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98 Cards in this Set

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  • Back
The area of the kidneys that contains the glomeruli of the nephrons is the:
a. medulla
b. cortex
c. pyramids
d. columns
b. cortex
The ____ is the functinoal unit of the kidney.

a. glomerulus
b. nephron
c. collecting duct
d. pyramid
b. nephron
All of the following are part of the nephron except the:

a. loop of Henle
b. renal corpuscle
c. proximal convoluted tuble
d. calyx
d. calyx
Together, the glomerulus and Bowman's capsule are referred to as:

a. the renal corpuscle
b. the renal capsule
c. the renal medulla
d. the renal pyramid
e. the renal functional unit
a. the renal corpuscle
Renin, an enzyme secreted from the juxtaglomerular apparatus, causes:

a. the inactivation of autoregulation
b. the direct activation of angiotensin II
c. the direct release of ADH
d. the activation of angiotensin I
d. the activation of angiotensin I
The blood vessels of the kidneys are innervated by the:

a. vagus nerve
b. sympathetic nervous system
c. somatic nervous system
d. parasympathetic nervous system
b. sympathetic nervous system
The end product of protein metabolism exreted in urine is:

a. glucose
b. ketones
c. bile
d. urea
d. urea
The concentration of the final urine is determined by antidiuretic hormone (ADH), which is secreted by the:

a. posterior pituitary
b. right atrium
c. left atrium
d. thalamus
a. posterior pituitary
____ is a hormone synthesized and secreted by the kidneys.

a. antidiuretic hormone
b. aldosterone
c. erythropoietin
d. estrogen
c. erythropoietin
The most common type of renal stone is:

a. magnesium
b. struvite
c. calcium
d. phosphate
c. calcium
Percentage wise, how much of cardiac output goes to kidneys?
20-25% cardiac output
Things that can lead to O2 deprivation? why is this bad for the kidney?
examples of O2 deprivation are anaphylactic shock, hypertension, hypovelmic shock, burns, hemorrhage. This is bad because the kidneys need a lot of oxygen to work, and if they are deprived, then they go into shock.
How many kidneys do you have? How many ureters? What are ureters? How many bladders?
You have 2 kidneys
2 ureters
Ureters are tubes that carry urine away from nephron in kidney to the bladder
1 bladder
How much does the bladder normally hold in cc's?
it holds about 250-300cc of urine without feeling the urge to urinate
What is a Micturition reflex?
it is the urge to urinate, which is around 400cc
What happens when you get to holding 500cc in your bladder?
this is where you begin to hurt, significantly expanded bladder; can plapate the bladder and tell it's full; "you've got to go or you're gonna have an accident"
What is the urethra?
Which is longer, the male urethra, or the female urethra?
it connects the outside of the body to the bladder
the male is longer (18-20cm)
the female is shorter (3-4cm)
Since the female urethra is shorter, what does that put them at higher risk for?
What should you teach for prevenetion of this?
Urinary Tract Infections (UTI)

Teaching about UTI prevention is wiping front to back.
What is the kidney surrounded by? What is its purpose?
fibrous capsule

protects the kidney
Where do the Kidneys sit?
they sit in retroperitineal space; you shouldn't be able to palpate them
What sits on top of the kidney?
the adrenal glands
Name 7 things the kidney does.
1. balances water and solute concentration
2. gets rid of wastes
3. conserves nutrients
4. regulates acids and bases
5. secretes renin for b/p regulation
6. secretes erythropoietin
7. activates Vit D for absorption of calcium
Which is the kidney responsible for, acid or base?
think "bicarb/base regulation"
What does the nephron regulate?
it regulates filtrate to maintain the body fluid volume, electrolytes, and pH within normal
What is the functinoal unit of the kidney?
the nephron
Because the nephron works very hard, and filters a lot, what does it require a lot of?
it requires a lot of O2 to work that hard
What will happen if the fibrous capsule is damaged?
if this is damaged it will bleed and bleed and bleed profusely
What will happen to the kidneys when there is a small deficit in blood pressure, blood supply and O2 (even the slightest deficit)?
the nephron is primary thing that is damaged, because the blood gets shunted away from the kidneys, so the nephrons require a lot of cardiac output
True/False.
The Kidney can regulate its own blood pressure, however, if the systemic BP drops to less than 70 systolic (on top), it loses its ability to regulate its own BP
True
True/False.
the nephron cannot regenerate
False.
the nephron has the ability to regenerate. (takes a while)
What is secretion?
it is the movement of substances from the plasma to the lumen for getting rid of as a waste product
What is reabsorption?
it is the movement of fluids and solutes from the lumen to the plasma (need to hold on to; going to reabsorb it)
What segements of the nephron are where water is reabsorbed?
the proximal tubule, distal tubule, loop of Henle
When water is reabsorbed in the proximal tubule, what is not needed?
ADH is not required for H20 reabsorption
What is required for water reabsorption in the Distal tubule?
ADH is required for H20 reabsorption
What happens in the Loop of Henle?
this is where primary concentration of urine takes place
When you begin to sweat, what happens to your plasma volume, and BP? What is released because of this?
plasma volume is decreased

BP is decreased

this causes renin to be released
What happens after Renin is released by the JGA?
detected by JGA, renin is released into blood strean causes conversion of antiotenin I to angiontensinon II (caused by converting enzyme in lungs). this causes the release of aldosterone. water is reabsorbed because of aldosterone. BP, BV goes up because we are retaining water.
7% water loss
minimal
Flow of Urine from nephron to the urethra?

What is urine flow controlled by?
urine is formed by the nephrons, it flows from the distale tubules and collecting ducts to the renal pelvis and then to the ureters, then to the bladder, then out the urethra

urine flow is controlled by peristalsis
True/False.

The bladder has a profuse blood supply and will readily bleed with trauma, surgery, or inflammation.
True
What are the two muscles called that control excretion of urine thru the urethra?
the two muscles are called sphincters
How much blood do the kidneys receive in ml of blood per minute?
about 1000 to 1200 ml of blood per minute, or about 20-25% of cardiac output
What is glomerular filtration rate?
the filtration of the plasma per unit of time. it is directly related to the perfusion pressure of the glomerular capillaries
What is filtration fraction?
the ratio of glomerular filtrate to renal plasma flow per minute 9125/600=0.20)
What is RBF?
renal blood flow, it is regulated by intrinsic autoregulatory mechanisms by neural regulation and by hormonal regulation.
Autoregulation, what are RBF and GFR kept constant by?
kept constant by a myogenic mechanism and tubuloglomerular feedback
What happens when systemic arterial pressure decreases?
this stimulates renal arteriolar vasoconstriction and decreaes both RBF and GFR. the decreaed RBF decreases the GFR and diminishes excretion of sodium and water, promoting an increase in blood volume and thus an increase in systemic pressure
During a hemmorrhage of some sort, what happens to RBF and GFR?
hemorrhage causes vasoconstriction and both RBF and GFR are reduced
What are some things that can influence RBF?
Exercise, body position, and hypoxia can also influence RBF.
What are the two renal hormones?
Vitamin D: obtained by diet or sunlight, converted to active form in the kidney
Erythropoeitin: stimulates the bone marrow to produce RBC's
What is the best indicator for looking at renal function? how your kidneys are filtering the blood?

a. Creatinine
b. BUN
c. GFR
c. GFR
What is your target GFR?
target is around 125
How is the GFR determined?
it is determined by a formula
How are GFR and Creatinine related?
they are inversely reltated, as one goes up, the other goes down
What is the best blood test for renal function?
Why is it the best?
What is the normal?
Creatinine

it is the best because it is not affected by fluid volume status (very consistent)

normal: 0.7-1.2
What does BUN stand for?

What does it look at?

What is the normal?

Will it be increased or decreased if someone is dehydrated?
Blood Urea Nitrogen

tests the concentration of urea in the blood

normal is 10-20

it will be increased if someone is dehyrated; once fluid is given back, BUN will come back down
What is a creatinine clearance test (24hr urine)?

What is the normal?

What do you do for this test?
it is a test done to see the amount of creatinine cleared from the blood in 1 minute

the normal is 90-130

you save the urine in a canister for 24 hrs; set it on ice; also get blood test
What is the cheapest lab you can run on a patient to see how their kidneys are doing?
Urinalysis (UA)
What are some things you can look at in a Urinalysis?
look at color (bright orange: more concentrated; some drugs cause urine to change color)
clarity
see if glucose is in urine (abnormal; diabetes)
blood?
see if protein is in urine (abnormal)
check specific gravity (dilute/concentrated)
What is the normal pH of urine?
5-6.5, normally acidic
What could you see in a urine sediment?
RBC, WBC, Bacteria, pus (pyuria), etc.
What kind of risk could you have when there is a catheter?
huge risk for infection
What are some age related changes in the Renal System?
decreased RBF and GFR
the amount of nephrons decrease (nephrons that are still there, hypertrophy to compensate for loss of others)
Tubular Transport is affected (electrolytes very sensitive in elderly)
Drug elimination is delayed
As we age, the amount of nephrons decrease (which is normal and natural), so what will happen to our mental status? and why?
the mental status would probably change due to increased toxins b/c of decreased filtration; older adults are on more meds, and these drugs won't be filtered as well (esp. narcotics)
What happens in a Urinary Tract Obstruction?

What could it cause?

What causes UTO?
there is an interference/decrease of urine flow at any site along the urinary tract

it could cause infection, pain, renal failure

can be caused by tumor(renal carcinoma/adenoma0, trauma, kidney stone, outflow problem w/ catheter, pregnancy, prostate enlargement
What is a kidney stone?
masses of crystals and protein that are a common cause of UTO in adults
What are the 3 types of kidney stones?

Which one is the most common?
calcium, uric acid, and struvite crystal

calcium stones are the most common (they have jagged edges that cause pain!)
Kidney Stones

Pathophysiology?
Clinical Manifestations?
Evaluation?
Treatment?
P: more predisposed of these w/ familial tendency; dehydration puts you at risk for these

CM: pain lower back and radiates to the groin; N/V; hematuria; decrease in urine output

Eval: look at urine pH (more basic than normal), may see WBC, obtain urinalysis, BUN (inc.), Creatinine (inc.); abdominal films: x-ray, CT; IVP

Tx: biggest nursing role: pain management, bump up fluid intake (IV fluids and drinking lots of water to flush kidneys); laser lithotripsy (high pitched sound waves to bust the stone up; stones are smaller, but there are more in number); teach hydration and strain urine to see when they pass the stone; can go in and surgically remove them
What happens in an IVP (Intravenous Pyelogram)?
inject dye into patients arm; once in kidneys do x-ray and where the dye stops there is an obstruction, ask if they have any allergies to see if allergic to dye first!
What is a Neurogenic Bladder?
it is a functional urinary tract obstruction, that is caused by an interruption of the nerve supply to the bladder. it is a bladder dysfunction secondary to some nerve disorder, can be seen in spinal cord injury depending on area of injury; somtimes in stroke patients, but mostly spinal cord injury
Neurogenic Bladder

Pathophysiology?
Clinical Manifestations?
Evaluation?
Treatment?
P: can't tell when bladder is full, and sometimes can't empty bladder themselves

CM: catherization; infection (biggest prob. b/c urine is sitting there and have to straight cath (taught to do it) themselves every 4 hrs. if spinal cord injury, they know they have infection b/c of systemic fever or high WBC. Have lots of UTIs

E: evaluate the UTI; sterile urine culture (see what grows), based on what grows determines what antibiotics to use
Tx: antibiotics
What are renal adenomas?
they are benign tumors that are solid and small tumors. they are usually surgically removed if found, b/c they have the ability to become metastatic
What is the most common type of renal tumor?
renal cell carcinoma is the most common and has a five year survival rate of 60%
Renal Cell Carcinoma

Pathophysiology?
Clinical Manefestations?
Evaluation?
Treatment?
P: generally metastasizes to other organs, survival rate decreases. higher risk w/ tobacco use (cigarettes), obesity, overuse of pain meds (analgesics even advil etc.), if confine to renal system, then high cure rate; if it spreads then less of a cure rate
CM: hematuria, flank (lower back pain), anemia, fatigue, wt. loss, malaise
Eval: x-ray, IVP
Tx: surgical removal of kidney (radical nephrectomy; can live w/ 1 kidney); Undergo chemo and radiation
Bladder Tumors

Pathophysiology?
Clinical Manifestations?
Evaluation?
Treatment?
P: highly linked to cigarette smoking; more common in younger men (20-40 yrs) than women; alteration in p53 gene; can remove but very often comes back
CM: pelvic pain; hematuria; frequent urination (silent disease), no symptoms until it has progressed
Eval: cystoscopy-insert lighted scope into bladder and visualize where tumor is
Tx: surgery to remove tumor, radiation, chemo, screen every 3-5 years
What are the four differnt types of Urinary Tract Infections?
Cystitis
Nonbacterial Cystitis
Acute Pyelonephritis
Chronic Pyelonephritis
What is Cystitis?

Pathophysiology?
Clinical Manifestations?
Evaluation?
Treatment?
it is the inflammation of the bladder, the most common site of UTI

P: most common cause is e. coli. often caused by bacteria (e coli, staph, pseudomonas) enters urinary tract and causes infection
CM: frequency, urgency, and dysuria (painful urination). Inflammation in bladder wall, reason is b/c infection has set up in lining of the bladder which causes swelling and feels like it is full of urine but it's not, it's the edema. Low back pain and superpubic pain
Eval: urinalysis, urine culture (if greater than 10,000 bacteria/ml then you get the diagnosis)
Tx: antibiotics usually clears it up; supposed to get repeat urinalysis after antibiotics are finished (often times all bacteria will not be killed)
What symptoms will you see with Nonbacterial Cystitis?
How will it be treated
the symptoms of cystitis are present, but the urine cultures are negative
It will be treated with antibiotics
What are two rare forms of Nonbacterial cystitis?
Urethral Syndrome: glands of urethra are inflammed, not the bladder, Found primarily in women 20-30 years of age
Interstitial cystitis: chronic inflammation of bladder wall causing s/s of UTI very often
When looking at an urine culture, you see WBC, will this be pyelonephritis or cystitis?
Pyelonephritis- you will see WBC's and white blood cell cast (particles of WBC)
Acute Pyelonephritis

What it is?
Pathophysiology?
Clinical Manifestations?
Evaluation?
Treatment?
It is an infection of the renal pelvis and interstitium.

P: usually caused by e. coli and reflux of urine from bladder (travels up and sits in kidneys)
CM: s/s more systemic than cystitis, fever, increased WBC, system wide, N/V, extreme pain in flank, lower back, still have the s/s such as frequency, urgency, dysuria, pus in urine. Starts as a bladder infection then travels to kidneys. Elderly may not have usual s/s, their mental status not same as usual, not cheery
Eval: look at urine culture and see WBC's and white blood cell cast
Tx: antibiotics; follow up urine culture
Chronic Pyelonephritis

What it is?
Pathophysiology?
Clinical Manifestations?
Evaluation?
Treatment?
Persistant or recurring infection of the kidney with inflammation and scaring of the kidney.

P: occurs w/ obstructive problems and acute pyelo often causing fibrosis and scarring which will lead to end stage renal disease. Acute pyelonephritis that was not treated properly and is starting to be chronic, causing scarring
CM: s/s like acute pyelo, but may see htn b/c of scarring
Eval: on x-ray, the kidneys seem smaller than normal, scarring has caused obstruction in kidney
Tx: remove obstruction and s/s will diminish
What will you see in glomerular disorders?
How is it diagnosed?
You will see hypertension, edema, and elevated BUN
It is diagnosed by renal tissue biopsy
There is reduced GFR as evidenced by increased creatinine levels.
autoimmune disorder: immune response starts all of this.
What is glomerulonephritis?
it is an inflammation of the glomerulus
What are the 4 different types of glomerulonephritis?
Acute Glomerulonephritis
IgA Nephropathy
Rapidly Progressive Glomerulonephritis
Chronic Glomerulonephritis
Acute Glomerulonephritis

Common age?
When does it occur?
Signs and Symptoms?
Evaluation?
Treatment?
postsstreptococcal

most common in school aged children, but can happen in adults

occurs about 7-10 days after strep infection

s/s: hematuria, proteinuria, dec. GFR, edema (especially around eyes (periorbital))

eval: do ASO titer to see if there is any strep in the blood

Tx: antibiotics
Rapidly Progressive Glomerulonephritis
(Good Pasteur's syndrome)

what it affects?
ages?
rapidly progressive

generally seen in early 20's-early 30's (mostly men)

higher risk w/ smokers; antibodies will form and damage kidney and lung membrane. resp failure and kidney failure, if caught then it can be treated but if not prognosis is dim. massive amounts of hematuria
What is Chronic Glomerulonephritis?
it is a progressive disease that leads to renal failure, more commonly than not results in End Stage Renal Disease; you will see massive proteinuria
What is Nepritic sediment?

What is Nephrotic sediment?
Nephritic: lot of hematuria; minimal proteinuria may not have any; reduced GFR, inc. creatinine

Nephrotic sediment: has tons of proteinura; also see lipiduria (fat in urine); minimal hematuria; red. GFR inc. creatinine
Glomerulonephritis

Evaluation?
Treatment?
4 differnt types

Eval: biopsy
Tx: manage s/s; dialysis may have to occur; may be on kidney transplant; reverse isolation (keep them from having an immune response)
Nephrotic Syndrome

What is it?
Pathophysiology?
Clinical Manifestations?
Evaluation?
Treatment?
Excretion of 3.5g or more of protein in the urine/day, usualy secondary to some other disease

P: membrane becomes permeable to protein and begins spilling out protein; associated w/ diabetes and lupus

CM: edema formation; low albumin (helps keep fluid in the vascular areas) levels; massive proteinuria; hyperlipidemia; lipiduria; see high lipid levels in blood
Tx: treat primary disese; low fat diet, normal protein diet; lower lipid levels; replace albumin; salt restriction to try and diurese them; steroids to decrease inflammation
Terms to know in Renal Failure:

1. Renal Insufficiency
2. Renal Failure
3. End Stage Renal Failure
4. Uremia
5. Azotemia
6. Nonoliguric Failure
1. it is the decline in renal funcion to about 25% of normal function. GFR 25-30cc/min
2. is is a significant loss of renal function
3. when less than 10% of normal renal function remains
4. are the s/s of renal failure; consequences of renal failure
5. is increased urea and creatinine levels
6. is failure of the kidneys but they will still be making urine; no change in urine output
Acute Renal Failure

What is it?
Pathophysiology?
Clinical Manifestations?
Evaluation?
Diagnostic/Lab Findings?
Treatment?
It is an abrupt reduction in renal function

P: generally caused by some sort of insult (hypovolemia, low BP) cause decrease cardiac output and goes into acute renal failure. Renal failure means they are not making at least 400 cc of urine/24hrs or 30cc/hr (anything less than this is acute renal failure). Usually reversible.
CM: insult will occur, (urine output decrease in about 24-48 hrs. oliguric stage: UOP diminish or stop altogether different time window) (BUN and creatinine does not respond fast, but starts going up); see hyperkalemia, high potassium level (hold on to extra potassium when you need to be getting rid of it); edema; maintain vitals, give drugs to inc. UOP in hopes to enter diuresis stage once kidneys wake back up UOP will start to increase, BUN and creatinine come down; recovery phase: BUN, creatinine, and UOP return back to normal (can take up to a year)
Eval: look at BUN, creatinine, UOP
D/Lab: UOP<400mL/24hr., Fluid retention, Metabolic acidosis: because kidneys lack the buffer, Sodium-normal or below normal, Hyperkalemia, Hyperphophatemia, Hypocalcemia, Azotemia, Elevated BUN/Cr, Proteinuria, urine--RBCs/WBCs, Neurologic s/s, muscle weakness, N/V, Anemia, Dialysis to get sodium to normal, these are s/s called uremia
Tx: fluid resuscitation: manage s/s overall goal: prevent dying from occuring until kidneys wake back up., start making urine after kidneys wake back up. Watch BUN and creatinine levels (make sure they're going down)
NI: limit fluid intake to Urine Output +300-500ml/day (such a small amount of urine that they're making, need to give them just a little more that UOP (restriction of 1200cc of fluid/day)), closely monitor intake and ouput, daily weights, medications (diuretics, monitor potassium (give or get rid of)), do the lab work (BUN, creatinine, and electrolytes), Low sodium, potassium, and protein diets
What is Pre-renal?

What is intra-renal?

What is post-renal?
1. problem w/ cardiac output/before blood is getting to kidney (cause: bp drop; anaphylaxis)

2. problem inside functional unit of kidney (different reasons)

3. problem after urine has left the kidney (some kind of obstruction such as enlarged prostate)
What are teh 3 stages of Acute Renal Failure?
Oliguria, diuresis, recovery (lasts up to 1-2 years; UOP, BUN, and Creatinine, electrolytes going back to normal0
Chronic Renal Failure

What is it?
Pathophysiology?
Clinical Manifestations?
Treatment?
it is progressive (know that people are losing control of kidneys), irreversible loss of renal function that affects all body systems. HTN and diabetes have direct correlation to chronic renal failure (major disease processes; one causes the other)
P: take years to develop; look at GFR
CM: uremic symptoms; see a lot of same s/s as acute: higher than normal creatinine; kidneys appear a great deal smaller; anemic b/c lack of erythropoietin
Tx: treat resulting s/s, strict dietary restrictions (sodium and potassium), monitor I&O; and once meet certain bench mark start dialysis (3-4 days/week) or may have kidney transplant; strict fluid restriction; have to significantly reduce K+; give erythropoeitin
Alterations of Renal and Urinary Tract Function in Children

1. What is Hypospadias?
2. Renal Aplasia?
3. Renal Agenesis?
4. Poststreptococcal Glomerulonephritis?
5. Wilms Tumor?
6. Enuresis?
1. urinary meatus of penis is on bottom side of penis. supposed to be on the end, usually has to be surgically repaired
2. kidneys do not grow in utero. Affect one or both sides but usually unilateral
3. born with no one kidney or no both kidneys
4. acute glomerulonephritis (common in children)
5. cancer, very rare tumor in urinary tract but does occiur; CM-lack iris of the eye; have horseshoe kidney; often will have hyospadias. 90% cure reate for localized cancer. Some type of genitourinary malformation
6. bed wetting. Primary: never develop ability to not urinate at night. Secondary: accomplished ability to not urinate at night, but start back.