Lecture 3 (urinary) Flashcards

Question

# Glomerulonephritis Chronic Glomerulonephritis | more likely to result in, can be result of, occasionally d/t

Answer 1

* Chronic inflammation that causes slow, cumulative damage and scarring of glomerulus * More likely to result in nephrotic syndrome than AGN * Can be a result of prolonged inflammation of AGN * Occasionally d/t hereditary nephritis * Cause is often unknown

Answer 2

* SSx are mild and subtle, often undetected for a long period of time * Facial and extremity edema may occur * HTN is possible * Increased fluids and HTN can eventually lead to H/A, visual disturbances, seizures, and/or coma * protein in urine

Answer 3

* Blood tests and urinalysis are performed in those with suspicious symptoms * Increased suspicion in those with recent strep throat or infection * Urinalysis shows protein and/or blood cells in urine * Normal function = no blood, no protein in urine * Rapid progression dz = RBC cast * Lab tests show increased waste products (urea and creatinine) in blood, increased WBC, and anemia * Kidney biopsy is confirmative and done to determine prognosis * done under US or CT guidance * Invasive yet safe

Answer 4

* Low sodium and low protein diet while kidney recovers (reduces strain on kidneys) * Diuretics to excrete excess sodium and water * Furosemide is the drug of choice * Loop diuretic (reduces Na+ and Cl- reabsorption in the ascending limb of Henle) * HTN medications PRN (as needed) * Beta-blockers * ACE inhibitors

Answer 5

* Corticosteroids given IV for rapidly progressive dz * After one week, followed by PO tx * Antibiotics are given if infection is still present * Tx should be started immediately to reduce likelihood of kidney failure and/or dialysis * Transplantation is considered if CRF develops * Rapidly progressive GN may recur even post-transplant

Answer 6

* CONTRAINDICATION * AGN requires medical attention, massage treatment is postponed until resolved * With chronic GN, both minimal abdominal and CVA pressure should be applied

Answer 7

* Genetic disorder of the kidneys that cause fluid-filled cysts to form on kidneys bilaterally * Can be a dominant or recessive trait * Recessive: severe illness in childhood * Dominant: adult onset with more mild SSx * Kidneys enlarge, but have less functional tissue * Scarring and reduction in blood flow causes loss of fxn

Answer 8

* Symptoms range from none to severe flank pain, frequent infections, and kidney stones * Recessive PKD: childhood onset * Abdominal distension * Kidney failure may develop in utero and lead to early death * Cystic liver resulting in portal HTN and eventual liver failure

Answer 9

* Blood work: kidney function tests (BUN/Cr, GFR) * Imaging: US or CT

Answer 10

* Treat sequelae: Antibiotics for UTI, anti-hypertensives for HTN, lithotripsy for kidney stones * Helps slow kidney destruction * Dialysis or transplantation for kidney failure

Answer 11

* Abdominal massage and massage over the CVA is CONTRAINDICATED for PKD * A note: * Lymphatic drainage has limited evidence of benefit for patients with PKD * It may provide relief of edema, but also increases stress on the kidneys by increasing fluid return * This should be discussed with patients medical team

Answer 12

* Diagnosis is beyond scope of practice, but awareness and recognition of kidney disorder is crucial to patient’s well-being and safety * Mistaking kidney inflammation for a muscular strain can result in inappropriate therapy. * Kidney inflammation is often mistaken for tense or strained back muscles. * Important to r/o kidney d/o for pts who present with lower thoracic and upper lumbar pain * Practitioners should never assume back pain is due to a muscular imbalance and should have a screening process to rule out kidney inflammation in place. * Taking the extra time during a client intake will enable condition-appropriate massage and prevent symptom exacerbation.

Answer 13

* Inflamed kidneys are more susceptible to injury from vigorous massage, due to being retroperitoneal. * Edema is often a sign of malfunctioning kidneys. * Systemic circulatory massage is inappropriate for pts with edema r/t kidney d/o, as it would push more fluid through an already overburdened system. * Post-acute pts can benefit from massage to release guarded back/core muscles and decrease SNS

Answer 14

* UTI is an infection that can occur anywhere along the urinary tract: kidneys, ureter, bladder, or urethra * MC in bladder and urethra * UTIs are classified as upper or lower * Upper: kidney (pyelonephritis) * Lower: bladder (cystitis) and urethra (urethritis) * In bilateral organs, can occur in one or both

Answer 15

* Two routes of infection 1. Pathogen enters through the urethral opening * Most common * Ascends urethra to bladder, possibly to ureters and kidneys 2. Pathogen spreads from the blood stream * Infection in blood spreads to kidneys

Answer 16

* Bacterial UTIs are very common * Sexually active women at higher risk * Hospitalized persons with catheter at higher risk * Escherichia coli is MC cause of lower UTI (75-95% of cases) * Kidney stones can harbour Proteus enterobacteria that can cause UTI

Answer 17

* **Viral** * HSV-2 is a viral cause of UTI, usually in the urethra * Causes painful urination, difficulty emptying bladder * **Fungi** can cause UTI, referred to as yeast infection * MC is Candida Albicans * Usually in immunocompromised persons * Others: blastomycosis (Blastomyces), coccidioidomycosis (Coccidioides) * **Parasites** * A number of parasites, including certain types of worms, can infect the urinary tract

Answer 18

* Obstruction (i.e. stones) anywhere in the urinary tract * Sexual intercourse * Abnormal bladder function that prevents proper emptying * Neurologic diseases like MS, nerve damage from CES/vaginal delivery/cord injury, diabetes, prostate enlargement * Backflow from bladder into ureter, possibly reaching kidney * More likely in children (less oblique orientation or ureters) * Urinary catheter

Answer 19

* In persons aged 20-50, UTI is 50x more common in females than males * In persons 50+, females and males have similar risk of occurrence Risk factors: * Shorter urethra * Proximity of urethra to bacteria of vagina and anus * Motion of sexual intercourse * Pregnancy * Increased pressure makes emptying bladder more difficult * Some women have recurring episodes * Decreased emptying of bladder, decreased acidity of urethra, weakened immune system, low estrogens

Answer 20

* is less common in males * Infection starts in urethra, moves to prostate, then bladder * MC cause of recurring cystitis: prostatitis * Antibiotics quickly clear bacteria from urine in the bladder * May need longer course of treatment to clear prostate

Answer 21

* Lower urinary tract symptoms (LUTS) * Urgency and frequency * Urgency can cause loss of bladder control (urge incontinence), esp. in elderly * Dysuria * Possible suprapubic pain * Rarely, low back pain * Fever does not usually happen with cystitis (may be low grade) * If fever present, more likely to be pyelonephritis * Urine can be cloudy or contain blood * Blood (hematuria) is visible in ~30% ## Footnote Fever not often present in lower UTI's

Answer 22

* Diagnosis based primarily on symptoms * Urinalysis: midstream clean catch (uncontaminated) urine sample may be taken, followed by urine culture * Dipstick chemical tests are used to test for foreign substances in urine * **Two positives indicative of infection:** 1. Nitrates = metabolic end product of bacteria 2. Leukocyte esterase = enzyme found in WBC, indicates WBC presence in urine * Culture helps determine causative agent for more specific treatment

Answer 23

* Antibiotics * Broad spectrum antibiotics started ASAP * Choice of drug and dosage may be modified based on urine culture * Complicating factors (diabetes, being immunocompromised) or conditions making elimination difficult (stones, strictures, prostate enlargement) may require stronger, longer course of antibiotics

Answer 24

* Drink plenty of fluids * Fluids flush bacteria * Wipe front to back * Post-coital voiding * Avoid tight, non porous underwear * Void often

Answer 25

Overview * Urethritis = inflammation of the urethra Etiology * Bacteria (flora overgrowth, gonorrhoea, chlamydia), fungi, or viruses (HSV) * MC cause in females is bacteria of the lower intestine (i.e. E. coli) * Infection in a women often results in cystitis * MC cause in males is an STI, usually gonorrhoea or chlamydia * In men, urethritis that is NOT caused by gonorrhoea is called NGU (non gonococcal urethritis) * Cystitis less likely * Chemical irritation (from spermicides or soaps)

Answer 26

* Lower urinary tract symptoms (LUTS) * Frequent, painful urination with sensation of urgency * **Less commonly** * painful ejaculation * Urethral discharge (d/c) * If d/t gonorrhoea or Chlamydia, men will often have yellow/green d/c. * Other organisms cause clear d/c. May present like cystitis or vaginitis * Discharge less common in women * Itching

Answer 27

* Untreated/inadequately treated infections can cause stricture of the urethra * Leads to increased risk of bladder and kidney infection * Can also progress to the kidney, which is a much more severe disease

Answer 28

* Based on symptoms and exam * If d/c present, a swab sample is taken to identify the invading organism * Urinalysis is not useful for urethritis

Answer 29

* Safe sex/condom for prevention of STIs * Tx depends on cause of infection * Cultures may take days to grow * MD can begin broad spectrum Ab before results are confirmed

Answer 30

* Massage should be postponed until the client is fever free or 24 hours * If fever free, there is no contraindications * Be careful with pressure applied to lower abdomen

Answer 31

* Occurrence: males > females (general urinary tract neoplasms) * Most are malignant * Primary tumors are more common

Answer 32

* 12,300 new cases each year in Canada * the MC malignancy involving GU system * 3x more common in males * Smoking: single greatest risk factor * Other risk factors: second-hand smoke, chronic or recurrent cystitis * Most occur > 50 yo * MC type: transitional cell CA

Answer 33

* MC early symptom: PAINLESS hematuria * Can lead to anemia w/ fatigue and pallor * About 1/3 of patients can have irritative voiding symptoms such as pain and burning during urination, urgency or frequency * If there is pain, usually related to local advanced or metastatic tumours: * Back pain * Suprapubic pain * Abdominal pain

Answer 34

* Suspected when there is blood in urine * Routine microscopic exam of urinalysis * Urine may be visibly red * Suspected when SSx linked to cystitis do not resolve with treatment for infection * MC diagnostic tool: cystoscopy * Accidental dx during CT or US * DDX * May mimic sx of cystitis, prostatitis * r/o UTI or infection

Answer 35

* Slow growing tumors and superficial tumors of the inner lining have 95% 5 year survival rate * Deeper tumors of the muscle layer have 45-60% 5 year survival rate * Metastatic bladder cancer has a much poor prognosis

Answer 36

* Superficial tumors may be removed completely during cystoscopy * Deeper tumors require partial or total cystectomy * Radiation and/or chemotherapy may be necessary

Answer 37

* No contraindications

Answer 38

* RCC is the most common type (80-85%) of renal cancer (involves renal cortex) * The 2nd MC type is transitional cell carcinomas of the renal pelvis * 2x more common in males * 2x more likely in smokers * Other risk factors: * age 50-70 * exposure to toxic substances – cadmium, asbestos * obesity

Answer 39

* Hematuria, flank pain, fever, weight loss * MC first sx: blood in the urine * May be microscopic * Abdominal exam may reveal palpable lump or enlarged kidney * Potential polycythemia * paraneoplastic syndrome d/t increased EPO release * Pruritis, H/A, fatigue, dizziness, visual disturbances * Potential anemia * Fatigue, dizziness, pallor, cold extremities

Answer 40

* Advanced imaging: CT or MRI * Often incidental finding * If dx is confirmed, further studies are required to r/o metastasis * CXR, CT of head and/or chest, and bone scan

Answer 41

* Dependent on many factors * If contained in the kidney, 5 year survival rate is 85% * Local spread to renal vein or IVC only, 5 year survival rate is 35-60% * Distant metastasis has 5 year survival rate of 10% * May be limited to palliative care

Answer 42

* Surgical removal may be curative when there is no metastasis or only local metastasis to vasculature * Total kidney * Tumor and locally adjacent tissue only * Early spread, especially to lungs, is common * Chemo/radiation * Palliative care

Answer 43

* No contraindications

Answer 44

* The MC type of malignancy affecting renal PELVIS and the URETERS is transitional cell CA * ~17% of patients with transitional cell CA of renal pelvis or ureters will have concurrent bladder cancer at presentation * Renal pelvis and ureters much less common than cancer of the rest of the kidney and bladder * Fewer than 6,000 people/year in US

Answer 45

* MC first SSx: hematuria (70-80% of patients present at diagnosis) * Other SSx: crampy flank pain, lower abdominal pain, obstruction of urine flow

Answer 46

* Urinalysis and microscopic exam may reveal cancer cells * Ureteroscope may be used for both diagnosis and treatment * Confirmative dx: CT scan * Can DDx neoplasms from stones and/or blood clots

Answer 47

* Local, non-metastatic tumors are often cured by surgical resection * If metastasis occurs, outlook is poor

Answer 48

* Nephroureterectomy and partial bladder removal for cases where there is no evidence of metastasis * If pt only has one functioning kidney, it is usually not removed * Avoid dialysis dependence * Certain cancers may be treated with laser therapy or minimally invasive resections * Non-cancerous portion of ureter and bladder remain * Metastatic cancer requires chemo and/or radiation

Answer 49

* Rare * May be r/t certain strains of HPV and frequent UTIs * Most commonly affects Caucasian females * Usually age 50+

Answer 50

* MC first sign: blood in the urine * Microscopic or visual * Weak, interrupted flow of urine (“stop and go”) * Frequent urge to urinate/feeling of incomplete emptying * Discharge from urethra * Enlarged lymph nodes in the groin * Friable tissue surrounding urethral meatus

Answer 51

**Diagnosis** * Cystoscopy * Urinalysis * Confirmed with biopsy **Prognosis** * Dependent on precise location and staging **Treatment** * Surgical resection * Chemo and/or radiation

Answer 52

* No contraindications

Answer 53

P – proteinuria H – hematuria A – azotemia R – RBC casts O – oliguria <400mL urine/day A – antistreptolysin O titers H – hypertension

Answer 54

P - proteinuria A – hypoalbuminemia L – Hyperlipidemia E – edema

Lecture 3 (urinary) Flashcards

(79 cards)