Patho Quiz 3

Active reabsorption of sodium

Concentration or dilution of urine

Adjustment of reabsorption of sodium and water

Contributes to production of concentrated urine
Fluid flows in opposite direction through parallel tubes
Fluid moves up and down the parallel limbs of the loop of Henle
The longer the loop, the greater the concentration gradient

Inhibits sodium and water reabsorption

Necessary for the absorption of calcium and phosphate

Released when decreased oxygen to the kidney

Clearance and glomerular filtration rate
Inulin
Creatinine
Clearance and renal blood flow
Blood tests
Plasma creatinine concentration
Blood urea nitrogen (BUN)

Decreased ability to remove excess water and solutes
Decreased concentrating ability
Narrow margin for fluid and electrolyte balance
Increased risk of drug toxicity

Decrease in renal blood flow and GFR
Altered sodium and water balance
Number of nephrons decrease due to renal vascular and perfusion changes
Response to acid-base changes delayed
Increased risk for drug toxicity
Alterations in thirst and water intake

Masses of crystals, protein, or other substances that form within and may obstruct the urinary tract
Risk factors
Gender, race, geographic location, seasonal factors, fluid intake, diet, and occupation

Supersaturation of one or more salts
Presence of a salt in a higher concentration than the volume able to dissolve the salt
Precipitation of a salt from liquid to solid state
Temperature and pH
Growth into a stone via crystallization or aggregation

Treatment
High fluid intake, decreasing dietary intake of stone-forming substances, stone removal

inflammation of the urinary epithelium caused by bacteria
Most common pathogens
Escherichia coli

Cystitis is an inflammation of the bladder
Manifestations
Frequency, dysuria, urgency, and lower abdominal and/or suprapubic pain
Treatment
Antimicrobial therapy, increased fluid intake, avoidance of bladder irritants, and urinary analgesics

Nonbacterial infectious cystitis
Manifestations
Most common in women 20 to 30 years old
Bladder fullness, frequency, small urine volume, chronic pelvic pain
Treatment
No single treatment effective, symptom relief

Acute pyelonephritis
Acute infection of the renal pelvis interstitium
Vesicoureteral reflux, E. coli, Proteus, Pseudomonas
Chronic pyelonephritis
Persistent or recurring episodes of acute pyelonephritis that leads to scarring
Risk of chronic pyelonephritis increases in individuals with renal infections and some type of obstructive pathologic condition

demonstrates a sudden or insidious onset of hypertension, edema, and an elevated blood urea nitrogen (BUN)

Elevated plasma creatinine, urea, and reduced creatinine clearance

Increased glomerular capillary permeability and loss of negative ionic charge barrier result in passage of plasma proteins into the urine
Resulting hypoalbuminemia encourages plasma fluid to move into the interstitial spaces
Edema

Inflammation of the glomerulus
Immunologic abnormalities (most common)
Drugs or toxins
Vascular disorders
Systemic diseases
Viral causes
Most common cause of end-stage renal failure

Excretion of 3.5 g or more of protein in the urine per day
The protein excretion is caused by glomerular injury
Findings
Hypoalbuminemia, edema, hyperlipidemia, and lipiduria, and vitamin D deficiency

Prerenal acute renal failure
Most common cause of ARF
Caused by impaired renal blood flow
GFR declines because of the decrease in filtration pressure
Intrarenal acute renal failure
Acute tubular necrosis (ATN) is the most common cause of intrarenal renal failure
Postischemic or nephrotoxic
Oliguria
Postrenal acute renal failure
Occurs with urinary tract obstructions that affect the kidneys bilaterally

Oliguria phase
Diuretic phase
Recovery phase

Chronic renal failure is the irreversible loss of renal function that affects nearly all organ systems
Stages
Chronic renal insufficiency
Chronic renal failure
End-stage renal failure

Proteinuria and uremia
Creatinine and urea clearance
Fluid and electrolyte balance
Sodium and water balance
Phosphate and calcium balance
Potassium balance
Acid-base balance

Alterations seen in following systems:
Musculoskeletal
Cardiovascular and pulmonary
Hematologic
Immune
Neurologic
Gastrointestinal
Alteration in protein, carbohydrate, and lipid metabolism
Endocrine and reproduction
Integumentary