Renal Patho Exam #3

amber-yellow

clear
purulent matter will make cloudy

4.6-8.0

adults 1.010-1.035
infants 1.010-1.018

negative
bleeding along urinary tract

none

negative

negative

negative

negative

negative

negativ

negative

negative

negative

100-260 mEq/24 hr

25-100 mEq/24 hr

negative-trace

8-25 mg /dl

male 0.6-1.5 mg/dl
female 0.6-1.1 mg/dl

approx. 5 inches (10-12cm)
size of a fist (taller should be larger)
decrease with age (80-90 yrs a lot smaller)

dizziness/fatigue
swelling/edema
changes in urination

ratio of density (substance) to the density of water
represents concentration ability of urine in relation to density of water
ability of kidneys to concentrate urine

high when contains glucose/protein
low when urine is dilute

test used to monitor kidney function

is greater than 90 and can be as low as 60ml/min/1.73m2

100 to 130 for males
90 to 120 in women below age 40 (decreases as age progresses)

blood, urea, nitrogen

10-20 (7-8) mg/dl

blood test
measures the amount of urea in the blood
formed in liver
**end product of protein metabolism, circulates in blood, removed by kidneys in urine**

>100 mg/dl indicates serious impairment of renal function

formed from metabolism of creatinine
nitrogenous compounds from metabolism (liver)
found in blood, urine, muscle tissue
indicates kidney function

0.5-1.1 mg/dL

diagnostic test for kidney function
24-hour test that measures the rate at which creatinine is cleared from the blood by the kidney

collect from certain time on 1st day to the same time on 2nd day
throw out first urine and collect all of the following urine
none of the urine can be thrown away

dilation of the ureter (accumulation of urine in the ureter)

dilation of renal pelvis and calyces (blockage of renal pelvis)
results in enlargement of kidneys with large stones

obligatory growth
compensatory growth
kidney adapts to whatever condition

urine just keeps flowing
potassium and sodium cause a systemic affect

made from crystals, protein or other substances
classified by minerals comprising the stone

calcium oxalate or phosphate 70%
struvite 15%
uric acid 7%

age
gender
race
geographic location (drinking water in the area)
seasonal factors
fluid intake
diet
occupation

supersaturation of one or more salts
precipitation of a salt from liquid to solid state through temperature and pH
growth into a stone via crystallization or aggregation

kidney stones

moderate to severe pain around flank area to groin
colic pain; urgency, frequent voiding, urge incontinence

stone and UA analysis
intravenous pyelogram (IVP)
kidney, ureter, bladder x-ray (KUB)
*Spiral abdominal CT* (best way)

inflammation of urinary epithelium from pathogen
**bacteria that most common: escherichia coli**
bladder infection

inflammation of the bladder
frequency
dysuria (painful urination)
urgency
lower abdominal pain/suprapubic pain (tender with palpation)

differ with age and urinary function
young adult: dysuria, frequency, suprapublic and lower back pain, foul smelling, cloudy
**Elderly: confusion, abd discomfort**

acidic juice could help flush out bacteriea

healthy individual with normal urinary system
first infection; or one year afte UTI

individual with abnormal urinary system; or compromised health

initial infection that is successfully treated, but reinfected within 5 to 10 days after resolution

persistent infection despite 3+ days of treatment

nonbacterial
cause obscure
associated with dysfunctions of external sphincter, vaginitis, urethritis, inflammation vaginal glands and urethra
women 20-30 years of age

bladder fullness, frequency, small urine volume, chronic pelvic pain

infection of renal pelvis and interstitium
one or both kidneys
most often in women

kidney stones, pregnancy, neurogenic bladder, female sex trauma, reflux
E. coli, proteus, pseudomonas

infiltration of WBC in renal medulla resulting in renal inflammation, renal edema, purulent urine
rarely causes renal failure

acute onset, with fever, chills, flank or groin pain, frequency, dysuria, costovertebral tenderness

one or both kidneys
persistent recurrent infection of the kidney leading to scarring
causative agent difficult to determine
sometimes caused by drug abuse

HTN, frequency, dysuria, flank pain; progression leads to renal failure

renal infections
obstructive pathologic conditions

sudden or insidious onset
HTN, edema, elevated BUN
increased plasma creatinine
decreased creatinine clearance
damage results from inflammation
more result from immune system dysregulation

inflammation of glomerulus

immunological abnormalities (most common)
ischemia; vascular disorders
free
radicals
drugs or toxins
systemic diseases
Most common cause of chronic and end-stage renal disease (put on dialysis)

streptococcal infection
begins abruptly; 7 to 10 days after strep infection

hematuria, RBC casts, proteinuria, decreased GFR, oliguria (little to no urine), HTN, edema of eyes or feet/ankles

rapidly progressive (Goodpasture syndrome)
develops over days to weeks
affects adults 5 decade
idiopathic or associated with proliferative glomerular disease

renal insufficiency; poor prognosis if untreated early

several diseases leading to chronic renal failure
associated with hypercholesterolemia and proteinuria

hematuria and proteinuria

abrupt reduction in renal function (can be one or both)
increased BUN and creatinine
**oliguria; but may be normal**
most types are reversible; if treated early

Prerenal
Intrarenal
Postrenal

impaired renal blood flow (most common cause)
GFR declines due to decreased filtration pressure

tubular necrosis; surgery sepsis, obstruction

urinary tract obstruction (bilateral)
can be after affects of UTI

progressive and irreversible loss of nephrons
decreased GFR; affects all organ systems
does not become apparent until <25% functions remains
**(best indicator = serum creatinine levels)**

uremia/azotemia
accumulation of toxins in plasma (don't urinate)
HTN, anorexia, nausea, vomiting, diarrhea, weight loss, pruritus, edema, anemia, and, neurologic changes