Renal Overview + Disorders

Front 1

What are the functions of the kidneys

Back 1

1. regulate pH, 2. eliminate metabolic wastes, 3. regulate osmolality of ECF, 4. blood pressure regulation; 5. activates vit D & regulates Ca & P; 6. production of RBCs

Front 2

How do the kidneys regulate pH?

Back 2

through reabsorption & elimination or conservation of Na, K, Cl, H, & bicarb

Front 3

How do the kidneys regulate osmolality?

Back 3

through the action of antidiuretic hormone (ADH) ... limit amount of H2O lost in urine/ increase qty of H2O absorbed

Front 4

How do the kidneys function to regulate BP?

Back 4

through the renin - antiotensin - aldosterone mechanism + regulation of salt & H2O elimination
BP drop = increase renin = increase angiotensin (vasoconstrictor) = increase aldosterone (increase Na & H2O = increase in volume = increase BP

Front 5

What is BUN?

Back 5

by product of protein metabolism in liver & eliminated entirely by kidneys .... related to GFR but also protein intake & hydration

Front 6

What is creatinine?

Back 6

product of creatine metabolism in muscles .... its formation & release are relatively constant & proportional to amount of muscle mass present .... serum levels depend closely on GFR

Front 7

What lab value is the best indicator of renal function?

Back 7

creatinine level & BUN: creatinine ratio

Front 8

What does a BUN: Creat ratio of 15:1 suggest?

Back 8

CHF or UGI bleed

Front 9

What could cause the BUN: Creat ratio to be out of balance?

Back 9

decrease blood flow to kidney m/b result of shock, severe dehydration, increase protein, sudden or acute kidney failure

Front 10

How do K+ levels change w/ renal function?

Back 10

will elevate in renal disease

Front 11

How do Ca levels change w/ renal function?

Back 11

will decrease in renal disease

Front 12

How do Phosphate levels change w/ renal function?

Back 12

will elevate in renal disease .... eliminated as part of buffer system in urine w/ H & HPO4

Front 13

How do CO2 levels change w/ renal function?

Back 13

reflects changes in bicarb

Front 14

What is the relationship btwn GFR & Creat?

Back 14

GFR drops by 75% = Creat value increases 3x

Front 15

What does a urinalysis assess?

Back 15

1. urea; 2. ammonia; 3. RBC & WBCs; 4. protein; 5. glucose; 6. specific gravity; 7. pH ... also looking at color & turbidity

Front 16

Presence of RBCs, WBCs & protein in urine is .....

Back 16

always abnormal ... presence indicates some disease process

Front 17

hematuria

Back 17

RBCs in urine

Front 18

Presence of glucose in urine is ....

Back 18

always abnormal

Front 19

What causes a drop in specific gravity?

Back 19

loss of concentrating ability or w/ dehydration

Front 20

How interpret pH values w/ regard to kidney function?

Back 20

increase acid puts at risk for kidney stones .... pH decreases w/ kidney failure .... pH increases w/ build up of ammonia

Front 21

Role of prostoglandin?

Back 21

in partnership w/ SNS regulate constriction & dilation of vasculature .... affect GFR

Front 22

How do Motrin, Advil & NSAIDS affect prostoglandin?

Back 22

Motrin & Advil are prostoglandin inhibitors ... NSAIDS dilate so alter vascular regulation

Front 23

What contributes to UTIs?

Back 23

1. bacteria - e-coli; 2. BR wiping habits; 3. sexual activity

Front 24

What are S&S of a UTI?

Back 24

burning when urinate, pass small & frequent; cloudy/ bright pink; strong smell; women - pelvic pain; men - rectal pain

Front 25

What contributes to UTIs in elderly?

Back 25

1. immobility; 2. bladder outflow obstruction; 3. bladder ischemia; 4. senile vaginitis; 5. constipation; 6. diminished bactericidal activity of urine & prostitic secretions; 7. decreased fluid intake

Front 26

What is cystitis?

Back 26

inflammation of bladder; q20min or more

Front 27

Dysuria

Back 27

painful urination

Front 28

S&S of cystitis

Back 28

dysuria, increase frequency & urgency of urination, purulent abnormal cells in urine; blood in urine

Front 29

What is pyelonephritis?

Back 29

infection of the kidney and the ureters, the ducts that carry urine away from the kidney ... often a UTI complication

Front 30

What is most common cause of pyelonephriitis?

Back 30

obstruction that causes backflow of urine into the ureters or kidney pelvis ...m/b kidney stone

Front 31

neurogenic bladder

Back 31

bladder is always full - not able to empty

Front 32

6 Urinary tract obstructions

Back 32

1. kidney stone; 2. scar tissue on ureter; 3. neurogenic bladder; 4. bladder outflow obstruction; 5. pregnancy or tumor; 6. uretero-vesicle junction stricture

Front 33

Assessing for a UT obstruction

Back 33

1. location ... 2. unilateral/ bilateral ... 3. partial or complete - H & P/ labs ... 4. acute or chronic

Front 34

S&S of kidney stones

Back 34

EXTREME pain .. 12/10; bleeding; pale; diaphoretic

Front 35

What is a kidney stone?

Back 35

crystalline structures that form from components of urine ....Ca+2 is most common; need environment that supports growth

Front 36

Hydonephrosis

Back 36

enlargement (distention) of the urine collecting structures and pelvis of kidney - can be unilateral or bilateral ... NOT a disease: a physical result of whatever disease is keeping urine from draining out of the kidneys, ureters, and bladder

Front 37

Clinical manifestations of Urinary Tract Stones

Back 37

#1!! PAIN: caused by intense smooth muscle constriction & peristalsis elicited in response to obstructing ureteral stone; #2 urine volume may decrease due to ureterorenal reflex (vasoconstriction of renal arterioles)

Front 38

Urinary tract pain is refered to ...

Back 38

dermatome of the nerves carrying the pain & skin sensory fibers

Front 39

What tests are used to diagnosis urinary tract stones?

Back 39

1. X-ray: only Ca stone are visible; 2. Scans like CT & MRI: see size of organs & internal fluid spaces; 3. Stone analysis: determine chem composition of expelled/ removed stone

Front 40

Preventing urinary tract stones ...

Back 40

1. avoid related pathophysiology - excess parathyroid hormone + acidosis + gout exacerbation; 2. avoid dehydration; 3. increase fluid intake

Front 41

How do excess parathyroid hormone & acidosis contribute to urinary tract stones?

Back 41

increase blood levels of calcium & phosphate

Front 42

How are urinary tract stones treated?

Back 42

1. pass if < 5mm; 2. narcotics for ureteral pain; 3. reduce size of stone so can pass; 4. surgical removal

Front 43

What is Altered Glomerular Dysfunction?

Back 43

glomerular capillary membrane becomes permeable to plasma proteins & blood cells

Front 44

Altered Glomerular Dysfunction leads to ....

Back 44

proteinuria - albuminuria = more important evidence of glomerular injury; hematuria, pyuria, oliguria, edema - by loss of albumin & retention of Na & H2O, HTN, azotemia

Front 45

Azotemia

Back 45

condition where the patient's blood contains uncommon levels of urea, creatinine, and other compounds rich in nitrogen

Front 46

pyuria

Back 46

pus in urine

Front 47

oliguria

Back 47

decreased amount of urine

Front 48

What are the S&S of Altered Glomerular Dysfunction?

Back 48

asymptomatic ... found w/ abnormal urinalysis proteinuria & an elevated BP

Front 49

Glomerular Disorder: Nephritic Syndrome A

Back 49

caused by diseases that produce proliferative inflammatory responses that DECREASE permeability of glomerular capillary membrane

Front 50

Glomerular Disorder: Nephritic Syndrome B

Back 50

caused by disorders that INCREASE permeability of glomerular capillary membrane, causing massive loss of protein in urine

Front 51

Glomerular Disorder: Nephritic Syndrome B ... manifestations

Back 51

Proteinuria + Hypoproteinemia + interstitial edema + hyperlipidemia

Front 52

4 reasons for Incontinence

Back 52

1. involuntary - no control; 2. stress - increased abdominal pressure (sneeze); 3. functional - unable to get to bathroom fast enough; 4. total - continuous & involuntary

Front 53

Risk Factors for Incontinence

Back 53

female - multiparity - white - age - menopause/ hypoestrogenism - obesity - neurological disease - smoking - chronic cough - diabetes - chronic constipation

Front 54

Causes of Incontinence

Back 54

1. increased bladder pressure: a. overactive bladder, b. overflow or overfilling bladder; 2. decreased ablity of vesicourethral sphincter to prevent escape of urine

Front 55

Transient causes of Incontinence

Back 55

D - delirium, depression, dementia, dehydration
R - restricted mobility, rectal impaction, retention
I - irritation, infection, inflammation
P - polyuria, pharmacotherapy

Front 56

Types of Urinary Incontinence

Back 56

1. Stress - involuntary loss of urine associated w/ activities that increase intra-abdominal pressure; 2. Overactive Bladder - urgency & frequency/ hyperactivity of detrusor muscle; 3. Overflow - loss of urine when vesicular pressure > urethral pressure