Renal Pathophysiology
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Transcript of Renal Pathophysiology
Alterations of Renal and Urinary Tract FunctionChapter 28, 29
Structures of the Renal System
2
Kidney FunctionFluid and electrolyte balance
Regulation of blood pressure
Excretion of metabolic wastes
Acid/base balance
Erythropoietin production
Vitamin D activation
4
Nephron-Functional Unit
5
Urinalysis– Color– Specific gravity– Protein– Glucose– Ketones– Nitrites– Casts– Crystals– pH
6
Hematologic Tests
• GFR mL/min [eGFR] 125/min
• Serum Creatinine 0.6-1.2 mg/dL
• BUN 10-20 mg/dL
7
Bladder Disorders
• Incontinence
– Requires physiological and cognitive capabilities• Need functioning nervous system, intact bladder and
urethral function
8
Incontinence
• Define the following types of incontinence– Stress
– Urge
– Mixed
– Overflow
– Functional
9
Enuresis
• Inappropriate wetting of clothes or bed
– Primary cause is maturational delay
– Diurnal vs. nocturnal
10
Urinary Tract Obstruction
Kidney Stones, Renal Calculi, Nephrolithiasis
• Etiology– Factors influencing formation
• Increased concentration of solutes• Abnormal urine pH• Low urine volume• Hypercalciuria• Genetic predisposition
12
Kidney Stone
• Clinical Manifestations– Vary with size and location
• Abdominal pain• Flank pain• Ureteral colic• Hematuria• Dysuria
13
Entry of Pathogens
14
Normal Defenses
Acidic urine and urea
Unidirectional Flow
Voiding
Urinary Tract Infection (UTI)
• Acute cystitis
– Cystitis is an inflammation of the bladder– Most common pathogen: E. coli
Cystitis• Clinical Manifestations
– Small % asymptomatic– Frequency, urgency, dysuria, hematuria, lower
abdominal or suprapubic pain
• Diagnostic Testing– Urinalysis
• Dipstick– WBC (Pyuria) , RBC, Nitrites– Pink/Cloudy May culture urine
16
Acute Pyelonephritis
• Infection of the renal pelvis and interstitium• Etiology
– Ascending bladder infection– Indwelling urinary catheters– Post cystoscopy– Prostate enlargement– Renal Stones– Reflux– Genetic
17
Acute Pyelonephritis• Pathogenesis
– Development of infection
– WBC infiltration and inflammation of renal parenchyma
– Altered renal function
– Recurrent infections may lead to scarring and chronic kidney disease
18
Acute Pyelonephritis
• Clinical Manifestations– Usually, sudden onset– Bacteriuria, fever, flank pain, chills, dysuria, WBC casts in urine
• Complications– Risk of permanent decrease in kidney function
is low– Renal damage from repeated
infections/chronic pyelonephritis19
Chronic Pyelonephritis
• Etiology– Recurrent and/or improperly treated infections– Obstructive disorders– Vesicoureteral reflux
20
Chronic Pyelonephritis
• Pathogenesis
– Repeated invasion of leukocytes and subsequent inflammation of renal parenchyma with recurrent infection
– Fibrosis and scarring of renal tubules decreases the number of functioning nephrons
21
Chronic Pyelonephritis
• Clinical Manifestations
– Similar to acute• Found during routine evaluation for other conditions
– Azotemia
22
Glomerular Abnormalities
23
Glomeruli are part of the nephron.
Fluid filtration from the blood to the nephron tubules takes placein the glomeruli.
Average GFR is 125 ml/min.
Nephron
Glomerular Disorders
• Glomerulonephritis– 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
Glomerulonephritis
• Clinical Manifestations– Hematuria
– Red cell casts
– Proteinuria
– Signs of fluid retention due to GFR
25
Nephrotic Syndrome
• 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
Acute Renal Failure
• Etiology– Decreased perfusion– Pyelonephritis– Drug toxicity– Autoimmune disease/glomerulonephritis– Contrast induced nephropathy
27
Acute Renal Failure
• Classification– Pre-renal
– Post-renal
– Intra-renal
28
Acute Renal Failure
• Clinical Manifestations– Sudden and near complete cessation of renal
function• Oliguria• Anuria• FVE, HTN• Elevated BUN, Creatinine• Fluid & Electrolyte imbalance
– Changes in LOC– Cardiac dysrhythmias
29
Chronic Renal Failure• Defined as decrease in kidney function or
kidney damage for 3 months or longer.
• Progressive loss of renal function– Tubular atrophy, glomerulosclerosis, interstitial
fibrosis– Damage to nephrons– Irreversible; terminates in ESRD
30
Chronic Renal Failure
• Etiology/Risk Factors– Diabetes Mellitus
– Glomerulonephritis
– HTN
– Cystic Kidney Disease
– Other
31
Chronic Renal Failure• Stages-based on degree of nephron loss and
clinical manifestations– Decreased Renal Reserve <75% nephron loss,
no s/s– Renal Insufficiency 75-90% nephron loss,
polyuria, nocturia, slight increase in BUN and creatinine, maybe controlled by diet and meds
– End Stage Renal Disease (ESRD) > 90% nephron loss, azotemia/uremia, F&E problems, anemia, dialysis or transplantation necessary
32
Chronic Renal Failure
• Clinical Manifestations of ESRD
– Increased BUN 180 – 200 mg/dL
– FVE decreased GFR and activation of RAAS
– Electrolyte imbalance- retention of K, Mg, Phos
– Uremic Syndrome -confusion, anorexia, N/V, pruritis,
33
Chronic Renal Failure
• Alterations seen in following systems:
– Musculoskeletal
– Cardiovascular and pulmonary
– Hematologic
– Immune
Chronic Renal Failure
– Neurologic
– Gastrointestinal
– Endocrine and reproduction
– Integumentary