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47 Cards in this Set
- Front
- Back
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How much renal function does the body need for adequate filtration, how much of CO goes to the kidneys per minute, what is the size range of the kidney, variation between kidneys, and pH range of urine? |
function: 1/2 of one kidney CO: 20-25% size: 10-13 cm long variation: < 1.5 cm pH: 4.5-8 |
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what are the lower and upper borders of the kidneys located with respect to the vertebrae, and where are they located within the thoracic cavity? |
Upper border: T-11/12 lower border: L-3 thoracic cavity: outside abdominal cavity in the retroperitoneal space |
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pararenal fat, renal fascia, perirenal fat, and the renal capsule are all components of what? |
external anatomy = protective structures of the kidneys |
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the cortex, medulla, renal pelvis, and the hilum are all components of what part of the kidney? |
internal anatomy |
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renal arteries, renal veins, and the ureter are components of what internal anatomy structure? |
hilum = indentation on kidney where vessels & nerve fibers enter/leave |
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what is the functional unit of the kidney, how do they function with respect to one another, and how many are there in each kidney? |
unit: nephron function: independently of one another how many: 1-1.25 million |
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what are the two types of nephrons, where are each located, which is more prevalent, and how are their respective loops of henley structured? |
types: cortical & juxtamedullary location: cortical = outer cortex, juxtamedullary = still in cortex but near the medulla more prevalent: cortical loops: cortical = thin and short; juxtamedullary = thin and long *juxtamedullary = concentrate & dilute urine* |
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is the glomerulus high or low pressure, how many capillaries are in each, and what are their two types of arterioles? |
pressure: high capillaries: 24 arterioles: afferent & efferent |
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what is another name for bowman's capsule and hat is it the beginning of? |
name: renal corpuscle beginning of: tubular components |
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what is the function of the proximal tubule? |
receives filtrate from the glomerulus & reabsorbs sodium & other electrolytes |
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what are the two components of the loop of henle and what are their functions? |
descending limb: thin, concentration & reabsorption of H2O ascending limb: thin = passive concentration; thick = active concentration |
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what is the function of the distal tubule? |
water and electrolyte mgmt |
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where does the collecting duct terminate and what is the function? |
terminates: renal pelvis function: final area of reabsorption & secretion |
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what structure does the peritubular capillary network lie parallel to, and what is the function? |
parallel to: loop of henle function: dilute & concentration of urine; provides blood flow to tubular structures |
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what are the two types of renal failure and how often do they need dialysis? |
types: acute & chronic dialysis: acute = full recovery; chronic = often need dialysis |
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are prerenal failure, intrarenal failure, and postrenal failure acute or chronic? |
acute |
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what causes prerenal failure and what is happening in the afferent and efferent arterioles? |
cause: decreased blood flow to kidneys afferent effect: dilation efferent effect: constriction |
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what is intrarenal failure and what can cause it? |
what it is: damage to renal structures cause: ischemia, nephrotoxic agents, infection, inflammation |
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what causes postrenal failure and how does it affect intraluminal pressure & GFR? |
cause: obstructed urine flow intraluminal pressure: increased pressure GFR: decreased |
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what are compensatory effects on renin, ADH, and the renal vasculature during acute renal failure? |
renin: increased production of renin = increased BP = goal of increased renal perfusion ADH: increased ADH production = increased BP = goal of increased renal perfusion Renal vasculature: constricted |
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What is BUN and how does it relate to kidney function? |
what it is: product of protein metabolism kidney function: filtered by the kidneys |
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what is creatinine and how is it an indicator of kidney function? |
what it is: waste product of muscle metabolism kidney function: indicator for GFR, but is neither reabsorbed nor secreted by the kidney |
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what is considered a normal BUN:creatinine ratio, but which type of renal failure can have this ratio? |
ratio: 10:1 failure: may occur in postrenal failure |
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BUN:creatinine ratios of > 20:1 and < 10:1 are indicative of what types of renal failure and why? |
> 20:1 = prerenal failure WHY: decreased perfusion to the kidneys results in less BUN being cleared from the blood < 10:1 = intrarenal failure WHY: reduced BUN reabsorption into blood stream bc damage to actual kidney structures |
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what is the time span for the occurrence of chronic renal failure, what are diseases that can cause it, what percent of kidney function constitutes end-stage renal disease, and what is acute-on-chronic? |
time: years diseases: DM, HTN, hyperlipidemia end-stage: < 10% functional nephrons (not < 10% GFR) actute-on-chronic: acute complication of long-term disease |
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what are the characteristic traits of stages 1-5 of renal failure? |
stage one: not much physiologic alterations, but might have a higher UOP w/o waste products stage two-four: UOP decrease & concentration increases stage five: end stage; need to discuss dialysis, transplant, palliative care |
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what is uremic frost and what type of renal failure is it seen in? |
what it is: body excreting urea through the skin type of failure: chronic only |
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what are diagnostic tests for renal failure? |
serum lab values urinalysis/24 hour UOP renal ultrasound renal biopsy CT/MRI WITHOUT contrast |
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what are broad techniques for management of end stage renal disease? |
dietary alteration pharm management dialysis transplant |
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what is the reasoning behind decreased sodium, decreasing phosphorus, varying protein intake, and fluid restriction? |
sodium = reduced ability to clear (2 g Na/day) phosphorus = hypocalcemic & bone degradation potassium "aware" = cardiotoxicity protein variation = protein is hard on the kidneys; may need more if on dialysis fluid = risk of fluid overload fluid restriction |
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what is dialysis? |
clinical purification of the blood as substitute for normal kidney function |
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what are osmosis and diffusion with respect to particles and fluid? |
osmosis: movement of fluid from high to low concentration diffusion: movement of particles from high to low concentration |
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what sort of catheter is used in peritoneal dialysis, where is it performed, what are the benefits, what are the 4 risks, who is a good candidate, and who cares for the port? |
catheter: Tenckhoff catheter = indwelling catheter in the peritoneal cavity where: at home benefits: less expensive and restrictive care: PT, most PTs hypervigilant about their ports bc infection means stopping PD risk: peritonitis = infection, adhesions, fibrin production, catheter failure good candidate: someone w/o severe dysfunction |
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up to how much fluid will be used in PD, what is the dialyzate made of, how it it done, what is the frequency? |
amount: up to 5 L dialyzate: dextrose sol'n = keeps fluid from being pulled into the bloodstream how: Pt infuses fluid into peritoneal cavity, fluid stays in cavity for prescribed time ("dwell time"), Pt hooks empty bag to catheter and allows to drain out per gravity, immediately puts a new bag in frequency: q3, 4, or 6 |
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how is PD performed at night? |
via a cycler machine performs continuous dialysis, infusing and draining sol'n throughout the night and manages the dwell time pt wakes up with clean dialyzate and goes about their day |
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what are the 3 steps of PD? |
fill dwell drain |
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what are adhesions and increased fibrin production with respect to how they affect PD, and what are ways to counter increased fibrin production and suspected infection? |
adhesions: scar tissue between organs that impacts osmosis fibrin: body reacts to "wound" of the cath and moves fibrin into the dialyzate (looks "spiderwebby" or cloudy) counteracting fibrin: heparin in the dialyzate counteracting infection: antibiotics in the dialyzate |
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which way do blood and the dialyzate run during hemodialysis and why? |
direction: blood runs down, dialyzate runs up why: as blood down dialysis it encounters the cleanest dialyzate running up the machine |
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what is continuous renal replacement therapy, who is it good for, what is the speed of CRRT relative to hemodialysis, and where is it done? |
what: continuous exchange of blood who: hemodynamically unstable pt = hypotensive or hypovolemic speed: slower than hemodialysis bc risk of tanking their BP where: ICU |
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what is an AV fistula, why is it done, and what sort of vein will we do it in? |
what: connection of vein to an artery why: increase pressure into the vein, otherwise the repeated vascular access into a vein will lead to the vein collapsing vein: scarred and dilated big vein, cannot be a peripheral vein |
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what is a AV graft, what are the sounds/feelings associated with it, what is the risk, and what is the benefit? |
what: plastic tubing connecting a vein to an artery sounds/feeling: bruit/thrill risk: infection benefit: well-cared for graft can last years (will last longer than a fistula) |
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when would a temporary dialysis catheter be sued versus a permanent venous catheter, and what do "red side" & "blue side mean? |
temp: when dialysis is needed now and a graft/fistula is not able to be done immediately permacath: when a fistula or a graft fail and dialysis is needed red side: blood going to the machine blue side: blood going back to the body |
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how is a permacath inserted, what material is it made from, and why is it made from that material? |
how: tunneled material: fibrous material why: so that skin can adhere to the catheter and reduce risk of pulling it out & it getting infected |
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why are exsanguination, sepsis, thrombus, impaired blood flow, and extreme fluid and electrolyte shifts risks of hemodialysis? |
exsanguination: these are big veins that can bleed out quickly thrombus: foreign body in the body is going to increase this risk impaired blood flow: reduced extremity perfusion fluid and electrolyte shifts: dialysis machine is not good at determining what are "good" and "bad" solutes |
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what are the three factors that transplantation are dependent on and which can be mitigated? |
DEAL BREAKER: blood type CAN BE MITIGATED: Human Leukocyte Antigen (HLA) factors Antibodies |
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what are methods of post-transplantation care? |
immunosupression fluids & electrolyte balancing pain management infection prevention |
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what are ways we can maintain renal health? |
adequate hydration: 6-8 cups per day dietary eduation perineal care: chronic UTIs = bladder infection = kidney infection early interventions for causative factors = HTN, DM, etc awareness of nephrotoxic agents *just bc it is beginning to fail doesn't mean it has to completely fail* |
