Exam 2 Flashcards
Glomerular filtration rate
Range from 125 mL/min to 200 mL/min
Specific Gravity:
measures the degree of concentration of the urine
1.010-1.025
Urine Osmolality
Number of solute particles in kilograms of water
250-900 mOsm/kg/24hr, 50-1200 mOsm/kg random sample
24-hour urine provide osmolality and creatinine clearance
Waste the first specimen, then collect every void in specified container for 24 hours on ice. Generally started first thing in the AM
BUN
10-20 mg/dL
Created by the breakdown of protein in the liver
May be elevated in dehydration, infection, chemotherapy and steroid therapy
Creatine
0.7-1.4 mg/dL
Results from protein and muscle breakdown
Specific to kidney disease or dysfunction
Bethanechol
Cholinergic Agonists/
Parasympatho-
Mimetics
increase rest and digest
Urinary Stimulant
Indications: Acute postoperative and postpartum non-obstructive (functional) urinary retention
-Neurogenic atony of the urinary bladder with urine retention
Affects: CNS: Seizures
CV: Bradycardia, profound hypotension
GI: Excessive salivation, belching, borborygmus
GU: Urinary urgency
Oxybutynin
Tolterodine
Fight or flight
Urinary Antispasmodics
Indications: Overactive bladder
- Bladder spasms related to neurogenic bladder
Affects: CNS: restlessness, dizziness
CV: Tachycardia, palpitations
GI: Dry mouth, constipation, thirst
Stages of Chronic Kidney Disease
GFR
Stages based on GFR (Normal 125 mL/min)
**Stage 1: Minimal kidney damage: GFR> 90 mL/min
Stage 2: Mild kidney injury: GFR 60-89 mL/min
Stage 3: Moderate Kidney Injury: GFR 30-59 mL/min
Stage 4: Severe kidney damage: GFR 15-29 mL/min
**Stage 5: Kidney failure and end stage renal disease (ESRD) with little or no GFR: Less than 15 mL/min
Acute Kidney Injury
know creatine levels
Stage 1 (risk stage): Serum creatinine 1.5 times baseline and. UO less than 0.5 mL/kg/hr for 6 or more hours
Stage 2 (Injury stage): Serum creatinine 2 times baseline and UO less than 0.5 mL/kg/hr for 12 hours or more
Stage 3 (Failure stage): Serum creatinine 3 times baseline and UO less than 0.3 mL/kg/hr for 12 hours or more
Stage 4 (Loss stage): Persistent AKI- complete loss of kidney function > 4 weeks
Stage 5 (End stage renal disease): ESRD > 3 months
The bladder can hold
400-500 ml of fluid.
Micturition
Voiding or Urinating
3 Steps for Urine formation in the nephrons
1) Filtration at glomerulus
2) Absorption into peritubular capillaries
3) Reabsorption into tubule for excretion in urine.
Diuresis
Increased urine volume
Specific Gravity
indicates an inability to concentrate and dilute the urine.
Normal Range: 1.010 to 1.025
Antidiuretic Hormone (ADH) aka Vasopressin
Hormone secreted by the pituitary gland in response to changes in osmolality of the blood.
*decreased water intake causes ADH to tell the kidneys to increase reabsorption of water to return osmolality back to normal.
* increase water intake suppresses AHD so less water can be absorbed and you urinate.
Normal Blood pH
7.35-7.45
Renal clearance
the ability of the kidneys to clear solutes from the plasma.
* 24 hour urine collection is the test is used. It evaluates how well the kidney perform its excretory function
Creatine
Normal Range: 0.7-1.3
a waste product of skeletal muscle that is filtered at the glomerulus and excreted through urine.
* used to measure GFR
* 24 hour urine is collected. Midway through the collection, the serum creatine level is measured.
Erythropoietin
glycoprotein from the kidney that stimulates the bone marrow to produce RBCs, which carry oxygen throughout the body
- it is released when the kidneys detect a decrease in oxygen in renal blood flow.
Functions of the Kidney
-Control of blood pressure
-Control of water balance
-Excretion of waste products
-Regulation of electrolytes
-Regulation of acid–base balance
-Regulation of red blood cell production
-Renal clearance
-Secretion of prostaglandins
-Synthesis of vitamin D to active form
-Urine formation
Chronic Kidney Disease (CKD)
kidney damage or a decrease in GFR lasting for 3 months or more.
*Final stage is end stage renal disease (ESRD)
Nephrosclerosis
(hardening of the renal arteries)
Two Types: Acute hypertensive and benign
Patho: Damage is caused by decreased blood flow to the kidney resulting in patchy necrosis of the renal parenchyma. Over time, fibrosis occurs and glomeruli are destroyed
Risk Factors: Prolonged hypertension, diabetes, aging, higher in African Americans
Medical management: antihypertensive therapy, ACE inhibitors
Labs: elevated BUN and creatine. Mild proteinuria
Primary Glomerular Diseases
Two Categories: Glomerulonephritis and glomerulosclerosis
Primary: in the kidney’s glomeruli
Secondary: glomerular disease due to systemic diseases, like diabetes or lupus.
Acute Nephritic Syndrome
* a type of glomerulonephritis
hematuria due to glomerular bleeding is seen as well as pus and cellular and granular casts in the urine.
Usually from post infection. Medications or antigen get deposited in the glomerli, increse the number of epithelial cells lining the glomerulus, causing leukocytes to infiltrate, to thickening and scarring, to lastly a decresed GFR.
Clinical Manfestations: hematuria, edema, azotemia (an abnormal concentration of nitrogenous wastes in the blood), and proteinuria. Edema and Hypertension
Nephrotic Syndrome
increased glomerular permeability and is manifested by massive PROTIENURIA
Clinical Manifest: EDEMA. puffy eyelids and swelling in the legs, ankles, feet, lower abdomen, or other parts of your body. White foamy urine with WBC in it.
Medical Manage: Treat the underlying disease causing proteinuria. Diuretics (edema), ACE inhibitors (reduce protien uria), lipid reducing agents, and sodium restriction
Polycystic Kidney Disease (Peds)
*cysts in the kidneys, which destroy the nephrons
- Genetic Disease
- no cure
- Tolvaptan slows the decrease in kidney function
Huntington Disease
- A chronic progressive hereditary disease that results in choreiform movement and dementia
- Transmitted as an autosomal dominant trait
- Pathology involves premature death of cells in the striatum of the basal ganglia (control of movement) and the cortex (thinking, memory, perception, judgment)
Parkinson’s Disease
*Slow, progressive neurologic movement disorder associated with decreased levels of dopamine
Manifestations:
- Cardinal: tremor (Pill-rolling tremor), rigidity, bradykinesia/akinesia, postural instability
- Autonomic: sweating, drooling, flushing, orthostatic hypotension, gastric and urinary retention
- Dysphagia
- Psychiatric changes: depression, anxiety, dementia, delirium, hallucinations
Treatment: control symptoms and maintain functional independence.
- LEVADOPA, Stereotactic Procedures; thalamotomy, pallidotomy
- Neural Transplant has ongoing research.
Pyelonephritis
Bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys.
Urinary Incontinence
unplanned, involuntary, or uncontrolled loss of urine from the bladder.
cystitis
inflammation of the bladder
prostatitis
inflammation of the prostate gland
urethritis
inflammation of the urethra
Ureterovesical or Vesicoureteral Reflux
refers to the backward flow of urine form the bladder into one or both ureters.
- the urine backflow can bring bacteria from the ureters, which can cause a UTI. If bacteria gets to the kidney’s it can cause damage
Signs and symptoms if UTI
- burning
- increased frequency
- nocturia
- incontinence
- suprapubic or pelvic pain
- sepsis. urosepsis (spread of infection from the urinary tract to the bloodstream)
- shock
Neurogenic Bladder
dysfunctional bladder
6 types of urinary incontinence
- Stress incontinence
- Urge incontinence
- Functional incontinence (physical or cognitive impairment)
- Iatrogenic incontinence (medical, factors like medications)
- Mixed incontinence (multiple reasons)
- overflow incontinence
Neurogenic Bladder
dysfunction that results from a disorder or dysfunction of the nervous system. this leads to incontinence.
Two Types: SPASTIC (loss of conscious sensation and cerebral motor control) and FLACCID (bladder muscles do not contract and overflows)
Nephrotic Syndrome
Scarring but it has a lot of inflammation and protein in the urine compared to
4 triggers of nephrotic syndrome
- smoking
- stress
- sickness or sepsis
- sun
Glomerulonephritis
inflammation of the kidney.
causes STREP
4 no’s of polynephritis
- no douching
- no spermicidal contraceptive
- no bubble baths
- no wiping back to front
After shock wave lithotripsy to remove kidney stones what two findings are not normal
fever and chills.
