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Chapter 3

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University of Calgary
NURS 203

Chapter 3: Other Problems related to kidneys: Example: pt has essential HTN over 10 yrs, and pt is not compliant with medication – kidney with cobblestone appearance = nephrosclerosis. Underlying dz causing it: hyaline arteriolosclerosis b/c there is decreased blood flow, tubular atrophy, glomeruli are fibrosing off, renal function is going down, and leads to renal failure. Example: lets say the pt wakes up with a big headache and blurry vision. Pt is getting dizzy, goes to dr, and pressure is 240/140, in the retina, dude has papilloedema with flame hemorrhages and hard and soft exudates, grade 4 hypertensive retinopathy, BUN/Cr are 80/8 – dx? Malignant HTN (aka flea bitten kidney – petechia visible on surface of kidney – see vessel changes ie hyperplastic arteriolosclerosis, and the BV’s are rupturing, leading to petechial lesions on the cortex – called flea bitten kidney). This is all you have to know. They can also ask Rx: IV nitroprusside to get the BP down. So, they have CNS edema with papilloedema, and if the BP isn’t lowered, they are gonna die. Example: kidney with abnormal areas that are pale and depressed – so, if you take a section through one of these, and you see an irregular irregular pulse, will see pale infarction with coagulation necrosis b/c what you are looking at are infarcts. Irregular irregular pulse is from atrial fib, and atrial fib is most dangerous for embolization. So, these infarcts are from multiple emboli, leading to multiple pale infarcts of the kidney. This is NOT pyelonephritis b/c has microabcesses Example: atrophy due to dilatation of the renal pelvis, leading to hydronephrosis. So, if you have hydronephrosis and increased pressure pressing on the cortex and medulla, what happens to that? Get ischemia and atrophy – which is called compression atrophy. This is very similar to cystic fibrosis ducts filled with mucous – the pressure is impacted back to the glands, and they undergo compression atrophy. Cortex and medulla are very thin, along with very dilated renal pelvices. MCC = stone Example: staghorn calculus – urine pH is alkaline and smells like ammonia; therefore, there must be a urease producer, and this is Proteus. B/c it is a urease producer, they break urea down to ammonia, and get an alkaline pH. This is why a staghorn calculus is Mg ammonium phosphate, and only develops in infections in pts that have urease producers. E coli are not urease producer and proteus species are and they predispose to these stones. Do not pass these stones (too big), therefore need to extract these (surgery). So, urease producer, alkaline pH, ammonia smell to the urine. If you see a mass in a kidney, and its an adult, it is a renal adenocarcinoma. If it’s a kid, it’s a Wilm’s tumor. So, if you see a mass in the kidney, its prob not mets (b/c not many things go there), its not b9, pick cance
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