RENAL PART 1 (urinary system, infections, renal&poly)

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38 Terms

1
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What is this

● Both an endocrine organ and a target organ

● Controls mineral and water balance

● MAIN FXN: filter waste product and remove excess fluid from blood

● 200quarts/day is filtered

● 2quarts leave the body

KIDNEYS

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What is this

○ Passage of filtered substance from kidney to the urinary bladder

● Ureters

3
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What is this

○ storage

● Urinary bladder

4
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What is this

○ Where urine passes

○ Shorter in females

● Urethra

5
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Give s/sx of urinary problem

● Urinary frequency ● Urinary urgency ● Urinary incontinence ● Nocturia ● Pain (shoulder, back, flank, lower abdomen) ● CVA tenderness ● Fever and chills ● Dysuria ● Hematuria ● Pyuria ● Dyspareunia

6
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Enumerate conditions under INFECTIONS

● Urinary Tract Infection

● Pyelonephritis

7
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In URINARY TRACT INFECTION, what condition affects urinary bladder?

ACUTE CYCSTITIS

8
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In URINARY TRACT INFECTION, what condition affects urethra?

ACUTE URETHRITIS

9
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In URINARY TRACT INFECTION, what condition affects kidney?

ACUTE PYELONEPHRITIS

10
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URINARY TRACT INFECTION is classified to?

COMPLICATED

UNCOMPLICATED

RELAPSE

RECURRENT

11
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What classification of UTI is this?

  • diabetes, stroke, pregnancy, immunosuppression structural or functional abnormality

COMPLICATED

12
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What classification of UTI is this?

  • no factors

UNCOMPLICATED 

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What classification of UTI is this?

  • infection that persists with the original organism without complete clearing

  • RELAPSE

14
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What classification of UTI is this?

  • different infection after a successful treatment

  • ○ RECURRENT :

15
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UTI PATHOGENESIS (FILL IN THE BLANKS)

PATHOGENESIS

  • Most common bacteria involved

    • ___ – 80%

    • __ – 5 to 15%

    • Enterecoccus, K

    • Klebsiella, Proteus

  • Most common route of entry: ascending up (urethra to UB)

  • —

  • __

  • Pathogens adheres to the mucosa, colonize resulting to infection

  • Bacteria contain genes allowing for greater virulence and ability to colonize the uroepithelium

  • __

    • Produces adhesins and toxins enabling them to colonize and invade

UTI PATHOGENESIS (FILL IN THE BLANKS)

PATHOGENESIS

  • Most common bacteria involved

    • Escherichia Coli – 80%

    • Staphylococcus saprophyticus – 5 to 15%

    • Enterecoccus, K

    • Klebsiella, Proteus

  • Most common route of entry: ascending up (urethra to UB)

  • Blood borne

  • Lymphatic

  • Pathogens adheres to the mucosa, colonize resulting to infection

  • Bacteria contain genes allowing for greater virulence and ability to colonize the uroepithelium

  • Uropathogens

    • Produces adhesins and toxins enabling them to colonize and invade

16
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In UTI, this often indicates an upper UTI or pyelonephritis

Flank pain, fever and chills –

17
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MEDICAL MANAGEMENT OF UTI (FILL IN THE BLANKS):

MEDICAL MANAGAMENT

  • PREVENTION

    • Drinking at least __ of water

    • Wiping of genital area from __ –

    • Urinating soon after __

    • Washing of genital for both and ___

    • __ – still controversial and needs further studies

      • __

  • DIAGNOSIS AND TREATMENT

    • Based on history and urine test

    • UA: bacterial count __ of urine

      • Leukocyte count __

      • Presence of leukocyte esterase, nitrites and protein

    • Urine Culture and sensitivity

    • TREATMENT

      • Empiric antibiotic for patients with uncomplicated and healthy

      • Increase oral fluid intake

      • Dietary modifications

MEDICAL MANAGEMENT OF UTI (FILL IN THE BLANKS):

MEDICAL MANAGAMENT

  • PREVENTION

    • Drinking at least 8oz of water

    • Wiping of genital area from front to back –

    • Urinating soon after intercourse

    • Washing of genital for both males and females

    • Foods/ juices – still controversial and needs further studies

      • Cranberry juice

  • DIAGNOSIS AND TREATMENT

    • Based on history and urine test

    • UA: bacterial count >100,000 organism/ml of urine

      • Leukocyte count >10/mm3

      • Presence of leukocyte esterase, nitrites and protein

    • Urine Culture and sensitivity

    • TREATMENT

      • Empiric antibiotic for patients with uncomplicated and healthy

      • Increase oral fluid intake

      • Dietary modifications

18
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In Pyelonephritis, what condition is this?

  • Infectious process involving the kidneys

  • Typically results from bacteria ascending from the bladder to infect the kidney

  • More common in women (men with higher complications)

  • 250,000 people/yr (100,000 hospitalization)

  • ETIOLOGY/RISK FACTORS

    • Ascending UTI

    • E. coli – most common organism

    • Proteus, Klebsiella, pseudomonas

    • Frequent sexual activity

    • Recent UT Recent UTI

    • Diabetes

    • Urinary incontinence

  • TREATMENT:

    • Antibiotics: Co-trimoxazole, nitrofurantoin

● Acute Pyelonephritis

19
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Acute Pyelonephritis (FILL IN THE BLANKS):

  • Infectious process involving the __

  • Typically results from bacteria ascending from the bladder to infect the kidney

  • More common in women (men with higher complications)

  • 250,000 people/yr (100,000 hospitalization)

  • ETIOLOGY/RISK FACTORS

    • Ascending UTI

    • __ – most common organism

    • Proteus, Klebsiella, pseudomonas

    • __

    • __

    • __

    • __

  • TREATMENT:

    • Antibiotics: Co-trimoxazole, nitrofurantoin

Acute Pyelonephritis (FILL IN THE BLANKS):

  • Infectious process involving the kidneys

  • Typically results from bacteria ascending from the bladder to infect the kidney

  • More common in women (men with higher complications)

  • 250,000 people/yr (100,000 hospitalization)

  • ETIOLOGY/RISK FACTORS

    • Ascending UTI

    • E. coli – most common organism

    • Proteus, Klebsiella, pseudomonas

    • Frequent sexual activity

    • Recent UT Recent UTI

    • Diabetes

    • Urinary incontinence

  • TREATMENT:

    • Antibiotics: Co-trimoxazole, nitrofurantoin

20
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What is the most common organism involved in acute pyelonephritis?

E. coli

21
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In Pyelonephritis, what condition is this?

  • Inflammatory disease involving the kidney parenchyma and renal pelvis

  • Tubulointerstitial disease

  • Characterized by specific changes

    • Cortical scarring

    • Deformation of calices

    • Leads to renal insufficiency

  • Specific abnormality in kidneys

  • CAUSES: reflux, idiopathic, obstruction

  • Most common cause: VESICOURETERAL REFLUX (VUR)

    • Urine is forced from the UB to the ureter

● Chronic Pyelonephritis

22
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Chronic Pyelonephritis (FILL IN THE BLANKS):

  • Inflammatory disease involving the __ and _

  • Tubulointerstitial disease

  • Characterized by specific changes

    • __

    • __

    • __

  • Specific abnormality in kidneys

  • CAUSES: __, _, …..

  • Most common cause: ____

    • Urine is forced from the UB to the ureter

Chronic Pyelonephritis (FILL IN THE BLANKS):

  • Inflammatory disease involving the kidney parenchyma and renal pelvis

  • Tubulointerstitial disease

  • Characterized by specific changes

    • Cortical scarring

    • Deformation of calices

    • Leads to renal insufficiency

  • Specific abnormality in kidneys

  • CAUSES: reflux, idiopathic, obstruction

  • Most common cause: VESICOURETERAL REFLUX (VUR)

    • Urine is forced from the UB to the ureter

23
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Chronic pyelonephritis is characterized by specific changes such as?

CDL (“si dean’s lister“)

  • Characterized by specific changes

    • Cortical scarring

    • Deformation of calices

    • Leads to renal insufficiency

24
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What is the most common cause of Chronic Pyelonephritis where urine is forced from the UB to the ureter

VESICOURETERAL REFLUX

25
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Medical Management of Pyelonephritis (FILL IN THE BLANKS):

MEDICAL MANAGEMENT

  • DIAGNOSIS

    • Clinical signs and symptoms and laboratory

  • LABORATORY

    • Urinalysis

      • —, —, —

      • Urine Culture and sensitivity

      • KUB ultrasound

  • Treatment

    • Infection severe

      • Hospitalization required for IV antibiotics

Medical Management of Pyelonephritis (FILL IN THE BLANKS):

MEDICAL MANAGEMENT

  • DIAGNOSIS

    • Clinical signs and symptoms and laboratory

  • LABORATORY

    • Urinalysis

      • Pyuria, bacteriuria, hematuria

      • Urine Culture and sensitivity

      • KUB ultrasound

  • Treatment

    • Infection severe

      • Hospitalization required for IV antibiotics

26
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What is this?

● Cavity filled with fluid or renal tubular elements making a semi-solid material

● Can lead to degeneration of renal tissue and obstruction of tubular flow

● Vary in size

Renal cyst

27
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What are the 6 categories of Renal Cyst?

[PCASCM]

1. Polycystic Kidney Disease (PCKD)

2. cystic disease of medulla

3. Acquired cystic disease

4. single cyst

5. Cystic renal dysplasia

6. Miscellaneous Renal cystic disorde

28
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This is a category of Renal Cystic Disease:

● leading cause of ESRD requiring dialysis or transplant

1. Polycystic Kidney Disease (PCKD)

29
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This is a category of Renal Cystic Disease:

● may develop secondary to dialysis, DM, glomerulonephritis Miscellaneous Renal cystic disorde

Acquired cystic disease

30
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This is a category of Renal Cystic Disease

● most common cystic disorder; no symptoms produced

4. single cyst

31
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What condition is this?

● Manifested as autosomal dominant or autosomal recessive

● Can occur spontaneously but mostly hereditary

● Genes with development of cyst found on chromosome 16 and 4

POLYCYSTIC KIDNEY DISEASE

32
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In Polycystic Kidney Disease, genes with development of cyst found on what chromosomes?

chromosome 16 and 4

33
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This is the most common symptom in Polycystic Kidney Disease. it involves bleeding, growth of cyst, infection, tumor

Abdominal or flank pain > most common symptom

34
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Diagnosis in Polycystic Kidney Disease (FILL IN THE BLANKS)

DIAGNOSIS

_____

  • Proteinuria

  • Hematuria

Tissue biopsy

_____

  • <30 y/o: 2 cyst in 1 kidney

  • 30-59 y/o: at least 2 cysts in each kidney

  • >60 y/o: 4 cysts in each kidney

_____

  • Useful test to distinguish between and solid and fluid filled mass and displaying its size

  • Can also reveal presence of hepatic cyst

_____

  • Better choice for children with renal dysfunction or early stage of the disease

Diagnosis in Polycystic Kidney Disease (FILL IN THE BLANKS)

DIAGNOSIS

Urinalysis

  • Proteinuria

  • Hematuria

Tissue biopsy

Ultrasound

  • <30 y/o: 2 cyst in 1 kidney

  • 30-59 y/o: at least 2 cysts in each kidney

  • >60 y/o: 4 cysts in each kidney

CT scan

  • Useful test to distinguish between and solid and fluid filled mass and displaying its size

  • Can also reveal presence of hepatic cyst

MRI

  • Better choice for children with renal dysfunction or early stage of the disease

35
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Diagnosis in Polycystic Kidney Disease

_____

  • Proteinuria

  • Hematuria

Tissue biopsy

URINALYSIS

36
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Diagnosis in Polycystic Kidney Disease

_____

  • <30 y/o: 2 cyst in 1 kidney

  • 30-59 y/o: at least 2 cysts in each kidney

  • >60 y/o: 4 cysts in each kidney

ULTRASOUND

37
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Diagnosis in Polycystic Kidney Disease

_____

  • Useful test to distinguish between and solid and fluid filled mass and displaying its size

  • Can also reveal presence of hepatic cyst

CT SCAN

38
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Diagnosis in Polycystic Kidney Disease

_____

  • Better choice for children with renal dysfunction or early stage of the disease

MRI