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187 Cards in this Set
- Front
- Back
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Adrenal gland disorders
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diabetes insipidus
SIADH |
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tasteless diabetes
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diabetes insipidus
insufficiency of ADH leading to the insufficiency of ADH > lots of free water is lost |
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types diabetes insipidus
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central type
nephrogenic type |
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central diabetes insipidus is
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not enough ADH produced; due to
head trauma pituitary gland tumors & infections |
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nephrogenic diabetes insipidus is
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a renal disease that makes kidneys not respond to ADH
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S/S
polyuria - excessive urine polydipsia - excessive thrist dehydration - dry MM, excessive Na |
diabetes insipidus
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treatment of central type of diabetes insipidus
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ADH IV or nasally (can't be given GI)
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treatment of nephrogenic type of diabetes insipidus
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treat the kidney disease
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Lots of Pee
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diabetes insipidus
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No pee
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SIADH
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SIADH aka
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syndrome of inappropriate (excessive) ADH
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Path of SIADH
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excessive ADH - H2O is retained excessively
problem with pituitary |
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Cause of SIADH
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lung cancer - ectopic production of ADH
Also caused by drugs diuretcs morphine chemotherapy general anesthesia |
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S/S
small amount of dark urine retention of water marked by crackles & cellular swelling diluted Na level anorexia n/v changes in sensorium > Sz > coma/death if not treated |
SIADH
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treatment of SIADH
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treat the cause
fluid restriction (600-800cc/day) diuretics |
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changes in sensorim cause __________ becasuse
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confusion
cellular swelling |
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increase urine specific gravity
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SIADH
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normal urine specific gravity
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1.010 - 1.030
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renal disorders
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urinary tract infections
kidney stones |
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2nd most common infection seen by MD
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urinary tract infection
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cystitis
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ragging bladder infection
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UTI
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an infection of urinary tract
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Causes of urinary tract infection
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1. bacteria ascends up urethra (or travels thru blood lymph)
2. foley catherters (bacteria ascends catheter) 3. Afftected by hormonal & anatomic changes |
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affected by hormonal & anatomic changes in women
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sexual activity "honeymoon" cystitis
pregnancy > dilation of ureters > cystitis & pyelonephritis |
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affected by hormonal & anatomic changes in men
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prostatic hypertrophy > reflux & obstruction > UTI
reflux from a sneeze or cough > forces urine into urethra & back into the bladder > urethra has organisms (bladder is sterile) |
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#1 Causative organism of UTI
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E.Coli
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S/S of cystitis (FUB)
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frequency
urgency burning |
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a potential complication of urinary tract infection
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acute pyelonephritis
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acute pyelonephritis is
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an UTI that ascends to kidney
abrupt onset of chills & fever dysuria & frequency back pain (also called CVA tenderness) |
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abrupt onset of chills & fever
back pain (also called CVA tenderness) Dysuria frequency |
acute pyelonephritis
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dx of urinary tract infections
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microscopic exam urine - look WBC & bacteria
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treatment of urinary tract infection
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cystitis - antibotics, increased fluids, vit C
pyelonephritis - longer course of antibotics or hospitalization & IV antibotics |
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prevention of urinary tract infections
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keep your urine acidic and drink lots of fluid
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collection of crystals and protein
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kidney stones (nephrolithiasis)
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another name of kidney stones
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nephrolithiasis
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kidney stones are more common in _____ with a _________ (recurrence is common)
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males
family history |
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Theories of Kidney stone causes
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saturation theory
stone inhibitor theory |
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saturation theory
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increase calcium & uric acid leads to stones
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stone inhibitor theory
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faulty inhibitor in kidney
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Urine becomes concentrated/output drops (stagnant uria)
stone begins w/ a nucleus |
patho of kidney stones
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kidney stones are effected by
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urine pH
stagnant urine immobilization increased calcium levels |
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#1 type of stone
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calcium (70 - 80% of stones)
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70-80% of stones are made of
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calcium
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other types of stone
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magnesium
uric acid cystine etc |
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S/S of kidney stones
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no symptom if inside kidney (renal pelvis)
Pain starts when descends to ureter "renal or urethral colic" Hematuria |
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"renal or urethral colic"
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abrupt, intense spasmodic pain in flank & upper quadrant of abdomen (ureter has peristalsis)
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treatment for kidney stones
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supportive - wait until it's passed
treat the pain w/ strong narcotics strain the uterine to document passage lithotropsy ureterscopy |
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lithotripsy
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ultrasound shock waves break up stone
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Kidney stone prevention
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decrease calcium alone doesn't help
Increase fiber - fiber binds w/ calcium increase fluids avoid calcium & tea toghther |
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risky food for kidney stones
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rhubarb
tea coffee spinach nuts chocolate |
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Renal tumors
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renal cell cacinoma
bladder cancer neuroblastoma/Wilm's tumor acute glomerulonephritis nephrotic syndrome |
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most common renal neoplasm
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renal cell carcinoma
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renal cell carcinoma occurs most often in
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men ages 50-70
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exposure to petroleum products/ heavy metals/abestos
high protein diet tobacco use obesity HTN family history are risk factors for |
renal cell carcinoma
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S/S of late renal cell carcinoma
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hematuria
flank pain palpable mass |
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only 10% of causes have S/S; mostly silent until metastasis
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renal cell carcinoma
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treatment for renal cell carcinoma
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remove the kidneys and then start chemo
decreased cure rate if metastasis |
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4th most common cancer in USA
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Bladder cancer
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renal tumor more common in
bladder cancer |
men over 60
bladder cancer |
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Cause of bladder cancer
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unknown
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#1 risk factor of bladder cancer is
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smoking
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other risk factors of bladder cancer include
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working w/ chemicals (rubber & textiles)
family history |
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saccharine has not been proven to be carcinogenic in
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bladder cancer
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S/S of bladder cancer
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hematuria - intermittent or ASYMPTOMATIC
NO PAIN |
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often diagnosed late in the course of disease
S/S hematuria no pain |
bladder cancer
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treatment for bladder cancer
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surgery
chemo cystectomy |
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renal tumor that has a high chance of recurrence
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bladder cancer
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rare kidney tumor found in kids under age 5
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neuroblastoma/wilms tumor
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tumor of embryonic orgin
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neuroblastoma/wilms tumor
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neuroblastoma/wilms tumor may be associated with
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paternal exposure to heavy metals & hydrocarbons
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neuroblastoma/wilms tumor S/S
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mostly asymptomatic except for upper abd. mass
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very rare and fragile tumor
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neuroblastoma/wilms tumor
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do not massage the abdomen
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neuroblastoma/wilms tumor
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treatment for neuroblastoma/wilms tumor
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surgery
chemo radiation |
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95% survival rate if no metastasis
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neuroblastoma/wilms tumor
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acute inflammation of glomerulus
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acute glomerulonephritis
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Acute glomerulonephritis is caused by
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inflammatory cells IgG/IgM that get trapped in glomerulus
leading to damage in glomerulus |
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Acute clomerulonephritis is a complication from
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infection
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circulating immune complexes get trapped in glomerular membrane
water & Na are retained as the body slows blood flow to damaged area blood can't be filtered decrease in GFR (waste not excreted well) |
Patho of acute glomerulonephritis
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S/S of acute glomerulonephritis
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abrupt onset of hematuria (cola)
oliguria azotemia proteinuria H2O & Na retention (face & hands) HTN |
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treatment of acute glomerulonphritis
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treat original infection
usually resolves self in time supportive treatment |
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azotemia
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nitrogenous water in blood as GFR drops
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rare tumor mostly in 2-3 year olds
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neuroblastoma/wilms tumor
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nephrotic syndrome
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glomerular disease causing excretion of 3.5 + grams of protein in urine a day
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patho of nephrotic syndrome
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gleomerualr filtration membrane is injured and leaks albumin & immunoglobulins
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most common cause of nephrotic syndrome
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diabetes
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S/S of nephrotic syndrome
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#1 hypoproeinemia/hypoalbunemia
edema proteinuria |
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fluid becomes trapped in tissues no proteins to pull it back in
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nephrotic syndrome
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losing plasma proteins
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nephrotic syndrome
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prevention of nephrotic syndrome
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keep blood sugar even
excessive sugar gradual damage glomerulas glomerules lets proten leak out when their damages |
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long term complication of renal damage
can only manage it |
nephrotic syndrome
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treatment of nephrotic syndrome
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steroid therapy
low sodium diet diuretics low fat normal protien diet |
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Acute renal failure (ARF)
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abrupt reversible kidney failure
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unable to remove wastes and regulate pH and electrolytes
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ARF
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Reversible kidney failure
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ARF
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Reversible causes of ARF
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Prerenal
Intrarenal Postrenal |
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Prerenal (starved to death)
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any cause that impairs renal blood flow
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60% of causes of reversible ARF
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prerenal
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Kidney is fine, but gets no blood
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prerenal
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what can cause prerenal
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CHF
dehydration circulatory collapse shock MI |
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Intrarenal
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some type of kidney disease leading to injury to glomerulus
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#1 cause of intrarenal
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Injury to glomerulus
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intrarenal injury to glomerulus
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damage to renal tubules from extended ischemia
debris builds up increased pressure in tubules decreased GFR |
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other causes of intrarenal
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trauma
antibiotics infection |
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posterenal
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from obstruction of urine outflow from the kidney
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postrenal can be casued by
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ureter obstruction
kidney stones prostatic hypertrophy |
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beign prostatic hypertrophy
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postrenal
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decreased blood flow to kidney
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prerenal
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stages & S/S ARF reversible
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1. Oliguria stage
2. Diuretic Phase 3. Concalescent stage |
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Oiguria stage
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decreased GFR
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occurs 1 day after ischemic event
last about 1-2 weeks |
oliguria stage
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Oliguria stage (list)
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urine output less than 500cc day
everything builds up because it can't get out except calcium increase BUN (azotemia) creatinine & phosphorus increased K fluid rention metabolic acidosis |
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everything builds up because it can't et out except calcium
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oliguria stage
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increased K leads to
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weakness
EKG change |
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fluid retention leads to
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pulmonary edema
HTN |
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in oliguria stage everything is retained except
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calcium
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calcium blood levels in oliguria stage
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are low because phosphorus is up
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in this stage calcium gets pushed itno joints and tissues, bones are demineralized
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Oliguria stage
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#1 cause of ARF
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Acute tubular necrosis
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diuretic phase occurs with
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start of recovery
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ARF stage that last 2-14 days
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diuretic phase
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In the hospital for atleast two weeks
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ARF
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Renal blood flow is improving
increased excretion > excretes H2O & electrolytes |
diuretic phase
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may over excrete because tubules are still damaged
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diuretic phase
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Renal diet
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decreased protein
carbs r better |
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concalescent stage may take how long
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3 -12 months
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ARF treatment
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treat the cause
limit fluid intake during acute phase (intake = output) adequate caloris (low proteins & high carbo) temporary dialysis don't let them get dehydrated |
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prevention of ARF for pt at risk
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maintain fluid volume to keep renal perfusion normal
Mannitol |
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mannitol
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dilates renal arteries & increased GFR
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chronic renal failure
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progressive and IRREVERSIBLE destruction of the kidney
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occurs 1 day after ischemic event
last about 1-2 weeks |
oliguria stage
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Oliguria stage (list)
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urine output less than 500cc day
everything builds up because it can't get out except calcium increase BUN (azotemia) creatinine & phosphorus increased K fluid rention metabolic acidosis |
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everything builds up because it can't et out except calcium
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oliguria stage
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increased K leads to
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weakness
EKG change |
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fluid retention leads to
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pulmonary edema
HTN |
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in oliguria stage everything is retained except
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calcium
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calcium blood levels in oliguria stage
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are low because phosphorus is up
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in this stage calcium gets pushed itno joints and tissues, bones are demineralized
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Oliguria stage
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#1 cause of ARF
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Acute tubular necrosis
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diuretic phase occurs with
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start of recovery
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ARF phase that last 2-14 days
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diuretic phase occurs with start of recovery
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renal blood flow is improving
increased excretion leads to excretion H2O & electrolytes |
diuretic phase
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may over excrete because tubules are still damaged
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diuretic phase
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increased excretion leads to
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excretes H2O & elctrolytes
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Hospital stay for ARF pt
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at least 2 weeks
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renal diet
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decreased protein
carbs good |
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concalescent stage of ARF may take
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3-12 months
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treatment of ARF
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treat the cause
limit fluid intake during scute phase (intake=output) adequate calories (low proteins & high carbs) temporary dialysis don't let them get dehydrated |
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prevention of ARF for pts. at risk
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maintain fluid volume to keep renal perfusion normal
Mannitol |
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mannitol
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dilates renal arteries and increases GFR
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Chronic renal failure
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progressive & IRREVERSIBLE destruction of the kidney
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causes of chronic renal failure
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anything that leads to permanent loss of nephrons
complications of many diseases |
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chronic renal failure #1 cause
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diabetes
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stages of chronic renal failure
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decrease renal reserves
renal insufficiency end stage renal disease |
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50% of renal function is gone (chronic renal failure)
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1st stage - decreased renal reserves
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S/S of renal reserves
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None because kidney can adapt
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75-90% of renal function is gone (chronic renal failure)
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2nd stage renal insufficiency
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renal insufficiency s/s
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slighly eleveted BUN & creatinine
polyuria (because kidney's can't concentrate urine) may be controlled w/ diet and medicaiton |
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end stage renal disease s/s
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profund S/S
need dialysis or transplant |
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more than 90% of function is gone in kidney
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end stage renal disease
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S/S of chronic renal failure
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Azotemia
fluid & Na buildup elevaed potassium metabolic acidosis elevated phosphorus levels increased loss of calcium RBC decreased pale dry pruitis skin uremic frost |
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uremic frost
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filtering; dandruff flakes off skin
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with chronic renal failure elevated potassium leads to
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arrythmias (irregular beat)
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with chronic renal failure calcium loss leads to
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stimulation of PTH and bones dissolve
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Chronic renal failure cause elevated resp because
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trying to get rid of acid
edema |
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#1 sign of chronic renal failure
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azotemia
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azotemia
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increased nitrogen in blood
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with chronic renal failure fluid & Na build up leads to
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bounding pulses
JVD crackles edema HTN |
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complication of chronic renal disease
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congestive heart rate CHF
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acid is part of regular
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metabolism
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treatment for chronic renal failure
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decrease protein (decrease nitrogenous wastes)
adequate calories (meet engery needs) Low K decrease fluids dialysis/kidney transplant |
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decrease fluids prevents
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circulatory overload (but don't decrease to much)
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Urinalysis checks urine for
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color
specific gravity pH |
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There should be no _______(6) in urinalysis
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glucose
RBC WBC protein cast crystals |
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creatinine is a product of
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muscle mass
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estimates glomerular filtration rate very well and is a very reliable measure
doesn't vary much |
creatinine
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creatinine normal levels
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.7 - 1.5
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Blood Urea Nitrogen
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nitrogen in the blood
substance normally in blood |
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by product of protein metabolism - substance normally in blood
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blood urea nitrogen
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BUN is easily effected by
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intact protien
GI bleeding hydration |
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BUN is a less reliable estimate of GFR than
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creatinine
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Normal BUN level
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10 - 20 mg/dl
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urine specific gravity
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a measure of the concentration of solutes (chunks) in the urine
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normal range of urine specific gravity
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1.010 - 1.030
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very dilute would have specific gravity of
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1.0
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very dark concentrated urine would have a spefic gravity of
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1.03
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this test _________ compares the urine to ______, which has the specific gravity of _____
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urine specific gravity
10 30 |
