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37 Cards in this Set
- Front
- Back
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What occurs in the proximal tubule?
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Reabsorption of 80% of electrolytes and H20; reabsorption of all glucose and amino acids; reabsorption of HCO3; secretion of H+ and creatinine
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What occurs in the Loop of Henle?
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Reabsorption of Na+ and Cl- in ascending limb; reabsorption of H20 in descending loop; concentration of filtrate
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What occurs in the distal tubule?
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Secretion of K+, H+, ammonia; reabsorption of water (reg by ADH); reabsorption of HCO3; regulation of Ca+ and PO42 by parathyroid hormone; regulation of Na+ and K+ by aldosterone
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What occurs in the collecting duct?
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Reabsorption of H20 (ADH required)
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What is reabsorption?
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is the passage of a substance from the lumen of the tubules through the tubule cells and into the capillaries using both active and passive transport.
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What is secretion?
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is the passage of a substance from the capillaries through the tubular cells into the lumen of the tubule.
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What is the normal findings of specific gravity in urine?
What does low indicate?and high? *special note* |
1.003-1.030
Low indicates dilute urine and possibly excessive diuresis. High indicates dehydration A fixed 1.010 indicates renal inability to concentrate urine, suggesting kidney close to ESRD |
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Abnormal findings in color of urine:
dark, smoky suggests.... yellow-brown to olive-green..... orange-red or orange-brown..... cloudiness...... colorless...... |
hematuria
excessive bilirubin Pyridium infection excessive fluid intake, renal disease, or diabetes insipidus |
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What drugs are used to treat an uncomplicated or initial UTI?
*special note* |
TMP/SMX (Trimethoprim/sulfamethoxazole)
or nitrofurantoin (Macrodantin) TMP/SMX: less expensive but E. coli becoming resistant Macrodantin take 3-4x/daily, long term use cause pulmonary fibrosis & neuropathies Macrobid: take 2x/day |
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What drugs are used to treat complicated UTIs?
drugs for UTIs secondary to fungi? |
Fluoroquinolones: Cipro, Levaquin, Noroxin, Floxin, Tequin
Amphotericin or Fluconazole |
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What OTC drugs may be used in combo with Abx therapy to relieve discomfort with UTIs?
*special note* |
Phenazopyridine (Pyridium): soothes effect of the UT mucosa.
Stains the urine a reddish orange; long term use produce hemolytic anemia Urised; may tint urine blue or green |
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Recommended amt of daily fluid intake?
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15ml per lb of body weight ie. 150lb =2250ml
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Acute intervention of a UTI
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Ensure adequate fluid intake; help flush out bacteria before they have chance to colonize in the bladder & empty bladder q3-4hrs
-local heat to suprapubic or lower back area -drink cranberry or lingonberry juice (250-750ml) daily |
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What is pyelonephritis?
What are the s/s in acute pyelonephritis? Risk factors? |
inflammation of the renal pelvis (collecting system) & parenchyma.
-fever, chills, flank pain, malaise, pain in the CVA or abd region; pain more severe, GI symptoms; NV, diarrhea Pregnancy, DM, renal calculi |
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How is acute pyelonephritis diagnosed?
What's found in the urine? How is treated? What drugs? |
By symptoms, UA, and culture.
RBC, WBC, positive antibody coated bacteria, and casts in the urine Treated aggresively: Abx therapy 7-14 days or longer. ceftriaxone or Rocephin & ampicillin |
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What can untreated acute pyelonephritis (APN) lead to?
What can untreated chronic pyelonephritis (CPN) lead to? |
APN -> urosepsis -> ARF
CPN ->CRF then dialysis |
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What is urosepsis?
characterized by what? |
systemic infection arising from a urologic source. Requires prompt dx and effective tx; can lead to septic shock and death.
bacteriuria and bacteremia (bacteria in blood) monitor VS with close observation |
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What is the primary manifestation of urinary calculi?
in the renal calyx? in the ureter in the bladder? |
Pain!!
dull CVA pain or even colic very intense and colicky to the point of mild shock with cool, moist skin s/s of irritation and UTI |
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What diagnostic tests are used in evaluating lithiasis?
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UA, culture, IVP, US, cystoscopy
urine collected to measure the amt of calcium, phosphate, uric acid, and oxalate. Keep stones to analyze!! |
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How to treat urinary calculi?
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-opioid analgesic IV or IM for pain
-antispasmodics: Ditropan and Probathine *these have anticholinergic effects -adequate hydration increases hydrostatic pressure behind stone and let it pass: atleast 8oz up to 3L -ambulation & diet changes |
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With urinary calculi how much urine output should one have?
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2L/day with atleast 2000ml intake
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What types of food should people avoid if they have or are prone to uric acid stones?
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Uric acid is a waste from purine in food.
High: sardines, herring, mussels, liver, kidney goose, venison, meat soups, sweetbreads Mod: chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham |
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What types of food should people avoid if they have or are prone to calcium stones?
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High: milk, cheese, ice cream, yogurt, milk sauces, all beans (except green), lentils, fish with fine bones (sardines, kippers, herring, salmon), dried fruits, nuts; Ovaltine, chocolate, cocoa
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What types of food should people avoid if they have or are prone to oxalate stones?
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High: dark roughage, cabbage, spinach, rhubarb, asparagus, tomatoes, beets, nuts, celery, parsley, worcestershire sauce, tea, ovaltine, instant coffee, chocolate, cocoa
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What drugs therapy is used for.....stones?
oxalate? calcium? uric acid? struvite? |
calcium & oxalate: give thiazide diuretics
uric acid: usually have hx of gout so give allopurinol or Zyloprim: need to alkalinize urine so eat: green veggies, fruits, and potassium citrate struvite: Lithostat and eat acidic foods: poultry, meat, some fruits |
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What is ESWL?
laser lithotripsy? *special note* |
(Extracorporeal shock-wave lithotripsy) noninvasive procedure, pt is anesthestized and placed in a water bath
Laser: used to fragment lower ureteral and large bladder stones and does NOT injure surrounding tissue. Most common & Preferred method! |
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How is a renal abscess dx?
What is the tx? |
Renal US or CT scan
Incision and drainage with ABx therapy |
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What is cystitis?
what are the clinical manifestations? does it affect elderly the same? |
inflammation of the bladder; a lower tract infection
bladder irritability- urinary freq, urgency, dysuria, foul-smelling urine, cloudy, nocturia, suprapubic pain No, instead they present with anorexia, lethargy, new incontinence, or confusion |
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What is non-infectious cystitis?
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They have the clinical manifestations but do not have bacteriuria!
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What is interstitial cystitis?
What are the complaints? aka..... |
a chronic painful inflammatory process that leads to bladder scarring and reduced capacity. Mostly affects women.
Pt complains of severe urinary freq & urgency up to 60x/day. Also they have pain in the suprapubic area but may involve the vagina, labia, or perineal area. Pain is relieved by voiding. The have the c/o of a UTI but lack the bacteria infection. Painful Bladder Syndrome |
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What is the etiology in IC/PBS?
treatment? |
the cause is unkown
dietary and lifestyle alterations to relieve pain and diminish voiding freq -avoid acidic foods & alcoholic drinks |
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What OTC drug is helpful for those with interstitial cystitis?
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a dietary supplement called calcium glycerophosphate (Prelief) alkalinizes the urine and can provide relief from the irritating effects of certain foods.
Helpful when eating out away frm home. |
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What are some relaxation techniques to use with interstitial cystitis?
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Sitz baths, application of heat or cold to perineum area or bladder, stress reduction tapes. Use of lubrication or altering posistions may decrease pain during sex
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What two drugs are used to reduce the burning pain and urinary freq in interstitial cystitis?
What is the only oral agent approved for the tx of IC? |
TCA antidepressants: amitriptyline (Elavil) and nortriptyline ( Aventyl)
Pentosan (Elmiron): does not provide immediate relief but good for acute exacerbation of symptoms. For immediate use short course of opioid analgesics. |
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What other drugs are useful in IC?
other treatments? |
Dimethyl sulfoxide (DMSO): instilled directly into bladder.
Heparin and hyaluronic acid also instilled. BCG: Bacille Calmette-Guerin, an attenuated form of Mycobacterium bovis is admin intravesically surgical urinary diversion: ileal conduit |
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What are some teaching ideals about cystitis?
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taking a sitz bath, applying warm pad, generous fluid intake (30ml/kg), avoid bladder irritants, acidify urine b/c bacteria thrive in alkaline (drink cranberry, empty bladder q3-4 hrs, void before/after sex, perineal hygiene important. Avoid bubble baths, douche, fmae sprays, wear cotton instead of nylon. Older women may take Estrogen replacement to increase suppleness/integrity of urethra.
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When is a bladder percussible?
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When it is full with atleast 150ml or urine heard above the pubis symphysis
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