Ch.25 & 27: Renal and Urinary Flashcards by Dhesseny Buenafe

functional unit of the kidney
works 24/7 continously
permeable to water and impermeable to protein or any large particles

nephron

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final concentration of urine is located in

the distal tubule

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What is the primary function of the kidney

to filter electrolytes, filter the waste, and homeostasis
maintain fluid/volume balance
hormones

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where is urine formed?

glomerulus

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how many mL does the kidney filter per minute

125 ml per minute
(250 ml of fluid in bladder- uncomfy)
(500 mL- needa pee)

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Function of the kidney:

production include

renin
erythropoietin
vitamin D

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Function of the kidney:

Regulation and excretion

reg ECF
reg. osmolarity
reg. pH
reg. key ions
excrete waste and toxins

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XXXX-Angiotensin-Aldosterone Mechanism System: BP regulation
Synthesized and stored in juxtaglomerular kidney cells
vital sign: low bp**, hypovolemia, diminished perfusion

renin

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stimulates RBC production, kidneys send the signal. Hypoxia stimulation, by triggering RBC prod in bone marrow. leads to anemia

erythropoietin

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Obtained via diet
Synthesized by UV radiation on cholesterol in skin
Metabolically activated in liver and kidney

activation of vitamin D (aids with calcium absorption)

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Kidneys affect on body:

waste products
bone
regulate blood acidity 
blood pressure
blood production
cardiac activity (potassium balance)

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General examination of urine to establish a tentative diagnosis and determine whether further studies are to be ordered
Normal urine is clear, amber-colored fluid (no protein)

urinalysis

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Ability of the kidney to filter and reabsorb and/or secrete substances in the blood.

Renal creatinine

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Importance of protein

building/repairing muscle
immunity
blood clotting
if loss- third spacing

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helps to visualize the kidneys, IV contrast (iodine) - allergy* do not wear any metal

MRI

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Failure to store urine

Incontinence

Splastic bladder dysfunction

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Failure to completely empty bladder

Urinary retention

flaccid bladder dysfunction

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Causes of urinary obstruction with stasis or retention of urine include

Congenital

Acquired: BPH, Calculi, Tumors, scar tissue, spinal cord injury, enlarged prostate, and pregnancy

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Major sites and causes of urinary obstruction:

fibrous band 
dysplasia
prostate hypertrophy
stenosis
polycystic kidney

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increases with age
Hesitancy  (dribbling, weak urinary stream)
Frequency
Urgency
Dysuria Nocturia
Hematuria
Urinary retention
Enlarged prostate
Not infection-related

Benign Prostatic Hypertrophy

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Inflammation of prostate
Prostate can be enlarged
Caused by infection
Curable in many patients
May experience pain with urination, ejaculations
May have constant pain related to inflammation
Can by asymptomatic

prostatitis

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Crystalline structures that form from components of the urine

Nephrolithiasis-kidney stones

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a general term referring to stones anywhere in the urinary tract, ureter, bladder, or urethra.

Urolithiasis-urinary stones

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Causes of kidney/urinary stones:

Obstruction and urinary stasis
Hypercalcemia
Dehydration
Immobility

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Clinical Manifestations of renal/ ureteral calculi

. Severe pain: depends on location of stone 2. Diaphoresis 3. Nausea/vomiting 4. Fever 5. Chills 6. Hematuria,WBCs in urine

``` Pain: Acute Extreme pain Colicky pain Location: Flank, radiating to groin ```

Renal colic

Pain: Acute Intermittent excruciating pain Flank and upper outer quadrant of abdomen Men: May radiate to lower abdominal-bladder area and scrotum

Ureter colic

Types of incontinence: | cough, laugh, dribble urine, lose of muscle tone- strength

stress incontinence

Types of incontinence: | bladder oversensitivity from infection, neurologic

urge incontinence

Types of incontinence: | bladder fills up, cannot get emptied, leaks out

overflow

ELDERLY URINARY INCONTINENCE:

``` Dementia Infection Aatrophy Pharmaceutical Psychologic Excessive excretion Restrict mobility Stool impaction ```

Lower urinary tract

cystitis

upper urinary tract

pyelonephritis

special uti considerations include

sexually active women pregnant women diabetics age-related

Anatomic obstructions- UTI associated with stasis of urine flow

Urinary tract stones Prostatic hyperplasia Pregnancy Malformations of the ureterovesical junction

Functional obstructions - UTI associated with stasis of urine flow

``` Neurogenic bladder Infrequent voiding Detrusor (bladder) muscle instability Constipation Increased pressure resulting in reflux ```

Most common causes of UTI related to bacteria that enter the urethra:

``` Escherichia coli AKA: E. coli Main causative organism Staphylococcus aureus Enterobacter ```

urine bladder into the kidney

vesicouretreral reflux

``` Associated signs/symptoms: Urgency, frequency, dysuria, lower abdominal or back discomfort. Occasionally cloudy and foul- smelling urine. Fever may or may not be present B. Diagnosis: 1. Inflammation of bladder 2. Predisposing factors: a. Females more prone b. Catheterization ```

cystitis

Pathogenesis of urinary tract infection

``` colonization uroepithelium penetration ascension pyelonephritis acute kidney injury ```

Upper urinary tract Inflammation of kidney medulla, parenchyma, & renal pelvis, affecting tubules Responds well to 2 weeks of organism-specific antibiotic therapy

Acute Pyelonephritis

Persistent or recurrent infection of the kidney by the same organism associated with resulting inflammation and scarring of the kidney: Reflux Structural abnormalities. Impairs the function of the kidneys and can lead to Chronic Kidney Disease

Chronic pyelonephritis

Clinical manifestations of pyelonephritis:

``` abrupt shaking mod-high fever ache in loin malaise CVA tenderness bacteria and WBC in urine- uti symptomes nausea and vomitting ```

Bladder inflammation E. coli, staph aureus, Enterobacter, Klebsiella Bacterial contamination by vaginal secretions, sexual intercourse, close proximity to anus, neurogenic bladder, urinary catheters, prostatic hypertrophy, reflux Frequency, urgency, burning w/urination, suprapubic & low back pain Hematuria & cloudy urine (serious), foul odor

cystitis

Inflammation of the kidney, medulla, parenchyma, & renal pelvis E. coli, proteus, pseudomonas, fungi Vesicoureteral reflux, vaginal secretions, kidney stones, neurogenic bladder, urinary catheters, sexual intercourse Fever, chills, flank pain, WBCs in medulla, renal inflammation, renal inflammation, edema, purulent urine (foul odor), poss. hypertension Urinalysis, urine culture, CBC

pyelonephritis

Fluid filled cavities in the kidney Cysts may be single or multiple Mostly inherited, but may be acquired later in life Autosomal dominant most common inherited kidney disease May cause kidney failure

cystic kidney disease

Complete failure of organ to develop Bilateral agenesis = incompatible with extrauterine life Unilateral agenesis = compatible w/life if no other abnormalities

renal agenesis

Small kidneys Less than normal # of calyces and nephrons Can be unilateral or bilateral Bilateral involvement progresses to renal failure History of polyuria and polydipsia

renal hypoplasia

Multidifferentiated primitive structures, primarily renal tubules Can affect all or part of kidney Palpable mass early in childhood Risk of neoplasms Annual follow-ups for BP, check for kidney function

renal dysplasia

RENAL TUMORS: Benign Predisposition for malignancy

renal adenoma

RENAL TUMORS: Most common renal neoplasm Classified according to cell type, extent of metastasis

renal cell carcinoma

RENAL TUMORS: Rare Usually males, 50-60 years old Risks: smoking, obesity, uncontrolled hypertension

renal transitional cell carcinoma

BLADDER TUMORS:

``` 5th most common malignancy >male 60 years risk smoking, aromatic mines metastasis to lymph nodes, live, bones, or lungs gross painless hematuria ```

most common bladder malignancy

transitional cell carcinoma

the amount of blood filtered each minute in the glomerulus

GFR

Glomerular injury causes

Infectious microorganisms Immunologic mechanisms Environmental agents Drugs

``` Causes: Systemic diseases (diabetes, lupus) ``` Damaged glomeruli 3+ grams of protein in 24 hours leaks into urine Signs/Symptoms: Weight gain, edema, fatigue, foamy urine, loss of appetite

nephrotic syndrome

Symptoms of nephrotic syndrome include

proteinuria hyperlipidemia hypoalbuminemia

Characteristic Manifestations of Nephrotic Syndrome

``` Edema Ascites Massive proteinuria Hypertension Hyperlipidemia Hypoalbuminemia Foamy urine ```

Encompasses several glomerular diseases Progressive, leading to chronic kidney failure Primary cause may be difficult to establish Secondary causes DM Lupus erythematosus Renal insufficiency nephrotic syndrome accelerated progression ESRD

Chronic Glomerulonephritis