Alterations of Renal Function Flashcards
1
Q
Percentage of Cardiac Output in the kidney. How many mL per minute?
A
25% (1200 mL/minute)
2
Q
Prerenal
A
issue the happen before the kidney
3
Q
Intrarenal
A
issues that happen inside the kidney
4
Q
Postrenal
A
issues that happen after the kidney
5
Q
Prerenal (reasons and example)
A
reasons: hypotension, hypovolemia, sepsis, low cardiac output
example: acute kidney injury
6
Q
Intrarenal (reason and examples)
A
Reason: ischemic acute tubular necrosis, surgery sepsis, obstruction
Examples: UTI, pyelonephritis, antibiotic toxicity
7
Q
Postrenal (reason and examples)
A
Reason: urinary tract obstruction (bilateral)
Ex: bilateral ureteral obstruction, urethral obstruction, tumors or neurogenic bladder
8
Q
What is Mean Arterial Pressure
A
the average pressure in the arteries throughout the cardiac cycle
9
Q
Normal values of mean arterial pressure
A
70-90
10
Q
Normal urine diagnostics - color
A
pale yellow to light amber
11
Q
Normal urine diagnostics - turbidity
A
clear with no sediment
12
Q
Normal urine diagnostics - pH
A
4.6-8
13
Q
What does more basic/alkaline urine mean
A
bacteria is present
14
Q
Normal urine diagnostics - specific gravity: normal values
A
1.0 - 1.02
15
Q
Is specific gravity increased or decreased with protein and glucose present
A
increased
16
Q
When is specific gravity low
A
when it is dilute
17
Q
Normal urine diagnostics - blood
A
negative
18
Q
Normal urine diagnostics - bacteria
A
yes or no
19
Q
What are ketones? normal value?
A
keto acids that are given off when body is burning fat instead of glucose (increase in fat metabolism)
normal value: negative
20
Q
What two lab values do we look at to judge kidney function?
A
BUN and creatinine
21
Q
Look at BUN/creatinine via blood or urine?
A
blood is more accurate
22
Q
Definition of specific gravity(AKA?)
A
an estimated measure of the solute concentration of the urine
AKA : weight of urine
23
Q
Specific gravity : ratio
A
ratio of density of substance to density of water
24
Q
What is urine composed of?
A
waste product and fluid
25
What are the two waste products in urine
urea and creatinine
26
What is BUN and what does it measure?
blood, urea, nitrogen: end product of protein metabolism, circulates in the blood, removed by the kidneys in urine
measures the amount of urea in the blood
27
What is the predominant waste product in blood?
urea
28
where is urea formed?
in the liver
29
Normal value for BUN
10 - 20
30
critical value for BUN
greater than 100
31
What is the job of kidneys?
to remove urea
32
What is creatinine?
serum and urine; nitrogenous compounds formed from metabolism of creatine
33
Where is creatine found?
blood, urine, muscle tissue
34
Normal values for creatinine
0.5-1.1 mg/dL
35
What is the creatinine clearance test and what does it measure?
24 hour diagnostic test for kidney function: measures the rate at which creatinine is cleared from the blood by the kidneys
36
Creatinine clearance test 7 steps
1. get order for 24 hour clearance test
2. go to lab and get red biohazard container
3. put container in bucket of ice (to keep urine from smelling and prevent bacterial growth)
4. tell pt whats happening and to call every time they go to the BR
5. have pt discard the first sample
6. keep all other samples for 24 hours
7. Have pt void one last time right at the end of 24 hours
37
Hydroureter (definition) (is it prerenal, intra or post?)
dilation of one of the ureters filled with urine
| post renal: bladder infection
38
Hydronephrosis (definition) (prerenal, intra, or post?)
dilation of renal pelvis and calyces, results in enlargement of the kidney: intrarenal
39
Post-obstructive diuresis (definition) (prerenal, intra or post?)
body is catching up on filtration and waste removal after you clear the obstruction (kidney does double work to catch up on filtration)
40
Risk factors of renal stones
fluid intake and diet, age, gender, race, geographic location, seasonal factors, occupation
41
Clinical manifestations of renal stones
moderate to severe pain in the flank area radiating to the groin
colic pain (achy on and off pain)
some people may not hurt until pushing urine
urinary urgency
frequent voiding(peeing few drops)
42
Evaluation of renal stones (what tests would you do...cheapest to most expensive)
1. stone and urinary analysis
2. Intravenous pyelogram (IVP)
3. KUB (kidney, ureter, bladder xray)
4. Spiral abdominal CT
43
What is a UTI?
Urinary tract infection: inflammation of urinary epithelium from pathogen
44
What is the most common bacteria found in a UTI?
Escherichia coli
45
Clinical manifestations of a UTI: young adult
```
differ with age and urinary function:
dysuria
frequency
suprapubic and lower back pain
foul smelling
cloudy
```
46
clinical manifestations of UTI in elderly
confused, septic, abdominal discomfort
47
uncomplicated UTI definition, most common in?
healthy individual with normal urinary system
- first infection or one year after UTI
Most common in women
48
Complicated UTI (who is it most common in? what is elevated?)
Individual with abnormal urinary system or compromised health
- older folks, BUN and creatinine are elevated
49
Recurring UTI definition
initial infection that is successfully treated but reinfected within 5 to 10 days after resolution
50
Persistent UTI definistion
persistent infection despite 3 days of treatment
51
Cystitis definition
type of UTI: inflammation of the bladder
52
Clinical manifestations of cystitis
```
frequency
dysuria (difficulty peeing)
urgency
lower abdominal pain
pain in suprapubic area over the bladder
```
53
More serious symptoms of cystitis
hematuria
cloudy and foul smelling urine
flank pain
54
Interstitial cystitis definition
an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder
55
Is Interstitial cystitis bacterial or nonbacterial?
nonbacterial
56
What is the cause of interstitial cystitis?
cause is unknown: autoimmune reaction may be responsible for the inflammatory response
57
Interstitial Cystitis is associated with...
dysfunction of the external sphincter, vaginitis, urethritis, inflammation of the vaginal glands and urethra
58
Interstitial Cystitis is most common in
women 20-30 years of age (usually that have multiple sexual encounters)
59
Clinical manifestations of interstitial cystitis
bladder fullness
increased frequency
small urine volume(output)
chronic lower pelvic pain
60
Acute pyelonephritis definition
type of UTI: an infection of one or both upper urinary tracts
- infection of renal pelvis and interstitium
- intrarenal
61
Acute pyelonephritis causes
```
female sex trauma
pregnancy
kidney stones
neurogenic bladder
reflux
Escherichia coli, proteus, pseudomonas
```
62
Clinical manifestations of acute pyelonephritis
```
acute onset
fever
chills
flank or groin pain
frequency
dysuria
costovertebral tenderness
```
63
chronic pyelonephritis definition
persistent or recurrent infection of the kidney leading to scarring of the kidney
- one or both kidneys involved bc kidney have trouble filtering and doing their job
64
Causative agent of chronic pyelonephritis
difficult to determine: hypertension is a common cause
65
Early symptoms of chronic pyelonephritis
hypertension
frequency
dysuria
flank pain
66
Late symptoms of chronic pyelonephritis
renal failure
67
Risk factors of chronic pyelonephritis
renal infections
| obstructive pathologic conditions
68
Glomerulonephritis definition
inflammation of the glomerulus
69
Causes of glomerulonephritis
immunological abnormalities (most common)
ischemia
vascular disorders (low volume--> MAP <70)
hypotension related issues
drugs/toxins
systemic diseases
70
What is the most common cause of chronic and end-stage renal disease
glomerulonephritis
71
Acute glomerulonephritis definition
Streptococcal infection --> bacteria in urine
| begins abruptly: 7 to 10 days after strep infection
72
Clinical manifestations of acute glomerulonephritis
```
hematuria
RBC casts
proteinuria
decreased GFR
oliguria
hypertension
edema in lower extremities
```
73
What is oliguria
decreased urination (low urine)
74
Chronic glomerulonephritis definition
caused by several diseases/conditions leading to chronic renal failure
75
Clinical manifestations of chronic glomerulonephritis
```
increased cholesterol (hypercholesterolemia)
protein spillover(proteinuria) / bleeding in uria (hematuria)
```
76
Acute Renal Failure definition
sudden abrupt reduction in renal function
77
Clinical manifestation of acute renal failure
elevated BUN and creatinine
oliguria
decreased GFR
78
Is acute renal failure reversible
yes
79
Prerenal definition
impaired renal blood flow (most common cause)
| - GFR declines due to the low filtration pressure
80
Intrarenal definition
tubular necrosis; surgery sepsis, obstruction
81
Postrenal definition
urinary tract obstruction (bilateral)
82
Chronic Renal failure definition
progressive and irreversible loss of nephrons
- GFR affects all organ systems
- does not become apparent until <25% function remains
83
Clinical manifestations of chronic renal failure
```
uremia/azotemia
- accumulation of toxins in plasma
Hypertension
anorexia
nausea
vomiting
diarrhea
weight loss
edema
anemia
pruritus
neurological changes
```
84
Uremia definition
high level of urea in blood
85
Azotemia definition
high level of urea and other toxins in blood
