What factors contribute to acute pyelonephritis? (p.12-13)

manifestation of UTI - bacteria; cystitis, prostatitis, urethritisorganisms - E. coli; Proteus klebsiella; enterobacter; pseudomonasresult of manipulation of urinary tract - catheterization; cystoscopyroutes - bloodstream, lower urinary tract

What parts are involved in acute pyelonephritis?

kidney and renal pelvis

Clinical manifestations of acute pyelonephritis?(p.13)

pain @ costovertebral anglesigns of systemic infection - fever, chills, malaiseUA = pyuria, bacturia

Azotemia

any substantial rise in plasma concentration of non-protein nitrogenous compounds= urea and creatinine

Prerenal ARF

result of decreased blood flow- inadequate perfusion- decreased glomerular filtration in presence of otherwise normal renal function- no parenchymal damage cause is outside kidney

Causes of ARF

Outside kidneySystemic hypotension or hypovolemia- decreased cardiac output (CHF)- burns, trauma (hemorrhage)- dehydration- bacterial sepsis- bilateral renal stenosis- any situation resulting in shock, thus renal hypoperfusion

Is prerenal ARF reversible?

Yes.If renal blood flow quickly restored and cardiac output normal

Prolonged hypoperfusion in prerenal ARF can lead to...

Acute tubular necrosisprolonged hypoperfusion --> severe damage to renal tubules --> ischemic acute tubular necrosis

Causes of postrenal ARF

beyond kidneys- obstruction of urethra or bladder neck- ureter obstruction = bilateral if 2 kidneys = unilateral if 1 kidney

Examples of causes of postrenal ARF

benign prostatic hypertrophy (BPH)blood clotstumorsrenal calculifoley catheter obstructionurethral strictures

Intrarenal ARF

Result of any lesion in any part of the kidney- glomeruli - progressive glomerulonephritis- blood vessels - malignant hypertension- DIC- HUS- tubules and interstitium - acute tubular necrosis, allergic acute interstitial nephritis

Major cause of intrarenal ARF

ATN - acute tubular necrosis- ischemic- nephrotoxic

Differentiate between prerenal and intrarenal ARF in terms of parenchymal damage.

prerenal - NO parenchymal damageintrarenal - + parenchymal damage

ATNAcute Tubular Necrosis

Acute injury of renal tubulesResult in acute suppression of renal function:- decreased GFR- oliguria = UOP < 400mL/day- anuria- increased BUN and serum creatinine levels (azotemia)

Ischemic ATN

Segmental necrosis with rupture of basement membraneInjury to renal tubulesResponse to shock or dehydration= decreased renal blood flow= decreased GFR Impaired Na+, Cl-, and fluid reabsorptionLittle urine produced= not concentrated (isotonic)= increased Na+ concentration (>40 mEq/L)Ischemia >60 minutes not likely reversible

Nephrotoxic ATN

No rupture of basement membrane - quicker repair processCauses:= poisons= metals - mercury, organic solvents= drugs - cephalosporins, gentamicin, tobramycin, constrastReversible if treated quickly

In ARF, oliguric phase is represented by approximately how much UOP?(p.16)

< 400 mL/24 hours(< 0.5 mL/kg/hr)