Pathophysiology Module 11: Renal/Urinary

glycosuria - answerglucose in urine diabetes mellitus false positives hematuria - answerintact RBCs in urine IgA nephropathy glomerular disease Thin basement membrane disease (TBMD) hemoglobinuria - answerfree hemoglobin in urine hemolytic anemia proteinuria - answerprotein in urine glomerular disease ketonuria - answerketone bodies in urine diabetic ketoacidosis starvation, fasting, low-card diets bilirubinuria - answerbilirubin in urine jaundice bacteriuria - answerbacteria in urine urobilinogen is sign of... - answerjaundice UTI signs in urine - answernitrites leukocyte esterase RBC casts are signs of... - answerglomerular disease WBC casts are signs of... - answerinflammation or infection of kidney Epithelial cells casts are signs of... - answeracute tubular necrosis protein casts are signs of... - answersevere proteinuria BPH - answerbenign prostatic hyperplasia v. common 20% of 40 yr olds, 90% of 70 yr olds prostatic enlargement may compress the prostatic urethra S/S: weak urine stream, incomplete emptying of bladder, frequent urination, nocturia, urge incontinence moderate/severe: leads to hydronephrosis can lead to acute or chronic pyelonephritis urinary obstruction - answerany obstruction, compression, narrowing in lower or upper urinary tract - backup of urine, urinary retention - stasis hydronephrosis stasis and reflux make fertile environment for bacterial growth infection common complication acute or chronic pyelonephritis development of kidney stones pressure increase - TIN electrolyte abnormalities GFR decreases (poor filtration) GFR - answerglomerular filtration rate measure of how well the kidney is filtering as pressure in system increases, pressure in glomerular capsule decreases, GFR goes down, kidney not filtering as well TIN - answertubulointerstitial nephritis damage to kidney tubules and interstitium umbrella term: pathology of kidney not directly involved with glomeruli electrolyte abnormalities (tubule fxn compromised) acute (acute infection, drug rxn) chronic (chronic infection, obstruction, stasis) much more common causes of urinary obstruction: urethra - answerurethral stricture fibrous scar tissue in corpus spongiosum (trauma, inflammtion, infection, cancer, congenital) young men: most common cause gonorrheal UTI hydronephrosis - answerurinary retention severe enough to increase pressure in the renal tubules effect of urinary tract obstruction AKA *obstructive uropathy* as hydronephrosis worsens - tubuloinstestitial nephritis inflammatory cells in kidneys, fibrosis renal pelvis dilated, blunting of pyramids (normal cortex tissue killed) encourages UTI, kidney stone formation pyelonephritis - answerinflammatory disorder of renal tubules, interstitium, calyces, and pelvis caused by infection, or some combination of infection, stasis, obstruction, or vesicoureteral reflux. common complication in lower UTIs acute acute pyelonephritis - answeracute pyogenic infection of kidney almost always bacterial acute interstitial nephritis chronic pyelonephritis - answerchronic tubulointerstitial inflammation and scarring of the kidney associated with pathologic involvement of renal calyces and pelvis usually assos. w/chronic infection; also chronic stasis *reflux nephropathy* is most frequent form, usually in children with congenital defect UVJ causes of urinary obstruction: bladder - answerbladder cancer UVJ abnormalities UVJ - answerureterovesical junction AKA vesicoureteral (VUJ) where ureter enters bladder, embedded in detrusor muscle; when bladder contracts, acts as internal sphincter to prevent backflow causes of urinary obstruction: ureters - answercompressed by nearby structures pregnant uterus metastatic cancer growth of endometrial tissue outside uterus surgical scars acute vs. chronic urinary obstruction - answeracute - if corrected, no long term damage chronic - irreversible anatomic and physiologic changes in kidney urolithiasis - answerformation of kidney stones, AKA calculi calcium, struvite, uric acid cystine renal colic - answerexcrutiating flank or abdominal pain caused by kidney stones calcium calculi - answer80% of stones contain calcium calcium oxalate or calcium phosphate hard, sharp stones, damage to ureters - hematuria