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Module 12

Terms in this set (59)

Define glomerulonephritis
Inflammation of the glomerulus that may be caused by any number of factors but is most commonly related to immunologic alterations
4 Main types of Glomerulonephritis
Acute poststreptococcal, IgA Nephropathy, Rapidly progressive glomerlunephritis, and chronic glomerulonephritis
Explain the general pathogenesis of glomerulonephritis regardless of cause
An immune response triggers inflammation and proliferation of glomerluar tissues resulting in damage to the basement membrane. The basement membrane of the glomerular contains a type IV collagen that is a target for autoantibodies. Formation of immune complexes form in the circulation and deposition in glomerlus. Activation of the complement system- recruiting neutrophils and macrophages that release cytokines and toxic oxygen radicals that damage the basement membrane. Since permeability is altered loss of proteins and blood cells release into the urine and further damages leads to activation of coagulation and deposits of fibrin which leads to scarring, decrease GFR and renal failure

Simple steps from notes
1. formation of immune complexes form in glomerlus
2. antibodies produced against strep organism cross-react with glomerluar endothelial cells
3. activation of complement
4. recruitment/activation of immune cells and mediators
Common causes of acute poststreptococcal glomerlonephritits
group a strep- impetigo, strep throat that was inadequately treated
The location of infection usually arising in Berger disease
Viral upper respiratory or GI infection
Crescent shaped lesions are found in what type of glomerlunephritis
rapidly progressive glomerlunephritis
common symptoms of glomerluonephritis
hematuria, edema, proteinuria
which type of glomerluonephritis has a rapid decline
RPGN
which type of glomerluonephritis has a rapid development
IgA or bergers disease
which type of glomerluonephritis has sudden onset after infection
acute poststreptococcal
what occurs in acute poststreptococcal glomerluonephritis
derivative of streptococcal proteins alter immunoglobulin G which combines with host antibodies
What is the role of glomerulus
to remove excess fluid, electrolytes and wastes from the blood stream and pass into the urine.
What are non infectious causes of glomerluonephritis
Vasculitis, SLE, Good pastures, serum sickness
What are infectious causes of glomerluonephritis
Strep A/B
Define Urge incontinence
Sudden and strong desire to urinate with involuntary contractions of detrusor
Define Stress incontinence
Loss of urine when there is an increased abdominal pressure (sneezing, laughing, bending)
Define mixed incontinence
Combination of stress and urge
Define Overflow incontinence
Over distention of the bladder associated with neurologic lesions. leaking of urine from full bladder, lesions below S1 (prostate enlargement)
Define causes of Functional incontinence
Dementia or immobility
Risk factors of incontinence
women, overweight, pregnancy, older age
Three key features that take part in the lower urinary tract function
1. CNS system
2. Bladder Detrusor muscles
3. Pelvis floor muscles (series of 10 muscles, 3 layers)

All three systems must communicate together to have a proper functioning bladder
What leg muscle coordinates/stimulates the pelvic floor muscle
Calf muscle.
Common causes of Incontinence
Bladder irritants, urinary tract infections, constipation, childbirth, pregnancy hormonal changes, enlarged prostate, MS, parkinson's stroke, brain tumor, spinal cord injury
Define Urinary Tract infection
inflammation of the urinary epithelium usually caused by bacterial from gut flora along urinary tract
What are age related physiological changes that lead to incontinence
changes to detrusor muscle
changes in bladder capacity
estrogen related changes
diurnal fluid excretion pattern changes
Define cystitis
Inflammation of the bladder
Define pyelonephritis
Inflammation of the upper urinary tract/kidneys. Specifically ureters, renal pelvis, renal parenchyma
Explain pathogenesis of UTIS
Occurs when the host defence mechanism against infection are not capable of preventing pathogens from attaching to the walls of urethra or bladder. Pathogens attach to the walls of bladder and urethra which prevent flushing and by grouping together to form a biofilm that transports nutrients to bacteria.
Risk factors for UTI
Sexually active women, diabetes mellitus, indwelling catheter, immunosuppression
Common clinical manifestations of cystitis
dysuria, frequency, urgency, pain in lower abdomen, hematuria, foul smelling urine
Common pathogens that can cause UTI
E.coli, staphylococcus, enterobacter,
plus...
klebsiella, proteus, psudomonas, candida, schistosmiasis
Asymptomatic bacteruira is usually asymptomatic however treatment is required in what population
Pregnancy
The most common cause of Pyelonephritis
E.coli, proteus, pseudomonas
Are fever, chills, CNA tenderness, vomiting, flank pain, hematuria, shock, septicemia, more common in UTI or pyelonephritis
pyelonephritis
Predisposing factors for pyelonephritis
BPH, Cancer of kidney, prostate or bladder, renal calculi, renal or neuro abnormalities, TB, HIV, ureteral stents
3 major processes in the production of urine include
1. filtration
2. reabsorption
3. secretion
Location of filtration
outer cortex
Location of reabsoprtion
medella
Location of secretion
medella
what is the functional units of the kidney where blood is filtered substances are reabsorb into blood stream while wastes are secreted into the filtrate for elimination
Nephron
Main case of pyelonephritis
a. bacterial infection
b. holding up urination
c. kidney stones
d. bladder tumor
a. e.coli
Who is most at risk for contracting pyelonephritis and why?
a. men because they suffer more often from kidney stones
b. men because prostate disease is one major risk factor
c. women because they have shorter and wider urethra
d. women because the close proximity of urethra and anus
c. women are more prone to contracting a bacterial infection that moves up from the bladder to kidneys
Which of the following conditions does not increase the risk of pyelonephritis
a. kidney stones
b. pregnancy
c. prostate disease
d. dehydration
d. although concentrated urine may be more easily cause irritation it does not increase the risk of pyelonephritis since this is caused by bacterial infection
Why are diabetics more at risk for developing pyelonephritis
Glucose uptake in the blood is impaired, resulting increased blood glucose levels, kidneys will excrete more glucose in the urine, therefore it is the ideal breading ground for bacteria
Difference between acute and chronic pyelonephritis
Acute caused by an infection, chronic persistent, or recurrent infection of kidney leading to scarring of the kidney usually associated with renal stones, drugs, ischemia.

Acute localized abscesses may form in medulla and extend to cortex, chronic there is fibrosis, scarring, renal pelvis dilation, blunting

Acute onset, systemic symptoms, constrovertebral tenderness, chronic metabolic acidosis, hyperkalemia, dehydration

Acute rarely causes renal failure, chronic may lead to renal failure

Acute organism is moving up urinary tract, chronic urinary obstruction prevents elimination of bacteria by voiding
edema inflammation and purulent urine is often found in acute or chronic pyelonephritis due to WBC invasion
acute
Define Nephrotic Syndrome
A group of symptoms due to damage to glomerular basement membrane leading to increased permeability and loss of negative charge in the glomerular. This Leads to increased filtration of plasma proteins resulting in a massive loss of protein from the body.
What are the three symptoms that define nephrotic syndrome
1. proteinuria/hypoproten
2. edema
3. lipoduria/hypoalbumineia
Why does proteinuria occur in nephrotic syndrome
protein is spilled into the urine due to increased glomerular permeability
Why does edema occur in nephrotic syndrome
loss of plasma protein reduces intravascular osmotic pressure. This reduces the pull of albumin into the intravascular compartment and fluid shifts from vessels and accumulates in interstitial tissues causing edema
Why does lipoduria occur in nephrotic syndrome
Increased synthesis of plasma protein by liver and since the liver is only able to synthesize one type of protein at a time it produces lipoproteins
Causes of nephrotic syndrome
diabetes, systemic lupus erythematosis, drugs, infections, malignancies, vascular disorders
Why does TB cause Pyelonephritis
TB is very fast growing and acid resistance therefore it can survive in urine. completely takes over epithelial cells and cause fibrosis which can cause obstruction of the urinary tract
presentation of cystitis
redness, pus formation, suppurative exudates, sloughing leading to ulcer formation, necrosis
main reason for bladder infection in pregnancy women
Due to fetus position unable to completely empty bladder fully
Define berger disease
characterized by deposition of mostly IgA but some IgM antibodies and complement in mesangial cells of glomerular capillaries... stimulates cells to proliferate and release oxidants and proteasees
What type of glomerulonephritis occur more often in children
Henoch-schonlein purpura nephritis.... or anaphylactoid purpura... IgA nephropathy that causes inflammation and damage to glomerular blood vessels---blood occlusion, decreased blood flow
Compare Nephrotic vs nephritic syndrome
Nephrotic
1. massive proteinuuria
2. hypoalbuminemia
3. edema
4. hyperlipidemia/hyperlipiduria

Nephritic syndrome
1. hematuria
2. oliguira
3. azotemia
4. hypertension
Compare nephrotic and glomerluonephritis
Nephrotic
1. proteinuira, hypoalbuminemia, edema, hypovolemia,

glomerulonephritis
1. proteinuira, hematuria, htn

nephrotic cause
-glomerular damage

glomerulonephritis caused by infection

Glomerular changes nephrotic- membrane damage permeability to protein/albumin where as glomerulonephritis is immune complex occludes glomeruli and causes damage
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