Patho233.mod.8.renal

Front 1

Urinary System

Back 1

 2 kidneys
 2 ureters
 Bladder
 Urethra

Front 2

Structure of the Kidney

Back 2

Renal Capsule, outer layer
Renal Cortex
Renal Medula
Pyramids of the Medula
Calyx
Renal Pelvis
Ureter, transporter

Front 3

What are 3 important taskes of the Kidney?

Back 3

 Balances solutes and water
 Excretes wastes and conserves nutrients
 Regulates acid-base balance
 ALSO: endocrine functions
 Regulating BP
 RBC production
 CA metabolism

Front 4

Urinary tract obstructions, what is it...dummy?

Back 4

 A urinary tract obstruction: a blockage of urine flow within the urinary tract
 Anatomic
 Functional
 Severity based on:
 Location
 Completeness
 Involvement of one or both upper urinary tracts
 Duration
 Cause

Front 5

Types of Urinary Tract Obstructions?

Back 5

Hydroureter-dilation of the ureter
Hydronephrosis-dilation of the renal pelvis and calyces
Tubulointerstitial fibrosis-deposition of excessive collagen and proteins
Apoptosis-excess cellular destruction of the nephrons. away from nepherone

Front 6

Post obstructive Diuresis (U.T.O)

Back 6

Transient period of brisk UO
Usually mild with little or no consequenses.
Rapid diuresis:
Dehydration
Dangerous electrolyte imbalance

Front 7

Upper Urinary tract Obstruction (UTO)Know this!!!!!

Back 7

Kidney stones
Calculi or urinary stones (Pain!!!)
Masses of crystals, protein, or other substances that form within and may obstruct the urinary tract
Risk factors---Gender, race, geographic location (south), seasonal factors (Hot), fluid intake, diet(green leafy vegetables, soda, milk), and occupation(toxic chemicals)
Kidney stones are classified according to the minerals comprising the stones

Front 8

How is a kidney stone formed?

Back 8

Supersaturation of one or more salts
Presence of a salt in a higher concentration than the volume able to dissolve the salt
Precipitation of a salt from liquid to solid state
Temperature and pH
Growth into a stone via crystallization or aggregation

Front 9

Endogenous factors affecting stone formation

Back 9

Crystal growth-inhibiting substances
Particle retention
Matrix

Front 10

-common minerals in renal stones, name them fool!

Back 10

Calcium oxalate or calcium phosphate-most common
Struvite stones-more common in women
Cystinuric stones
Uric acid stones
Indinavir

Front 11

Kidney stones, Manifestation?

Back 11

Renal colic-rhythmic contractions of ureter attempting to remove the stone, this causes the pain. Stones can be as large as an inch

Front 12

What is the evaluation for Kidney stones?

Back 12

Stone analysis
Intravenous pyelogram
Spiral abdominal CT

Front 13

You gotta stone, how do you fix it?

Back 13

-Stone Removal, on their own (small),
-Lithotropy
-fish them out
-surgery

Front 14

Lower Urinary Tract obstruction(LUTO)

Back 14

Bladder neck dyssynergia
Prostate enlargement
Urethral stricture
Severe pelvic organ prolapse

Front 15

Neurogenic bladder Tumors (renal)

Back 15

Renal adenomas-uncommon
Renal cell carcinoma-most common, usually men

Front 16

Neurogenic bladder tumors

Back 16

Metastasis to the lymph nodes, liver, bone, and lung
-Flank pain
-blood in urine
-palpable mass
-rubber tire plants increase the risk.

Front 17

KUB x-ray

Back 17

Kidney, ureters, bladder

Front 18

UTI (cystitis)

Back 18

 UTI is inflammation of the urinary epithelium following invasion and colonization by some pathogen within the urinary tract

Front 19

Cystitis

Back 19

Frq, urgent urination
-suprapubic pain
-dysuria
-hematuria
-fever
-confusion, in older adults

Front 20

Dx of UTI

Back 20

Dip stick
-leukocyte esteraseand nitrates
-UA/C&S

Front 21

Tx of UTI

Back 21

-Anti mocrobials
-increase fluid intake
PREVENTION

Front 22

S/S of Pyeloneephritis

Back 22

Flank pain
-dysuria
-pain at costovertebral angle
-same S/s as cystitis

Front 23

Nursing goals of Cystitis?

Back 23

-Symptom relief
-teaching and prevention
--Showers prefered
--perineal cleaning, front to back
--void after intercourse
--antimicroe therapy
--no scented toi;et paper
--pee regularly
--no perfumes in peraneal area

Front 24

UTI's come from?

Back 24

S#%t
Most common pathogens
Escherichia coli
Staphylococcus saprophyticus
Enterobacter spp
Virulence of uropathogens
Host defense mechanisms

Front 25

Pyelonephritis

Back 25

 Acute pyelonephritis
 Acute infection of the ureter, renal pelvis, and/or renal parenchyma
 Chronic pyelonephritis
Persistent or recurring episodes of acute pyelonephritis, intense flank pain.
 Risk of chronic pyelonephritis increases in individuals with renal infections and some type of obstructive pathologic condition

Front 26

Cystitis

Back 26

 Cystitis is an inflammation of the bladder
 Manifestations
 Frequency, dysuria, urgency, and lower abdominal and/or suprapubic pain
 Treatment
 Antimicrobial therapy, increased fluid intake, avoidance of bladder irritants, and urinary analgesics

Front 27

Glomerular disorders

Back 27

The glomerulopathies are disorders that directly affect the glomerulus
Urinary sediment changes
Nephrotic sediment
Nephritic sediment
Sediment of chronic glomerular disease

Front 28

Glomerular disorders

Back 28

Glomerular disease demonstrates a sudden or insidious onset of hypertension, edema, and an elevated blood urea nitrogen (BUN)
 Decreased glomerular filtration rate
 Elevated plasma creatinine, urea, and reduced creatinine clearance
 Glomerular damage causes a decreased glomerular membrane surface area, glomerular capillary blood flow, and blood hydrostatic pressure

Front 29

Glomerular disorders

Back 29

Increased glomerular capillary permeability and loss of negative ionic charge barrier result in passage of plasma proteins into the urine
Resulting hypoalbuminemia encourages plasma fluid to move into the interstitial spaces
Edema

Front 30

Normal urine output

Back 30

>30ml/hr
>400 ml 24hr

Front 31

Glomerulonephritis

Back 31

Inflammation of the glomerulus
Immunologic abnormalities (most common)
Drugs or toxins
Vascular disorders
Systemic diseases
Viral causes

Front 32

BUN, urea

Back 32

10-20mg/dl in an adult
-increases with age

Front 33

End product urea

Back 33

-digestion affects BUN

Front 34

BUN up by 75%

Back 34

ready for dialysis
-50%

Front 35

Creatinin #'s

Back 35

Female 0.6-1.2
Male=0.5-1.1
-indicitive of muscle catabolism

Front 36

Glomerulonephritis

Back 36

 Mechanisms of injury
 Deposition of circulating soluble antigen-antibody complexes, often with complement fragments
 Formation of antibodies against the glomerular basement membrane
 Streptococcal release of neuramidase

Front 37

Classification of Renal Dysfunction

Back 37

Renal insufficiency-decline in renal function to about 25% of normal
Renal failure-significant loss of renal function
End-stage real failure-less than 10% of renal function remains, dialysis, replacements
Uremia-is the name for the syndrome of RF
Azotemia-inc. urea and freq. incr. creatinine

Front 38

Prerenal ARF

Back 38

Most common cause of ARF
Caused by impaired renal blood flow
GFR declines due to the decrease in filtration pressure

Front 39

Intrarenal ARF

Back 39

Acute tubular necrosis (ATN) is the most common cause of intrarenal renal failure
 Postischemic
 Nephrotoxic
In the kidney itself

Front 40

Postrenal ARF

Back 40

Occurs with urinary tract obstructions that affect the kidneys bilaterally

Front 41

Phases of acute renal failure

Back 41

Initiation phase
 Lasts hours or days
Maintenance phase
 Inability to excrete waste, need to understand, food and inake is important, need to maintain balance, immunosupressed
 Urine output is at its lowest
Recovery phase
 Process of renal repair begins

Front 42

How much Kidney do we need to survive?

Back 42

50% 0f one.

Front 43

Anuria

Back 43

No urine

Front 44

Management of AFR

Back 44

Correcting fluid & elctrolyte imbalances.
Managing BP.
Treating infections.
Maintaining nutrition.
Remembering that drugs or their metabolites are not excreted

Front 45

Treatment options for AFR

Back 45

-Restricting dietary K+
Nonpotassium sparing diuretics, lasix spares K+
Kay-excelate
Hemodialysis-severe hyper K->6.5mEq/L
K+driven back temporarily by:
Glucose & insulin

Front 46

Diastolic BP has more effect on renal?

Back 46

True, according to Edie

Front 47

Chronic Renal Failure

Back 47

Irreversible loss of renal function that affects nearly all organ systems

Front 48

Stages of chronic renal failure..

Back 48

Reduced renal reserve-GFR decrease to about 50%
Renal insufficiency-GFR severely reduced
Renal failure-GFR reduced below 20%
End-stage renal disease-near complete absence of GFR

Front 49

normal K+ level

Back 49

3.5-4.5
-Renal problems increase this level, dialysis removes this and fluid

Front 50

Lasix loop diarretic

Back 50

Removes NaCl? at the loop of henley, K+ sparring diaretic

Front 51

Chronic Renal failure will effect many systems

Back 51

Skeletal and bone alterations
Cardiopulmonary system
Neural function
Endocrine and reproduction
Hematologic alterations
Immunologic
Gastrointestinal
Integument
Alterations in proteins, carbohydrates, and lipids

Front 52

HypoK+

Back 52

Muscle twitches->cramps->parasthesia
-irr, anx
-EKG changes, flat P, PR long, st depression, peaked T
-dysrhthmias
-

Front 53

Deminished renal reserve slide

Back 53

---

Front 54

renal insufficiancy slide

Back 54

-Headaches
-can't concentrate urine
-polyuria->oliguria
-inc. BUN
-edema
-GFR decrease 90->30 ml/min\\
-mild anemia
-inc. ser. K+
-inc. BP
-weakness and fatigue

Front 55

Exam prep

Back 55

 See posted Chapter 36 Learning Objectives
 Review McCance Study Guide and Workbook-Chapter 36
 I used from the posted articles:
 The Formation of Urine
 Lecture 12-Renal Pathophysiology
 Stones in the Urinary Tract
 Kidney


 Class Handouts:
 Chronic Kidney Disease
 Help for Acute Renal Failure

Front 56

Chronic renal failure S/S

Back 56

-fatigue, confusion, weakness
-incr. BP
-periobital edma
-pericaritis
-thick sputum, depressed cough
-GI, breath

Front 57

What does Bumex (Bumetanide) Do?

Back 57

Tx for L sided HF
-Get the the Water off
-Increases NaCl and K excretion at the Loop of H. and PCT
-Can cause HypoTN
-Urine Fx and Vol.

Front 58

Relationship between Ca and Phos...

Back 58

Inverse
-Normal Values
--Ca 9-11mg/dl
--Phos 3-4.5 mg/dl

Front 59

CRF, Deminished Renal reserve Characteristics..

Back 59

-GFR >/= 90 ml/min
-Kidney damage w/normal or inc. GFR
-Decreased Urinary concentration, nocturia

Front 60

CRF Deminished renal reserve assessment and Tx..

Back 60

-Observe and control BP
-24 hr urine, creatinine clearance to detect ranal reserve loss
-tx other conditions, DM, HTN, Renal artery stenosis

Front 61

CRF, ESRD (End Stage) Neuro effects

Back 61

-Weakness, fatigue, confusion

Front 62

CRF, ESRD (End Stage) CV effects

Back 62

inc. BP, Edema (pitting, periorbital, Inc. CVP, Paricarditis

Front 63

CRF, ESRD (End Stage) Pulmonary effects

Back 63

SOB, Depressed Cough
Thick sputum

Front 64

CRF, ESRD (End Stage) GI effects

Back 64

Ammonoa odor breath, Metalic taste, Oral sores, anorexia, nausea/vomit

Front 65

CRF, ESRD (End Stage) Psychological effects

Back 65

Withdrawn, depressed, changes in Behavior

Front 66

CRF, ESRD (End Stage) Hematological effects

Back 66

-Anemia, bleeding tendancies, inc. K+

Front 67

CRF, ESRD (End Stage)Skin effects

Back 67

Dry Flacky Skin,Pruirus, Eccymosis, purpura, Yellow-gray skin

Front 68

CRF, ESRD (End Stage)Musculoskeletal effects

Back 68

Cramps, renal Osteodystrophy
,bone pain

Front 69

Hymodialysis assessment and precautions

Back 69

-No BP or Lb draws on access side
-assess for patency and infection

Front 70

CRF, Renal insufficiency S/S

Back 70

-Headache, edema, can't concentrate urine, poly to oliguria, inc. BUN and Creatinine, GFR decreases from (90-30ml/min), mild anemia, inc. K+, inc. Bp, weakness and fatigue

Front 71

Glomerulonephritis causes...

Back 71

-Antigen-antibody complex(From recent strep infection) in Glomeruli Causing: Inflammation, Decreased, GFR

Front 72

Glomerulonephritis S/S

Back 72

Headache
-^BP
-Facial and pariorbital edema
-lethergy
-low grade fever
-Wt gain (edema)
-Proteinuria
-hematuria
-oligruia
-dysuria

Front 73

HyperKalemia S/S

Back 73

Muscle twitch-cramps-parasthesia
-Irritability and anxiaty
-decreased BP
-EKG, peaked T-waves, flat p wave, wide QRS
-dysrhythmias
-ABD Cramp
-Diarrhea

Front 74

Mannitol (Osmitrol)

Back 74

-Gets rid of Na, Cl, K, H2O
-Contraindicated for Pulm. edema
-Used for Inc. ICP, intraoccular pressure, Renal disease,(Oliguric )

Front 75

Hypokalemia S/S

Back 75

Alkalosis
Shallow resp.
Irritability
-weakness, fatigue
-arrhythmias, irr/tachy
-lethergy
-thready pulse
-decreased GI motility
-N/v/paralytic illeus

Front 76

Preventing cystitis

Back 76

-Drink 8-10 glasses of H2O/day
-Ladies wipe front to back
-avoid vag deodorants, bubble baths
-pee after sex

Front 77

Renal Calculi incidence

Back 77

Increased in Males

Front 78

Renal Calculi S/S

Back 78

-N/V
-Flank pain, radiate to groin, testies,abd area
-sudden sharp pain, intermittent poss. due to stone movement
-hematuria
-dysuria
-pee Fq

Front 79

Dx of Renal Calculi

Back 79

U/S
IVP
Renal stone analysis
retrograde pylogram
-Cystoscopy
-Urine pH

Front 80

Risk factors for Renal Calculi

Back 80

-infection
urinary stasis, retention
immobility
dehydration
inc. uric acid (gout)
inc. urinary oxalate

Front 81

What is Spironolactone (Aldactone)

Back 81

-Saves K, gets rid of water, blocks aldosterone at kidney, excreate NA and water.
--Watch for...Headache, diarrhea, hyperK, electro imbalance, fatigue, GI disturbance

Front 82

UTI Cystitis S/S

Back 82

Fq, Urge, Suprapubic pn., dysuria, hematuria, fever, confusion(geriatric)

Front 83

UTI (Pyelonephritis) S/S

Back 83

Flank pain, dysuria, pain at Costovertebral angle, inaddition to S/S of Cystitis

Front 84

Dx Of UTI

Back 84

Dip stick, Leulocyte esterase and nitrates, UA/C&S, older adults at more risk

Front 85

Tx of UTI

Back 85

Antimicrobals, inc. fluid in, prevention

Front 86

Nursing goals for UTI

Back 86

-Relieve S/S
-Teach and prevent

Front 87

Who needs Dialysis?

Back 87

-Acid base problems
-electrolyte problems
-Intoxications
-fluid overload
-Uremic Symptoms