Chp 7 Urinary System Flashcards
waste products generated as end product in PROTEIN metabolism
nitrogenous waste
types of nitrogenous waste
urea, creatinine, uric acid
4 functions of the kidney are
- Filter nitrogenous waste to form urine
- maintain water balance
- release hormones (3)
- degrade and eliminate hormones from bloodstream
enzymatic hormone important in adjusting blood pressure
Renin
hormone that stimulates RBC production in the bone marrow
Erythropoetin
active form of vitamin D necessary for the absorption of calcium from the intestines
Calciferol
where does blood enter through the kidney?
Right or Left Renal Artery
What carries the blood to the capillaries in the kidney?
Arterioles
what filters the blood in the kidney
glomeruli
How kidneys produce urine in detail (include glomeruli, Bowman’s capsule and renal tubule)
- Blood passes through glomeruli
- Glomerular (Bowman’s) Capsule surrounds each glomerulus
- Renal tubule attached to each Capsule
3 basic steps in urine formation
Glomerular Filtration, Tubular Reabsorption, Tubular Secretion
the glomerulus and a renal tubule form a unit called
a nephron
all collecting tubules lead to the
renal pelvis
small, cup-like regions of the renal pelvis
calyces or calices
meatus means
opening or canal
trigone
triangular area in the urinary bladder
tests included in a urinalysis (10)
- Color
- Appearance
- pH
- specific gravity
- protein
- glucose
- ketone bodies
- sediment
- phenylketonuria
- bilirubin
Female pt complains of urgency, dysuria, low back pain and has a low grade fever. What test do you want for this patient? what do you think is wrong with the pt?
Urine Culture
Cystitis
What would the urine culture show in a positive cystitis case?
WBC’S, bacteria, positive leukocyte esterase, positive nitrites
How do you treat Cystitis? (UTI)
Antibiotics
What is the Gold standard in diagnosis of a urine culture but is not often done?
catheter, suprapubic tap
inflammation of the kidney glomerulus, usually in response to an infection
Glomerulonephritis
what infection is found most commonly in Glomerulonephritis?
Streptococcal
What is a risk to having Glomerulonephritis?
Damage of the renal glomerulus, can develop a chronic condition
A pt has complaints of peripheral and periorbital edema, dark urine, HTN, and their urinalysis shows hematuria, red cell cats, and proteinuria. What is their Dx?
Glomerulonephritis
Tx of Glomerulonephritis
decrease salt, restrict protein, avoid high potassium foods. (more severe cases include dialysis or transplant)
A pt complains of dysuria, increased frequency of urination in small amounts, urgency, skin rash and lab testing shows eosinophils in blood and the urine culture appears sterile. what is the dx?
interstitial nephritis
inflammation of the renal interstitum
interstitial nephritis
what is the renal interstitum?
CT that lies between the renal tubules
cause of interstitial nephritis?
reaction to medication, connective tissue disorder
how do you definitively diagnose interstitial nephritis?
renal biopsy
Tx interstitial nephritis
corticosteroids
a condition relating to the presence of stones in the urinary tract
nephrolithiasis (kidney stones)
what are kidney stones made of?
uric acid and calcium build up
when can nephrolithiasis cause a problem (or pain?)
they are formed in proximal tract. As migrating distally they can become lodged in areas of the ureter.
higher incidence of nephrolithiasis in (men/women) and what area of the USA?
men, “stone belt” = southeastern USA
a patient comes to you complaining of renal colic, N/V, chills, abd tenderness and they have tachycardia and are diaphoretic and experiencing urinary frequency. They say this pain is 10/10. Dx?
Kidney stones
Tx of nephrolithiasis?
pain control, hydrate, ESWL, Cystoscopy
A pt has high urine protein excretion, peripheral edema, hypoelbuminemia, hypercholeterolemia, ascites, and has experienced significant weight gain. Dx?
nephrotic syndrome
groups of symptoms caused by excessive protein loss in the urine
nephrotic syndrome (nephrosis)
Tx nephrotic syndrome?
lasix, ACE inhibitors
what do ace inhibitors do?
decrease proteinuria
an inherited disorder caused by the growth and development of cysts in the kidneys. Sometimes seen in end stage renal disease
Polycystic Kidney Disease
What are the S/S for Polycystic Kidney Disease?
Asymptomatic until adulthood (HTN, palpable kidneys, abd/flank pain, hepatomegaly)
50% of people with PKD will progress to
renal failure
infection of the pyelo-calyceal system
pyelonephritis
characterized as back/flank pain combided with system symptoms (fever, chills) and can progress into septic shock
pyelonephritis
will have leukocytic casts and recurrent infections cause scarring on kidney tissue
pyelonephritis
a pt walks into the ER with a fever, bilateral pain in the lumbar flank area, anorexia and suprapubic discomfort. What is your dx? what do you use to to dx this?
pyelonephritis, Renal sonogram, Contract enhanced CT
hypernephroma, cancerous tumor of the kidney in adulthood
renal cell carcinoma
most common type of renal cell carcinoma is
adenocarcinoma
risk factors for renal cell carcinoma
smoking, obesity, use of diuretics, asbestos
where does renal cell carcinoma commonly metastasize?
bone
tx for renal cell carcinoma
nephrectomy
pt comes in with peripheral edema, skin pallor, ecchymosis, oliguria, delirium, and back pain and after testing you see that the patients kidneys are no longer excreting urine correctly. What is your dx?
renal failure
failure of the kidney to excrete urine, can be acute or chronic
renal failure
3 types of renal failure
prerenal, postrenal, intrinsic
prerenal failure (how does it work and what type of patients would you see this in?)
inadequate perfusions, hypovolemia, low BP, CHF, cirrhosis, sepsis
postrenal failure (how does it work and what type of patients would you see this in?)
outlet obstruction, ureteral obstruction (kidney stones) and renal vein occulsion
intrinsic renal failure
direct damage to kidneys glomerulonephritis, ATN, drug toxicity, contrast nephropathy
high blood pressure from kidney disease
renal HTN
two types of renal HTN
Renovascular HTN, fibromuscular Dysplasia
what is the most common cause of secondary HTN?
renal HTN
cause of HTN is not known =
essential HTN
malignant kidney tumor in childhood, pretty common.
Wilm’s tumor
tx wilms tumor
surgery, radiation, chemo
Wilms tumor pt presentation
abd mass, hematuria, pain
2nd most common genitourinary CA in adults, occur most commonly in adults over ___
bladder CA, 60
is bladder CA more common in men/women?
men
what can increase your risk for bladder CA?
smoking, occupational exposures
pt presentation with bladder CA
painless gross hematuria
how does bladder CA work?
transitional cells lining the bladder undergo changes that cause disease. level of transitional cell invasion = severity of CA
most common type of bladder CA
transitional cell carcinoma
male pt presents with painless gross hematuria and irritative urination symptoms. What must you rule out?
Bladder CA
Dx of bladder CA
urine test, cytology, Intravenous pyelogram, cystoscopy, biopsy, transurthreal resection
Tx Bladder CA
chemo, cystectomy, radiation
gold standard for Dx of Bladder CA
cystoscopy
inadequate secretion or resistance of kdiney to the action of ADH
diabetes insipidus
S/S in DI
polyuria/polydipsia
Tx DI
DDVAP desmopression acetate, nasal spray
inadequate secretion or improper use of insulin
Diabetes Mellitus
leading cause of end stage renal disease (ESRD)
DM
glycosuria, hyperglycemia, polyuria, and microalbuminuria are all S/S in
DM
BUN
blood urea nitrogen
what is a BUN test used for?
evaluate kidney function under wide range of circumstances and to monitor pt with acute or chronic kidney dysfunction or failure
what does BUN measure?
urea levels in blood
measures the rate at which creatinine is cleared from the body by the kidney
creatinine clearance test
protein produced by the cells in your body, levels elevate when kidney is not working
Cystatin C
what test helps evaluate glomerular filtration rate
Cystatin C
CT of the urinary tract
CT Urography
is CT urography done with or without contrast
either
indications of CT urography
hematuria, urothelial mass, hydronephrosis, malignancy
what is unqiue about CT urography?
gives both anatomical and functional information
KUB
kidney, ureters, bladder
the flat plate of the abd is known as
KUB
what does KUB detect
radiopaque kidney stones
x ray study used to study arteries
angiogram
placing a small tube into the arterial system to advance near the kdineys and assess function after injecting contrast
renal angiography
if renal artieries are constricted what is done to fix it?
renal angioplasty
contrast injected directly into opening from ureter to bladder to locate kidney stones or abnormalities
retrograde pyelogram (RP)
what does retrograde pyelogram eliminate the risk of?
allergic reaction to contrast
what does a retrograde pyelogram need in order to be completed on a patient?
general anesthesia
test to measure bladder function where pt voids radiopaque dye while under X ray
Voiding Cystourethrogram (VCUG)
uses high frequency sound waves to visualize the kidneys and any possible abnormality
Ultrasound
image of hte kdiney after injecting a radioactive substance into the bloodstream
radioisotope scan
what does a radioisotope scan help determine (3)
- size of blood vessel
- kidney function
- diagnose obstruction
renal scan measures
size and shape
renogram measures
function
done to evaluate kidney wihtout using radiation
MRI urography
what types of patients would use a MRI urography?
children, pregnant pts
telescope is inserted into the bladder and urethra to help diagnose conditions
cystoscopy
two types of cystoscopes are
rigid, flexible
tell me about the rigid cystoscope
solid, straight telescope. has a separate channel to allow other instruments through
tell me about the flexible cystoscope
fiberoptic, can bend easy and has a maneuverable tip that makes it easy to pass along the curves of the urethra
process of filtering nitrogenous waste from blood
dialysis
two types of dialysis
hemodialysis, peritoneal dialysis
which type of dialysis is more common
hemodialysis
uses sound waves to break kidney stones so they can pass more easily
extracorporeal shockwave lithotripsy (ESWL)
to remove kidney tissue for evaluation
renal biopsy
what are the 3 main ways to perform a renal biopsy?
US guided, CT scan guided, Trans-jugular
transplant of a kidney into a pt with ESRD
renal transplatation
what are the best type of kidney donors?
living, related donors
do you take out the bad kidneys during a transplant
no
is the new transplanted kidney in the same area as the bad kidneys?
no in an inferior position to the bad kidneys
suprapubic catheter is placed where
through abd and into bladder
