Where else can renal pain occur other than flank?
contralateral shoulder
What is the kidney's function?
control mineral and water balance, filter waste products in the form of urine, removes excess fluid from the blood
UTI pathogenesis
- Fecal associated gram negative; E. coli (80%)
- Hospitalized patients: enterobacter, klebsilla, proteus, pseudomonas, enterococci, staphylococci
adhere to urinary tract mucosa, colonize and cause infection
Complicated UTI
functional or anatomic abnormalities
associated with metabolic disorders like diabetes
Uncomplicated UTI
Occurs in otherwise normal urinary tract
Usually involves only the bladder
in younger patients
usually associated with cystitis (inflam of bladder)
pyelonephritis - acute infectious process
ascending UTIs from bladder to kidneys affecting nephrons
what is an emergency that can result from pyelonephritis - acute
can become bbp > patient can become septic (emergency)
Pyelonephritis chronic inflammatory disease
permanent damage to kidneys (nephrons)
analgesic nephropathy - 6+ pills per fay over 3 yrs
What is the hereditary link associated with Renal cell carcinoma
Von hippel-Lindau
what are the triad of symptoms for renal cell carcinoma
flank pain, hematuria, palpable abdominal mass
What is significant about renal call carcinoma and the kidneys close association with the parathyroid
paraneoplastic syndrome/ ectopic hormone production
patient could see cushings syndrome symptoms
Spontaneous polycystic kidney disease
Rapid progression linked to hypertension, multiple pregnancies, male gender, genetic mutation PKD1
hereditary polycystic kidney disease
autosomal dominant
appears around 30-40 yrs
What are the 4 types of renal calculi
struvate - recurrent infection
uric acid - increased level of urate (gout)
calcium stones - most common (dehydration)
hereditary
renal calculi risk factors
disorders that lead to over excretion and hypersaturation of calcium or oxlate
low quantities of citrate which binds to calcium to minimize overabundance
Chronic Kidney Disease
alteration of kidney function or structure for 3+ months
what are the most common causes of chronic kidney disease
diabetes, hypertension, glomerulonephritis
What is CKD pathogenesis
hyperglycemia
Angiotensin II causing vasoconstriction
reduced glomerular filtration rate
CKD stage 1
no symptoms and reversible
CKD stage 2
small amounts of albumin in urine (hypertension and anemia)
CKD stage 3
increase albumin in urine, decrease in blood (anemia)
-BUN and creatinine increases
-accumulation of waste products
-noticeable edema in LE
CKD stage 4 and 5 (ESRD on dialysis)
proteinuria
hypertensive (increase renin)
uremia (asterixis - tremor of hand with wrist extended)
what cardiovascular disease is chronic kidney disease associated with
congestive heart failure - b/c L ventricular hypertrophy
Musculoskeletal systemic effects of chronic kidney disease
increase calcium resorption
-renal osteodystrophy causes cone mineralization deficiency)
extraskeletal calcification
myopathy - proximal muscle weakness of shoulder and pelvic girdle
What is the most common cause of End Stage Renal Disease
glomerular disease
what is glomerular disease
a group of conditions that damage the kidney's filtering units
What is bladder cancer
inflammatory conditions cause transitional cell carcinoma (most common)
Sensory neurogenic bladder
disruption of nerves between bladder and spinal cord
-Diabetes, vitamin B12 deficiency, syphilis
Motor paralytic bladder
destruction of parasympathetic motor nerves
-Trauma, pelvic surgery
Uninhibited neurogenic bladder
damage to corticoregulatory tract, capacity to store urine is decreased
-CVA, brain or spinal cord tumors, Parkinson's disease, brain tumor
Reflex neurogenic bladder
following spinal cord injury, complete disruption between sacral spinal cord and brainstem
Autonomous neurogenic bladder
-Occurs in the cauda equine
-Complete separation of sensory and motor nerves of the bladder
-Damage to sacral roots or cord or pelvic nerves
-Medical emergency
functional urinary incontinence
unable to reach bathroom due to impairments
Most common in older adults
Stress urinary incontinence
involuntary leakage of urine while exercising, sneezing, laughing or lifting
urge urinary incontinence
frequent, sudden urge to urinate with little control of bladder
overflow urinary incontinence
cannot completely empty bladder
what is the altered anatomy of urinary incontinence
pelvic floor muscle weakness, cystocele or uterine prolapse, congenital, pudendal nerve damage