of glomeruli |
| Partial obstruction of urinary tract present with symptoms of... | fluid retention: weight gain, nausea, anorexia, malaise, headaches, increased abdominal girth, ankle edema |
| Why does partial obstruction of urinary tract lead to inability to concentrate urine, secrete potassium or hydrogen ions? | moderate decrease in blood flow and GFR |
| What is the most common cause of urinary tract obstruction? | renal calculi (nephrolithiasis; kidney stones) |
| What complications can occur as a result of renal calculi? | prolonged or repeated, may cause scarring of the kidney, or CKD (bilateral calculi) |
| Explain why blood in urine is a symptom of cystitis | increased capillary permeability |
| Explain why urgency is a symptom of cystitis | attempting to flush bacteria; increase in cellular activity due to infection |
| Explain why frequency is a symptom of cystitis | attempting to flush bacteria; increase in cellular activity due to infection |
| Explain why painful (burning) urination is a symptom of cystitis | inflammation |
| Explain why cloudy urine is a symptom of cystitis | increase in WBCs from immune response |
| Explain why foul smelling urine is a symptom of cystitis | bacteria from infection |
| Explain why for older adults, sudden onset of confusion (delirium) is major symptom of cystitis | bacteremia causes toxic byproducts that reach the brain |
| pyelonephritis | bacterial infection (e. coli :feces) may travel up ureters to kidney |
| Explain why sudden onset fever and chills is a symptom of pyelonephritis | infection by bacteria |
| Explain why flank pain (back above hips) is a symptom of pyelonephritis | inflammation of kidney |
| Explain why CVA tenderness is a symptom of pyelonephritis | costovertebral is where ribs meet the spine, vert. 12. Kidneys lie underneath; inflammation causes pressure in this area |
| Explain why WBC casts in urine is a symptom of pyelonephritis | neutrophils as part of inflammation get into distal tubules; when they die get pasted on inside of tubule, then they break off and go through urine |
| Explain why signs and symptoms of cystitis may be a symptom of pyelonephritis | cystitis often occurs before pyelonephritis |
| why do pregnant women tend to get pyelonephritis? | relaxin relaxes ureters, allowing contaminated urine to get into kidneys |
| why does cystitis cause more risk for pyelonephritis? | bladder is already contamined with urine |
| why does vesicouretal reflux increase risk for pyelonephritis (ie children)? | contaminated urine can come up through ureters |
| Common presentation of chronic pyelonephritis | silent except for recurrent lower urinary tract infections as organisms get down into bladder |
| what is most common cause of glomerulonephritis | immune system damages glomeruli; |
| what can happen several to 10 days after an infection with group A streptococcus? | acute poststreptococcal glomerulernephritis; parts of glomerulus can be confused with group A strep cells |
| Why are we particularly interested i antibiotic treatment of "strep throat?" | treat strep A infection immediately so that immune system isn't triggered against it |
| What classification system is used for diagnosis of glomerulonephritis; finding out cause and course of treatment | histologic appearance of glomerular damage |
| How would we classify glomerulernephritis by Clinical progression? | acute, rapidly progressive, chronic |
| what type of glomerulonephritis is characterized by sudden onset; may resolve with treatment (immune suppression) | acute gn |
| what type of glomerulonephritis leads to acute kidney injury | rapidly progressive gn |
| what type of glomerulonephritis leads to leads to chronic kidney disease (ckd) and end-stage renal disease (esrd) | chronic gn |
| What is the difference in appearance between a normal glomerulus and acute poststreptococcal glomerulonephritis? | swollen; packed with immune cells |
| why is oliguria a symptom of acute glomerulonephritis | swelling and increase in cells, fluid is more difficult to filter through glomerulus |
| why is hematuria a symptom of acute glomerulonephritis | breaks in walls of glomerular capillary walls |
| Why are RBC casts in urine a symptom of acute glomerulonephritis | if hematuria, pastes onto walls of tubules and breaks off |
| define cast in terms of urinalysis | dead cells in tubules create a mold of inside walls |
| Why is azotemia a symptom of acute glomerulonephritis | accumulation of nitrogenous wastes in the blood (lab: increased BUN and serum creatinine) |
| Why is edema a symptom of acute glomerulonephritis | b/c of oliguria, not excreting enough water |
| Why is hypertension a symptom of acute glomerulonephritis | renin disturbance b/c of changes in flow through glomerulus |
| chronic glomerulonephritis | not caused by streptococcus; caused by immune system damage |
| How is azotemia manifested in chronic glomerulonephritis | increased nitrogenous waste products in the blood; slow increase in BUN and serum creatinine |
| Why does hypertension +/- mild proteinemia occur in chronic glomerulonephritis | inability to filter enough fluid at proper rate |
| nephrotic syndrome | glomerular membrane loses its normal negative charge |
| What characteristics of normal glomerular structure are affected by glomerulonephritis? | basement membrane holds endothelial cells; made up of endothelial cells and podocytes; provides structure to glomerulus; negatively charged barrier |
| why won't albumin go through glomerular capillary? | Albumin is negatively charged and basement membrane is neg charged; even if enough space through fenestrations, albumin won't go out into urine |
| what will happen if negative charge is lost? | albumin will go out of capillary into the tubules and into urine (all other proteins also) |
| why is massive generalized edema a clinical manifestation of neprotic syndrome? | factors in the kidney cause them to retain Na+ and H2O; counteract osmotic loss of albumi in urine (old answer was that hypoalbuminemia decreased blood colloid osmotic pressure of the glomerulus) |
| why is proteinuria (looks foamy) a clinical manifestation of neprotic syndrome? | proteins are able to go out into urine b/c of loss of neg charge on glomerular capillary |
| why is hypoalbuminemia a clinical manifestation of neprotic syndrome? | albumin is low in the blood because it's leaking out faster than the liver can create more albumin |
| why is high cholesterol a clinical manifestation of neprotic syndrome? | perhaps because it's going wild tying to make albumin; higher rate of synthesis by liver? Mechanism not well known |
| How does nephrotic syndrome increase the risk of infection? | low antibodies -- they are filtering out into urine along with other proteins |
| What is AKI? | acute kidney injury (used to be ARF -- acute renal failure) |
| What is CKD? | chronic kidney disease (used to be CRF -- chronic renal failure) |
| What is ESRD? | end-stage renal disease (used to be CRF -- chronic renal failure) |
| what is acute kidney injury | rapid decrease in GFR, occurs over minutes to days, leading to acute azotemia (and oliguria) |
| why does acute azotemia occur in AKI? | nitrogenous wastes stay in blood because the filtering happens more slowly |
| what is cause in prerenal AKI? | decreased renal perfusion |
| What is cause in intrarenal AKI? | nephron damage |
| What is cause in postrenal AKI? | obstruction of urine flow (distal to nephrons) |
| Cause of prerenal AKI | very low cardiac output; severe ECV deficit |
| Why does oliguria occur in prerenal AKI? | prerenal oliguria is kidney's normal response to decrease in perfusion |
| what can long-term prerenal AKI lead to? | intrarenal AKI |
| What is the factor in intrarenal AKI? | acute tubular necrosis: ischemia over time leads to decrease in function then necrosis; also through nephrotoxic drugs and other poisons |
| why does oliguria occur in intrarenal AKI? | tubules get clogged with dead cells and debris |
| What is acute tubular necrosis? | cells lining the tubules die due to ischemia or nephrotoxic drugs/poisons |
| What are the phases of ATN? | oliguric (or anuric), diuretic, convalescent (from bad to recovery) |
| Why does oliguria or anuria occur in ATN? | tubules are blocked |
| why does oliguric phase of ATN lead to azotemia? | less excretion of nitrogenous wastes |
| why do oliguric phase of ATN have aspects of uremic syndrome? | loss of kidney functions (excretion of ions, water, wastes) |
| what is the characteristic of the diuretic phase of ATN | inability to concentrate the urine; not enough functioning nephrons together to initiate countercurrent system in order to concentrate |
| postrenal AKI | ureters, bladder, urethra (prostate); obstruction of urine flow; increased pressure back up to kidneys opposes capillary filtration pressure |
| what happens if the GFR is too low (ATN) | azotemia |
| chronic kidney disease | progressive decline in GFR; GFR is below normal for at least 3 months |
| Stages of CKD | decreased renal reserve; renal insufficiency; end-stage renal disease |
| < 70% of nephrons lost | no signs and symptoms; stage of decreased renal reserve |
| from 75 to 90% of nephrons lost | inability to concentrate urine; polyuria, nocturia, slight increase in BUN and creatinine; stage of renal insufficiency |
| >90% of nephrons lost | oliguria, azotemia, hyperkalemia; end stage renal disease |
| who will get uremic syndrome | people with AKI and ESRD |
| Why does uremic syndrome include ECV excess? | retention of sodium and water |
| Why does uremic syndrome include edema | retention of sodium and water |
| Why does uremic syndrome include hyperkalemia | decreased excretion of potassium ions |
| Why does uremic syndrome include hyperphosphatemia | decreased excretion of phosphate ions |
| Why does uremic syndrome include hypermagnesemia | decreased excretion of magnesium ions |
| Why does uremic syndrome include metabolic acidosis | decreased excretion of metabolic acids |
| Why does uremic syndrome include azotemia | decreased excretion of nitrogenous wastes |
| Why does uremic syndrome include encephalopathy | decreased excretion of nitrogenous wastes |
| Why does uremic syndrome include sallow color | decreased excretion of nitrogenous wastes |
| Why does uremic syndrome include uremic frost (crystals on skin) | decreased excretion of nitrogenous wastes |
| Why does uremic syndrome include anemia | decreased secretion of erythropoietin |
| Why does uremic syndrome include fatigue | decreased secretion of erythropoietin |
| Why does uremic syndrome include disrupted calcium homeostasis | dysfunctional kidneys activate less vit D than normal |
| Why does uremic syndrome include hypocalcemia (transient) | less Ca absorption from GI b/c of less active vit D |
| Why does uremic syndrome include secondary hyperparathyroidism | hypocalcemia triggers increased PTH secretion |
| Why does uremic syndrome include renal osteodystrophy? | PTH secretion causes calcium and phosphate release from bones (bone resorption) |
| Why does uremic syndrome include pruritis due to calcium phosphate crystals in skin; joint aching, stiffness; conjunctivitis | elevated Ca and Pi in body fluids causes precipitation of calcium phosphate crystals in tissues (and leads to another transient hypocalcemia) |
Created by:
hezasan
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