Unit 1: Chapter 33

Question 1

Obstructive Uropathy

Answer 1

Classified according to site, degree and duration of obstruction.
The condition causing he obstruction can cause complete or partial occlusion of urine

Question 2

Causes of Urinary Tract Obstruction: Renal Pelvis

Answer 2

Renal calculi
Papillary necrosis

Question 3

Causes of Urinary Tract Obstruction: Ureter

Answer 3

Renal calculi
Pregnancy
Tumors that compress the ureter
Ureteral stricture
Congenital disorders of the ureterovesical junction and ureters pelvic junction

Question 4

Causes of Urinary Tract Obstruction: Bladder and Urethra

Answer 4

Bladder cancer
Neurogenic bladder
Bladder stones
Prostatic hyperplasia or cancer
Urethral strictures
Congenital urethral defects

Question 5

Lower Urinary Tract Obstructions

Answer 5

Located below the uretherovesical junction and are bilateral in nature

Question 6

Upper Urinary Tract Obstructions

Answer 6

Located above the ureterovesical junction and are usually unilateral

Question 7

Bilateral Acute Urinary Tract Obstructions

Answer 7

Short in duration
Usually caused by conditon such as renal calculi
Causes acute renal failure
Often reversible so prompt recognition is important

Question 8

Unilateral Chronic Urinary Obstructions

Answer 8

Develops slowly and is longer lasting
Used by conditions such as congenital ureterovesical abnormalities .

Question 9

Renal Calculi

Answer 9

Or kidney stones. Polycrystalline aggregates comprising material, excreted in the urine.
Most common cause of upper urinary tract obstruction
Exceeded only by UTI and prostate disorders

Question 10

Renal Calculi Formation

Answer 10

Supersaturate urine, present of a nidus (nucleus for crystal formation and deficiency of inhibitors of stone formation.

Question 11

BPH: Benign Prostatic Hyperplasia

Answer 11

Conditon in males where the prostate gland is enlarged but not cancerous.
Growth impinges on the urethra obstructing the flow of urine
The bladder wall thickens and the bladder weakens and loses the ability to empty completely

Question 12

UTI

Answer 12

Bacterial infection that enter though the urethra.
Most uncomplicated lower UTI caused by E. Coli
Complicated UTI are caused by a number of pathogens.

Question 13

UTI: Reflux or ureterovesical Reflux

Answer 13

Other contributing factor to UTIs
Occurs when urine from the ureter moves into the bladder (ureterovesical reflux)
In women: can occur during activities such as coughing or squatting due to increase pressure
Also when voiding is abruptly interrupted

Question 14

UTI: Vesicoureteral Reflux

Answer 14

Second type of reflux
Occurs at the level of bladder and ureter
The ureters enters the bladder at a right angle such that urine is forced into the ureter during micturition
Seen in children, congenital defects of ureter

Question 15

Glomerulonephritis

Answer 15

Inflammatory process that involves glomerular structures
Second leading cause of kidney failure as hero in

Question 16

Acute Nephritic Syndrome

Answer 16

Clinical correlate of acute glomerular inflammation
S&S: Sudden onset of hematuria
Protienurea
Diminished GFR
Oliguria
Signs of impaired renal fucntion
Causes extracellular fluid accumulation , hypertension and edema

Question 17

Acute Nephritic Syndrome Cause

Answer 17

Inflammatory processes that occlusde the glomerular capillary lumen and damage the capillary wall cause it
RBC esophageal urine and produce hemodynamics changes that decrease GFR

Question 18

Nephrotic Syndrome

Answer 18

Not a specific disease but constellation of clicking finding that result in increase glomerular permeability and loss of plasma protein in the urine
Characterized by massive proteinuria
> 3.5 g/day and lipiduria along with hypoalbuminemia (< 3g/day)
generalized edema (hallmark) and hyperlipidemia ( >300mg/dL

Question 19

Acute Postinfectious Glomerulonephritis

Answer 19

Usually occurs after infection with certain strains of group A bata hemolytic strep
Caused by deportion of immune complexes of antibody and bacterial antigens
Primary seen in children

Question 20

Systemic Lupus Erythematosus Glomerulonephritis

Answer 20

Glomerular involvement
Seen more with black solemn
Related to B cell immiunirty with production of autoantibodies to a variety of nuclear, cytoplasmic, extracellular matrix and cell membrane components

Question 21

SLE Treatment

Answer 21

Depends of the extent of glomerular involvement.
Class I or II require no treatment
Higher classes need oral corticosteroids and angiotensin converting enzyme
Advanced disease: immunosuppressive agents

Question 22

Pyelonephritis

Answer 22

Infection of the kidney parenchyma and renal pelvis
Acute and chronic

Question 23

Acute Pyelonephritis

Answer 23

Represents an upper UTI specifically renal parenchyma and pelvis
People with DM are at increased risk
Caused by gram negative bacteria: e. Ecology and proteus

Question 24

Acute Pyelonephritis Contributing Factors

Answer 24

Cauterization and instrumentation
Vesicoureteral reflux
Pregnancy and neurogenic bladder

Question 25

Necrotizing Pyelonephritis

Answer 25

Less frequent and more serous Complication from acute pyelonephritis Necrosis of the renal papillae

Question 26

Acute Pyelonephritis S&S

Answer 26

Abrupt onset of chills, high fever and ache or tenderness in the costovertebral angle (flank) That is un/bilateral Lower urinary s&S: dysuria, frequent and urgency Other: nausea, vomiting and abd pain Pyuria

Question 27

Chronic Pyelonephritis

Answer 27

Progressive process, reflux is the most common cause of Scarring and deformation off the renal calyces and pelvis Appears to involve a bacterial infection superimposed on obstructive abnormalities or Vesicoureteral reflux

Question 28

Chronic Pyelonephritis S&S

Answer 28

Same symptoms as acute but onset may be indigenous History of recurrent episode of UTI or acute pyelo Severe hypertension is often a contributing factor in the progression of disease

Question 29

Diabetic Glomerulosclerosis

Answer 29

Diabetic nephropathy is a major cause of chronic kidney disease Most common cause of kidney failure treated by renal replacement therapy Lesions most of only include the glomeruli. Widespread thickening of capillary BM, without evidence of proteinuria. Occurs in both type 1 and 2 More prevalent among African Americans and Asians

Question 30

Diabetic Glomerulosclerosis S&S

Answer 30

Closely linked to this of DM. Increased GFR associated with microalbuminuria. Excretion of 30 to 300 mg in 24 hours