alterations in renal function (exam 4) Flashcards
1
Q
define oliguria & lab values for them
A
- low urine output/production
- 8 to 400 ml/day (.5 ml/kg/hr)
2
Q
define anuria
A
- little to NO urine output
- < 50 mL/day
3
Q
define nocturia
A
- urinate at night
- to the point of distress to patient
4
Q
what blood tests are used to test renal function? and what does it mean if they’re elevated?
A
- serum creatine = secreted by muscle
- blood urea nitrogen (BUN) produced in the liver
- if elevated or increased we are worried about kidney function as these are products that should stay in the blood stream, therefore if they are being filtered out (indicating a elevated level) that means the kidney isn’t filtering well and is malfunctioning
5
Q
for a kidney and liver diseases what diet should they be put on?
A
- low protein diet
6
Q
define creatinine clearance? and what it should be in normal physiological kidney? & how it’s tested
A
- creatinine clearance is the amount of creatinine that the kidneys are excreting
- value should be low, as the creatinine is supposed to stay in the blood stream and not be excreted out
- tested through blood test & 24 hr urine collection
7
Q
what does a urinalysis (UA) sample test for? and why
A
- ph, specific gravity (how hydrated pt is), protein, glucose, ketones, (want to be low in urine as it should be in the blood), nitrites, leukocytes, (to look for infection), RBCs (want to be low)
8
Q
what are all the types of clinical assessments for renal function?
A
- urinalysis (US)
- ultrasound
- CT/MRI
- BUN & creatine blood test
9
Q
what are common clinical manifestations of kidney disease?
A
- pain
- lower urinary tract pain (subpubic pain/pain when peeing)
- kidney pain = nephralgia
- CVA tenderness/flank pain/renal colic (inflamed or injured kidney)
- abnormal UA
- dysuria, urgency, frequency when urinating
- oliguria
10
Q
what are common pain manifestations of kidney disease?
A
- lower urinary tract manifesting into subpubic pain or pain when peeing
- kidney pain = nephralgia
- CVA tenderness/flank pain/renal colic (inflamed or injured kidney)
11
Q
when a pt has an abnormal UA, what does that present as? what in the UA is abnormal
A
- abnormal color, odor, turbidity
- hematuria in females (but be careful bc could be period)
12
Q
when discussing urinary tract disorders what part of the urinary system is being refured to?
A
- kidneys & down
13
Q
define UTI
A
- Inflammation of the urinary epithelium following invasion and colonization by some
pathogen within the urinary tract - most infections are ascending meaning they are coming from the outside in
14
Q
what is the most common pathogen in UTI’s?
A
- ecoli
- most infections are ascending meaning they are coming from the outside in
15
Q
what are risk factors for UTI
A
- female gender & pregnancy
- diabetes (bc glucose molecule)
- urinary obstruction = bacteria is stuck and blocking part of the system AND causing infection
- catheters
16
Q
define urethritis and what diseases its apart of
A
- urethra inflammation
- apart of UTI
- mostly due to STI infections (gonorrhea & chlamydia
17
Q
define cystitis
A
- bladder inflammation
- most common
- apart of UTI
- many causes, bacterial infection being most common
- causing pubic pain
18
Q
define pyelonephritis & what disease its apart of?
A
- kidney inflammation
- apart of UTI
- acute & chronic back pain
19
Q
what does urine statis & urinary retention mean?
A
- meaning there is an obstruction somewhere
20
Q
what is the etiology of a UTI?
A
- ascending infection/inflammation
- bacteria = mostly e coli
- could also be due to urinary reflux (e.g. vesicoureteral – backward flow)
- Urine stasis, Urinary Retention = meaning obstruction
21
Q
what does urinary reflex mean? & what disease could it lead to?
A
- meaning backward flow
- the urine isn’t going the one way flow it’s supposed to meaning that its going backwards which can cause more bacteria & infection
- can lead to UTI
22
Q
what are the C.M of UTI
A
- Dysuria, frequency, urgency, fever, chills
- Hematuria = blood in urine
- turbid UA = cloudy pee
- CVA = costovertebral angle) tenderness on PYELONEPHRITIS infection only
23
Q
where is CVA tenderness located?
A
- us located on your back at the bottom of your ribcage
24
Q
what are the different locations for UTI’s-
A
- urethritis = urethra inflammation
- cystitis = bladder inflammation
- pyelonephritis = kidney inflammation
25
what is the treatment for UTI?
- antibiotics & fluids (to push stuff out)
26
define urinary tract obstruction
- Blockage of urine flow within the urinary
tract
27
what can cause an define urinary tract obstruction
- anatomic or functional defect
- called obstructive uropathy (blockage)
28
the severity of a UTO is based on...
- location
- Completeness
- Involvement of one or both upper
urinary tract
- duration
- cause
29
define renal calculi or Nephrolithiasis
- kidney stones
30
what are kidney stones made of
- Masses of crystals, protein, or other substances that form within and may
obstruct urinary trac
- MOSTLY calcium oxalate/phosphate (70%-80%)
31
where are the locations that kidney stones can block
- Nephrolithiasis (Renal pelvis)
* Utertolithiasis (Ureter)
* Vesical urolithiasis (Bladder
32
what are the risk factors for kidney stones?
- Male
* Age 20-40 years
* Inadequate fluid intake (biggest contributor)
* Living in desert or tropical region
* Temperature, humidity, fluid, and dietary patterns
33
what are the C.M of kidney stone?
- renal colic - flank pain - CVA tenderness
- hematuria
34
how do we diagnose or evaluate for kidney stones?
- * Kidney-ureter-bladder (KUB) radiograph (top rt)
* Spiral abdominal computed tomography (CT)
* Stone analysis
* Intravenous pyelogram (X-ray & contrast due to see urinary system)
35
how is kidney stones treated?
- Stone removal
* Pain management
* Fluids
*Dietary decrease of stone contributing substances
36
what are some other causes of lower urinary tract obstructions?
- bladder neck dyssynergia
- prostate enlargement
- urethral structure = narrowing of urethra from injury of infection
- sever pelvic organ prolapse
- neurogenic bladder (no bladder control bc it increases risk for infection)
37
what are the urinary tract obstruction complications?
- dilation of the tract proximal to the obstruction (meaning swelling so the tubing is closing)
- causes risk for UTI
38
what could a partial urinary tract obstruction lead to?
- Compensatory hypertrophy in unaffected
kidney
39
what could bilateral urinary tract obstruction lead to
- fluid retention
40
what can prolonged urinary tract obstruction cause?
- postrenal acute kidney
injury and acute tubular necrosis (kidney death)
41
define the issues with glomerular disorders
- alterations in structure/function of the glomerular capillary circulation
*Sudden or insidious (gradual) onset
42
what are the classifications of glomerular disorders?
- primary vs. secondary (ex: DM or HTN)
- diffused = whole area
- focal = one specific area
43
what are the results/ C.M of glomerular disorders?
- proteinuria
- hematuria
- urinary casts = microscopic tube shaped particles in pee indicating issue
- decreased GFR
- hypertension
44
what starling force is affected with glomerular disroders?
- increased hydrostatic capillary pressure
45
what does an decreased GFR affect
- elevated plasma creatinine, BUN and reduced creatine clearance
- bc the glomerular isnt filtering well when the rate is down waste products stay in the body while some products of the blood are escaping
- ex: proteins in the urine, making less proteins in the blood (hypoalbuminemia)
46
what are the two types of glomerulopathies? & which is worse?
1. nephritic syndrome
2. nephrotic syndrome (worse)
47
what are the C.M of nephritic syndrome and the cause
- inflammation of the glomeruli = cause
- HTN
- oliguria
- hematuria
48
what are the C.M of nephrotic syndrom?
- hypoalbuminemia
- hyperlipidemia
- peripheral edema
- proteinuria
49
what is acute Glomerulonephritis
- INFLAMMATION of the glomerulus
- triggered by bacteria, viral, parasitic, and systemic causes
- most common way to get it is bc of the strep throat bacteria bc the body overreacts and produces antibodies that attack the strep throat bacteria AND the kidneys
50
what are the C.M of acute glomerulonephritis?
- decreased GFR due to inflammation
- increased BUN & serum creatinine
- decreased creatinine clearance
- hypertension
- hematuria (!)
- proteinuria
- eventual oliguria
51
how is acute nephritis diagnosed?
- H&P, UA (proteinuria, hematuria)
*BUN and creatinine levels increased
*Renal biopsy
52
how is Acute nephritis (inflammation of glomeruli treated?
-Supportive and symptomatic
*Usually resolves with minimal treatment (esp. if post-streptococcal infection);
however, may progress to chronic case or nephrotic syndrome
*Dialysis with worsening disease
53
what are the major findings in nephrOtic syndrom?
- Hypoalbuminemia, proteinuria, edema,
hyperlipidemia
- biggest finding in increased protein inthe urine per day
54
what are contributing fatcors to nephrOtic syndrome?
- Glomerulonephritis leading to nephrotic syndrome
*Defects that alter the glomerular membrane
*Systemic diseases (*diabetes*, SLE)
*Drug/toxin injury
* Infections (especially chronic and/or recurrent
55
what is the treatment for nephrotic sydnrome?
- conservative symptom managemen
- Diuretics
*Lipid-lowering agents
*Antihypertensives
* Immunosuppression/immunomodulation
- Management of underlying process when identified
- May resolve spontaneously, others progress to end-stage renal disease
56
define acute kindey injury & what it effects
- Sudden and rapidly progressive within hours (often reversible); abrupt reduction in renal function
- Disruptions in fluid, electrolyte, acid/base balance, waste excretion, GFR
57
define chronic kidney disease?
- Chronic, slowly progressing to end-stage renal failure over months or years
*Progressive and irrevocable loss of nephrons
- needs dialysis and could live on it for a long time or needs kidney transplant
57
what are the causes of postrenal acute renal failure?
- sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor or injury
57
what are pre renal causes of acute renal failure?
- sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injuries
57
what are intrarenal causes of acute renal failure?
- direct damage to kidneys by inflammation, toxin, drugs, infection, or reduced blood supply
57
what are the 3 phases of acute kidney failure?
1. prodrome = don't notice less urine output
2. oliguric = urinary output is severely diminished, can be 1 day to 8 weeks
3. post-oliguric = output returns to normal but BUN & creatinine levels remain high for a few
58
what is prerenal acute kidney injury caused by? & what happens?
- caused by impaired renal blood flow, hypovolemia, hypotension
- ex = getting stabbed and bleeding out
- GFR declines due to decrease in filtration pressure (oliguria)
- ischemia can lead to acute tubular necrosis if renal perfusion < 20 %
59
what is the cause of postrenal acute kidney injury
- occurs w/ UTO that affect the kidneys bilaterally and increase the intraluminal pressure upstream
- ATN develops if injury uncorrected in a
few hours
60
what is the cause of intrarenal acute kidney injury (AKI)
- Damage to the renal parenchyma that can cause ATN
- due to ischemia, sepsis, low BO
- acute glomerulonephritis (inflammation)
61
what are the CM for Acute Tubular Necrosis (ATN) in the prodromal phase
- normal or small decreased urine output
- rising BUN & creatine
- probs won't notice
62
what are the C.M. of ATN during the oliguric phase?
- decrease UO
- increased BUN & CR
- increased water retention
- metabolic acidosis and hyperkalemia
63
what are the CM for ATN during postoliguric phase
- beginning of renal recovery
- diuresis (pee pain)
- decreasing BUN & CR
64
CM of AKI?
- Oliguria/anuria
* Elevated BUN and creatinine
- fatigue, anorexia, nausea,
vomiting, diarrhea, weight loss, pruritus/skin changes, edema, neurologic changes (bc toxic wastes)
- Hyperkalemia (H+ and K+ exchange & can’t excrete K+)
- Metabolic acidosis (Can’t excrete H+)
- Hypertension (volume overload
65
what is the treatment for AKI?
- identify at risk PT
- prevent development
- address hypotension/hypovolemia
- decrease invasive procedures (catheterization)
- enhance renal perfusion before ATN develops
- Aggressive management of glomerulonephritis
- recovery = 1 wk - 1 yr
66
define Chronic Kidney Disease
- The irreversible loss of renal function that
affects nearly all organ systems
- Decreased kidney function for 3+ months
based on blood tests, UA, imaging, GFR
- Diabetes and HTN primary risk factors due to them being hard to manage
67
what are the 3 different stages of CKD
- classified by nephron loss
1. decreased renal reserve
- <75% nephron loss
2. renal insufficiency (75 - 90% nephron loss)
- polyuria/nocturia
- slight BUN/CR increase
3. end stage renal failure (>90% nephron loss)
- anemia
- azotemia (increased BUN
68
what are the C.M of CKD
- kidneys have impact on many body systems:
- HTN and cardiovascular disease
*Anemia d/t ↓erythropoietin
*Metabolic acidosis
*Electrolyte imbalances
*Mineral and bone disorders
- Malnutrition
*Pain
*Depression
69
how does CKD cause metabolic acidosis?
- Retention of acidic waste products (uremia)
- kidneys cannot secrete H+ ions into urine; cannot produce bicarbonate
*Hyperkalemia association
70
how does CKD cause anemia?
- due to the lack of erythropoietin
- Uremia creates a toxic environment for RBCs
* Cardio-renal anemia syndrome causing worse CKD, anemia, heart failure
