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NURS 444 > Altered Renal Fx > Flashcards

Altered Renal Fx Flashcards

1
Q

Difine Glomerular filtration rate (GFR)

A

An estimate of how much blood passes through the

glomeruli each minute

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2
Q

Urine output for normal, Polyuria and Oliguria

A

Normal 1000-1800 L/day
Polyuria over 2.5 L/day
Oliguria under 500 L/day, ie < 0.5 ml/kg/hr

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3
Q

Name Renal function tests

A

Creatine levels
ACR (albumin-to-creatinine ratio) - Less than 30
Urine culture
Specific gravity

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4
Q

Name 5 Renal function diagnostics

A
  • Renal Ultrasound
  • Duplex ultrasound or angiography or spiral CT
  • Cystoscopy
  • Renal Scan
  • Intravenous Pyelogram (IVP)
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5
Q

Define Urinary Tract Obstruction

and Causes

A

interference with the flow of urine at any site along the urinary tract

  • anatomical: stricture or narrowing of the lumen
  • functional: neurological defect
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6
Q

What are Renal calculi?

A

Crystals, protein or other substances that form in the kidneys and may obstruct the (upper) urinary tract.

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7
Q

Kidney calculi formation

A

1 - Precipitation of salts from liquid to solid state
2 - Salts crystallise forming a nidus/seed around
which the stone forms

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8
Q

What are the clinical manifestations of Kidney calculi?

A
  • Renal (ureteric) colic
  • Haematuria
  • Nausea and vomiting
  • Fever
  • Chills
  • WBC’s in urine
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9
Q

What does the lower urinary tracts consists of?

A
  • ureters
  • urinary bladder
  • urethra
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10
Q

Define Hydronephrosis

A

Distention and dilation of the renal pelvis and calyces, usually caused by obstruction of the free flow of urine from the kidney

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11
Q

Hydronephrosis: Causes

A
  • Intrinsic
  • Extrinsic: pregnancy, uterine prolapsed, prostate hypertrophy
  • Functional: Neurologic
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12
Q

Define Urinary Tract infection (UTI)

A

Inflammation of the urinary epithelium caused by bacteria

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13
Q

Bacterial diseases in Upper and Lower Urinary Tract

ie UTI

A 
Upper urinary tract
- Pyelonephritis
- Ureteritis
Lower urinary tract
- Urethritis
- Cystitis - urinary bladder
- Prostatitis
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14
Q

Name the 2 UTI most common pathogens

A
  • Escherichia coli

* Staphylococcus aureus

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15
Q

Define the upper UTI Acute Pyelonephritis

Name 3 Bacteria

A

Infection of the renal pelvis and interstitial

  • E. coli
  • Proteus
  • Pseudomonas
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16
Q

Acute Pyelonephritis: Diagnoses

A
  • Urine culture
  • Urinalysis - *White blood cell casts in urine
  • Increase ESR and C-reactive protein levels
  • Increase creatinine
  • Clinical signs and symptoms
17
Q

When does Acute Pyelonephritis turns into Chronic Pyelonephritis?

A

When there is a persistent or recurrent infection of the kidney (same organism) resulting in inflammation and scarring

18
Q

What is the Normal Glomerular Filtration Rate (GFR)? And how much is reabsorbed?

A

(GFR) is 125 ml/minute of which 124 ml is reabsorbed

19
Q

What are the clinical manifestations of Glomerular disorders?

A
  • hypertension
  • oedema
  • elevated blood urea nitrogen (BUN)
  • Decreased glomerular filtration rate
  • Elevated plasma creatinine and urea
  • Reduced creatinine clearance
  • proteinuria (increased permeability of glomerular capillaries)
20
Q

What is Acute Glomerulonephritis and what causes it?

A

Immune-complex hypersensivity reaction (inflammation) to streptococcal infection elsewhere in the body. It causes gram negative septicaemia. For eg group A streptococcal infection of the throat

21
Q

Glomerulonephritis: Pathophysiology

A

Streptococcal infection of the skin or pharynx
• Depositing antibody-antigen complex on the BM in glomeruli
• Complement activation and inflammatory reaction
• Damage to surrounding tissue
- Decreases blood flow and GFR, while a increasing BM permeability

22
Q

What characterises Glomerulonephritis in children?

A

Acute poststreptococcal

Deposition of mainly IgA and some IgM antibodies and complement into the glomerular capillaries

23
Q

Define Chronic Glomerulonephritis

A

Progressive hardening and scarring of the basement membrane in the glomerulus, and with tubular injury

24
Q

Chronic Glomerulonephritis:

Pathophysiology

A

Loss of plasma protein (albumin) causes decreased oncotic pressure -> generalised oedema
• Decreased circulating blood volume activates the reninangiotensin system
• retention of sodium and further oedema

25
Q

Define Nephrotic syndrome

A

Excretion of 3.5 g or more of protein in the urine over 24 hours due to disturbances in glomerular BM

  • Na retention
  • Hypoalbuminaemia
  • Hyperlipidaemia
26
Q

Define Chronic kidney disease (CKD)

A

Irreversible loss of renal function that affects nearly all organs
CKD include diabetic nephropathy, IgA nephropathy and polycystic kidney disease
CKD has a strong connection with cardiovascular disease

27
Q

Define End Stage Chronic kidney disease

A

Less than 10% of renal function remains and dialysis or kidney transplant is required to sustain life

28
Q

How does End Stage Chronic kidney disease come about?

A

Nephrons destroyed while some hypertrophy. Excess solute load causes the remaining nephrons to be injured leading to uraemia

29
Q

What happens in the Stages of Chronic kidney disease?

A

GFR decreases while plasma Creatinine and Urea increase

30
Q

Hyperkalaemia

A

When potassium rises over 5mmol/L

There is a GFR decrease too

31
Q

Paediatrics: Enuresis

A

Involuntary passage of urine by a child who is beyond 4–5 years old

32
Q

Paediatrics: Nephroblastoma or Wilms’ tumour

A

Embryonal tumour of the kidney due to undifferentiated embryonic renal tubule and glomerular cells called metanephric blastemal cells

33
Q

Define Detrusor hyperreflexia

A

Neurological disorder in the pons, micturition centre.

- Uninhibited or reflex bladder

34
Q

Define Flaccid (hypotonic) neurogenic bladder

A

Result from peripheral nerve damage or spinal cord damage at the S2 to S4 level.
• volume is large
• pressure is low
• and contractions are absent

35
Q

Neurogenic bladder: Causes

A 
Stroke
MS
Spinal cord injury
Parkinson disease
Brain tumours

NURS 444 (7 decks)

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