Summary NR507 Final Exam Study Guide – Key Concepts in Advanced Pathophysiology Disorders

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FINAL EXAM STUDY GUIDE
Concepts:
 Genitourinary disorders
 Gastrointestinal disorders
 Neurobiological disorders
 Endocrine disorders
 Neurodegenerative disorders
 Demyelinating diseases
 Convulsions
 Headache syndromes
 Cranial nerve disorders
 Central nervous system inflammation
 Central nervous system ischemia
 Dermatologic conditions

GENITOURINARY DISORDERS
 Acute Renal Failure
o Reversible
o Prognosis- kidneys respond to diuretic with good output= kidneys are functioning well
 Acute Pyelonephritis
o Pathophysiology
 Bacterial colonization
 Adherence and invasion
 Inflammation and immune response
 Renal injury and complications (upper urinary system)
o Assessment
 Diagnosing by clinical symptoms alone can be difficult; can be similar to cystitis;
pyelonephritis involves the upper tract and cystitis involves the lower tract.
 Flank pain, abdominal tenderness, and fever. Systemic signs, such as high fever, chills,
and tachycardia, may suggest severe infection.
o Diagnosis
 Urinalysis: Positive urine culture with significant bacteriuria (>10^5 CFU/mL) and the
presence of pyuria (≥10 white blood cells per high-power field) on urinalysis. WBC casts
indicates pyelonephritis, but may not always be present
 CBC: Complete blood count (CBC) elevated white blood cell count =infection.
 Imaging studies: renal ultrasound or computed tomography (CT) scan, can help identify
structural abnormalities and complications like abscess formation or obstruction.
 Renal Calculi
o Pathophysiology
 Supersaturation: urine becomes oversaturate with certain substances like calcium
 Nucleation: crystals act as nucleation sites, where further crystal deposition can occur.



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 Crystal retention: urinary stasis or inadequate urine flow allows crystals to remain in the
urinary tract
 Stone growth and composition: overtime, crystals accumulate and grow into stones.
o Assessment
 Medical history: identify risk
 Physical exam: flank or abdominal pain; costovertebral angle (CVA) tenderness;
hematuria
 Imaging studies: crucial for assessing the presence, size, location and composition of
the stones- CT scan, renal ultrasound or x-ray
 Lab tests: urinalysis (blood, crystals or infection); blood tests evaluate renal function and
identify metabolic abnormalities
o Treatment
 Conservative treatment: for stones <5 mm that are asymptomatic or causing mild
symptoms
 Medical management: thiazide diuretics or allopurinol can be used for calcium stones or
uric acid stones, respectively
 Stone removal: larger stones >5 mm or stones causing severe symptoms-lithotripsy.
 The goals of treatment:
 Manage acute pain
 Promote passage of stone
 Reduce the size of stone already formed
 Prevent new stone formation
 Chronic Renal Failure
o Review who is a candidate for dialysis
o Chronic kidney disease (CKD) is the progressive loss of renal function associated with systemic
diseases such as hypertension, diabetes mellitus (most significant risk factor) systemic
lupus erythematosus, or intrinsic kidney disease
o CKD stage is determined by estimates of GFR and albuminuria.
o Review 5 stages of CKD

eGFR
Stage Description (mL/min) Complications of Decreased GFR

1 There is kidney damage with normal or elevated 90-120  Anemia
GFR  Hypertension
 Decreased calcium absorption
 Hyperlipidemia
2 There is kidney damage with mild decrease in 60-89  Heart failure
GFR  Left ventricular hypertrophy
 Fluid volume overload
3 There is a moderate decrease in GFR 30-59  Hyperkalemia


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