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Patho Renal Bladder

Definitions, symptoms of renal and bladder pathophys: copstead, banasik

QuestionAnswer
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