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PC705 - Renal and Integumentary Disorders

Terms in this set (115)

Most common mineral that causes kidney stones are?
Calcium, especially calcium oxalate and calcium phosphate.
Obstruction by a stone will cause what?
Hydronephrosis, hydroureter or both.
Obstruction by a stone over time will cause what?
Tubulointerstitial fibrosis or cellular destruction and death of the nephrons of the kidney.
Risk factors for nephrolithiasis?
Male gender
Develop after 50
Inadequate fluid intake
Geographic location d/t heat, humidity
Food with phosphorus like chips and Colas
What is renal colic?
pain that comes and goes with the peristalsis of the ureter that is trying to move the stone as it does urine. With each contraction of the ureter, there is pain. The pain will also be along the sensory dermatomes.
What is renal agenesis?
Absence of one or both kidney may be unilateral or bilateral, and may occur randomly or hereditary.
Unilateral renal agenesis is most common in _____ and is missing the _____ kidney.
Males
Left
Extra-renal congenital abnormalities are relatively more common in _______ renal agenesis.
Unilateral.
What renal manifestation is associated with wide-set eyes, "parrot beak" nose, low-set ears, and receding chin?
Potter syndrome (bilateral renal agensis).
What is hypospadias?
Congenital condition where urethral meatus is located on the ventral site or undersurface of the penis.
Chordee or penile torsion may accompany what condition?
Hypospadias.
Chordee is what?
Shortage of skin on the ventral surface causes the penis to bend or to bow ventrally.
Penile torsion is what?
Counterclockwise twist of the penile shaft.
What is epispadias in males?
Urethral opening is on the dorsal surface of the penis.
What is epispadias in females?
Cleft along the ventral urethra usually extends to the bladder neck.
Majority of children with epispadias can achieve urinary _______?
Continence.
When does autosomal dominant polycystic kidney disease present?
Late childhood or adulthood.
What occurs in polycystic kidney disease (AD)?
Cyst formation and obstruction accompanied by the renal parenchyma (body of the kidney), and interstitial fibrosis and loss of functional nephrons.
Which form of polycystic kidney disease is most common?
Autosomal dominant.
What occurs in autosomal recessive polycystic kidney disease?
Cystic changes in the kidney and liver and often first suspected on a prenatal ultrasound.
The child will have systemic hypertension in which type of polycystic kidney disease?
Autosomal recessive.
What is nephroblastoma a.k.a. Wilms Tumor?
Embryonal tumor of kidney arising from epigenetic and genetic changes that lead to abnormal proliferation of renal stem cells (metanephric blastema) and diagnosed between 1 and 5 years of age.
Nephroblastoma is most common in?
Females and African American.
Clinical manifestations of nephroblastoma?
Enlarging asymptomatic upper abdominal mass in a healthy, thriving child. Vague abdominal pain, hematuria, fever and hypertension.
Specific age-related renal changes are?
Decreased kidney size
Decreased renal blood flow (RBF) and glomerular filtration rate (GFR)
Decreased number of nephrons from renal vascular and perfusion changes
Decreased tubular transport response
Decreased elimination of drugs
Increased sclerotic glomerular capillaries (meaning scarred or hardened)
Increased excretion of glucose
Increased bladder symptoms such as urgency, frequency, nocturia
Decreased ability to conserve salt and water which leads to hyperosmalarity.
Decline in renal activation of Vitamin D
Plasma creatinine concentration.
Is produced by muscles. Is most valuable for monitoring the progress of chronic rather than acute renal disease. Measures progressive renal dysfunction.
Plasma cystatin C concentration.
Plasma protein is freely filtered at the glomerulus.
Measures progressive renal dysfunction.
Blood urea nitrogen (BUN).
Varies as a result of altered protein intake and protein catabolism. Is a poor measure of GFR. Is a better indicator for hydration status. Increases in dehydration and kidney failure.
Which test is the most widely used test for kidney infection?
Urinalysis.
Normal urine color?
Clear, light yellow because the urochrome and other pigments.
When formed substances (crystals, blood cells, casts) are in the urine, it appears?
Turbid.
The protein in the urine create marked _______ when shaken and is yellow or orange when the urine contains _____ pigments.
Foaming, bile.
Urine is more ________ after eating and then becomes less _________ before the next meal.
Alkaline, alkaline.
Because sleep is accompanied by intermittent hypoventilation, urine is more _________ on awakening.
Acidic.
Dipstick evaluations may be falsely ______ when urine pH is less than 6 and falsely ______ when the pH is more than 7.
High, low.
If a large number of red blood cells are present, this is known as?
Hematuria.
Red cell casts indicate?
Bleeding into the tubules.
White cell casts are associated with an?
Inflammatory process.
Epithelial cell casts indicate?
Degeneration of the tubular lumen or necrosis of the renal tubules.
Crystal formation is diagnostically significant, usually indicating?
Inflammation, infection or metabolic disorder.
Finding of WBC casts reflects a kidney infection because these casts are not?
Formed in the bladder or prostate.
Reagent strips (dipstick) for detecting other substances such as?
Glucose, bilirubin urobilinogen, leukocytes esterase and nitrates, ketones, proteins, hemoglobin and myoglobin.
What is acute pyelonephritis?
Infection of one or both upper urinary tracts (ureter, renal pelvis and kidney interstitium).
What are the most common underlying risk factors for acute pyelonephritis?
Urinary obstruction and reflux of urine from the bladder.
Clinical manifestations of acute pyelonephritis in children?
Chills, fever, flank or abdominal pain along with enlarged kidney(s) caused by edema.
Primary organism in acute pyelonephritis is?
E.coli, Klebsiella, Proteus, and Pseudomonas.
Clinical manifestations for acute pyelonephritis is?
Acute with fever, chills, flank or groin pain, frequency, dysuria and costovertebral tenderness. Older adults may have nonspecific symptoms such as low-grade fever and malaise.
What is acute glomerulonephritis?
Renal diseases in which glomerular inflammation is caused by immune mechanisms that damage the glomerular capillary filtration membranes including endothelium, basement membrane and epithelium (podocytes).
Classic symptoms of acute glomerulonephritis include?
Sudden onset of hematuria including red blood cell casts and proteinuria. In severe cases these symptoms accompany edema, hypertension and impaired renal function.
Which condition is a cause of an upper urinary tract obstruction?
Kidney stones.
Which bacteria is the most common cause of urinary tract infections?
E. coli.
Most common type of adult glomerulonephritis and occurs after a viral infection is?
Berger disease.
Berger disease is?
It is an immunoglobulin A (IgA) nephropathy where there is a binding of abnormal IgA to mesangial cells in the glomerulus resulting in injury and mesangial proliferation and sclerosis.
Clinical manifestations of Berger disease are?
Hematuria with RBC cast causing a smoky, brown-tinged urine.
Proteinuria exceeding 3-5 grams/day with albumin.
Low serum albumin
Edema
Oliguria is seen in severe or progressive disease
Nephrotic sediment contains massive amounts of protein and lipids, and either a microscopic amount of blood, or no blood.
What is the most common immune complex mediated renal disease in children ages 5 to 15 years and it is a representative of acute glomerulonephritis?
Acute Poststreptococcal Glomerulonephritis.
This occurs after a throat or skin infection with certain strains of Group A beta-hemolytic streptococci.
Acute Poststreptococcal Glomerulonephritis.
Clinical manifestations of acute poststreptococcal glomerulonephritis?
Sudden onset of hematuria with RBC cast, proteinuria accompanied by renal salt and retention, edema, and HTN. Care is supportive. In severe cases you will see azotemia which is a decreased GFR.
Over-active bladder is?
A chronic syndrome of detrusor overactivity in the absence of infection. Characterized by urgency with involuntary detrusor contractions during the bladder filling phase.
It occurs when urine is involuntarily lost with increases in intra-abdominal pressure (sneezes or laughs real hard), due to the weakening of the pelvic muscles or the fascial support of the bladder and urethra.
Stress incontinence.
Is the involuntary, sudden leakage of urine along with, or immediately following the sensation of a need to urinate, usually due to an overactive detrusor muscle.
Urge incontinence.
Stress and urge incontinence is fairly common among women.
Mixed incontinence.
Disruption of nervous communication that governs our ability to void.
Neurogenic bladder.
Obstruction of the urethra, as in benign prostatic hyperplasia (BPH) will cause what kind of incontinence?
Overflow incontinence.
No time to find a toilet will result in what kind of incontinence?
Functional incontinence.
Nighttime wetting is called?
Enuresis.
What are the associations with enuresis?
Obstructive sleep apnea, ADHD, anxiety, depression and oppositional defiant disorders.
Child who has experienced a period of dryness of at least six months after toilet training becomes incontinent again is called?
Secondary incontinence.
What is urinary tract infection?
Inflammation of urinary epithelium d/t bacteria from gut flora. Occurring anywhere along urinary tract including urethra, bladder, ureter, or kidney.
Causes of UTIs are?
Cystitis - Bladder inflammation
Pyelonephritis - Inflammation of upper urinary tract
Uncomplicated UTI - Occur in a normally functioning urinary system
Complicated UTI - Occur with defects in urinary system or in individuals with health problems
Those at risk for UTIs are?
Premature newborns, prepubertal children, sexually active and pregnant women, women treated with antibiotics that disrupt vaginal flora, spermicide users, estrogen-deficient postmenopausal women, individuals with indwelling catheters, persons with DM, neurogenic bladder, urinary tract obstruction.
What is cystitis?
Is an inflammation of the bladder and is the most common side of UTI.
More common in women because of the shorter urethra and the closeness of the urethra to the vagina and anus is?
Cystitis.
Frequency, urgency, dysuria and suprapubic and low back pain are clinical manifestations of what?
Cystitis.
Interstitial cystitis is what kind of condition?
Is a condition that includes non-bacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal) and noninfectious cystitis (radiation, chemical, autoimmune, hypersensitivity).
Allergic contact dermatitis (inflammatory disorder) is associated with?
Delayed hypersensitivity (type IV).
Allergens that can form the sensitizing antigen in allergic contact dermatitis are which ones?
Microorganisms, chemicals, foreign proteins, drugs, metals, latex. Contact with poison Ivy is a a common example.
What are manifestations of allergic contact dermatitis?
Erythema, swelling with pruritic (itching) vesicular lesions in area of allergen contact.
Irritant contact dermatitis (inflammatory disorder) is what?
Nonimmunologically-mediated inflammation of the skin.
Atopic dermatitis (inflammatory disorder) is _____ mediated.
IgE (type I hypersensitivity).
Atopic dermatitis is most common in?
Children and usually improves with age.
Clinical manifestations for atopic dermatitis and can be found where on the body?
Lesions are very itchy and may ooze and crust.
Antecubital spaces, on the face, behind the ears, and on the wrist.
If a person scratches a lot and skin thickens, what is this called?
Lichenification.
You are seeing a 39 year old female who tells you that she has been embarrassed to go out in public and shows you her scaly area in the nasal labial folds on her face. What is this called?
Seborrheic dermatitis (inflammatory disorder).
Psoriasis (inflammatory disorder) is what kind of condition?
Inherited, inflammatory condition with immune system involvement that causes hyperproliferation of the skin. Papules and plaques with an overlying silvery scale.
Where does psoriasis occur?
Knees, elbows, the lower back, and the scalp, nails.
You notice a herald patch on a patient and he states it has been itching. You suspect what?
Pityriasis rosea (inflammatory disorder).
Sensitivity to sun and flushing to the face is seen in what disease? What are they supposed to avoid d/t vasodilation?
Acne rosacea (inflammatory disorder).
Hot drinks and/or alcohol.
Urticaria (hives) is another form of which dermatitis'?
Contact and allergic.
Most common skin disease that affects 12 to 25 year olds?
Acne vulgaris (inflammatory disorder) and affects males the most.
Fever, headache, fatigue, and a characteristic skin rash called erythema migrans is from and causes and if left untreated can infect what?
Tick bite (deer or mouse tick [parasitic disorders] lyme disease.
Joints, heart, nervous system.
Headache, fever, nausea, vomiting, muscle aches, and a macular or maculopapular rash on the wrist and ankles is caused by?
Rocky Mountain Spotted Fever (tick bite [parasitic disorders] that passes spirochete rickettsia).
They are surface dwellers and lay nits on hair shafts! What are they called and which different forms are there?
Lice (parasitic disorders)
Pediculosis pubis (crab lice)
Pediculosis capitis (head lice)
Pediculosis corporis (body lice)
Hands and wrists are often infested by these parasites?
Scabies.
Clinical manifestations for scabies?
Small, erythematous papules with dry scale or crust and linear burrows.
This sucker punctures the skin, are vampires and then leave you hanging. leaving behind a red spot (with a papule or a little swelling) and cause intense itching.
Chiggers.
Keloids are?
Rounded, firm, elevated scar tissue with irregular claw-like margins. Always bigger than the original wound.
Basal Cell Carcinoma is?
The most common benign type of skin cancer. Depressed center, rolled edges, and the well-defined borders. UV radiation and sun exposure put you at risk.
Squamous cell carcinoma sometimes?
Metastasize.
It is a benign tumor, smooth or warty elevated lesions?
Seborrheic keratosis.
Older people, seen on chest, back and face.
Caused by prolonged exposure to UV radiation and highest incident in light-colored people.
Actinic keratosis.
Is a lethal cancer if untreated?
Melanoma.
What are the ABCDE's of melanoma?
A - asymmetrical
Does the mole or spot have an irregular shape with two parts that look very different?
B - border
Is the border irregular or jagged?
C - color
Is the color uneven?
D - diameter
Is the mole or spot larger than the size of a pea?
E - evolving
Has the mole or spot changed during the past few weeks or months?
This viral infection is also known as Shingles.
Herpes Zoster and usually unilateral on body. Eruption is painful and it occurs as vesicles along a dermatome.
Benign papilloma's caused by the DNA containing papillomaviruses.
Verrucae (warts).
Communicable, viral disease, rash is macular and blotchy, begins on the face and spreads to the appendages, high fever and Koplik spots on the buccal mucosa, photosensitivity and cold-like symptoms.
Measels.
Usually caused by staphylococci or streptococci and an acute, contagious skin disease characterized by vesicles, pustules, and yellowish crust.
Impetigo and school-aged child should stay home until lesions have cleared.
Has one single "pus-head"?
Furuncle.
Has several "pus-heads"?
Carbuncle.
Reddened, inflamed skin, it is usually caused by staphylococci, streptococci, and MRSA.
Cellulitis.
A fungal infection is called?
Tinea. Erythematous macules or plaques with a peripheral scaling a central clearing.
Tinea capitis of the scalp
Tinea barbae of the beard
Tinea faciei of the face
Tinea corporis of the trunk
Tinea manus of the hand
Tinea cruris of the groin
Tinea pedis of the foot
Prolonged skin moisture, occlusive clothing, topical agents, skin trauma and poor hygiene are associated with what kind of bacterial infection?
Folliculitis.
This fungi is found on mucous membranes, on skin, GI tract, vagina.
Candidiasis (whitish yellow curdlike substance over infected area).
Is the flow of urine retrograde from the bladder?
Vesicoureteral reflux.
Clinical manifestation for vesicoureteral reflux?
Asymptomatic, recurrent UTIs, unexplained fever, poor growth and development, irritability and feeding problems,
Geriatric changes!
Skin becomes thinner, drier, wrinkled, changes in pigmentation, capillary loops shorten and decrease, sebaceous, eccrine, and apocrine glands atrophy, temperature regulation is compromised, pressure and touch receptors and free-nerve endings decrease in number, protective functions of skin also decrease.
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