Disorders of Renal Function

What are the functions of the kidneys?

uremoval of metabolic wastes

umaintenance of blood pressure through the influence of:

•RAAS

•atrial natriuretic peptide (ANP)

•aldosterone

uregulation of:

•pH balance

•fluid & electrolyte balance

•erythropoiesis

uactivation of vitamin D

What is the severity of Urinary Tract Obstruction based on?

•location

•degree of obstruction

•unilateral or bilateral

•duration

•cause

What is the most damaging effects of Urinary Tract Obstruction?

•urinary stasis

orisk for infection & stone formation

•loss of kidney function

What are Renal Calculi (Kidney Stones)

Crystalline structures that form from components of the urine.

What factors influence formation of Renal Calculi?

•concentration of stone components in the urine (calcium salts, oxalate, uric acid, cystine, xanthine, and phosphate)

•ability of stone components to complex and form stones

•presence of substances that inhibit stone formation (citrate, magnesium)

Clinical Manifestations of Renal Calculi

Flank pain

•acute, intermittent & excruciating

•may radiate to lower abdomen & groin

Other s/s may include:

•nausea, vomiting

•urinary frequency, urgency

•hematuria

•fever, chills, foul smelling urine (if infection)

What are the common causes of Lower Urinary Tract Obstruction?

•urethral stricture

•prostate enlargement

•pelvic organ prolapse

tumor compression

What are symptoms of Lower Urinary Tract Obstruction?

•frequency, urgency, nocturia

•bladder spasms

•straining when initiating urination

•small & weak stream

•feeling of incomplete bladder emptying

•overflow incontinence

Urinary Tract Infection

Inflammation of the urinary epithelium caused by bacteria

What is the most coomon pathogen for a UTI?

E. Coli

Who is at risk for UTI?

Women, babies, young children, old people in diapers

What factors provide protection against UTI?

Peeing, pH, proper wiping, proper hygiene

What is Cystitis?

Inflammation of the bladder (Lower UTI)

• most common site for UTI

What are the clinical manifestations of Cystitis?

•urinary urgency

•urinary frequency

•dysuria (painful urination)

•lower abdominal pain and/or low back pain

•pyuria (↑ WBCs in urine)

What is Pyelonephritis?

Inflammation of the Kidney (Upper UTI)

What are the causes of Pyelonephritis?

bacterial infection ascending from lower urinary tract

What are the clinical manifestations of Pyelonephritis?

•high fever, chills

•flank pain

•nausea, vomiting

•foul smelling urine

•hematuria

•lower UTI symptoms are also common

What are main causes of disorders of Glomerular Function?

•infection

•drugs/chemicals that are harmful to the kidneys

•results from other diseases that also cause glomerular injury (diabetes, hypertension, autoimmune diseases)

What are the clinical manifestations of Disorders of Glomerular Function?

•hematuria

•proteinuria

•edema

What is Nephritic Syndrome?

Glomerular Inflammation

What is Nephrotic Syndrome?

Glomerular Damage

What are the clinical manifestations of Nephritic Syndrome?

•hematuria (RBCs) “coke-colored urine”

•pyuria (WBCs)

•oliguria (low urine output)

•hypertension

•proteinuria (mild)

•edema (mild)

What are the clinical manifestations of Nephrotic Syndrome?

•massive proteinuria “foamy urine”

•generalized edema

•hypoalbuminemia, hyperlipidemia

•lipiduria (lipids in urine)

What is Acute Kidney Injury? (AKI)

Rapid decline in renal function; generally reversible

What causes AKI?

•disrupted blood flow to the kidneys (prerenal AKI)

•conditions which directly damage the structures of the kidneys (intrarenal AKI)

•conditions that interfere with the excretion of urine (postrenal AKI)

What does AKI cause?

•a buildup of nitrogenous waste products  (azotemia)

•blood urea nitrogen (BUN)

•creatinine

•impairs fluid & electrolyte balance

What are the different kinds of AKI?

• prerenal AKI

• intrarenal AKI

• postrenal AKI

What is Prerenal AKI?

Sudden marked reduction in  blood flow to the kidneys

Causes:

•hypovolemia

•heart dysfunction

•decreased renal perfusion

What is Intrarenal AKI?

Damage to structures within the kidney

Causes:

•acute tubular necrosis due to

•ischemia (prerenal AKI)

•sepsis

•nephrotoxic effects of drugs

•tubular obstruction

•toxins from a massive infection

•direct trauma to the kidney

What is Postrenal AKI?

Obstruction of the urinary tract below the kidneys

•ureters – e.g. calculi, strictures,

•bladder – e.g. tumors, neurogenic bladder

•urethra – e.g. benign prostatic hyperplasia

What are the most common causes of Chronic Kidney Disease?

•hypertension

•diabetes

Other causes:

•glomerulonephritis

•SLE (lupus)

•polycystic kidney disease

What are common complications of CKD

•accumulation of nitrogenous wastes

•hypertension

•left ventricular hypertrophy

•chronic anemia

•weak & brittle bones

electrolyte imbalances