patho11

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LaurenFleming
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157645
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patho11
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2012-06-06 22:32:53
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chpt 11
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patholecture11
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  1. What are the comorbidities for acute renal failure??
    –Existing kidney impairment, atherosclerosis, hypertension, diabetes mellitus, heart failure, and liver impairment or failure
  2. What are the types of Actue Renal Failure
    • Prerenal Acute renal failure
    • Postrenal Acute renal fialure
    • Intrarenal Acute renal failure
  3. Prerenal Acute renal failure develops b/c
    of diminished perfusion of kidney (decreasee amount of blood that comes into the kidney)
  4. What are things that cause Prerenal Acute renal Failure??d
    decrease in blood bolume due to excesive vomitting or diarrhea, excessive burn , excessive hemorrage, over use of diuretics
  5. Postrenal Acute Renal Failure caused by an
    obstruction of outflow of urine
  6. Intrarenal Acute Renal Failure is due to
    failure of nephrons w/in kidney
  7. What is usually present in Acute Renal Failure
    Oliguria
  8. Prolonged prerenal renal failure results in ..??
    intrarenal renal failure
  9. Postrenal Acute renal failure obstruction results in ..
    results in elevated pressure in Bowman's capsule which impedes in glomerular filtration
  10. Prolonged postrenal renal failure results in
    intrarenal renal failure
  11. Intrarenal failure most often the problem is...
    w/in the renal tubules, resulting in acute tubular necrosis
  12. Acute tubular necrosis may occur w/ ...
    nephrotoxic or ischemic insults
  13. Acute Tubular Necrosis is a combination of ...
    ischemia and an inflammatory process
  14. Acute Tubular Necrosis (ATN) in the Distal tubule is the site of
    the most apoptotic cell death
  15. What are the Stages of Acute Tubular Necrosis
    • Oliguric stage
    • Diuretic Stage
    • Recovery Stage
  16. what is the Oliguric stage??
    w. water retention, hypervolemia leads to edema and hypertension
  17. Diuretic Stage is the ....
    beginning of renal recovery, as renal function returns
  18. What is no reversible in all cases w/ diuretic stage ??
    Acute renal Failure
  19. Recovery Stage is
    Full recovery of renal function and may take a week or as long as a year
  20. Why do you end up w/ water retention w/ ATN??
    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
  21. The first stage of ATN is characterized by...
    oliguria and progressive uremia

    may last 1-2 wks
  22. What is oliguria followed by ???
    followed by a diuretic stage that lasts 2-10 days
  23. What happens during the diuretic phase??
    urine volume increases by tubular function remains impaired and azotemia continues
  24. How long does the recovery phase last ??
    lasing up to 12 months
  25. What is the recovery pahse characterized by ??
    characterized by gradual normalization of serum creatinine and BUN

    often a degree of renal insufficiency persists
  26. What is monitored with ARF??
    • serum creatinine
    • calculated creatinine clearance
    • retention of metabolic wastes (azotemia/uremia) monitored by BUN
  27. What are the risk factors of Chronic Kidney disease??
    Diabetes mellitus and hypertension

    • other factors:
    • glomerulonephritis
    • cystic kidney disease
    • family hitory of chronic kidney disease
    • exposure to toxins
    • ethnicity (African american, hispanic)
  28. what happens when the chronic kidney disease progresses
    glomerulosclerosis and interstitial inflammation and fibrosis ocurr
  29. in Chronic kidney disease what injury contribute to impairment of renal function
    Tubulointerstitial injury

    by diminishing the GFR
  30. What are the stages of Chronic Kidney Disease
    • Diminished renal reserve
    • Renal insufficiency
    • End-stage renal disease
  31. What is the Diminished renal reserve stage
    you still have functional kidney and is asymptomatic

    less than 75% of nephrons have been lost
  32. what happens in Renal insufficiency stage
    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
  33. What happens in End-stage renal disease??
    more than 90% of nephrons have been lost

    Azotemia, uremia, anemia, fluid and electroyte imbalances

    Transplantation or death are available outcomes
  34. What are the complications of Chronic Kidney Disease??
    • Hypertension and cardiovascular disease
    • Uremeic Syndrome
    • Metabolic Acidosis
    • Electrolyte imbalances
    • Renal Osteodystrophy
    • Malnutrition
    • Anemia
  35. What is markedly increased in chronic kidney disease (CKD)
    Hypertension and cardiovascular disease
  36. what complication in CKD affects many organ systems??
    Uremic Syndrome (retention of waste products)
  37. What complication in CKD depresses cardiac and central nervous system function ??
    Metabolic Acidosis, retention of the acidic waste products of metabolism
  38. What electrolytes are affected in CKD
    retention of potassium, phosphate, magnesium

    hyperkalemia is the most serious, due to its cardiac effects
  39. What happens in renal Osteodystrophy in CKD
    breakdown of bone due to phosphate imbalance
  40. Malnutrition in CKD is caused by
    anorexia of uremic syndrome and by chronic illness
  41. Anemia in CKD is caused by ...???
    diminished secretion of erythropoietin by kidneys
  42. Chronic kidney diseasae is characterized by a gradual ...
    irreversible loss of functional nephrons
  43. Progression of CKD can be monitored by two staging systems
    • 1. percentage of nephron loss
    • 2. reduction in GFR
  44. What happens to the laboratory values in the stage of decreased renal reserve ???
    lab values are normal and the condition is usually asymptomatic
  45. With end-stage renal disease what is markedly elevated??
    BUN and creatinine
  46. what can you avoid in acute renal failure to prevent CKD??
    Nephrotoxic chemicals
  47. What do you want to limit in CKD
    limit dietary phosphorus, protein, sodium, and potassium
  48. What kind of drugs are used in CKD
    calcium and noncalcium phosphate binding drugs

    synthetic erythropoietin to address anemia

    drug management for DM, HTN, and hyperlipidemia
  49. What kind of Dialysis is recomended for CKD
    • hemodialysis or peritoneal dialysis
    • initiated to address the development or uremia
  50. slowing the progression of CKD is ...
    the focus intervention until stages 4-5
  51. nutritional needs for pt in fenal failure include
    increased calories as well as calcium and vit. supplementation
  52. What is usually restricted in renal failure??
    fluid, phosphorus, potassium, sodium, and protein intake
  53. Voiding dysfunction may be
    secondary to disorders of the lower urinary tract

    due to pathologies affecting the central, autonomic, and peripheral nercous systems
  54. Urge incontinence may be idiopathic or due to
    bladder infections that irritate the bladder lining, radiation therapy, tumors or stones in the urinary tract, or central nervous system damage to inhibitory pathways
  55. what results in stress incontinenece ??
    weakening of pelvic muscles or intrinsic urethral sphincter dificiency
  56. Mixed incontinence is a ...??
    combination of both stress and urge incontinence
  57. What causes overflow incontinence??
    Obstruction of the urethra, or an underactive or inactive detrusor muscle
  58. Functional incontinence is related to
    physical or environmental limitations in reaching a toilet in time to void
  59. Neurogenic bladder ...
    a broad classification of voiding dysfunction in which the specific cause is a pathology that produces a disruption of nercous communication governing micturition
  60. Enuresis is ....
    inappropriate wetting of clothing or bedding, w/ the term usually reserved for incontinence in children, particularly at night
  61. What is the primary cause of enuresis
    maturational delay
  62. What is the treatment for enuresis
    usually behavioral modification w/ or w/o pharmacologic intervention
  63. Neurogenic bladder describes ..
    voiding disorders in which the cuase is the disruption of nervous communication governing micturition
  64. Urge incontinence is most common in ...
    older women
  65. Stress incontinence is common in
    pregnancy, w/ weakening of pelvic muscles

    urine lost w/ increases in intra-abdominal pressure
  66. Overflow incontinence is caused by
    obstructed urethra, due to enlarged prostate or prolapsed urterus
  67. Bladder cancer is the ____ most common in women and ___ most common in men
    8th and 4th
  68. Over 90% of bladder cancers are
    transitional cell (urethelial) carcinomas, arising in the lining of bladder
  69. What is the greatest risk of bladder cancer
    Smoking !!
  70. Bladder cancer treatment typically involves...
    radiation, surgery and chemotherapy, which radiation and chemotherapy occuring preoperatively or postoperatively or both
  71. Hematuria could be microscopic so we ....
    cant rely on it
  72. Neosplasia increases the chance of ...
    mutation
  73. bladder cancer is primarily manifested as ....
    hematuria
  74. Dysuria in bladder cancer is ...
    NOt Common
  75. The most frequently used invasive test in the diagnosis of bladder cancer is ...
    a cystoscopy, w. biopsy of any questionable tissue and washings to free cells for cytologic examination
  76. Treatemtn protocols in bladder cancer are based on ...
    • the tumors features:
    • type of bladder cancer
    • grade and stage

    Primary options are surgery, radiation therapy, chemo, immunotherapy
  77. Urethritis
    inflammation of urethra
  78. Urethritis may causes
    pain, burning, urinary incontinence
  79. Urethritis if due to infection may lead to
    infective cystitis
  80. Cystitis
    Inflammation of bladder lining
  81. Cystitis may result from
    bacterial, fungal, or parasitic infections, chemical irritants, foreign bodies (stones), or trauma
  82. what infection in Cystitis is by far the most common cause??
    Bacterial infection
  83. Cystitis common symptoms are..
    acute onset of frequency, urgency, dysuria, and pain (suprapubic area)
  84. Interstitial Cystitis
    painful bladder syndrom

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

    cause is unknown
  85. What are some of the causes of painful bladder syndrome
    but correlated w/ alcohol abuse, large number of citrus fruits, tomatos, drinks too much coffee or tea, too much carbonated beverages, chocolate

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