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What factors contribute to acute pyelonephritis? (p.12-13)
- manifestation of UTI - bacteria; cystitis, prostatitis, urethritis
- organisms - E. coli; Proteus klebsiella; enterobacter; pseudomonas
- result of manipulation of urinary tract - catheterization; cystoscopy
- routes - bloodstream, lower urinary tract
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What parts are involved in acute pyelonephritis?
kidney and renal pelvis
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Clinical manifestations of acute pyelonephritis?
(p.13)
- pain @ costovertebral angle
- signs of systemic infection - fever, chills, malaise
- UA = pyuria, bacturia
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Azotemia
- any substantial rise in plasma concentration of non-protein nitrogenous compounds
- = urea and creatinine
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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
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Causes of ARF
- Outside kidney
- Systemic hypotension or hypovolemia
- - decreased cardiac output (CHF)
- - burns, trauma (hemorrhage)
- - dehydration
- - bacterial sepsis
- - bilateral renal stenosis
- - any situation resulting in shock, thus renal hypoperfusion
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Is prerenal ARF reversible?
- Yes.
- If renal blood flow quickly restored and cardiac output normal
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Prolonged hypoperfusion in prerenal ARF can lead to...
- Acute tubular necrosis
- prolonged hypoperfusion --> severe damage to renal tubules --> ischemic acute tubular necrosis
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Causes of postrenal ARF
- beyond kidneys
- - obstruction of urethra or bladder neck
- - ureter obstruction
- = bilateral if 2 kidneys
- = unilateral if 1 kidney
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Examples of causes of postrenal ARF
- benign prostatic hypertrophy (BPH)
- blood clots
- tumors
- renal calculi
- foley catheter obstruction
- urethral strictures
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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
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Major cause of intrarenal ARF
- ATN - acute tubular necrosis
- - ischemic
- - nephrotoxic
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Differentiate between prerenal and intrarenal ARF in terms of parenchymal damage.
- prerenal - NO parenchymal damage
- intrarenal - + parenchymal damage
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How will urine labs differ between prerenal and intrarenal ARF?
(urine sodium concentration, BUN/creatinine ratio, etc.)
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ATN
Acute Tubular Necrosis
- Acute injury of renal tubules
- Result in acute suppression of renal function:
- - decreased GFR
- - oliguria = UOP < 400mL/day
- - anuria
- - increased BUN and serum creatinine levels (azotemia)
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Ischemic ATN
- Segmental necrosis with rupture of basement membrane
- Injury to renal tubules
- Response to shock or dehydration
- = decreased renal blood flow
- = decreased GFR
- Impaired Na+, Cl-, and fluid reabsorption
- Little urine produced
- = not concentrated (isotonic)
- = increased Na+ concentration (>40 mEq/L)
- Ischemia >60 minutes not likely reversible
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Nephrotoxic ATN
- No rupture of basement membrane - quicker repair process
- Causes:
- = poisons
- = metals - mercury, organic solvents
- = drugs - cephalosporins, gentamicin, tobramycin, constrast
- Reversible if treated quickly
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In ARF, oliguric phase is represented by approximately how much UOP?
(p.16)
- < 400 mL/24 hours
- (< 0.5 mL/kg/hr)
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