Urinary tract infection in older adults
2. Confusion and poorly localized abdominal discomfort
2. difficult diagnose due to vague symptoms
Acute
... [Show More] unilateral renal obstruction and hypertension.
1. Reduced perfusion activates RAAS
2. Leads to constriction of peripheral arterioles
kidneys receive ___________________cardiac output
20-25% or or 1000 to 1200ml per minute
Most common type of renal stone
Calcium oxalate
Kidney stone refers pain
1. Umbilicus if high in the urethra (sensory innervation of the upper part of the ureter arising from the 10th thoracic nerve root)
2. Abdomen or groin if low in the urethra
Painful bladder syndrome/interstitial cystitis (PBS/IC)
1. condition that includes non-bacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal)
2. noninfectious cystitis (radiation, chemical, autoimmune, hypersensitivity)
Cause of PBS/IC
1. Unknown
2. autoimmune reaction may be responsible for the inflammatory response, which includes
mast cell activation,
altered epithelial permeability,
neuro-inflammation,
increased sensory nerve sensitivity
Pyelonephritis
infection of one or both upper urinary tracts (ureter, renal pelvis, and kidney interstitium).
Pyelonephritis: the most common underlying risk factors
1. Urinary obstruction
2. reflux of urine from the bladder (vesicoureteral reflux)
3. Pregnancy
4. neurogenic bladder
5. instrumentation: catheters, endoscopy
6. female sexual trauma
Microorganisms usually associated with acute pyelonephritis
1. E. coli
2. Proteus, or
3. Pseudomonas.
These microorganisms also split urea into ammonia, making alkaline urine that increases the risk of stone formation.
specific diagnosis: cystitis vs pyelonephritis
1. Difficult to do by clinical manifestations alone
2. urine culture,
3. urinalysis, and
4. clinical signs and symptoms
pyelonephritis UA lab finding
White blood cell casts, but they are not always present in the urine.
Reduced GFR during glomerular disease
1. elevated plasma urea,
2. creatinine concentration, or
3. reduced renal creatinine clearance.
Acute glomerulonephritis
includes renal diseases in which glomerular inflammation is caused by immune mechanisms that damage the glomerular capillary filtration membrane including the endothelium, basement membrane, and epithelium (podocytes)
Acute glomerulonephritis: classic symptoms
1. sudden onset of hematuria including red blood cell casts and
2. proteinuria (milder than nephrotic syndrome),
Acute glomerulonephritis: severe symptoms
1. Hematuria
2. protienuria
3. Edema
4. HTN
5. Impaired renal function
Nephrotic syndrome
1. excretion of 3.0 g or more of protein (massive proteinuria) in the urine per day,
2. hypoalbuminemia (less than 3.0 g/dl), and
3. peripheral edema
Nephrotic syndrome is characteristic of
Glomerular injury
Primary causes of nephrotic syndrome
1. minimal change disease (lipoid nephrosis),
2. membranous glomerulonephritis, and
3. focal segmental glomerulosclerosis
(see Table 38-7).
Secondary forms of nephrotic syndrome
occur in systemic diseases including
1. diabetes mellitus,
2. amyloidosis, and
3. systemic lupus erythematosus
Nephrotic syndrome also is seen with
1. certain drugs,
2. infections, malignancies, and
3. vascular disorders.
Acute Kidney injury may be
acute and rapidly progressive (within hours), and the process may be reversible
Kidney failure can be
chronic, progressing to end-stage kidney failure over a period of months or years.
Renal insufficiency refers to
1. a decline in renal function to about 25% of normal
2. or a GFR of 25 to 30 ml/minute
3. Levels of serum creatinine and urea are mildly elevated
Kidney injury diagnostic delays that make the implementation of early therapy very difficult, contributing to disease progression and mortality
changes in serum creatinine level occur only if more than 50% of glomerular filtration is lost and are often delayed by more than 24 hours.
Obesity
1. body mass index (BMI) that exceeds 30 kg/m2 2. develops when caloric intake exceeds caloric expenditure in genetically susceptible individuals
Obesity is a major risk factor for
morbidity, death, and high healthcare cost in the United States and worldwide
Three leading causes of death in US associated with obesity:
1. cardiovascular disease,
2. type 2 diabetes mellitus, and
3. cancer.
Visceral obesity
1. intra-abdominal, central, or masculine obesity
2. distribution of body fat is localized around the abdomen and upper body, resulting in an apple shape
Visceral obesity is associated with
1. accelerated lipolysis
2. an increased risk for inflammation,
3. metabolic syndrome (hypertriglyceridemia, reduced high-density lipoprotein,
4. increased low-density lipoproteins,
5. hypertension, and insulin resistance),
6. type 2 diabetes mellitus,
7. cardiovascular complications, and
8. cancer.
Peripheral obesity
1. gluteal-femoral, feminine, or subcutaneous obesity
2. occurs when the distribution of body fat is extraperitoneal and distributed around the thighs and buttocks and through the muscle, resulting in a pear shape
3. it is more common in women
Peripheral and subcutaneous fat is
1. less metabolically active and
2. less lipolytic and
3. releases fewer adipocytokines (particularly adiponectin) than visceral fat.
4. Risk factors are still present but they are less severe
Gastroesophageal reflux disease (GERD)
reflux of acid and pepsin from the stomach to the esophagus that causes esophagitis
Risk factors for GERD
1. obesity,
2. hiatal hernia, and
3. drugs or chemicals that relax the LES (anticholinergics, nitrates, calcium channel blockers, nicotine).
GERD may be a trigger
asthma or chronic cough
Clinical manifestations of reflux esophagitis
1. heartburn from acid regurgitation,
2. chronic cough, asthma attacks, and
3. laryngitis
4. Upper abdominal pain usually occurs within 1 hour of eating and can be relapsing and [Show Less]