exam 3 patho renal portion

Acute Kidney Injury: Risk Factors

• Hypotension

• exposure to

• Hemoglobinuria & Myoglobinuria (Pre, intra, post)

• Dehydration

• Pre-existing renal disease (Intra)

• Chronic Hypertension

• exposure to radiocontrast dyes

Acute Kidney Injury

Sudden ↑ in nitrogenous wastes products

• Urea Nitrogen (BUN)- Protein in diet

• Creatinine (Cr)- muscle

- ↓ urine output

cause of acute renal failure

1. Prerenal: Sudden drop in BP (SHOCK) or injury/Illness

2. Intrarenal: Inflammation, toxins, infections or reduced blood supply

3. Postrenal: Obstruction of enlarged prostate, Kidney stones, bladder tumor, or injury

RIFLE Criteria for Acute Dysfxn/failure

Prerenal Dysfunction

• reduced cardiac output or severe hypovolemia

• directly or indirectly ↓ renal perfusion

Intrarenal Dysfunction

Direct damage to renal tissue

• Nephrotoxic medications (Aminoglycosides)

• NSAIDs ex: ibuprofen

Autoimmune Diseases

• Untreated Hypertension

• Uncontolled Diabetes

Postrenal Dysfunction

Obstructive uropathy preventing Urine outflow from the kidney

• kidney stones

• prostate enlargement

• bladder cancer

Leads to Hydronephrosis

increasing risk of infection EX: cath uti

Acute Tubular Necrosis (ATN)

• Ischemia, cell slough into the tubular lumen BLOCKING it, preventing flow through lumen, reducing urine

• blockage further Ischemic injury

Glomerulonephritis

• immune complex: inflammation & membrane damage

• seen suddenly 7 to 21 days after strep infection

Goodpasture’s syndrome

• Acute rapidly progressive form of glomerulonephritis caused by antibodies to glomerular basement membrane

• person w particular Positive HLA tissue types are more susceptible

• T cells : initiation of the disorder

• Tx: Plasmapheresis (washing of cell) & Immunosuppressants

Nephrolitiasis

formation of kidney stones, or calculi

Cause: Dehydration

it can come back (recurrence 52%)

Predisposing Factors

• Age >40 yrs male

• Dietary ↓

(Purines; organ meets-Liver/Kidney, Beef, & bacon)

(Calcium; Milk, diary, cheese)

( Oxalate: Spinach Soy Almond Potatoes)

• high sodium diet

• gastric bypass surgery

• Hypercalcemia, hyperparathyroidism, hyperuricemia (uric acid in blood)

• inflammatory bowel disease

• Dehydration

Pyelonephritis

• infection of renal pelvis

• Acute or chronic

• Bacteria usually ascend from lower urinary tract

S/S:

• chills

• fever

• pain in your back CVA TENDERNESS, side or groin

• V/N

• Cloudy, dark, bloody or foul-smelling urine

• freq, painful urination

Polycystic Kidney Disease

• autosomal-dominant

• hereditary cause of renal disease

• dialysis PT other organs Liver, pancreases, and spleen may also experience Heart Valve problems & cerebral Aneurysms

Polycysric Kidney Disease

Fluid-filled cysts in both kidneys

(genetics)

Chronic Renal Failure

• FH

• Age >60 yrs

• Diabetes

• Hypertension

Chronic Kidney Disease (CKD)

End-stage Renal Disease (ESRD)

• Requires Renal replacement therapy or a kidney transplant

  1. Peritoneal dialysis

  2. Hemodialysis (don’t give Vancomyocin)

s/s

• N/V , fatigue/weakness,↓ mental sharpness, persistent itching from urate crystals

Neuromuscular Bladder Control

• Detrusor muscle fibers in spiral, longitudinal, & circular layers

• Alpha adrenergic fibers relax detrusor muscle tighten internal sphincter of bladder neck

• PNS contract the Detrusor muscle & relax internal sphincter

• Bladder usually holds (300 to 400mL)

• Micturition (urination) Reflex

Spinal cord reflex, cortex can override it

Obstructive Uropathy

• kidney stones

• Benign prostatic hypertrophy (BPH)

Causation oh how much urine to let out at a time following placement of a Foley Cath

Lower UTIs

• more prevalent in women than men

• cloudy, strong smelling urine and hematuria

Cause: E. Coli

Urolithiasis

• kidney stones moved wedged themselves in the ureters

• form in the bladder w low fluid intake, low urine production>highly concentrated urine result in stone development

cause: Dehydration

Urinary Incontinence

1. Stress incontinence

2. urge incontinence

3. overflow incontinence

4. neurogenic bladder

5. functional incontinence

Bladder Cancer

caused by: cigarette smoking , occupational exposure (chemicals)

a pt presents w flank pain and anuria followed by polyuria after undergoing catheterization of the ureters, What is the most likely cause of this condition

Postrenal acute injury