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NURS 320 > Exam 2: Renal Disorders And Drugs > Flashcards

Exam 2: Renal Disorders And Drugs Flashcards

1
Q

Kidneys regulate:

A

Fluid Volume
Electrolytes
Acid-Base Balance

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2
Q

What do kidneys secrete?

A

Renin
Erythropoietin
Calcitrol

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3
Q

Renin

A

For blood-pressure regulation

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4
Q

Erythropoietin

A

To stimulate blood-cell production

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5
Q

Calcitrol

A

Active form of vitamin D for bone homeostasis

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6
Q

The urinary system consists of

A

Two kidneys
Two ureters
One bladder
One urethra

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7
Q

Nephron

A

Function unit of the kidney - form final urine product

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8
Q

How is urine formed?

A
  1. Blood enters nephron and is filtered through Bowman’s capsule.
  2. Fluid is called filtrate which passes through the loop of Henle then to distal tubule.
  3. Filtrate emptied into collecting ducts and leaves nephron as urine.
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9
Q

Functions of the Nephron

A
  1. Filters plasma at glomerulus
  2. Reabsorption and secretes different substances along tubular structures
  3. Forms a filtrate of protein-free fluid
  4. Regulates the filtrate to maintain body fluid volume, electrolyte composition and pH
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10
Q

Glomerulus

A

Tuft of capillaries that loop into Bowman’s capsule.

Forms primary urine.

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11
Q

Glomerular filtration membrane

A

Filters blood

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12
Q

Decrease in GFR can be caused by

A
  1. Obstruction to the outflow of urine (strictures, stones, or tumors)
  2. Excessive loss of fluid (vomiting, diarrhea, diuretics, excessive sweating)
  3. Renal disease (altering capillary permeability and the surface areas available for filtration)
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13
Q

What race has higher GFR than other races?

A

African Americans

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14
Q

Renal Functions include

A
  1. Estimated Glomerular Filtration Rate (eGFR)
  2. Plasma Creatine
  3. Blood Urea Nitrogen
  4. Potassium (Serum)
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15
Q

Estimated Glomerular Filtration Rate

A

Best estimate of functioning renal tissue.

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16
Q

Loss or damage to nephrons leads to

A

Decreased GFR: measures creatinine clearance by tubules.

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17
Q

When GFR decreases, what happens to plasma creatinine?

A

It increases.

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18
Q

Plasma Creatinine

A

Most valuable monitoring AKI and CKD.

Take s7-10 days to stabilize.

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19
Q

What happens to BUN when GFR decreases?

A

It increases

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20
Q

Blood Urea Nitrogen can increase in

A

Dehydration

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21
Q

Potassium (serum)

A

Elevated in renal failure

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22
Q

Glomerular Disorders

A

Affects kidney function by attacking the glomeruli (where blood is cleaned)

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23
Q

Two Major Glomerular Disorders

A
  1. Glomerulonephritis

2. Glomerulosclerosis

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24
Q

Glomerulonephritis

A

A group of diseases that injure the part of the kidney that filters blood (glomeruli)

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25
Q

Glomerulosclerosis

A

Scarring or hardening of the tiny blood vessels within the kidney

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26
Q

What diseases can cause glomerular disorders?

A
  • Acute post-streptococcal glomerulonephritis
  • Bacterial endocarditis
  • Diabetes: diabetic neuropathy
  • Systemic Lupus Erythematosus (SLE)
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27
Q

Bacterial endocarditis

A

Infection of tissues in the heart

28
Q

Signs and Symptoms of Glomerular Disorders

A
  • Albuminuria (large amounts of protein in urine)
  • Hematuria
  • Decreased GFR (inefficient filtering of wastes from the blood)
  • Hypoproteinuria (low blood protein)
  • Edema
29
Q

When the kidney is injured

A

It cannot get rid of wastes and extra fluid in the body

30
Q

Glomerulonephritis is the most common cause of

A

Chronic and end-stage renal failure

31
Q

Acute Glomerulonephritis: S&S

A
  • Infection in throat or on skin
  • Puffiness of face in the morning
  • Blood in urine (or brown urine)
  • Urinating less than usual
  • SOB and cough (caused by extra fluid in lungs)
32
Q

Chronic Glomerulonephritis: S&S

A
  • May develop without symptoms over several years. Often leads to complete kidney failure
  • Hematuria and proteinuria
  • High blood pressure
  • Edema
  • Frequent urination at night (nocturia)
  • Very bubbly or foamy urine
  • Lack of appetite
  • N/V
  • Fatigue
  • Difficulty sleeping
  • Dry/itchy skin
  • Nighttime muscle cramps
33
Q

Clinical Manifestations of Glomerulonephritis

A
  • Urinalysis will reveal proteinuria and hematuria
  • Decreased urine output accompanies decreased estimated glomerular filtration rate (eGFR)
  • Fluid retention…edema and high blood pressure
34
Q

Treatment for Glomerulonephritis

A
  • Antibiotics (management of infections)
  • Corticosteroids (suppress inflammatory responses)
  • Correcting accompanying problems such as edema and HTN
35
Q

Nephrotic Syndrome

A

More common in children than adults.
AKA nephrosis.
Happens when the kidneys start losing large amounts of protein in urine.

36
Q

Nephrotic Syndrome includes an excretion of

A

3.5 g or more of protein in the urine per day. (Protein excretion is caused by glomerular injury)

37
Q

Secondary forms of nephrotic syndrome include

A 
Diabetes
Lupus
Infections
Malignancies
Vascular Disorders
38
Q

Nephrotic Syndrome: Pathophysiology

A

-Disturbance in glomerular basement membrane -> increases permeability of protein and loss of electrical negative charge -> hyperalbuminemia (d/t urinary loss of albumin and diminished synthesis of replacement albumin in the liver)

39
Q

Clinical Manifestations of Nephrotic Syndrome

A 
Hypoalbuminemia
Edema
Hyperlipidemia
Proteinuria
Vitamin D Deficiency
40
Q

Nephrotic Syndrome: Evaluation

A
  • Diagnosed when the protein level is greater than 3.5 g in 24 hour period.
  • Low serum albumin
  • Increase in serum cholesterol, phospholipids and triglycerides
  • Biopsy needed for specific pathology.
41
Q

Nephrotic Syndrome: Treatment

A

Normal Protein Diet (1g/kg/day)
Low fat, Low salt diet
Treat HTN and Edema (Diuretics, CCB, ACEI or ARBs, corticosteroids)

42
Q

Renal Failure

A

Decrease in the kidney’s ability to function.

43
Q

What should you take into consideration when giving drugs to patients with renal failure?

A
  • Drugs can accumulate in high levels.
  • Medication dosages need to be adjusted.
  • Administering average doses to a person in renal failure can be fatal.
44
Q

How is Renal Failure Diagnosed?

A
  • Urinalysis
  • Serum creatinine and estimate glomerular filtration rate
  • Diagnostic imaging: US, CT, MRI
  • Renal biopsy
45
Q

Urinalysis in Renal Failure

A

Primary measures of structural kidney damage -> proteinuria and albuminuria.

46
Q

Renal Failure Diagnosis: eGFR

A

Best marker for estimating renal function.

Measures volume of water filtered per minute through Bowman’s capsule

47
Q

Acute Renal Failure or Acute Kidney Injury

A

Sudden decline in kidney function.
Decrease GFR.
Accumulation of waste products in blood.

48
Q

Pretense acute renal failure can cause

A
  • Most common cause of ARF.
  • Decreased renal function with increased BUN and creatinine. (Caused by impaired renal blood flow)
  • GFR declines (d/t decrease in filtration pressure)
49
Q

Causes of prerenal ARF

A 
Hypovolemia
Hypotension
Shock
Hemorrhage
MI with poor cardiac output
Left ventricular failure
50
Q

Intrarenal acute renal failure

A

Caused by impaired blood flow within the kidney.

51
Q

Intrarenal acute renal failure is a result of

A

Direct damage to the kidney including ischemia or inflammatory damage.

52
Q

What is the most common cause of intrarenal renal failure?

A

Acute tubular necrosis

53
Q

What are other causes of intrarenal acute renal failure?

A

Glomerulonephritis
Malignant HTN
Disseminated intravascular coagulation (DIC)
Renal vasculitis

54
Q

Disseminated intravascular coagulation (DIC)

A

condition affecting the blood’s ability to clot and stop bleeding

55
Q

Postrenal Acute Renal Failure

A

Caused by impaired outflow from the kidney.

Urine is unable to pass d/t obstruction (urine backs up into renal pelvis and changing pressures within kidney)

56
Q

Causes of Postrenal acute renal failure include

A

Kidney stones
Bladder outlet obstruction
Enlarged prostate

57
Q

Acute Renal Failure or Acute Kidney Injury: Evaluation

A

Diagnosis r/t cause of the disease.

Ex. Hx of surgery, trauma, CVD, exposure to nephrotoxins and obstruction.

58
Q

Acute Renal Failure or Acute Kidney Injury: Treatment

A
  • Treat underlying cause and prevention of AKI
  • Maintain life until renal function has recovered. (Correcting F&E disturbances such as hyperkalemia, hyperphosphatemia and hypermagnesemia)
  • Treat infections
  • Maintain nutrition
  • Remembering that drugs and metabolites are not excreted.
59
Q

Chronic Renal Failure aka Chronic Kidney Disease

A
  • The irreversible loss of renal function that affects nearly all organ systems.
  • Includes conditions that damage kidneys and decrease their ability to keep you healthy.
60
Q

What is the major cause of death for all people with CKD?

A

Heart disease

61
Q

What is the best estimate of kidney function?

A

GFR

62
Q

How is HTN related to CKD?

A

HTN causes CKD and CKD causes HTN

63
Q

Persistent proteinuria indicates that what disease is present?

A

CKD is present

64
Q

High risk groups for CKD includes those with

A

Diabetes
HTN
Family Hx of kidney failure

65
Q

What are other conditions that can lead to chronic renal failure?

A
  • Glomerulonephritis
  • Polycystic kidney disease – large cysts that form in the kidneys and damage surrounding tissue
  • Malformations – narrowing of ureter that prevents normal outflow of urine
  • Diseases that affect the body’s immune system – SLE
  • Obstructions caused by problems like kidney stones, tumors, or an enlarge prostate gland in men
  • Repeated urinary infections
66
Q

Symptoms of CKD include

A
  • Fatigue
  • Trouble concentrating
  • Poor appetite
  • Trouble sleeping
  • Muscle cramps at night
  • Swollen feet/ankles
  • Puffiness around eyes especially in the morning
  • Dry/itchy skin
  • Need to urinate more often especially at night

NURS 320 (28 decks)

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