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Pathophysiology Renal

Terms in this set (71)

There's a problem with the ________ when hematuria & proteinuria is present.
glomerulus
The glomerulus is the site of fluid filtration from blood to the nephron; More ________ than other capillaries in the body; _______ passage of blood cells and proteins.
permeable/Prevents
________ clearance is a good measure of GFR.
Creatinine
GFR should be ___mL/min.
125
GFR is influenced by _____
volume
Post renal acute renal failure is due to ____
obstruction (BPH, kinked or obstructed catheters, tumors, strictures, Calculi)
If only ___ kidney is affected, the other will _____ production to compensate.
1/increase
Chronic Kidney disease
progressive loss of functioning nephrons.
In Chronic Kidney Disease ___ of nephrons are lost before symptoms manifest.
75%
Chronic Kidney disease risk factors
diabetes, HTN
Normal micturition means
normal urination
The normal bladder capacity (adult) is _______
300/500 mL
Urge to void at about ____ to ____ mL.
150/300
Incontinence is 2 to 3x more common in _____
women
Urge incontinence is common in ______ and males with _____ (overactive detrusor muscle that contracts)
older women/BPH
Incontinence caused by abdominal pressure
stress incontinence
______ is normally cleared of the bladder by flushing urine itself
Bacteria
A CAUTI is a _____ event
sentinel
CAUTI is also known as
Catheter Associated Urinary Tract Infection
A common clinical manifestation for ___________ is costoverterbral angle tenderness.
Acute Pyelonephritis
Due to alterations in the urinary tract, __________ is a major risk for Acute Pyelonephritis.
pregnancy
________ is the causative organism in 80% of Acute Pyelonephritis cases.
E. coli
___________ is characterized by small atrophied kidneys with diffuse scarring.
Chronic Pyelonephritis
What is vesicoureteral reflux (VUR)?
the abnormal flow of urine from the bladder to the upper urinary tract.
Chronic or recurrent infections, Chronic interstitial inflammation, and Reduction in the # of functional nephrons is the pathogenesis of
Chronic Pyelonephritis
Clinical Manifestations may be minimal for __________
Chronic Pyelonephritis
Obstructions of the renal system may be ________ or _______
congenital (anatomical malformation) or acquired (calculi)
Clinical manifestations for a renal system obstruction depends on -
Depends on cause, Location of obstruction, and Size
Lithotripsy
use shock waves to break up stone
Hydronephrosis
enlarged kidney due to dilation
Primary glomerulopathies only the ______ is involved
kidney
injury due to drug exposure, infection, systemic or vascular pathology
Secondary glomerulopathies
Glomerular damage may result in
Hematuria, Proteinuria, decreased GFR, Edema, Hypertension, Abnormal cast (WBC's, RBC's, kidney cells in urine)
Glomerulopathies are classified according to the degree of ______.
proteinuria
Glomerulopathies often follow _____ infections.
strep
Acute Glomerulonephritis are more common in _____.
men
Clinical Manifestations for Acute Glomerulonephritis include
Dark Urine, Oliguria, high BUN/ Creatinine levles
Acute Glomerulonephritis is diagnosed by
BUN & Creatinine levels
Acute Glomerulonephritis may progress into
end stage renal disease
_______ is defined by by urinary elimination of > 3-3.5 g of protein per day secondary to Glomerular damage
Nephrotic Syndrome
Nephrotic syndrome may have clinical manifestations such as
Hypoalbuminemia, Hyperlipidemia, Edema, Hypercoagulability
Tx for Nephrotic syndrome
Diuretics, Lipid lowering meds, Immunosuppressive therapy, Hypertensive therapy
Acute renal failure is characterized by
abrupt deterioration of renal function
At age 80 GFR is of ___ of what it was at age 30
1/2
Acute renal failure has _ broad categories (pre-renal, post-renal, and infra-renal)
3
Pre-renal Acute Renal Failure is caused by
Drug use: ACEI, NSAIDS, ARBs. other causes include burns, Diuretics, and dehydrations.
Post-renal Acute Renal Failure is caused by
Obstruction of normal urine outflow from kidney, BPH, Kinked or obstructed catheters, Calculi
in Post-renal Acute Renal Failure, if one kidney is affected,
the other will increase production to compensate
Which Acute renal failure is Easiest to treat?
Post-renal Acute Renal Failure
______________ is caused by a dysfunction of the nephrons
Intra-renal Acute Renal Failure
Normal creatinine is an indication for(Acute Tubular Necrosis)
full recovery
The recovery phase can last(Acute Tubular Necrosis)
1 week to 1 year
Filtration mechanisms aren't fully recovered and patient may be @ risk for hypovolemia, hypokalemia, azotemia, and uremic syndrome during the _______ phase.(Acute Tubular Necrosis)
diuretic
azotemia
abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood.
__________________ has 3 stages
Acute Tubular Necrosis
Chronic Renal Failure (CRF) is also known as
End Stage Renal Failure (ESRF)
Chronic Kidney Disease has _ stages
3
Decreased renal reserve (CKD stage)
<75% (nephron loss), No S&S, BUN & Creatinine normal, May not be diagnosed
Renal insufficient (CKD stage)
75%-90% (nephron loss), Polyuria, Nocturia, slight elevation in BUN & Creatinine, Controlled by diet & meds
End stage renal (CKD stage)
>90% (nephron loss), Azotemia/ Uremia, Fluid & electrolyte abnormalities, Osteodystrophy, Anemia, Dialysis or transplantation essential
Complications of Uremic Syndrome (p689) include
-Metabolic acidosis
-Electrolyte imbalances
-Renal Osteodystrophy (high PO4/ low Ca+)
Fractures
-Malnutrition
-Anemia (erythropoietin)
Treatment/prevention of acute renal failure
Identify risk factors
-Treat hypoperfusion promptly
-Nephrology consult
-Nutrition
Treatment/prevention of Chronic Kidney Disease
Dialysis, Low protein/high calorie diet, Fluid restrictions, Aluminum hydroxide gel, Diuretics, BG control,
Post-voiding residual volume is about ____ (what's left in bladder)
50mL
Urge incontinence can cause
Bladder infections
Tumors/ radiation
Calculi
Combination of stress & urge incontinence, greater volume leakage can disrupt ADLs
Mixed incontinence
Bladder becomes so full it overflows. Caused by obstruction/Bladder too weak to contract (Spinal injuries/Diabetes)
Overflow incontinence
Physical or environmental limitations that prevent access to toilet in "time"
• Lack of facilities
• Cognitive deficits
• Physical limitations
Functional incontinence
Cystitis (bladder infection) are caused by
Catheterization, Obesity, Pregnancy, Obstruction
Clinical Manifestations of Cystits (bladder infection)
Cloudy urine, Hematuria, Dysuria, Urgency, Frequency
CAUTI's are
The most common nosocomial infection today
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