Exam 4 Renal System

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Total Incontinence.

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Total Incontinence.

Inability to store urine

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Overflow Incontinence

Frequent dribbling that relieves a constantly full bladder

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Urge Incontinence***

Sudden and uncontrollable need to void that cannot be suppressed

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Stress Incontinence***

Uncontrollable voiding that occurs with weakness of the pelvic floor muscles

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Urinary frequency

need to urinate excessively, but voiding normal or less than normal amounts

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Urinary urgency

sudden urge to urinate

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Urinary hesitancy

difficulty starting or maintaining urinary stream

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Nocturia

excessive urination at night

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Oliguria

decreased urine output (<30 ml/hr or <400 ml/day)

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Polyuria

excessive urine output

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Anuria

little to no urine output (<100 ml/day)

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Dysuria

difficult, painful urination

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Pyuria

pus in urine

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Urinalysis

lab test to evaluate the urine chemistry- looks at WBCs, RBCs, protein, color, ketones

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Obstructive uropathy

a structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction

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Urolithiasis

formation of urinary calculi (stones) in the urinary tract. Generally asymptomatic until they pass into the lower urinary tract

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What are the different types of stones?

  • Calcium oxalate (75-85%)

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  • Struvite (15%)

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  • Uric Acid (7%)

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Where do stones usually form?

· Stones usually grow on the papillae or in the renal tubules, calyces, or renal pelvis

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· Can also occur in the ureter or bladder

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What are risk factors for stone formation?

· Gender (more common in males)

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· Frequent UTI

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· Dehydration

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· Tubular defects

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· Diet (high protein & tea)

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· Alterations in urine pH (high or low)

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What are the symptoms of stones?

Pain (depend on location- generally renal colic, flank pain; can be painless unless actively being passed)

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Obstruction: can cause obstruction at upper or lower urinary tract

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  • Urinary urgency, frequency

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  • Hematuria- blood in urine

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  • Nausea and/or vomiting

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  • Hydronephrosis: kidneys are backed up and swell> Renal failure

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Hydronephrosis

Occurs when a kidney has an excess of fluid (swelling) due to a backup of urine, often caused by an obstruction in the upper part of the urinary tract

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How does hydronephrosis occur with urolithiasis?

When a stone causes a blockage, it can cause backup of urine (hydronephrosis)

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Benign Prostatic Hypertrophy (BPH)

  • Non-malignant enlargement of the prostate

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  • Occurs in 50% of men > 50 yo and 90% of men past 80 years old

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  • Pushes on the urethra

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and results in bladder

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outflow obstruction

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What is the concern with BPH?

  • can lead to UTIs and create obstructions

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  • Also post renal kidney injury/failure

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What are the manifestations of BPH?

· Nocturia

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· Urinary frequency

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· Urinary hesitancy

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· Hematuria

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· Interruption in urinary flow

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· Large smooth prostate

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· Increased serum PSA

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What are the most common risk factors for UTIs?

· Female: TEACH GIRLS TO WIPE FRONT TO BACK

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· Sexually active (multiple partners increases risk; STIs like gonorrhea & chlamydia increase risk)

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· Use of diaphragm with spermicide, bubble baths

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· Diabetics

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· Recent catheterization

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· Obstructive uropathy

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Most common cause of UTIs

E. coli (80% of cases)

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What are the classic manifestations of lower UTIs?

WBC and/or nitrites in urine

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Hematuria

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Urinary frequency and urgency

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Dysuria

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Foul smelling urine

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Cloudy urine (pyuria- pus in urine)

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What are the classic manifestations of upper UTIs?

Same symptoms of lower UTI

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Fever

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Chills

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Nausea

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Vomiting

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Malaise

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Low back "flank" pain

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How do elderly usually present with a UTI?

May have new onset of confusion along smelly urine

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Nephritis

  • Infection and inflammation in kidney- affects the renal pelvis, calyces, medulla

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  • Usually caused by E.coli, Proteus, or Pseudomonas

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  • Typically starts in lower tract and infection ascends from bladder

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Systemic Manifestations of Infection- could lead to sepsis, if not taken care of

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  • Filtration, reabsorption, and secretion can be impaired (can decrease renal function)

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  • Repeated attacks can cause scarring and renal damage

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Glomerulonephritis

damage to kidneys as a result of immune response; type 3 hypersensitivity-immune complex hypersensitivity

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Pyelonephritis

  • inflammation of the kidney and renal pelvis

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  • CVA (costovertebral angle) tenderness and fever

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Hallmark manifestation of Glomerulonephritis

Tea colored urine

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Key difference between pyelonephritis and glomerulonephritis

pyelonephritis is the inflammation of the kidney due to the urinary tract infections that reach the renal pelvis of the kidney, while glomerulonephritis is the inflammation of tiny blood vessels of the kidney known as glomeruli due to inflammation and thickening of the glomerular basement membrane that becomes leaky

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Acute Glomerulonephritis (AGN) causes

  • streptococcal infection

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  • bacterial endocarditis

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  • viral infections

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