Patho Exam 4 pt. 2

What are the parts of the urinary tract? (4)

- Kidney

- Bladder

- Ureter

- Urethra

What is the interference to the urine flow anywhere along the urinary tract known as? May lead to damage if not corrected.

Urinary tract obstruction

What 5 things are the severity of the obstruction determined by? (LIODC)

- Location (urethra: more severe)

- Extent of involvement of urinary tract (both, upper, lower)

- Completeness of obstruction (partial or 100%)

- Duration (longer: more severe)

- Cause

What is the dilation of the kidneys known as? Caused by a backflow issue of UTO. (H)

Hydronephrosis

What is the dilation of the ureter known as? Caused by a backflow issue of UTO. (H)

Hydroureter

What is the enlargement of the other kidney compensating for the UTO known as? Will get enlarged due to increased workload.

Compensatory hypertrophy

What is the loss of urine and fluids once the obstruction is resolved known as? Can lead to dehydration and electrolyte imbalances.

Post-obstructive diuresis

*peeing a lot at one time after obstruction

What are kidney stones known as? Has a high recurrence rate. (NR)

- Nephrolithiasis

- Renal calculi

What are the factors that influence nephrolithiasis? (LFDG)

- Geographic location

- Fluid intake

- Diet

- Genetics

What are some things that can cause nephrolithiasis? (HDDC)

- Hard water

- High calcium levels

- Dehydration

- Diet sodas

Where is nephrolithiasis typically seen in? There is a super-saturation of salt. It causes a liquid precipitation to become solid through crystallization.

- Upper urinary tract

*issue when it hits ureters

What are the three types of Nephrolithiasis? (CSU)

- Calcium oxalate/ Calcium phosphate (most common: high calcium)

- Struvite (magnesium-ammonium-phosphate)

- Uric acid

What are the signs of Nephrolithasis (kidney stones)? Usually, it only affects one side. (FUUHNV)

- Flank Pain (Unilateral back pain)

- Urinary urgency

- Microscopic hematuria

- N/V

*No Oliguria since only one sided

What are the tests used for nephrolithiasis? (KCUU)

- KUG x-ray

- 24 hour urine collection

- CT scan

- Urinalysis

What is it known as when we collect a stone and send it for testing? It determines the type of stone, and we must have diet modifications based on the type.

24 hour urine collection

*used for neprholitasis

What are the treatments for Nephrolithiasis? It can pass on its own, or may need medical intervention. (PFMD)

- Pain medications

- Increased Fluids (flush out stones)

- Medication to dilate ureters (help pass stones)

- Diet Modification (decrease stone-forming substance)

What are the treatments for Nephrolithiasis if it needs medical intervention? (SLS)

- Stent (open ureter)

- Lithotripsy (break stones with waves)

- Surgery

What is decreased urine output known as? Less than 30 ml/hr?

Oliguria

What is the involuntary loss of urine? Typically seen with lower urinary tract obstructions.

Incontinence

What type of incontinence is the complete loss of all urine?

Complete incontinence

What type of incontinence is when the person will leak a little urine, but can make it to the bathroom?

Incomplete incontinence

What kind of incontinence involves involuntary contraction of the detrusor muscle (bladder muscle)?

Urge Incontinence

Who is urge incontinence commonly seen in?

Older adults

What kind of incontinence involves weakness of the pelvic floor muscle (starts urination stream)? Occurs during belly pressure such as coughing, sneezing, or laughing.

Stress incontinence

Who is stress incontinence commonly seen in?

Post-partum woman

*after birth

What type of incontinence involves a lower urinary tract obstruction of the urethra? The bladder will overfill, then pressure will build and cause incontinence.

Overflow incontinence

Who is overflow continence commonly seen in?

Males with enlarged prostates

What kind of incontinence involves mobility or neurological issues? Nothing is wrong with the urinary tract itself.

Functional incontinence

What type of person is functional incontinence seen in? The person can't get up and go to the bathroom.

Immobile

What type of person is functional incontinence seen in? The person can't remember to get up and go to the bathroom.

Neurodegenerative disorders (Dementia)

What is a common sign of incontinence? Seen a lot with immobile patients. (S)

Skin breakdown

What are there giant risks of with incontinence? (PIUYP)

- Pressure ulcers

- Infection (UTI's, Yeast infections)

- Psychological implications (pregnant woman w/ stress incontinence)

What is the narrowing, inflammation and edema of the lumen known as?

Strictures

What are the causes of strictures? (ISIKP)

- Infection

- Surgery (scar tissue or accidents during surgery)

- Injury (kidney stones)

- Prostatic enlargement

Who are strictures more common in? They have longer urethra and only gender with prostates.

Males

What is the inflammation of the urinary mucosa caused by bacteria known as?

Urinary tract infection

What two types of bacteria cause UTIs? (SE)

- E. Coli (more common)

- Staph

What types of people are at a high risk of UTIs? (WCOICS)

- Women (shorter urethra, urethra and anus are anatomically closer)

- Children (bad hygiene)

- Older adults (dementia)

- Pt. w/ incontinence

- Urinary catheters

- Sexually active

What are the different types of host defense mechanisms our body has to help prevent UTIs? (UVSN)

- Urination (flushing)

- Valves (stop reflux of pathogens)

- Secretions

- Normal flora

What type of UTI is inflammation of the bladder? Typically caused by E. Coli. (A)

Acute Cystitis

*most common

What are the causes of acute Cystitis? (RG)

- Retrograde movement of GI bacilli into the urethra

- Genetic predisposition

What are the signs of Acute Cystitis? UTI. (DPUPFCFC)

- Pain/burning during urination (dysuria)

- Urinary urgency

- Lower abdominal pain

- Increased frequency

- Cloudly urine, foul odor

- Confusion (older adults)

What tests are ran for acute cystitis? (UC)

- Urinalysis (Tells us WBC and bacteria but not specific)

- Urine Culture (tells us specific bacteria present)

What are the treatments for acute cystitis? (FA)

- Fluids (flush pathogens out, prevent dehydration)

- Antibiotics

What bladder irritants should be avoided for acute cystitis? (CA)

- Caffeine

- Alcohol

What type of UTI is a non-bacterial bladder inflammation? The cause is unknown but considered autoimmune. (I)

Interstitial Cystitis

What are some signs of interstitial cystitis? Mimics signs of acute cystitis. (FPO)

- Urinary frequency

- Pelvic pain

- Small urine output

Are pathogens seen in interstitial cystitis?

NO PATHOGENS

*same as acute but no pathogens

What type of issue is interstitial cystitis? The tests are to just rule out other causes.

Chronic issue (>6 weeks)

What are the treatments for interstitial cystitis? We don't know what causes it so it cannot be fixed. (AP)

- Pain medications

- Anti-inflammatory

*Will be chronic

What type of UTI is the infection of one or both upper urinary tracts? (A)

Acute Pylonephritis

*upper UT

What are the causes of Acute Pyelonephritis? (RRPRES)

- Renal Calculi (kidney stones)

- Reflux

- Procedures in urinary tract

- Urinary retention

- E. Coli, Staph infection

What are the signs for acute pyelonephritis? It has the same signs as acute cystitis. (FIFLMC)

- Flank pain (back pain: both or one side)

- Systemic infection signs (fever, leukocytosis, malaise, chills)

What tests are run for acute pyelonephritis? (UCRU)

- Urinalysis

- Urine culture

- Renal imaging: Ultrasound/CT (look for swollen kidneys)

What are the treatments for acute pyelonephritis? (IAASF)

- Potent IV antibiotics

- Anti-inflammatory

- Steroids

- Fluids

What type of UTI involves a persistent an recurring infection of the upper urinary tract? It leads to scarring of the kidneys. (C)

Chronic pyelonphritis

What are the causes of Chronic Pyelonephritis? (RFPA)

- Renal calculi (kidney stones)

- Reflux (of pathogens)

- Diagnostic procedures

- Multiple or untreated acute pyelonephritis

What are the signs of chronic pyelonephritis? It has the same signs of acute pyelonephritis but MORE frequently. (R)

- Renal failure (from scarring)

What is the treatment for chronic pyelonephritis? It has the same tests and treatments of acute pyelonephritis. (F)

Fix the underlying cause

What is the three renal lab values we need to check?

- Creatinine

- BUN (blood urea nitrogen)

- Glomerular filtration rate (GFR)

What type of Creatinine and BUN tests look at the BLOOD levels of the substance?

Serum

*blood levels

What type of Creatinine and BUN tests look at the URINE levels of the substance?

Clearance

*urine levels

What is a waste product from muscle metabolism? We want our kidneys to filter it out.

Creatinine

We want ____ levels of creatinine in the URINE.

High

*clearance

We want ____ levels of creatinine in the BLOOD.

Low

*serum

What is a waste product of protein breakdown? We want our kidneys to filter it out.

BUN (blood urea nitrogen)

We want ___ levels of BUN in our URINE.

High

*clearance

We want ___ levels of BUN in our BLOOD.

Low

*serum

What is the rate at which our kidneys filter our waste products?

Glomerular filtration rate (GFR)

What type of GFR do we want? It means the kidneys are working quickly to filter out waste.

High levels of GFR

*good

What renal levels will be seen with kidney disease? They are all bad.

- High creatinine and BUN serum (blood) levels

- Low GFR

What is inflammation of the glomerulus known as? It filters for the kidneys.

Glomerulonephritis

What is seen with glomerulonephritis? (SCPVPH)

- Decreased membrane surface area -->

- Decreased capillary blood flow -->

- Increased glomerular capillary permeability -->

- Glomerular vasodilation -->

- Decreased perfusion to glomerulus -->

- Hypoxia

Glomerulonephritis is the most common cause of what?

Renal Failure

What are the causes of Glomerulonephritis? (DSNS) (DHL)

- Direct kidney damage

- Untreated strep infection

- Nephrotoxic drugs

- Systemic diseases (diabetes, HTN, lupus)

What are the signs of Glomerulonephritis? There is NO bacteria present. (EHPHHSCDO)

- Edema (increased permeability: fluid goes into interstitial space)

- Hypoalbuminemia (increased permeability: plasma proteins leave blood)

- Proteinuria (proteins in urine from blood)

- Hematuria (increased permeability: RBCs leak into urine)

- Hypertension (Decreased renal blood flow stimulates RAAS to cause fluid retention and vasoconstriction)

- Elevated serum (blood) creatinine and urea

- Reduced creatinine clearance (urine)

- Decreased GFR

- Oliguria (decreased urine output)

What tests are ran for Glomerulonephritis? (UPHCBG)

- Urinalysis (Will see proteins and blood in urine)

- Creatinine, BUN, GFR

What are the treatments for Glomerulonephritis? (FSACS)

- Treat cause (strep infection -> support kidneys)

- Steriods, Anti-inflammatories

- Fluids (no diuretics)

What is severe glomerular injury known as that leads to >3.5 grams of protein loss per day? It has the same causes of glomerulonephritis. (N)

Nephrotic Syndrome

What are the signs of Nephrotic Syndrome? (PHHHLVTH)

- Proteinuria (very high >3.5 grams per day)

- Hematuria

- Hypoalbuminemia

- Hyperlipidemia (liver compensates and produces lipoproteins)

- Lipiduria

- Vit D deficiency (no kidney synthesis)

- Tachycardia (compensates for hypotension)

- Hypotension (loss of plasma protein)

What type of pressure is lost in Nephrotic Syndrome due to losing a ton of plasma proteins? This causes hypotension to be seen.

No capillary oncotic pressure

What tests are ran for Nephrotic syndrome? (UC)

- Urinalysis

- 24 hour urine collection (need protein total)

What are the treatments for nephrotic syndrome? (DLFS)

- Diet modifications (low-fat)

- Fluids (for hypotension)

- Salt restrictions

What is a sudden decline in kidney function related to ischemic injury known as?

Acute Kidney Injury or Kidney failure

What type of renal failure is seen before the kidneys? It is a blood flow issue. (P)

Pre-Renal acute renal failure

What is pre-renal acute renal failure caused by? (PHHNVDD)

- Decreased kidney perfusion

- Hypovolemia

- Hypotension

- N/V/D

- Dehydration

What type of renal failure is a kidney issue itself? The kidneys are being damaged. (I)

Intra-renal acute renal failure

What are the causes of intra-renal acute renal failure? The kidney is being damaged. (GNIP)

- Glomerulonephritis

- Nephrotoxic drugs

- Infections

- Pyelonephritis

What type of renal failure is something after the kidneys cause an issue? (P)

Post-renal acute renal failure

What are the causes of post-renal acute renal failure? (UKSP)

- UTI

- Kidney stones

- Strictures

- Prostate

What are the signs seen for acute kidney injury? Seen in all types. (GBC)

- Decreased GFR

- Increased serum (blood) BUN and creatinine

*also seen in chronic renal failure

What phase of acute kidney injury is when the injury is actively occurring? Such as low blood volume, taking nephrotoxic drugs, kidney injury from diabetes.

Initiation phase (1)

What phase of acute kidney injury is when the kidney function is at its worst? The injury has already occured, will see high serum BUN and creatinine, low GFR.

Maintenance/Oliguric phase

*need to fix to go to next stage (2)

What can be seen in the maintance phase of acute kidney injury which causes decreased urine output? Kidneys are at its worse.

Oliguria

What phase of acute kidney injury is when the kidney function is re-established to baseline?

Recovery/polyuric phase

What will be seen during the Recovery stage of acute kidney injury? The kidneys will go into overdrive when working again. (DP)

- Post-injury diuresis

- Polyuria (excess peeing)

*be careful with fluids and electrolyte imbalances

What is the progressive and irreversible loss of all renal function? It will affect all organs systems if this occurs.

Chronic renal failure

*responsible for electrolytes, removing waste, blood, etc.

What are the causes of chronic renal failure? (APGS) (GDL)

- Unresolved AKI

- Chronic pyelonephritis or glomerulonephritis

- Systemic disease (HTN, diabetes, lupus)

How many stages are in chronic renal failure? Tell us how low our GFR is and how damaged the kidneys are.

5 stages

What stage are symptoms commonly seen for chronic renal failure?Nephrons that are undamaged can be compensated until <25% function remains (stage 4-5)

- Stage 3 (symptoms)