Renal Disorders Practice Flashcards

A set of vocabulary-style flashcards covering infectious, obstructive, glomerular, congenital, and chronic renal disorders based on Unit 6 lecture notes.

Intrarenal Disorders

A category of disorders occurring primarily within the kidney including infectious, obstructive, glomerular, and congenital types that can result in renal insufficiency or failure.

Acute Pyelonephritis

An infection caused by obstruction or ureteral reflux allowing contaminated urine to enter the kidney, characterized by sudden onset of fever, nausea, vomiting, chills, and classic flank pain (CVA tenderness).

Risk Factors of Acute Pyelonephritis

-pregnancy

-DM

-anatomic abnormalities of the urinary tract

-obstructions (ex. renal calculi/ kidney stones)

Abscesses, sepsis (e.coli), ARDS, recurrent/ chronic pyelonephritis, and CKD are complications of what disorder?

Acute pyelonephritis

Chronic Pyelonephritis

A condition resulting from chronic reflux of infected urine into the renal pelvis causing urine stasis

etiology of chronic pyelonephritis

Backflow of infected urine; obstruction, causing growth of bacteria

What disorder often leads to kidney atrophy and scarring as seen on renal ultrasound

Chronic pyelonephritis

Risk factors for chronic pyelonephritis

-renal calculi

-neurogenic bladder

-vesicoureteral reflux

-underlying intrarenal disease

Signs and symptoms of chronic pyelonephritis

Vague and inconsistent

Flank or abdominal pain

Fever

Malaise

Anorexia

Hydronephrosis

The swelling of a kidney due to a build-up of urine, which is classified in Grades $1$, $2$, $3$, and $4$.

Nephrolithiasis

The formation of stones specifically within the kidneys.

Urolithiasis

The formation of stones anywhere within the urinary tract.

Renal Colic

Spasmodic, intermittent sharp pain typically Localize flank pain radiating to the groin, associated with kidney stones. (Ex. Nephrolithiasis, and urolithiasis)

What is the definitive diagnosis for kidney stones?

CT scan

Clinical manifestations of glomerular diseases

-Persistent proteinuria

-with or without hematuria

-⬇GFR

-in generalized edema

-hypertension

Acute Glomerulonephritis

An inflammatory process triggered by infections in other parts of the body that causes the immune system to attack glomeruli walls, leading to smoky or coffee-colored urine.

Production of antibodies in response to a virus

Acute glomerulonephritis

smoky, coffee colored urine, hypertension, and edema

Signs and symptoms of acute glomerulonephritis

Azotemia

A clinical manifestation of acute glomerulonephritis characterized by elevated levels of blood urea nitrogen (BUN) and creatinine.

Risk factor of acute glomerulonephritis

Group A Strep/ Strep throat/ impetigo or infectious organism stimulate the production of antibodies, and the initiation of inflammatory process triggered by virus or bacteria

Glomerular diseases that assume a progressive course ultimately develop into

Chronic kidney disease

In chronic glomerulonephritis, what happens to the kidneys and nephrons

Nephrons= atrophy,

kidneys= small, scarred and nonfunctional

Chronic glomerulonephritis

Caused by hypertension, umbrella term for many causes, chronic kidney disease, kidneys become atrophy, progressive to ESRD

Primary glomerulopathy

Kidneys is the only or The predominant organ involved

Secondary glomerulopathies

Involves systemic disorders (ex. good pasture syndrome, Systemic lupus erythematosus, diabetic neuropathy)

Goodpasture syndrome

An autoimmune disease that alters the lungs and kidneys, leading to bleeding in the lungs and kidney failure.

Diabetic nephropathy

Kidney damage caused by increased blood sugars where damaged glomeruli become leaky and allow protein into the urine.

Systemic lupus erythematosus

Autoimmune disease, where the body attacks his own tissues (Kidneys, joints, heart, brain, skin, etc.)

Nephrotic Syndrome

A glomerulopathy characterized by the urinary elimination of >3 to $3.5 \text{ grams}$ of protein per day due to increased glomerular permeability (glomerular leakiness)

Causes: elimination of protein (serum albumin) in urine; causes a decrease in osmotic pressure

Nephrotic syndrome

Most common risk factors for nephrotic syndrome

Diabetes mellitus

Risk factors for nephrotic syndrome

Systemic lupus erythematosus, infections, malignancies, vasculitis, DM (all Systematic diseases)

S/s of Nephrotic syndrome

-hypoalbuminemia ⬇albumin

-hyperlipidemia

-generalized edema

-Propensity for thrombus formation

Nephrotic Syndrome Triad

1) proteinuria= hypoalbuminemia

2) fluid retention= edema

3)hyperlipidemia

Autosomal Recessive Polycystic Kidney Disease (ARPKD)

A genetic disorder identified in the neonatal period involving enlarged kidneys and dilated collecting ducts, often accompanied by pulmonary hypoplasia.

neonatal; Can be fatal; Dramatic effects on liver function; Cyst on kidney lining, also present in the liver tissue- Caused tissue remodeling

Autosomal recessive polycystic kidney disease

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

The most common hereditary cystic kidney disease where cysts multiply and expand, increasing kidney size and eventually resulting in end-stage kidney disease.

In what disease does cysts move to other organs, most commonly the liver

Autosomal dominant polycystic kidney disease

Signs and symptoms of autosomal dominant polycystic kidney disease

Hypertension and back pain can result from cyst expansion in the kidneys

Patho of Autosomal dominant polycystic kidney disease

Cyst on kidney lining, as they increase-Cause a decrease in GFR (Need to have their GFR monitored); Most patient experiences spread to liver

Another term used for Acute kidney injury

Acute renal failure

Acute kidney injury comorbidities

Cardiovascular disease, peripheral vascular disease, hypertension, diabetes, benign prostatic hypertrophy

RIFLE Classification System

A criteria used to categorize Acute Kidney Injury severity and outcomes: Risk of injury, Injury, Failure, Loss of function, and End-stage kidney disease.

What does the R stand for in RIFLE

Risk for injury

What does the I stand for in RIFLE

Injury

What does the F stand for in RIFLE

Failure

What does the L stand for in RIFLE

Loss of function

What does the E stand for in RIFLE

End stage kidney disease

Prerenal Kidney Injury

Acute kidney injury due to conditions that diminish perfusion of the kidneys, which activates the Renin-Angiotensin-Aldosterone System (RAAS).

Risk factors for Prerenal Kidney Injury

Vomiting, diarrhea, edema, fever, overuse of diuretics, myocardial infarction, heart failure

BEFORE the kidney, inadequate perfusion (MI, bleeding)- RAAS will try to compensate, can progress to intrarenal if not fix

Prerenal kidney injury

Intrinsic/Intrarenal Kidney Injury

Kidney injury caused by primary dysfunction of the nephrons and IN THE KIDNEYS itself, often following exposure to NSAIDs or radiographic contrast media.

Risk factors for Intrinsic/ intrarenal kidney injury

Glomerulonephritis, NSAIDs, radiographic contrast media

Postrenal Kidney Injury

Kidney injury due to obstruction of the normal outflow of urine, such as BPH, renal calculi, or urethral strictures.

Risk factors for postrenal kidney injury

BPH, renal calculi, urethral strictures, intraabdominal tumors, prolapse

Both prerenal and postrenal kidneys injuries

Can progress to intrinsic/ intrarenal kidney injury

-Increase in serum creatinine by 0.3mg/dL within 48

Hours

-increase in serum creatinine to 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days

-urine volume is less than 0.5mL/kg/hr for 6 hour

Diagnostic test for acute kidney injury

Chronic Kidney Disease (CKD)

The progressive and irrevocable loss of functional nephrons, defined as decreased kidney function or damage lasting $3$ months or more.

remaining nephrons try compensating by enlarging and increasing their clearance capacity. But in the end, this continued enlargement causes them to become dysfunctional too.

Chronic kidney disease

Primary risk factors for chronic kidney disease

Diabetes, hypertension, smoking

What signs and symptoms associated with anemia due to decrease ability to produce erythrocyte, Increase potassium, Hyperthyroid, Hypocalcemia, Low vitamin D (Which increased risk for fractures), And elevated BUN

Chronic kidney disease

What happens when chronic kidney disease is left untreated

Metabolic Acidosis, Increased BUN, Hyperkalemia, Dysrhythmia, Rapid breathing

Uremic frost

A sign of uremic syndrome involving the deposition of uremic crystals on the skin.

Example of an acute-on-chronic kidney disease

Someone with CKD who received contrast medium and now having AKI

Arteriovenous (AV) fistula

The preferred surgical access for hemodialysis, typically created in the arm to connect an artery and a vein.

Continuous Renal Replacement Therapy (CRRT)

A dialysis modality used for in-hospital AKI patients who are not hemodynamically stable enough to tolerate standard hemodialysis.

Peritonitis

A potentially serious complication associated with Peritoneal Dialysis.

Ureters

Collect urine and transport to bladder

Bladder

Stores and expels urine to urethra

Urethra

Urine exits the body

Associated urinary sphincters

Relaxation aids voiding

Mechanisms of micturition (Peeing)

Internal and external sphincter

Internal sphincter

Bladder is prevented from emptying until the pressure in the body of the bladder rises above a specific threshold

External sphincter

Allows voluntary emptying of the bladder or the prevention of urination

What is the cause of incontinence?

Involuntary, Neuron demyelination (damage to the myelin sheath that causes a loss of message or inhibits nerve communication to bladder)

reversible causes of incontinence

UTI, Drugs that caused urgency (Lasix), Fecal impaction

Clinical manifestation of incontinence

Leakage of urine

What are some of the changes that adults go through dealing with the bladder?

Bladder capacity decreases, Nocturia, Urinate more frequently- But they should maintain control.

Stress urinary incontinence SUI

Due to the weakening of pelvic muscle muscles or intrinsic urethral sphincter deficiency

Examples of Times where stress urinary incontinence Occur

Effort or exertion examples coughing, Laughing, Lifting heavy objects, Sneezing, Or bending

Occurs when urine is involuntarily lost with increases in intra-abdominal pressure

Stretch urinary incontinence SUI

Urgency urinary incontinence UUI

Involuntary sudden leakage of urine along with or immediately following the sensation of a need to urinate

Due to an overactive detrusor muscle

Urgency urinary incontinence UUI

Overflow urinary incontinence

The bladder become so full that it leaks urine due to urethral obstructions such as enlarged prostate gland

Functional incontinence

Physical or environmental limitations, resulting in an inability to Access a toilet in time; In accessibility toilets, mobility disorders, cognitive dysfunction, or mental disabilities, prevent normal or timely toilet usage

Transit incontinence

Sudden onset and it’s due to potentially reversible conditions,

examples UTI, constipation, fecal impaction

transit bladder

Neurogenic bladder

Broad classification of voiding dysfunction in which the specific cause is a Pathology that produces a disruption of nervous system communication to the bladder

What are protective measures to prevent urinary tract infections?

Bacteria is normally cleared from the bladder by the flushing and dilution effects of voiding. The high urea with high osmolarity along with the low pH of urine (epithelial cells), act as a natural barrier to pathogens (acidic environment, Unidirectional flow)

Risk factors of UTIs

Poor hygiene after bowel movement can Introduce E. coli to the urinary tract. Less common in men, but can be caused by an STI or immunosuppression.

Clinical Manifestations of UTI

Acute sudden onset urgency, Suprapubic pain

Atypical symptoms of UTIs

Delirium and incontinent, but no change to vital signs

Uncomplicated UTI

Infections not associated with abnormalities of lower tract, anatomy or function, urinary catheterization, pregnancy or diseases this such as diabetes

Complicated UTI

Infections involving multi drug resistant bacteria, or where the host is immunocompromise or has abnormalities of the genitourinary tract

Recurrent UTI

Repeated infections within a short period of verified resolution of the earlier infection