Acute Kidney Diseases part 1 (Gas#6) Flashcards
Cystocele & what does it cause
herniation of the bladder into vaginal vault. Causes urine retention
Rectocele & what does it cause
hernication of rectum into vaginal vault. Causes urine retention
When percussing a persons kidneys, if they are tender what is that indicative of?
acute renal disease
a normal BUN creatine is and what do you look at this for
10:1 (look at this with renal disease)
what is the most reliable urine sample collection? least reliable?
by catheter, bagged is the least
Renal Angiogram
a catheter is inserted into the artery which then the dye is injected & x-rayed. It checks for any small vessel defects in kidney
Cystourethrography
a liquid dye is injected thru a catheter into a full bladder and x-rayed to see the bladder when it is full and while it is emptying
Cystoscopy
a cytoscope is inserted thru the urethra. The dr can take samples and is able to see things that xray might not be able to pick up. Its used to diagnose tumors, calculi, strctures, for stone removal
Pre-procedure care for Cystoscopy
make sure consent is signed, give sedation meds as ordered, asses understanding of procedure
IVP (Intravenous Pyelogram)
dye is injected, xray is taken, it evaluates structure, function of kidneys, ureters, and bladder
Pre-procedure care for IVP & cystourethrography
asses knowledge of procedure, ask about allergies esp to dye, have you had dye before? & did you have a bad rxn? verify consent was signed, obtain vs
post procedure care for IVP & cystourthrography
monitor vs, report allergic rxn (coughing may be an allergic rxn) increase fluids!!
Closed biopsy & what if they are prone to bleeding?
they insert a needle into bladder & collect cells to evaluate, If person is prone to bleeding, will do an open biopsy to make sure no hemorrhaging is occurring
what has a direct correlation between UTIs
catheters
Lower UTI include
Cystitis & Urethritis (basically the urethra & bladder)
Cystitis & Urethritis are what type of UTL lower or upper
lower
Upper UTI
Pyelonepritis (basically the kidneys)
Pyelonepritis is what type of UTI lower or upper?
upper
what 3 tests are looked at to diagnose a UTI
urine analysis, urine culture, WBC
if WBC is not elevated how do we treat?
cranberry tablets
lower UTI s/s
back pain, hematuria, cloudy urine, inability to urine, frequent need to urinate, dysuria (painful urination), fever, malaise (general discomfort
upper UTI s/s
pain below the ribs, n/v, chills, fever, malaise, polyuria (excessive urination), Nocturia (going at night)
Pyelonephritis & which organism is responsible for this
inflammation of the kidney & renal pelvis; E. coli
Risk factors of Pyelonephritis
UT obstruction, Renal calculi, congenital malformation, uncontrolled DM (glucose is a breading ground for bacteria) and valve problems
what kinds of people are at risk for Pyelonephritis?
young women and old men
UTI treatment
antibiotics/Force fluids
major s/s for neonates, infants & older children with UTI
fever
major s/s for older people with UTI
confusion
If UTIs are left untreated they can lead to
Septic shock, ARDS, DIC
lethargy, jaundice, fever, vomiting & seizures are UTI symptoms of a neonate, infant, older child or older adult?
neonate
fever, diahrrhea, vomiting, abdominal pain & poor wt gain are UTI symptoms of a neonate, infant, older child or older adult?
infant
dysuria, hematuria, urgency, frequency, flank pain, fever, foul smelling urine or onset of wetting are UTI symptoms of a neonate, infant, older child or older adult?
older child
Acute Glomerulonephritis
inflammation & infection of the tiny filters in your kidneys.
When is acute glomerulonephritis commonly seen after what infection and with who?
commonly seen in children 5-21 days after a Beta hemolytic strep infection
Beta hemolytic strep infection can cause?
acute glomerulonephritis
s/s of acute glomerulonephritis
hematuria, proteinuria, azotemia/uremia, Na & water retention=edema & HTN, decreased GFR and increased permeability
Nephrotic syndrome what is it and what does it cause
glomeruluslets leak out protein which causes thromboemboli & hypoalbuminemia which then causes edema, hyperlipidemia & the risk of clotting
what does the loss of plasma proteins in nephrotic syndrome stimulate the liver to do?
the loss of plasma proteins stimulates the liver to increase albumin & lipoprotein synthesis causing triglycerides & LDL levels to increase
Does Nephrotic syndrome resolve in kids?
yes, completely
Urolithiasis
the process of forming kidney stones
increased risk of developing a kidney stone
immobility, hypercalcemia, UTIs, urine stasis, fractures, dehydration with increased urine concentration, excessive intake of calcium, oxalate, or proteins
what is the greatest risk factor for urolithiasis?
personal or family history
s/s of a kidney stone
severe pain, renal colic, n/v, fever, chills, hematuria, rarely oliguria or anuria, urine retention
Kidney stone treatment
force fluids, mobilize, relieve pain, diet, allow to pass or get it removed
can a staghorn kidney stone pass on own?
no
Calcium (oxalate & phosphate) kidney stone causes
immobility, bone disease, increased calcium in diet & hyperparathyroidism
Calcium (oxalate & phosphate) kidney stone treatment
increased fluids, thiazide diuretics, low calcium diet
Magnesium Ammonium Phosphate kidney stone causes
UTIs
Magnesium Ammonium Phosphate kidney stone treatment
increase fluids, acidification of urine
Uric Acid-gout kidney stone causes
increased purine diet
Uric Acid-gout kidney stone treatment
increase fluids, allopurinol, alkalinization of urine, low fat, low protein diet
Cystine-cystinuria kidney stone causes
breakdown of protein by acid
Cystine-cystinuria kidney stone treatment
increase fluids, alkalinization of urine, low protein
if a person has a Calcium (oxalate & phosphate) kidney stone which foods should they stay away from?
oxalate rich food such as:
spinach, rhubarb, strawberries, beets, nuts, chocolate & black tea
Alkaline foods
most fruits/veggies, figs, mineral water, orange juice, potatoes, spinach, watermelon, dendelion greens
Acidic foods
corn, meat, fish, fowl, most grains, coffee, plums, prunes, cranberries, distilled water
Lithotripsy
using sound or shock waves to crush a stone, its the preferred treatment for urinary calculi
Percutaneous ultrasonic lithotripsy
a nephroscope is inserted into the renal pelvis & ultrasound waves are used to fragment the stone & then be removed
3 s/s of kidney cancer when palpating/hitting kidneys
hematuria, flank pain, palpable abdominal mass
cancer of the kidneys is more common in what age group
50-70
Treatment for kidney cancer
renal nephrectomy (kidney removal), there is no treatment for advanced renal carcinoma
Post op care after a renal nephrectomy
remaining kidney must be protected, pain will be significant, may have respiratory complications due to painful incision (patient wont want to TCDB), patient might grieve loss of organ
Intravesical therapy
meds that are placed into bladder to destroy cancer cells
can some bladder tumors come back?
yes, some are hard to remove;high grade
