8) Neph / Uro Flashcards
At what blood sugar level is glucose excreted through urine?
180 mg/dL
For hemodialysis to effectively rid the body of excess electrolytes, what must be true?
The dialysate must contain electrolytes in a concentration lower than in the patient’s blood
How do kidneys and liver differ in drug metabolism?
Kidneys excrete water-soluble drugs; liver processes fat-soluble drugs.
How does aging affect nephron count?
After age 40, kidneys lose 1% of nephrons per year.
Y-chromosome sperm movement
X-chromosome sperm movement
Y-chromosome sperm swim faster but have a shorter lifespan
X-chromosome sperm swim slower but are more resilient.
How does the urinary system regulate blood pressure?
Releases renin, which activates the RAAS system to regulate arterial BP.
How does kidneys help regulate blood pressure?
Releases Renin, activating RAAS, which increases BP.
Pitting edema assessed:
Ascites test:
+1 to +4 pitting edema measures depth;
Tap one side, feel waves on the opposite side.
How is hypertension due to RAAS overactivation treated?
Treat with Nitroglycerin before CPAP for preload reduction; BiPAP preferred over CPAP when possible.
How is oliguria defined?
Urine output of less than 400-500 mL daily
How long does it take for sperm to reach the fallopian tubes?
25-40 minutes.
In which organ is ammonia converted into urea for excretion?
Liver
What additional symptom would you expect in a patient with flank pain radiating into the groin?
Painful urination
What are common complications of dialysis?
Hypotension, dyspnea, chest pain, neurologic issues (headache to coma).
What are signs of severe ARF?
Altered mental status (AMS) & decreased consciousness, indicating potentially life-threatening condition.
What are the functions of the penis?
Serves as an output for urine & sperm.
Leading causes of end-stage renal failure?
Uncontrolled diabetes mellitus and hypertension
Most common causes of CRF?
Diabetes mellitus (Type 1 & 2) & uncontrolled hypertension.
Most common causes of kidney failure?
Diabetes mellitus (both types) & uncontrolled hypertension.
What are the most common UTI locations?
Urethra (urethritis), bladder (cystitis), prostate (prostatitis), kidney (pyelonephritis).
What are the primary functions of the urinary system?
Maintains blood volume, balances water, electrolytes, & pH, removes toxic wastes, regulates BP, & controls RBC production.
What are the primary structures of the urinary system?
Kidneys, ureters, urinary bladder, urethra.
What are the three types of ARF?
Prerenal (perfusion issue),
Renal (kidney tissue pathology),
Postrenal (obstruction distal to kidney).
What are the two main regions of the kidney?
Cortex (outer) & Medulla (inner).
What are the two types of dialysis?
Hemodialysis & peritoneal dialysis.
What are the two types of kidney failure?
Acute Renal Failure (ARF) & Chronic Renal Failure (CRF).
What changes in blood chemistry occur in a patient with chronic renal failure?
Urea and creatinine levels increase
What condition is suspected in a jaundiced patient with white frosty dust on the skin?
Uremic Frost
What condition is suspected in a patient with steadily declining urine output, voiding only approximately 400 mL?
Acute Renal Failure
What factor would most increase the likelihood of a urinary tract infection?
Urinary stasis
What happens when fifty percent dextrose solution is placed on side A of a membrane and twenty-five percent dextrose on side B?
Net movement of water from side B to side A will occur
What hormone is responsible for RBC production?
Erythropoietin, which stimulates RBC production in bone marrow.
Urinary Tract Infection (UTI)?
Pathogenic colonization of bladder due to bacteria entering via urethra.
Ammonia toxicity?
Highly toxic to body, particularly brain cells; Liver converts ammonia into urea for excretion.
Chronic renal failure (CRF) diagnoses rq
CRF is diagnosed when 70 percent of the nephrons are lost and the patient is clinically unstable.
What is bilirubin and its relation to jaundice?
RBC breakdown releases bilirubin; liver failure causes gray-colored stool & jaundice due to poor bilirubin processing.
Circumcision?
Removal of foreskin, often performed in infancy.
Nephrology?
Study of kidney function & disease.
Omotic diuresis?
Occurs when BGL
Excess glucose in filtrate pulls water into urine, leading to dehydration.
≥180 mg/dL.
Postrenal ARF?
Due to blockages in the ureter, bladder, or urethra; commonly kidney stones or enlarged prostate.
Prerenal ARF?
Dysfunction before the kidney, often due to hypovolemic shock, hypotension, or poor perfusion.
priapism?
Painful, prolonged erection; can be caused by sickle cell disease, spinal injuries, or toxins.
Renal (Intrinsic) ARF?
Damage within the kidney tissue itself, caused by hypertension, nephrotoxins, or rhabdomyolysis.
Testicular torsion?
Twisting of the spermatic cord, cutting off blood supply to the testicle.
blood flow pathway through the kidneys?
Afferent arteriole → Glomerulus → Efferent arteriole → Systemic circulation.
Cystitis dangers
Rare but can progress to sepsis & death if untreated.
Acute Renal Failure (ARF) def
Sudden drop in urine output (oliguria/anuria) over days.
Chronic Renal Failure (CRF) def
End stage occurs w/
Permanent loss of nephrons (≥70%);
metabolic instability occurs at ≥80% nephron loss.
Kidney stones (Renal Calculi) def
Crystal aggregation in kidney collecting system; extreme pain as stones pass through ureters.
What is the flow of filtrate in the nephron?
Glomerulus → Bowman’s capsule → Proximal tubule → Loop of Henle → Distal tubule → Collecting duct.
What is the focused history for ARF?
Determines severity, duration, underlying causes.
What is the function of Juxtaglomerular (JG) cells?
Monitor kidney perfusion, release renin when BP drops.
phosphodiesterase inhibitors prescribed for
Treat benign prostate hypertrophy, pulmonary hypertension, & erectile dysfunction.
Renal pyramids fn
Fan-shaped regions in the medulla that funnel urine to the renal pelvis.
Bladder fn
Stores urine; can hold up to 1L.
Epididymis fn
Stores mature sperm.
Hilum in the kidneys & Fn
Entry/exit point for renal artery/vein, nerves, lymphatic vessels, ureter.
What is the function of the penis in copulation?
Male organ of copulation, erectile tissue (Corpus Cavernosum) fills with blood for erection.
Prostate gland fn
Surrounds bladder neck, produces seminal fluid to nourish sperm.
Scrotum fn
Keeps sperm at optimal temperature (93-96°F).
Testes fn
Primary male reproductive organs, produce testosterone & sperm.
Vas Deferens fn
Transports sperm from epididymis → prostate → urethra.
Functional unit of the kidney?
Nephron; each kidney contains about 1 million nephrons.
What is the leading cause of Acute Renal Failure (ARF)?
Hypovolemic shock.
Liver’s role in waste processing?
Converts ammonia to urea (less toxic) for kidney excretion.
What is the management of shock in kidney failure?
Dopamine/Dobutamine (Direct Inotropy); avoid Alpha-1 agonists if weak heart (increases afterload).
What is the mechanism of action of ACE inhibitors?
They inhibit the conversion of angiotensin I to angiotensin II
What is the medical term for urination?
Micturition.
MAP minimum for organ perfusion?
60 mmHg.
ARF mortality
50% but reversible if diagnosed early.
most common metabolic cause of ARF death?
Hyperkalemia, leading to TdP (Torsades de Pointes) due to unsynced cardiac depolarization.
What is the most common symptom of renal calculi?
Severe visceral pain in the flank that may radiate toward the groin.
What is the most likely cause of neurological changes during hemodialysis?
Accumulated blood urea
What is the normal Blood Urea Nitrogen (BUN) level?
7-20 mg/dL; indirect indicator of GFR.
What is the normal creatinine level?
0.6-1.2 mg/dL; direct indicator of GFR.
What is the primary hormone regulating RBC production?
Erythropoietin (EPO), released by kidneys (90%) in response to hypoxia, stimulates RBC production in red bone marrow (RBM).
RAAS pathway?
JG cells release renin →
Liver converts renin to Angiotensin I →
ACE (lungs) converts Angiotensin 1 to 2 → Vasoconstriction & Aldosterone release.
What is the renal perfusion dose for vasopressors?
2-5 mcg/kg/min to improve kidney perfusion.
Kidneys’ size & amount of nephrons contained:
Size of a fist; ~1 million nephrons per kidney.
What is the treatment for hyperkalemia in ARF?
Sodium Bicarbonate (8.4%) = Alkalinizes blood to shift K+ into cells.
Albuterol (LVN nebulizer) = Promotes cellular uptake of K+.
Calcium Chloride (0.5-1g IV) = Stabilizes cardiac membrane, prevents arrhythmias.
urethra length in females?
3-4 cm, opens anterior to the vagina.
urethra length in males?
~20 cm, ends at the tip of the penis.
Urology?
Study of all urinary components, including surgical interventions.
% of ICU PTs account for ARF?
Accounts for 30% of ICU patients, 5% of all hospitalizations.
What procedure is a patient undergoing if they are hooked into two large bags, one on an IV stand and one below their waist?
Peritoneal dialysis
What question is imperative to ask in a possible renal emergency?
“How many times have you urinated today?”
What structures may be affected in a urinary tract infection in a female patient?
Urethra, bladder, kidney
Where are the kidneys located?
Retroperitoneal; Left kidney behind spleen, Right kidney slightly lower behind liver.
Where does filtration occur in the kidneys?
Bowman’s capsule, receives filtrate from glomerulus via hydrostatic pressure.
bladder located in men?
Bladder wall is structurally continuous with the prostate gland at the neck.
bladder located in women?
Connective tissue attaches bladder’s posterior wall to the anterior vaginal wall.
Which chemistry finding would suggest acute renal failure?
Elevated blood urea nitrogen (BUN)
Which hormones are involved in urinary function?
ADH & Aldosterone regulate water retention & Na balance.
Which of the following is a prerenal cause of acute renal failure?
Embolism of the renal vein
Why are urinary tract infections more common in females than in males?
The female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract.
Why don’t healthy kidneys release glucose?
Glucose is fully reabsorbed unless serum levels exceed 180 mg/dL.
In response to low blood O2 Lvls, cells w/in the kidney secrete
erythropoietin (EPO) hormone.
EPO stim/s red bone marrow to increase its
rate of erythrocyte formation
