ALU 201: Intermediate Medical Life Insurance Writing PDF

DISORDERS OF THE KIDNEY AND URINARY TRACT Introduction Isak Dinesen, the 20th 1. 2. to maintain water and electrolyte homeostasis. 1. erythropoietin, which stimulates the bone marrow to produce red blood cells 2. 1. an outer layer, the cortex 2. an inner layer, the medulla. 1. the glomerulus 2. the...

DISORDERS OF THE KIDNEY AND URINARY TRACT Introduction Isak Dinesen, the 20th 1. 2. to maintain water and electrolyte homeostasis. 1. erythropoietin, which stimulates the bone marrow to produce red blood cells 2. 1. an outer layer, the cortex 2. an inner layer, the medulla. 1. the glomerulus 2. the tubule. Page 249 ALU 201: Intermediate Medical Life Insurance Writing 1. endothelial layer 2. basement membrane 3. epithelial layer. molecules through and keeping others in the circulating blood. 1. 2. The basement membrane traps the larger protein molecules and does not allow them into 3. The capsule that surrounds a glomerulus is the Bowman’s capsule. Bowman’s space is the space within the capsule surrounding the glomerulus. The tubule is the other structure in the nephron. place. 1. 2. and minerals). There are sphincter muscles at the ureterovesical junction (where the ureters enter the bladder) it leaves the bladder. Page 250 related purpose is to maintain water and electrolyte balance in the body. Since the kidneys also process. 1. 2. Aldosterone causes the kidneys to retain sodium. only causes more salt to be retained but also directly constricts small blood vessels, causing an increase in blood pressure. This mechanism explains why so many kidney disorders are associated as though the blood pressure were low (i.e., more renin is produced in an attempt to increase the blood pressure and thus their own blood supply). Proteinuria 1. 2. orthostatic proteinuria – a condition in which an individual has proteinuria when upright have mild renal lesions, but overall excess mortality is very low. Page 251 ALU 201: Intermediate Medical Life Insurance Writing Microalbuminuria to diabetes, microalbuminuria can also be associated with hypertension, lipid abnormalities, and 1. 2. Microscopic hematuria indicates that there is not enough blood to color the urine, but that red blood cells can be seen on microscopic examination. 1. 2. 3. 4. 5. stones nephritis – usually associated with proteinuria and casts tumors – both benign and malignant prostate disease Pyuria prostatitis. Casts 1. red blood cell casts – glomerulonephritis 2. interstitial cystitis 3. epithelial casts – nephritic syndrome, tubular injury, glomerulonephritis 4. granular casts – glomerulonephritis 5. 6. Page 252 Dysuria cystitis. incomplete or chronic, with the bladder being incompletely emptied at each voiding. Most cases (e.g., spinal cord injury), diabetes mellitus, cystocele, and some medications (e.g., cold medications and antidepressants). Azotemia 1. 2. 3. prostatic hypertrophy). nausea and vomiting, excessive bleeding, edema, convulsions, and lethargy progressing to coma) that are secondary to renal damage. 1. dehydration 2. total urinary tract obstruction ((e.g., stones, enlarged prostate) 3. 4. medications (e.g., anticholinergics, methotrexate, diuretics). Anuria that produce a sustained drop in blood pressure, such as shock or hemorrhage. It can also be caused hypertrophy). Page 253 ALU 201: Intermediate Medical Life Insurance Writing by edema, hyperlipidemia, hypercoagulability, and hypoalbuminuria. The massive proteinuria is triggered by damage to the glomeruli, which causes them to become more permeable to protein molecules. below 1.005, cells and casts are likely to dissolve and disappear. Blood Testing Blood Urea Nitrogen (BUN) interpreting moderate elevations is needed. In addition, acute gastrointestinal bleeding can increase normal in this situation. Serum Creatinine creatinine above 1.6 mg/dl. Page 254 Creatinine Clearance usually over 24 hours, which is neither easy to do nor reliable. For this reason, creatinine clearance 15%). Creatinine Clearance (expected) = 72 x (serum creatinine in mg/dl) Cystatin C obese, malnourished, or who have a reduced muscle mass). Cystatin C is a protein that inhibits the monitor known kidney disease. There is also evidence that increased levels can be associated with Diagnostic Testing 1. 2. Cystoscopy to inspect the prostate. A cystoscope is inserted through the urethra into the bladder and Intravenous pyelogram (IVP) ureters can be seen. The rapidity with which the substance is excreted allows some crude 3. Retrograde pyelogram Page 255 ALU 201: Intermediate Medical Life Insurance Writing 4. Renal scans are similar to an IVP but the substance that the kidney is excreting is labeled with a radioactive isotope (i.e., iodine or technetium), and the scan is done with a gamma 5. Ultrasonography waves to delineate structures in the urinary system. It can be used to detect hydronephrosis, 6. arteries and veins. CT scanning urinary obstruction, and malignancies. 7. 8. Renal angiography kidneys. Contrast medium, introduced into the blood stream by catheter, is used to allow 1. 2. 3. secondary to another disease such as diabetes or lupus erythematosus, the mortality/morbidity associated with that disorder should also be considered. Page 256 hematuria. Both are easily treated and very rarely have serious consequences. The causative are nearly always contracted during sexual exposure. 1. acute, with symptoms similar to acute cystitis 2. chronic, with milder, more prolonged symptoms. Interstitial Cystitis though its cause is still unknown. Suggested causes include collagen diseases or other autoimmune processes. 1. diminished capacity 2. hematuria 3. incontinence. such as oxybutynin [Ditropan® V Page 257 ALU 201: Intermediate Medical Life Insurance Writing bladder to the kidney. The m Bladder Cancer 1. 2. Caucasians. 3. 4. genetic variations increase the risk. 5. personal history – Bladder cancer has an up to 80% recurrence rate. 6. ® ) 7. in rubber, chemical, and leather industries, plus printers, painters, textile workers, and exposure. Page 258 normal cells lining the bladder. The other, much rarer types which are considered more aggressive 1. squamous cell – 3% 2. adenocarcinoma – 2% 3. aggressive tumors prone to invade through the bladder wall and spread to lymph nodes and distant cystectomy) in more serious cases. tumor, it will be discussed separately). a Carcinoma in Situ (CIS) of the Bladder tumors. Invasive Bladder Cancer cell membrane) in the lamina propria or muscle. Almost all such tumors are high grade and tend to the most important independent prognostic indicator. Page 259 ALU 201: Intermediate Medical Life Insurance Writing Treatment of Bladder Cancer abnormalities that indicate that a new cancer is present. a is carcinoma in situ (Tis) or a Ta th and doxorubicin. pathways. 1. multiple sclerosis 2. spinal injury or surgery 3. cerebral vascular disease Page 260 century, is 4. 5. 6. 7. 8. 9. Parkinson’s disease diabetes mellitus meningomyelocele disc herniation pelvic surgery (e.g., hysterectomy). bladder is. Acute Pyelonephritis show an elevated white blood cell count. A urine culture will show the causative bacterium. 1. urinary stones 2. benign prostatic hypertrophy 3. obstruction, ureteropelvic junction narrowing) Page 261 ALU 201: Intermediate Medical Life Insurance Writing 4. tumors. is necessary. the two kidneys are joined at their lower poles (i.e., horseshoe kidney). Medullary sponge kidney is a disorder in which the terminal collecting ducts that drain urine Though usually asymptomatic, medullary sponge kidney can cause hematuria or pyuria. In and, sometimes, even in the glomeruli. It is characterized by an insidious onset and progression. Page 262 Diseases that induce hypercalcemia, such as hypertension, sarcoidosis, multiple myeloma, develops. Benign nephrosclerosis Senile nephrosclerosis also produces arteriolar wall thickening, similar to benign nephrosclerosis, but does not appear to be related to hypertension. It is characterized by insidious onset and progress mortality associated with this disorder. controlled. The kidneys can be damaged or involved in diseases that are not primarily kidney diseases. inhibitor (e.g., enalapril, lisinopril) can retard its progression. Page 263 ALU 201: Intermediate Medical Life Insurance Writing 1. autosomal dominant 2. autosomal recessive. Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney and more than 12 million worldwide. It is characterized by numerous cysts in both kidneys. The tissue. obliterated, leaving only atrophic, sclerotic tissue. Individuals with the disorder sometimes also have cysts in the liver, pancreas, and spleen. 1. mitral valve prolapse 2. 3. 4. hiatal hernia. 1. 2. 3. 4. 5. diagnosis at a younger age male gender gross hematuria large kidney size hypertension. Dialysis or kidney transplantation will eventually be needed. Page 264 Autosomal recessive polycystic kidney disease (ARPKD) is a rare disease that almost always transplantation can be done. Besides polycystic kidney disease, there are other rare genetic kidney disorders. Alport syndrome Benign familial hematuria, or thin basement membrane disease, is usually inherited in an Nephrogenic diabetes insipidus can be either an acquired or inherited disorder. The acquired 1. 2. 3. 4. blockage in the urinary tract high calcium levels low potassium levels certain drugs (e.g., lithium, amphotericin B). respond to the antidiuretic hormone vasopressin. As a result, the kidneys produce a large amount Chronic Pyelonephritis or kidney transplantation. due to an anatomic anomaly in an individual’s urinary tract. The anomaly can be one that causes Page 265 ALU 201: Intermediate Medical Life Insurance Writing The most obvious change in a kidney damaged by chronic pyelonephritis is the scarring and 1. 2. 3. 4. exposure to lead or cadmium radiation metabolic abnormalities (e.g., hyperoxaluria, hyperuricemia, hypercalcemia, hypokalemia) systemic diseases (e.g., multiple myeloma, amyloidosis, sarcoidosis, systemic lupus or can be secondary to a systemic disease. 1. capillary membrane (90%) 2. 1. diabetes mellitus 2. systemic vasculitis, cryoglobulinemia) 3. AIDS, syphilis) 4. cancer 5. ® 6. 7. drug abuse (e.g., heroin). 1. 2. 3. 4. and basement membrane abnormalities to be seen. Membranous lesions indicate that the glomerular Page 266 obstructing lesions). and extracellular matrix material that accumulates in Bowman’s space when severe glomerular injury causes breaks in the capillary wall. Crescents will compress and distort the glomerular Types of Glomerulonephritis 1. 2. 3. syndrome in children. The cause is probably secondary to an immune reaction involving 4. biopsy can miss the lesions because disease begins at the corticomedullary junction and 5. circulating antibodies that attack the glomerular basement membrane. It is called therapy with prednisone and cyclophosphamide is necessary. Plasma exchanges are given Page 267 ALU 201: Intermediate Medical Life Insurance Writing 6. (i.e., idiopathic necrotizing glomerulonephritis) or it can be secondary to Wegener’s granulomatosis or to a microscopic polyarteritis. In most cases, it is a rapidly progressive glomerulonephritis requiring urgent treatment with corticosteroids and immunosuppressive therapy. 7. secondary to diseases such as systemic lupus erythematosus, hepatitis B, or malignant disorder, although some can actually be asymptomatic. Prognosis is extremely variable 8. kidneys. 9. deteriorates rapidly over days or weeks. It is a medical emergency requiring management 1. calcium oxalate and/or phosphate (75%) – Disorders that derange calcium levels in the body, such as hyperparathyroidism, sarcoidosis, or bone diseases, cause calcium stones. 2. magnesium ammonium phosphate, i.e., struvite (15%) 3. 4. acid, cystine. Page 268 Lithotripsy intractable pain can be removed by either open surgery or by cystoscopic basket extraction. In 1. bladder. 2. 3. usually advised. kidney stones. Acute Renal Failure (ARF) 1. 2. 3. usually reduced urine volume. Page 269 ALU 201: Intermediate Medical Life Insurance Writing 1. volume depletion (e.g., hemorrhage, intractable vomiting) 2. 3. advanced liver disease. For example, urinary tract obstruction in combination with vesicoureteral valve incompetence can tubules, such as acute tubular necrosis or glomerulonephritis. Acute tubular necrosis causes acute 1. ischemia – hypovolemia, major surgery 2. damage (i.e., rhabdomyolysis) or intravascular hemolysis, uric acid 3. exogenous toxins – radiocontrast media, platinum, amphotericin B, aminoglycosides, and other drugs. permanent renal damage is the usual outcome. Chronic Kidney Disease Stage 1 Description proteinuria 2 3 4 5 Page 270 to properly concentrate urine. 1. 2. 3. Dialysis With hemodialysis, the membrane is in the dialysis machine, while with peritoneal dialysis, the membrane. Survival rates are similar whether individuals are treated with hemodialysis or peritoneal disease. The other alternative, chronic renal dialysis, has higher mortality and morbidity. peripheral blood. Page 271 ALU 201: Intermediate Medical Life Insurance Writing 1. 2. 1. 2. trauma to the kidney 3. renal cancer 4. tuberculosis. mortality implications (e.g., renal cancer, tuberculosis). Cystectomy 1. intractable interstitial cystitis 2. 1. urostomy/ileal conduit – the most common method. The ureters are anastomized to a attached to the abdomen. 2. to the abdominal wall and is drained by using a small catheter inserted through the small periumbilical stoma. 3. Page 272 Cysts and Tumors cause severe pain or constant hematuria and will have to be drained or surgically removed. with a cystic component. represent polycystic kidney disease. almost every time. Sometimes a cyst puncture, under ultrasound guidance, is needed to retrieve can be cured. Page 273