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NURS 319 Exam 1
Chp 22/23 - Renal and Urologic Disorders Pt 2. (slides 20-61)
| Question | Answer |
|---|---|
| Why is acute kidney injury dangerous? | It can quickly lead to damage if not caught soon enough. |
| What are the three common signs of AKI? | 1) Azotemia 2) Elevated creatinine 3) Fluid retention |
| What are the three classifications of AKI and where are they located? | 1) Prerenal, "center" or blood flow region 2) Intrarenal, inside kidney 3) Postrenal, renal pelvis and down |
| What occurs in each of the three AKI stages and which is the most common? | 1) Prerenal: decreased perfusion, most common! 2) Intrarenal: nephron damage 3) Postrenal: obstruction |
| Why can prerenal dysfunction reduce cardiac output and cause shock? | it can lead to severe hypovolemia which reduces blood volume |
| Prolonged renal hypoperfusion is caused by what? | not enough blood flow |
| What can prolonged renal hypoperfusion lead to? | Acute Tubular Necrosis (ATN) which is damage to the nephron tubule epithelial cells |
| You just found out a patient is experiencing oliguria. He recently came to the hospital for severe hypovolemia and shock. What is directly causing the oliguria? | The severe hypovolemia led to prolonged renal hypoperfusion which then caused the development of acute tubular necrosis. The dead cells sloughed off the tubules and blocked the lumen which blocked urine formation and is producing oliguria as a symptom. |
| Explain how a prerenal acute kidney injury can lead to renal failure. | When prerenal injury leads to Acute Tubular Necrosis (ATN) then the prerenal injury worsens into an intrarenal injury. If this is not corrected, then the result will be nephron death and renal failure. |
| What is an indication that a patient has oliguria? (lab values) | A patient is urinating less than 400 mL in 24 hours or less than 30 mL in one hour. |
| What are the three broad causes of intrarenal dysfunction? | 1) Trauma to kidney 2) Infection of kidney 3) Nephrotoxic drugs |
| Give two examples of diseases that cause trauma on the kidney. | Pyelonephritis and certain autoimmune conditions like Lupus |
| What is a common cause of intrarenal dysfunction in patients who recently had strep? | Post-streptococcal glomerulonephritis |
| What type of drugs can destroy the nephrons if taken in excess? | Any drug that reduces inflammation and isn't a steroid |
| What type of medication is given to lower BP for kidney disease? | ACE Inhibitor |
| What other medication can assist ACE Inhibitors in lowering BP? | Angiotensin-receptor blockers |
| Obstructive uropathy can lead to which AKI classification? | Postrenal dysfunction |
| What can cause hydronephrosis to develop? | 1) Renal calculi 2) Prostate gland hyperplasia 3) neurogenic bladder |
| What are the four phases of AKI? | 1) Initial insult 2) Oliguria 3) Diuresis 4) Recovery |
| Explain the Initial Insult stage of AKI. | Initial Insult means that a disruption to the kidney has occurred and resulted in a prerenal, intrarenal, or postrenal condition. |
| Explain the Oliguria stage of AKI. | Low GFR, lack of urine output, and fluid overload |
| Explain the Diuresis stage of AKI. | A large amount of unconcentrated urine outflow, slight improvement, but kidney is still not concentrating urine properly. |
| Explain the Recovery stage of AKI. | The healthy nephrons take over the function of the damaged nephrons and kidney function resumes. |
| In which stage does the GFR "reboot"? | Diuresis |
| What is the common cause of acute kidney injury? | Acute Tubular Necrosis (ATN) |
| Acute Glomerulonephritis (AGN) causes a group of symptoms known as _____________ ____________. | Nephritic Syndrome or Nephritis |
| How does AGN cause damage to the glomerulus? | By triggering inflammation of the membranes in the glomerulus. |
| What is the cause of AGN? | Infection, typically from strep (known as post-streptococcal glomerulonephritis or PSGN) |
| What irreversible disease can AGN progress to? | End Stage Renal Disease (ESRD) |
| Since AGN is caused by an infection, then it is common for antigen-antibody immune complexes to form. When these complexes damage the glomeruli, what does that cause? | Hyperpermeability of the glomeruli |
| There are six results of damaged glomeruli caused by AGN. what are they? | 1) Protein loss 2) Periorbital edema 3) Oliguria 4) Hypervolemia (HTN) 5) PSGN if 7 to 21 days post-strep infection 6) Dark urine (fill of RBCs) |
| Why would someone with AGN have elevated creatinine and BUN? | Since the glomerulus is damaged, it can not properly excrete creatinine in the urine, bringing its levels up in the blood. BUN would also be elevated because the GFR has decreased as a result of the glomeruli damage. |
| Would someone with AGN have low or high serum albumin? Why? | A person with AGN would have low serum albumin. This is because the proteins that typically stay in the blood are allowed to "spill" into the urine due to the damaged glomeruli. |
| What would be present in the urinalysis of someone with AGN? | Protein, WBC's, and blood |
| What is another way of diagnosing AGN outside of blood and urinalysis testing? | Through an Anti-streptolysin O titer (aka looking for antigens to strep virus) |
| What is the main different between nephrotic syndrome and nephritic syndrome? | Nephrotic syndrome is usually brought on by a chronic condition and causes damage to the glomerulus. Nephritic syndrome is where inflammation from infection can cause the glomerulus to suffer damage. |
| What are the two major signs of nephrotic syndrome? | Frothy urine (proteinuria) and full body edema |
| What are the three most common causes of nephrotic syndrome? | Diabetes mellitus, Lupus, and amyloidosis |
| Along with proteinuria and full body edema, what other symptoms can occur from nephrotic syndrome? | Major albuminuria, hyperlipidemia, hematuria, hypertension, and oliguria |
| Why is hyperlipidemia a cause for concern in Nephrotic Syndrome? | Hyperlipidemia is a sign of liver damage due to overproduction of albumin. The liver increases its lipid/albumin synthesis to try and compensate for the urinary loss. |
| Why is there full body edema in nephrotic syndrome? | Due to extreme albuminuria, there is no albumin left in the bloodstream. Albumin is what helps pull fluids from interstitial spaces back into the blood stream, so without it, fluid stays in the tissues. |
| If albumin is a protein, then why does hyperlipidemia occur? | Lipids are required for the process of making proteins. Since the body is losing albumin rapidly, the liver goes into overdrive to make albumin, which also requires lipids to be made. |
| What are the two types of renal calculi? | Urolithiasis and Cystolithiasis |
| What do kidneys do to try and stop the formation of kidney stones? | secrete stone-inhibitors |
| Name a few risk factors of renal calculi. | genetics, diet, metabolic abnormalities, dehydration, excess CA intake, hyperparathyroidsim, gout, hyperuricemia, immobility, immobility, gout, uti, urinary stasis |
| Why is hyperparathyroidism a concern for renal calculi formation? | Too much parathyroid hormone leads to excess calcium excretion in the urine, which increases the likelihood to develop kidney stones |
| What are the four main types of renal calculi? Which one is the most common and which one is the most rare? | 1) Calcium (most common) 2) Struvite 3) Uric acid 4) Cystine (rare) |
| What is cause for calcium renal calculi? | Hypercalcemia |
| What is the cause for struvite renal calculi? | 1) Proteus UTI (a certain type of bacteria) is known to cause urolithiasis with persistent infections |
| What is struvite? | Magnesium and ammonium phosphate |
| Who is most at risk for a struvite renal calculi? | Patients with spinal cord injuries |
| What are the two causes for uric acid renal calculi? | 1) A diet high in purines (uric acid) 2) Gout - inflammatory arthritis in the joints caused by the accumulation of uric acid crystals |
| What causes cystine renal calculi to develop? | A rare cystine metabolism disorder |
| Describe the three types of pain that can occur from urolthiasis. | 1) CVA pain or "flank" pain 2) Severe abdominal pain 3) Severe and intermittent pain known as Renal Colic |
| Describe what Renal Colic is. | Renal Colic is a severe type of pain that usually results from a urinary tract obstruction. The pain is caused by spasms of the ureter and comes and goes in waves lasting up to 20-60 minutes. |
| What are three indicators of urolithiasis in the urine? | 1) Hematuria 2) Pyuria 3) Crystalluria |
| If a kidney stone causes a backup, what condition can that lead to? | Hydronephrosis |
| Along with pain and urine indicators, what are some physical symptoms of urolithiasis? | Vomiting, nausea, and a fever |
| What is the most important aspect of diagnosing a kidney stone? | Stone analysis |
| This is a type of infection that has not spread into the entire kidney yet, and is caused by an ascending UTI | Pyelonephritis (infection of the renal pelvis) |
| What is vesicoureteral reflux and why can it contribute to the development of pyelonephritis? | Vesicoureteral reflux is when urine is spilling up from the bladder and into the ureters. This can cause stasis of urine or backup of urine. |
| Along with obstruction, vesicoureteral reflux, and pregnancy, what is another factors in developing pyelonephritis? | Neurogenic bladder (loss of innervation) |
| What is a distinguishing symptom between a lower UTI and Pyelonephritis? | Fever is usually seen in pyelonephritis but very uncommon in lower UTI. |
| What is seen in the urine of a patient with pyelonephritis? | Microscopic hematuria and pyuria (elevation of WBCs) |
| What is the most common cause of Pyelonephritis? | E. coli infection |
| What are some diagnostic ways to see if a patient has pyelonephritis? | CECT, CT scan, ultrasound |
| What genetic disorder results in cyst formation and 6-8% of patients on dialysis in the United States? | Polycystic Kidney Disease (PKD) |
| What is the most common PKD? | Autosomal Dominant PKD (ADPKD) |
| What are the four common symptoms of PKD? | Pain, renal calculi, CVA tenderness, increased BP |
| How is PKD diagnosed? | Through an ultrasound or CT scan |
| What disease affects 90 to 95% of the nephrons and is irreversible and progressive? | Chronic Renal Failure (CRF) |
| CRF usually progresses to ______. | ESRD |
| What treatment is needed if CRF progresses to ESRD? | Hemodialysis or kidney transplant |
| What are the four leading causes of CRF? | Diabetes mellitus, hypertension, glomerulonephritis (chronic), and PKD |
| How many stages of CRF progession are there? | five |
| What is the GFR value for stage 1 CRF and what does this mean for kidney function? | [greater than 90 mL/min] kidney is damaged but has normal or increased GFR |
| What is the GFR value for stage 2 CRF and what does this mean for kidney function? | [60 to 89 mL/min] mild reduction |
| What is the GFR value for stage 3 CRF and what does this mean for kidney function? | [30 to 59 mL/min] moderate reduction, symptoms start to appear! serum creatinine and BUN increase |
| What is the GFR value for stage 4 CRF and what does this mean for kidney function? | [15 to 29 mL/min] severe reduction |
| What is the GFR value for stage 5 CRF and what does this mean for kidney function? | [Lower than 15 mL/min] kidney failure, patient requires dialysis or transplant |
| Name some complications of CRF. | Uremic encephalopathy (toxins in blood, causing cognitive decline), proteinuria, hypoalbuminemia, electrolyte imbalance, thrombocytopenia, hyperkalemia, etc. |
| How is CRF diagnosed? | blood work, BUN and CR serum levels, renal imaging |
| In what scenario would a patient with CRF be evaluated for a kidney transplant? | When their GFR is less than 10 to 20 mL/min. |
| Why can benign prostatic hyperplasia (BPH) cause urolithiasis? | The extra amount of cells presses on the ureter, causing dysuria and backup of urine. |
| Why are lower UTI's more common in women? | Women have much less anatomy separating themselves from the outside than men |
| Explain the innervations related to the bladder. | The sympathetic nervous system relaxes the detrusor while tightening the internal sphincter. The parasympathetic nervous system contracts the detrusor while relaxing the internal sphincter. |
| How much urine does the bladder usually hold and what amount triggers the urge to pee? | The bladder usually holds 300 to 400 mL of urine. Around 250mL of urine is where the urge to pee begins to develop. |
| What is the micturition reflex and what triggers it? | The micturition reflex is how urine is released from the bladder. Bladder stretching sends signal to the cerebral cortex indicating that the bladder is full. The brain then opens the urethra. |
| What is the most common pathophysiological problem in the urinary tract? | Obstructive uropathy |
| What is the most common obstruction? | Renal Calculi |
| What is the most common cause of obstructive uropathy in men over 60 years old? | Benign prostate hyperplasia (BPH) |
| What does prolonged obstruction result in? | Increased hydrostatic pressure leading to nephron damage and decreased GFR. |
| Is hydronephrosis reversible? | Yes, if it is acute and not chronic |
| Hydroureter vs Hydronephrosis | Hydroureter is the dilation of the ureters due to an obstruction. Hydronephrosis is the dilation/expansion of the renal pelvis due to obstruction. |
| A proteus infection is more commonly associated with ____________________ or the use of another urinary instrument. | catheterization |
| Why are lower UTI's most commonly caused by E.coli? | Some people wipe back to front instead of front to back like they're supposed to (improper perineal hygiene). |
| Why is diabetes a risk factor for a lower UTI? | High blood sugar feeds bacteria |
| What is asymptomatic bacteriuria (ASB) and what normally causes it? | ASB is the presence of bacteria in the urine without any UTI symptoms. This most common cause of ASB is pregnancy. |
| What are the 5 male risk factors for lower UTI? | 1) Chronic dehydration 2) Diabetes 3) BPH 4) Bladder cancer 5)urinary catheterization |
| What is CAUTI? | Catheter-associated urinary tract infections |
| Hospital-acquired UTI's are from these three causes: | 1) CAUTI (catheter-associated urinary tract infection) 2) Multi-drug resistant pathogen 3) Polymicrobial infection |
| What are the four main symptoms of a lower UTI? | 1) Increased frequency 2) Dysuria 3) Urgency 4) Hematuria (not always) |
| What three things in a urinalysis would indicate a UTI? | 1) RBC's 2) Positive leukocyte esterase (WBCs) 3) Nitrates --> indication of bacteria |
| What would the urine culture of a lower UTI produce? | A CFU of more than 100,000 CFU/mL |
| What is a severe complication of UTIs that immunocompromised, elderly, and catheterized patients are at risk for? | Urosepsis (UTI spreads to bloodstream) |
| What symptoms does the acute, severe urosepsis produce? | Fever, chills, confusion, disorientation, and hypotension |
| What urine culture confirms an ASB diagnosis? | Two consecutive urine cultures with a colony count of over 100,000 bacteria and no reported UTI symptoms. |
| What is the most common cause of ASB? | E.coli |
| What are the five types of urinary incontinences? | 1) Stress incontinence 2) Overactive bladder (OAB) 3) Functional incontinence 4) Overflow incontinence 5) Neurogenic bladder |
| Which incontinence is due to the loss of strength and elasticity in the detrusor muscle? | Overflow incontinence (bladder involuntarily leaks) |
| What incontinence is due to inability to hold urine? | Functional incontinence |
| What is the most common incontinence that women are more at risk for? | Stress incontinence |
| What incontinence produces the constant urge to pee? | Overactive bladder (OAB) |
| There are many ways to diagnose a urinary incontinence. Which four are most commonly associated with urinary incontinence and no other illness? | 1) Urodynamic testing (electrodes) 2) Measuring postvoid residual volume in the bladder 3) Simple urinary cough test 4) Cotton swab test |
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