Pathophys Test 3

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Author:
cgordon05
ID:
14478
Filename:
Pathophys Test 3
Updated:
2010-04-14 13:29:11
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Renal 12 15
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Description:
Renal 12-15
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  1. Acute pyelonephritis (p.12-13)
    • Acute inflammatory condition involving kidney and renal pelvis caused by bacterial infection
    • Manifestation of UTI
    • Usually involves infection originating in lower urinary tract
    • - cystitis, protatitis, urethritis
  2. What factors contribute to acute pyelonephritis? (p.12-13)
    • Organisms likely to cause:
    • - E. coli (most common)
    • - Proteus klebsiella
    • - Enterobacter
    • - Pseudomonas
    • Often result of manipulation of urinary tract:
    • - catheterization
    • - cystoscopy
    • Routes for bacteria to reach kidneys:
    • - bloodstream
    • - lower urinary tract
  3. What are the clinical manifestations of acute pyelonephritis? (p.13)
    • Onset of pain at costovertebral angle
    • Signs of systemic infection - fever, chills, malaise
    • Can be self-limiting
  4. Azotemia
    • Substantial rise in plasma concentration of non-protein nitrogenous compounds
    • Urea
    • Creatinine
  5. Prerenal ARF (azotemia)
    • Result of decreased blood flow
    • - inadequate perfusion
    • - decreased glomerular filtration in presence of otherwise normal renal function
    • No parenchymal damage
    • Reversible - if renal blood flow quickly restored and cardiac output normal
  6. Causes of prerenal ARF
    • Systemic hypotension or hypovolemia
    • - decreased cardiac output (CHF)
    • - burns, trauma (hemorrhage)
    • - dehydration
    • - bacterial sepsis
    • - bilateral renal stenosis
    • - any situation resulting in shock --> renal hypoperfusion
  7. Postrenal ARF (azotemia)
    • 5% of cases of ARF
    • Usually result of obstruction of urethra, bladder neck, bilateral ureters, or unilateral ureters in patient with one functioning kidney
  8. Causes of Postrenal ARF
    • Benign prostatic hypertrophy
    • Blood clots
    • Tumors
    • Renal calculi
    • Foley catheter obstruction
    • Urethral strictures
  9. Intrarenal ARF
    • Result from any lesion in any part of the kidney, including:
    • - glomeruli (progressive glomerulonephritis)
    • - blood vessels (malignant hypertension)
    • - DIC
    • - HUS
    • - tubules and interstitium - acute tubular necrosis, allergic acute interstitial nephritis
  10. Cause of intrarenal ARF?
    • Most common cause = Acute Tubular Necrosis (ATN)
    • Either ischemic or nephrotoxic
  11. Differentiate between prerenal and intrarenal ARF in terms of parenchymal damage.
    • Prerenal = no parenchymal damage
    • Intrarenal = + parenchymal damage
  12. How will urine lab values differ between prerenal & intrarenal ARF?
  13. Acute Tubular Necrosis (ATN) (p.16-17)
    • Acute injury of renal tubules
    • Result in acute suppression of renal function
    • - decreased GFR
    • - oliguria (<400 mL/day)
    • - anuria
    • - increased BUN and serum creatinine levels (azotemia)
  14. Ischemic ATN
    • Segmental necrosis
    • + basement membrane rupture
    • Injury to renal tubules
    • Impaired Na+, Cl-, and fluid reabsorption
    • Little urine produced - unconcentrated (isotonic), increased Na+ concentration (>40 mEq/L)
    • Ischemia >60 minutes = irreversible
    • Occurs as response to shock or dehydration
    • - decreased renal blood flow
    • - reduced GFR
  15. Nephrotoxic ATN
    • No rupture of basement membrane
    • Reversible if treated quickly
    • Repair process not long because basement membrane still intact
    • Caused by many poisons, heavy metals, numerous drugs
  16. In ARF, the oliguric phase is represented by approximately how much urine output? (p.16)
    • <400 mL/day
    • (< 0.5 mL/kg/hr)

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