Exam 3 Review Guide

• Renal Calculi


  Kidney stone

  most common is calcium oxalate

  can be painful
• Pyelonephritis


  Infection of one or both urinary tracts

  Upper urinary tract infection
• Urinary tract infection


  infection in the urinary tract, treatment is antibiotic therapy
• Acute glomerulonephritis


  Symptoms include sudden onset of hematuria, proteinuria, edema, hypertension, impaired renal function
• Nephrotic syndrome


  Excretion of 3 g or more of protein in the urine, hypoalbuminemia, hyperlipidemia, peripheral edema

  Usually secondary to something else
• Acute kidney injury


  renal insufficiency decline to 25% of normal GFR
• Prerenal


  Hypovolemia

  water and electrolyte loss

  hypotension or hypoperfusion

  septic shock

  acute or chronic heart failure
• Intrarenal


  Acute tubular necrosis

  glomerulonephritis

  acute interstitial necrosis

  vascular damage

  bilateral acute pyelonephritis
• Postrenal


  Obstruction

  ureteral destruction

  bladder neck obstruction

  neurogenic bladder
• Chronic kidney disease


  Know GFR levels

  gradual decline in function over time

  • Stage 1 with normal or high GFR (GFR > 90 mL/min)
  • Stage 2 Mild CKD (GFR = 60-89 mL/min)
  • Stage 3A Moderate CKD (GFR = 45-59 mL/min)
  • Stage 3B Moderate CKD (GFR = 30-44 mL/min)
  • Stage 4 Severe CKD (GFR = 15-29 mL/min)
  • Stage 5 End Stage CKD (GFR <15 mL/min)
• Dysmenorrhea


  attributed to excessive endometrial prostaglandin

  causes uterine hypercontractility and pain

  Secondary is from disorders such as endometriosis, PID, tumors
• PCOS


  irregular/impaired ovulation

  elevated levels of androgen

  polycystic ovaries

  insulin resistance
• Osteoporosis


  imbalance in bone production and resorption
• HPV


  no symptoms

  visible lesions

  double stranded DNA virus

  not all strains are high risk for cancer

  treatments are available

  HPV vaccination
• Chlamydia


  Most common reportable sTI

  bacterial

  ana, vaginal, conjunctival, and mother to baby transmission

  gram negative without lipopolysaccharide membrane

  can be oral

  may progress to PID

  treatment of patient and partner
• Gonnorhea


  Anal, vaginal, oral, mother to baby

  gram negative diplococci

  in males causes mucopurulent discharge in urethra, females in cervix
• Syphillis


  spirochete

  skin or mucus membranes

  primary and secondary sages

  primary - painless, 3-4 weeks post exposure

  secondary - 4-8 weeks, rash appears usually palms of hands

  latent phase - can be years later
• Herpes virus


  HSV 1 - cold sores

  HSV 2 - genital herpes

  virus enters thorugh skin or mucus

  painful ulcers or blisters

  lymphadenopathy

  intermittent outbreaks

  suppressive therapy

  transmission always possible
• Obstructive uropathy


  acute vs chronic

  partial vs complete

  unilateral vs bilateral
• Obstructive uropathy severity


  Location

  involvement of renal structures

  completeness of blockage

  duration of blockage

  nature of the lesion
• Upper Urinary Tract Obstruction Causes

  Stricture

  Compression

  Inflammation

  Kidney Stones

  Tumor

  Scarring
• Upper obstruction complications


  Hydroureter

  hydronephrosis

  tubulointerstitial fibrosis

  apoptosis

  compensatory hypertrophy

  postobstructive diuresis

  infection
• Hydroureter


  Dilation of ureter

  usually due to blockage and backing up of urine
• Hydronephrosis


  dilation of renal pelvis and calyces

  caused by backup of urine
• tubulointerstitial fibrosis


  deposition of excessive ECM by inflammation due to kidney injury, including obstruction.

  TF can lead to irreversible kidney damage and AKI
• Apoptosis


  normal cell death

  obstruction promotes excessive apoptosis which leads to necrosis and inflammation
• Compensatory hypertrophy


  unobstructed kidney grows in size r/t obstruction of other kidney
• postobstructive diuresis


  diuresis caused by relief of obstruction, urine that has backed up will excrete
• Nephrolithiasis


  Most common kidney stone is calcium oxalate

  causes diffuse flank pain, usually unilateral

  will generally pass without intervention
• Types of incontinence


  urge incontinence

  stress incontinence

  mixed incontinence

  overflow incontinence

  functional incontinence

  continuous incontinence

  insensible incontinence
• Urge incontinence


  Loss of urine associated with strong desire to void

  involuntary contractions of detrusor muscle causing incontinence
• Stress incontinence


  Loss of urine during coughing, sneezing, etc due to increased abdominal pressure
• Mixed incontinence


  Combination of stress and urge incontinence
• Overflow incontinence


  Loss of urine due to overdistention of the bladder
• Functional incontinence


  Loss of urine caused by dementia or immobility
• Continuous incontinence


  Loss of urine related to fistulas or sphincter deficiency
• Insensible incontinence


  Incontinence without a known etiology
• anatomic obstructions


  urethral stricture

  prostate enlargement

  pelvic organ prolapse
• Urethral stricture


  narrowing of the lumen of the ureter, caused by infection, injury, or surgery that causes scarring
• Prostate enlargement


  caused by inflammation, BPH, or prostate cancer

  prostate compresses the urethra causing hesitancy, inability to empty bladder, and weakening of bladder wall