patho11

–Existing kidney impairment, atherosclerosis, hypertension, diabetes mellitus, heart failure, and liver impairment or failure

• Prerenal Acute renal failure
• Postrenal Acute renal fialure
• Intrarenal Acute renal failure

of diminished perfusion of kidney (decreasee amount of blood that comes into the kidney)

decrease in blood bolume due to excesive vomitting or diarrhea, excessive burn , excessive hemorrage, over use of diuretics

obstruction of outflow of urine

failure of nephrons w/in kidney

Oliguria

intrarenal renal failure

results in elevated pressure in Bowman's capsule which impedes in glomerular filtration

intrarenal renal failure

w/in the renal tubules, resulting in acute tubular necrosis

nephrotoxic or ischemic insults

ischemia and an inflammatory process

the most apoptotic cell death

• Oliguric stage
• Diuretic Stage
• Recovery Stage

w. water retention, hypervolemia leads to edema and hypertension

beginning of renal recovery, as renal function returns

Acute renal Failure

Full recovery of renal function and may take a week or as long as a year

b/c tubules breaking down and cells slothing off and gettin into tubule and you end up w/ water retention --> leading to no passage of urine

oliguria and progressive uremia

may last 1-2 wks

followed by a diuretic stage that lasts 2-10 days

urine volume increases by tubular function remains impaired and azotemia continues

lasing up to 12 months

characterized by gradual normalization of serum creatinine and BUN

often a degree of renal insufficiency persists

• serum creatinine
• calculated creatinine clearance
• retention of metabolic wastes (azotemia/uremia) monitored by BUN

Diabetes mellitus and hypertension

• other factors:
• glomerulonephritis
• cystic kidney disease
• family hitory of chronic kidney disease
• exposure to toxins
• ethnicity (African american, hispanic)

glomerulosclerosis and interstitial inflammation and fibrosis ocurr

Tubulointerstitial injury

by diminishing the GFR

• Diminished renal reserve
• Renal insufficiency
• End-stage renal disease

you still have functional kidney and is asymptomatic

less than 75% of nephrons have been lost

not getting any filtration, lose of the ability to concentrate urine, no more water being reasbsorbed

• Polyuria and nocturia, due to lost ability to concentrate urine
• 75-90% of nephrons have been lost

more than 90% of nephrons have been lost

Azotemia, uremia, anemia, fluid and electroyte imbalances

Transplantation or death are available outcomes

• Hypertension and cardiovascular disease
• Uremeic Syndrome
• Metabolic Acidosis
• Electrolyte imbalances
• Renal Osteodystrophy
• Malnutrition
• Anemia

Hypertension and cardiovascular disease

Uremic Syndrome (retention of waste products)

Metabolic Acidosis, retention of the acidic waste products of metabolism

retention of potassium, phosphate, magnesium

hyperkalemia is the most serious, due to its cardiac effects

breakdown of bone due to phosphate imbalance

anorexia of uremic syndrome and by chronic illness

diminished secretion of erythropoietin by kidneys

irreversible loss of functional nephrons

• 1. percentage of nephron loss
• 2. reduction in GFR

lab values are normal and the condition is usually asymptomatic

BUN and creatinine

Nephrotoxic chemicals

limit dietary phosphorus, protein, sodium, and potassium

calcium and noncalcium phosphate binding drugs

synthetic erythropoietin to address anemia

drug management for DM, HTN, and hyperlipidemia

• hemodialysis or peritoneal dialysis
• initiated to address the development or uremia

the focus intervention until stages 4-5

increased calories as well as calcium and vit. supplementation

fluid, phosphorus, potassium, sodium, and protein intake

secondary to disorders of the lower urinary tract

due to pathologies affecting the central, autonomic, and peripheral nercous systems

bladder infections that irritate the bladder lining, radiation therapy, tumors or stones in the urinary tract, or central nervous system damage to inhibitory pathways

weakening of pelvic muscles or intrinsic urethral sphincter dificiency

combination of both stress and urge incontinence

Obstruction of the urethra, or an underactive or inactive detrusor muscle

physical or environmental limitations in reaching a toilet in time to void

a broad classification of voiding dysfunction in which the specific cause is a pathology that produces a disruption of nercous communication governing micturition

inappropriate wetting of clothing or bedding, w/ the term usually reserved for incontinence in children, particularly at night

maturational delay

usually behavioral modification w/ or w/o pharmacologic intervention

voiding disorders in which the cuase is the disruption of nervous communication governing micturition

older women

pregnancy, w/ weakening of pelvic muscles

urine lost w/ increases in intra-abdominal pressure

obstructed urethra, due to enlarged prostate or prolapsed urterus

8th and 4th

transitional cell (urethelial) carcinomas, arising in the lining of bladder

Smoking !!

radiation, surgery and chemotherapy, which radiation and chemotherapy occuring preoperatively or postoperatively or both

cant rely on it

mutation

hematuria

NOt Common

a cystoscopy, w. biopsy of any questionable tissue and washings to free cells for cytologic examination

• the tumors features:
• type of bladder cancer
• grade and stage

Primary options are surgery, radiation therapy, chemo, immunotherapy

inflammation of urethra

pain, burning, urinary incontinence

infective cystitis

Inflammation of bladder lining

bacterial, fungal, or parasitic infections, chemical irritants, foreign bodies (stones), or trauma

Bacterial infection

acute onset of frequency, urgency, dysuria, and pain (suprapubic area)

painful bladder syndrom

chronic condition consisting of bladder pain, urgency, frequency and nocturia

cause is unknown

but correlated w/ alcohol abuse, large number of citrus fruits, tomatos, drinks too much coffee or tea, too much carbonated beverages, chocolate