Question

Describe common types of renal disorders: causes, clinical manifestations, diagnostic tests, and treatments.

Answer 1

Ans) Acute Pyelonephritis:

E: infection of renal pelvis/parenchyma. When acidic env of urea and unidirectional urine flow fails. Due to staphylococcus or E. coli. Risk factors: pregnancy, catheter
CM: Costavertebral angle tenderness/flank pain, fever/chills, n/v, anorexia, dehydration, urosepsis, WBC casts in urine.

Renal Calculi are kidney stone formation caused by solute supersaturation, decreasing urine volume and abnormal urine pH. Crystals are formed from calcium, uric acid, struvite, and cystine.

Prerenal AKI starts at the renal artery, before the kidney, caused by decreased renal blood flow. Decreased renal perfusion leads to renal cell hypoxia. This causes decreased GFR, oliguria, & increased urine concentration. If continues for more than 3 hours, leads to acute tubular necrosis.
T: Lasix (furosemide) with fluid. Renal diet (minimize sodium, limit potassium, protein, phosphorus). Dialysis to take place of the kidney f(x)

Intrarenal AKI is the damage to structures in the kidney itself. Caused by nephrotoxins or ischemia. Example: Acute Tubular necrosis causes inflammation & tubular injury cause cast formation to block off tubules, increased tubular intraluminal pressure, tubular back leak. CM are decreased GFR & oliguria.
T: careful use of fluid since they have excessive fluid already, renal diet, at risk of hyperkalemia so minimize potassium, dialysis.

Postrenal AKI is the obstruction distal to the kidney; urine outflow obstruction causes urine to back up into kidney; blockage of urinary tract by
1. (Renal calculi: kidney stone)
2. (linked/obstructed catheters)
When urine stasis occurs, increase in pressure in bowman capsule, decrease GFR. If urine stasis occurs for >3 hr: acute tubular necrosis, irreversible kidney damage
T: careful use of fluid, renal diet, dialysis.

1. Basic chem panel: measures how efficiently the kidneys are excreting creatinine and blood urea nitrogen.
2. Urine Analysis: measures pH, specific gravity, levels of protein/glucose/ketones
3. CBC: hemoglobin, hematocrit, WBC amount

Acute Pyelonephritis:
E: infection of renal pelvis/parenchyma. When acidic env of urea and unidirectional urine flow fails. Due to staphylococcus or E. coli. Risk factors: pregnancy, catheter

P: ascending infection (started in bladder/ureter and travel up to kidney)

CM: Costavertebral angle tenderness/flank pain, fever/chills, n/v, anorexia, dehydration, WBC casts in urine

T: get catheter out ASAP, antibiotic.

Acute Glomerulonephritis: from a post-infection process
E: Producing inflammation
Primary (kidney is source of problem): immunologic abnormalities attacking kidney, or toxins.
Secondary (related to other diseases or medication): post-infection after beta hemolytic streptococci or viruses immune response attacks glomerulus.

P: immune response decrease capillary perfusion, glomerulus contracts, decrease GFR, increase membrane permeability, increase serum creatinine, increase hypertension, leads to proteinuria & hematuria (main indication)

T: Steroids to decrease inflammation, renal diet, careful fluid balance, renal/systemic HTN management, plasmapheresis get rid of excess immune factors & fluid volume.