Kidney and Urologic Disorders

what is nephrolithiasis

stones in urinary tract

Risk factors

dehydration, increased calcium intake, hypercalcemia, hyperparathyroidism, hyperuricemia

urine flow in urinary tract

kidney → ureter → bladder → urethra

what is flank pain

• renal colic

• pain that starts in flank and radiates down towards groin

• occurs in waves + ureteral spams

what is hematuria

blood in urine due to mucosal irritation from kidney stone moving

Tamsulosin

alpha 1 antagonist (vasodilation)

dilates smooth muscle to increase urine flow

Hydronephrosis

• swelling of the kidneys due to urine back up

• kidney stone → inc pressure → hydronephrosis → ischemia → damage

hydronephrosis

kidney stone → inc pressure → hydronephrosis → ischemia → kidney swelling due to urine back up

What is ischemia

poor perfusion to kidney → hypoxia (low O2 in organs)

treatment for hydronephrosis

• ureteral stent (allows urine to drain from kidney to bladder)

  • nephrostomy (catheter inserted in back into kidney)

Pyelonephritis

stasis → inc bacteria → pyelonephritis → sepsis

Pathology of pyelonephritis → sepsis

bacterial growth leads to UTI, if left untreated then spreads to kidney (pyelonephritis). If it becomes systemic then sepsis

Chronic Kidney Disease

recurrent stone → inflammation + fibrosis (scar tissue) → dec GFR → CKD

Allopurinol

MOA

Use

Contra

ADR

DI

Nurse

MOA: inhibits xanthine oxidase reducing uric acid

Use: uric acid stones, gout, hyperuricemia

Contra: acute gout flare

ADR: rash, nausea, renal/hepato

DI: warfarin

Nurse: w food, avoid high purine (red meat)

Ketorolac (NSAID)

MOA: Inhibit Cox 1 and 2 reducing pain + inflammation

ADR: GI bleeding, renal damage, anaphylaxis

DI: anticoagulants

Nurse: w/ food, hydration, bleeding, RFT

Prerenal Kidney Injury (before kidney)

causes:

decreased perfusion → ischemia

cause: shock, renal artery occlusion

Intrarenal Kidney Injury

causes:

direct kidney damage

causes:

• nephrotoxic drugs

• hemolysis (inc free hemoblogin = toxic), Rhabdomyolysis

• Pyelonephritis, glomerulonephritis

What is rhabdomylosis

muscle breaking down releasing myoglobin

Postrenal Kidney Injury (after kidney)

causes:

• Obstruction → backflow

causes:

• Nephrolithiasis (stones)

• benign prostate hyperplasia

• hydonephorsis

Acute Tubular Necrosis (ATN) patho and what does it lead to

Ischemia (poor perfusion) → tubular injury (casts) → ATN

leads to: dec GFR → oliguria → azotemia → fluid retenion (edema, HTN) → electrolyte imbalance (inc K+/H+/P dec Ca)

what is azotemia

increase in waste products (BUNS, Creatinine)

Lab Findings

Creatinine

BUN

GFR

Urine

- Casts

- Hematuria

- Proteinuria

Cr: 0.5-1.2 mg/dL

BUN: 7-20 mg/dL

GFR: 90-120 mL/min (below 15 = kidney failure)

Urine: normal 0.5-1.5

Casts: tubular damage

Hematuria: inflammation/injury

Proteinuria: glomerular damage (protein in urine)

AKI Phases

1, 2, 3, 4

1. Initiation: dec perfusion

2. Oliguric: dec GFR/urine → fluid retention, electrolyte imbalance

3. Diuretic: inc dilute urine → dehydration, electrolyte loss

4. Recovery: nephron recovery, inc GFRA

acute kidney disease is ____ compared to chronic kidney disease

reversible

AKI Treatment

• Dialysis: for fluid retention, uremia (waste in urine)

• Strict input/output

• hyperkalemia: insulin, glucose + Kayexalate

• hyperphosphatemia: Ca carbonate, Ca acetate binders

• Diuretics: to dec fluid overload

• Diet: inc carbs, dec protein/Na/K/Phos

Chronic Kidney Disease

Cause:

Patho:

Ind:

cause: HTN, diabetes

patho: nephrons lost, compensate by working harder → more damage

Ind: inc waste (uremia), fluid retention, inc K+/H+, inc P/dec Ca, dec erythropoietin (anemia)