Patho ch33.txt

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Patho ch33.txt
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2011-10-19 07:28:01
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Mountain State University Physician Assistant Class of 2014 - Pathophysiology Ch 33 - Disorders of Renal Function
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  1. Define agenesis
    • Complete failure of an organ to develop
    • Unilateral renal 1 in 1000 boys and left more common
    • Usually asymtomatic
  2. Define hypoplasia
    • Organ does not develop to normal size
    • Unilateral more common
    • Secondary common true rare
  3. Define dysgenesis
    Failure of an organ to develop properly
  4. Cite the effect of urinary obstruction in the fetus
  5. Describe the inheritance, pathology, and manifestation of the different types of polycystic kidney disease
    • Dom (adult) most common
    • Type I dom pkd1 gene 85%
    • Type II dom pkd2 gene 15%
    • Dominant pckd in every segment of the nephron
    • RECESSIVE - 75% fatal 1st yr
    • Cystic dilation of CT, PKHD1 gene
    • Recessive pckd in collecting ducts
  6. How often do abnormality of the kidneys ureters occur and what are the most common?
    • 3-4% of newborns
    • Anomolies of shape and position are most common
  7. What is the progression of the fetal kidneys?
    • Develop in fifth week
    • Function 8th week, urine 9-12w
    • Urine main part of amniotic fluid
  8. What is oligohydramnios?
    Small amount of amniotic fluid due to nonfunctioning or obstructed fetal kidneys. Compresses fetus and can cause impaired lungs
  9. What is potters syndrome?
    • Low widely seperated ears nose broad and flat chin receding limb defects
    • Related to oligohyramnios
  10. What is the mostcommon cause of an abdominal mass in newborns?
    Unilateral multicystic renal dysplasia
  11. What is nephronophthisis-medullary cystic disease complex?
    • Cysts at cortical medullary junction in dct
    • 10-25% of renal fail in peds
    • Impaired urine concentration
  12. What are simple and aquired renal cysts?
    • Simple common usually asymptomatic
    • Aquired in end stage renal failure on dialysis
  13. List four common causes of urinary tract obstruction
    Most common is urinary calculi
  14. Define the term hydronephrosis and relate it to the destructive effects of urinary tract obstruction
    • Urine filled dilation of renal pelvis and calices
    • Caused by urinary obstruction
    • Acute cause pain chonic doesnt but both destroy kidney
  15. Describe the role of urine supersaturation, nucleation, and inhibitors of stone formation in the development of kidney stones
    • Supersaturated urine has high concentrations of stone components
    • A nucleation or nidus of crystal calcium oxalate begin formation
    • Inhibitors such as magnesium, citrate, and tamm-horsfall mucoprotein may bind calcium
  16. Describe methods used in the diagnosis and treatment of kidney stones
    • Symptoms of pain, radiology, urinalysis, iv pyelography, ultrasound
    • treat for pain, <5mm should pass, strain urine to test,
    • Uteroscopic, percutaneous, or extracorpreal lithtripsy less invasive
    • Large may need open surgery
  17. What is the difference between upper/lower urinary tract obstruction?
    Above or below uterovesical junction
  18. Cite organisms responsible for UTIs and why catheters, obstructions, and reflux predispose to infections
    • E. Coli - most uncomplicated lower UTI but could be S. Saprophyticus
    • complicated UTIs - gram neg rods (Proteus Mirabilis, Klebsiealla, Enterobacter, Psuedomonas A.) and gram pos cocci (S. Aureus)
    • uti usually comes up from urethra
    • reflux in interupted voiding, coughing, squatting,
    • catheter most common gram neg septicemia
  19. List three physiologic mechanisms that protect against UTIs
    • washout phenomenon, perstalic ureters
    • mucin lining of bladder
    • IgA and phagocytic blood cells
    • normal flora of periurethral in women
    • prostate secrections in men
  20. Describe the signs and symptoms of UTIs
    • acute cystitis - frequent urination, lower ab or back discomfort, burning and pain on urination, ocassional urine foul smelling and cloudy
    • symptoms usually cease within 48 hrs of tx
  21. Describe the factors that predispose UTIs to children, sexually active women, pregnant women, and older adults
    • CHILDREN - female short urethra, fecal proximity
    • WOMEN - sex pushs bacteria up, spermicide can kill flora
    • PREGNANT - dilated upper urinary, decreased ureter peristalsis, displaced bladder
    • OLDER - decreased mobility, decreased bactericidal, obstructions, bladder ischemia
  22. Compare the manifestations of UTIs in different age groups including infants toddlers teens adults and older
    • INFANTS - commonly upper UTI (pyelonephritis), bacteremia, septicemia, fever, hypothermia, apnea, abdominal distention, diarrhea, vomiting, lethargy, irritability
    • TODDLERS - abdominal pain, vomiting, diarrhea, abnormal voiding patterns, foul smelling urine, fever, and poor growth
    • TEENS - enuresis, freq, dysuria, suprapubic discomfort, unexplained fever
    • ADULTS - same but usually no fever
    • OLDER - typical sx may be absent, may have freq urgent incontent w/o UTI
    • vauge sx - anorexia, fatigue, weakness, changed in mental status
  23. Cite measures used in the diagnosis and treatment of UTIs
    • UTI diagnosed by symptoms and positive urine culture. gram stain to differentiate. nitrites and leukocyte esterace less sensitive,
    • usually TMP-SMX for acute lower but e.coli becoming resistant.
    • find and treat cause of chronic (obstruction, reflux)
  24. Describe the two types of immune mechanisms involved in glomerular disorders
    • 1-injury from antibody reaction to fixed glmerular antigens or antigens planted within the glomerulus
    • 2-injury from circulating antigen-antibody complex trapped in glomerular membrane
  25. User the terms proliferation, sclerosis, membranous, diffuse, focal, segmental, and mesangial to explain changes in glomerular structure that occur with glomerulonephritits
    • proliferative - increase in glomerular or inflammatory cell number
    • membranous - basement membrane thickening
    • sclerosis - increase in mesangial extracellular matrix
    • fibrosis - deposition of collegan fibers
    • diffuse - all glomeruli and all parts
    • focal - only some glomeruli
    • segmental - certain segment of glomeruli
    • mesangial - only mesangial cells
  26. relate the proteinuria, hematuria, pyuria, oliguria, edema, hypertension, and azotemia that occur with glomerulonephritis to changes in glomerular structure
    • proteinuria,hemtauria from damage to glomerulus filter
    • pyuria from inflammatory immune response
    • oliguria from permeability
    • edema, azotemia, and hypertension from renal insufficiency
  27. what is the difference among the nephritic syndromes, rapidly progressive glomerulonephritis, nephrotic syndrome, asymptomatic glomerular disorders, and chronic glomerulonephritis
    • Nephritic syndrome- produce proliferative inflammatory response
    • Rapid - immunologic SLE and Goodpasture
    • nephrotic syndrome - produces increased permeability
    • asymptomatic - significant 16% of population have small amounts of proteinuria,hematuria, lowGFR
    • chronic - progression of asymptomatic or acute
  28. Cite a definition of tubulointersitial kidney disease
    • disoders which affect renal tubular structures and the intersitial tissue
    • acute - sudden interstitial edema by pyelonephritis or drug hypersensitivity
    • chronic - intersitial fibrosis,atrophy, by imbalances caused by changes in tubular function
  29. differentiate between the defects in tubular function that occur in proximal and distal tubular acidosis
    • PROXIMAL RTA - defect in PCT where 85% of bicarb is reabsorbed, pt has decreased plasma bicarb, seldom severe acidosis
    • DISTAL RTA - DCT and CT, hypokalemia, hyperchloremic metabolic acidosis, inability to acidify the urine, nephrocalcinosis, nephrolithiasis
  30. explain the pathogenesis of kidney damage in acute and chronic pyelonephritis
    • ACUTE - gram neg (e.coli etc) thru UTI, S.aureus thru blood, abrupt chills fever loin pain,
    • CHRONIC - scarring and deformation, reccurent caused by reflux, may be insidious, severe hypertension contributes
  31. explain the vulnerability of the kidneys to injury caused by drugs and toxins
    drugs can decrease renal blood flow, obstruct urine, directly damage structures, or produce hypersensitivity reactions
  32. Characterize Wilms tumor in terms of age of onset, oncogenic origin, manifestations, and treatment
    • 3-5 yo, most common malignant abdominal tumor
    • congenital, large asymptomatic abdominal mass and hypertension,
    • TX - Surgery, chemo, radiation, 60% all, 88-98 I-III
  33. cite the risk factors for renal cell carcinoma, describe its manifestation, and explain why the 5 year survival rate has been so low
    • heavy smoking, obesity in women, petroleum heavy metals asbestos, aquired cystic KD
    • most commonly upper pole, clear cell PCT epithelial
    • usually asymptomatic until advanced except small hematuria,
    • 90-95% of kidney cancers

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