Exam 3 - Alterations In Renal And Urinary Tract Function Flashcards
1
Q
What does MAP stand for?
A
Mean Arterial Pressure
2
Q
How is MAP calculated?
A
From blood pressure
3
Q
How much Cardiac Output is in the kidneys?
A
25% or 12,000 mL/min
4
Q
What measurement should MAP be at for blood to properly diffuse the kidneys?
A
70-90 mmHg
5
Q
What does a MAP of <70 mean?
A
MAP is too low for blood to diffuse the kidneys, and pt will not have have enough urinary output
6
Q
What does a MAP >90 mean?
A
Pt has high blood pressure
7
Q
What is glomerular filtration rate (GFR)?
A
How much the glomerular cells filter in one minute, in order for adequate reabsorption and waste removal
8
Q
What measurement should the GFR be?
A
80-125 mL/min
9
Q
If pt has a GFR of 80-125 mL/min, how much filtrate would they have per day?
A
180 L
10
Q
What is filtrate?
A
Waste and reabsorption from the kidneys
11
Q
How much GFR is in the tubules?
A
99%
12
Q
Why is it important to know that a majority of GFR is in the tubules
A
All renal drugs act in the tubules
13
Q
How much should normal kidneys produce each hour?
A
At least 30 ml/hr
14
Q
What is a normal urine output?
A
0.5-1 mL/kg
15
Q
How much urine output is normal per hour?
A
30-60 mL/hour
16
Q
When should you add fluids for your pt?
A
If their urine output is 29 mL or less per hour
17
Q
What color should urine be?
A
Amber - yellow
Shouldn’t be bright, unless pt takes multivitamin
18
Q
What should turbidity of urine be?
A
Clear (no sediment)
May be strands of protein
19
Q
What should specific gravity of urine be?
A
1.0-1.02
20
Q
Lab value for normal pH of urine
A
4.6 to 8.0
21
Q
What does it mean if there is blood in pt’s urine?
A
Blood along urinary tract
(If pt is female, could be from menstruation, need to ask pt if they are on cycle. Males should never have blood in urine)
22
Q
What is urinary chemistry checking for?
A
If there is any spill-over (things consumed in excess that body cannot absorb)
23
Q
Why would a pt have ketones in urine?
A
Given off as a result of fat breakdown
Could be from ketogenic diet or diabetes
24
Q
What normal serum values do we look at?
A
BUN
Creatinine
25
Why do we test BUN and creatinine?
To test kidney function
26
How do we test BUN and creatinine?
Through a blood sample, not urine sample
27
What is specific gravity?
The weight of urine (how heavy it is)
28
What does specific gravity represent?
Concentration ability of urine in relation to density of water
29
When is specific gravity of urine high?
When it contains glucose/protein
30
When is specific gravity of urine low?
When it is dilute
31
What does BUN stand for?
Blood
Urea
Nitrogen
32
What is BUN?
A blood test that measures the amount of urea in the blood
33
Where is urea formed?
In the liver
34
What is urea?
The end product of protein metabolism that circulates in the blood and then is removed by the kidneys in urine.
Predominant waste product in blood
35
What does the BUN test tell us?
The metabolic function of liver
| And excretory function of kidneys
36
What is a normal value for BUN?
10-20 mg/dL
37
What would a critical BUN value be?
>100
38
What does a BUN value of >100 indicate?
Serious impairment of renal function (renal failure)
39
What are the two waste products from urine?
BUN & creatinine
40
How is creatinine formed?
From metabolism of creatine
41
What is creatine?
Nitrogenous compounds from metabolism
42
Where is creatinine found?
Blood
Urine
Muscle tissue
43
What do creatinine levels tell us?
Level of kidney function
44
What is the purpose of a Creatinine clearance test?
Measures the rate at which creatinine is cleared from the blood by the kidney
45
Explain the relationship between creatinine and BUN
They go together, if one is up, the other will be too
46
Explain the process for a creatinine clearance test
Collect urine for 24 hours
Red container in lab that stays on ice
Pt needs to call every time they urinate
1st sample is discarded, next is kept
Every time a pt urinates, it is kept for 24 hrs
Have pt void once more at end of 24 hrs, this is kept
47
When is a creatinine clearance test ordered?
If pt has a normal BUN, but a slightly elevated creatinine level
48
What is a hydroureter?
Dilation of ureter due to an accumulation of urine
49
Is hydroureter pre, intra, or post renal?
Post renal
50
What is hydronephrosis?
Dilation of renal pelvis and calyces which results in enlargement of the kidney
51
How can hydronephrosis be detected?
By a KUB
52
Is hydronephrosis pre, intra, or post renal?
Intra renal
53
What is postobstructive dieresis?
Obstruction is cleared, and body is catching up on filtering and restoring fluid and electrolyte balance
54
Is hydroureter pre, intra, or post renal?
Post renal
55
Is compensatory hypertrophy pre, intra, or post renal?
Could be pre or intra
56
Risk factors for kidney stones
Top 2: fluid intake and diet
| Also: age, gender, race, geographic location, seasonal factors, occupation
57
Where is renal calculi usually located?
In ureter, heading to bladder
58
Clinical manifestations of renal calculi
```
Moderate to severe pain
Pain is usually in flank area, and in men radiates to groin
Colic pain
Urinary urgency
Frequent voiding
Urge incontinence
```
59
Types of evaluation for renal calculi (to see where blockage is located)
Stone and UA analysis
Intravenous pyelogram (IVP)
KUB (kidney, ureter, bladder) X-ray
Spiral abdominal CT scan
60
Ways to treat a kidney stone
1- pee it out
2- go in and get it
3- break it up so pt can pee it out
61
What is a UTI?
Inflammation of urinary tract
62
What are UTIs normally caused by?
Bacteria
| Usually E. Coli
63
How is cystitis caused?
By a UTI
64
What is cystitis?
Inflammation of the bladder
65
Signs and symptoms of cystitis
#1: frequency of urination
Dysuria
Urgency
Lower abdominal pain/suprapubic pain
66
How do the clinical manifestations of a UTI differ with age?
```
In a young adult:
Dysuria
Frequency
Suprapubic and lower back pain
Foul smelling, cloudy urine
```
Elderly:
Confusion
Abdominal discomfort
(Elderly pts are usually septic by the time they go to the hospital)
67
What does uncomplicated UTI mean?
A healthy pt with normal urinary system
| Who is having their first infection, or hasn’t had a UTI in one year
68
What does complicated UTI mean?
Pt with abnormal urinary system, or compromised health
69
What does recurring UTI mean?
Initial infection that is successfully treated, but reinfected within 5 to 10 days after resolution
70
What does persistent UTI mean?
Persistent infection despite 3 days of treatment
71
Type of UTI that is no bacterial and has an obscure cause
Interstitial cystitis
72
What is interstitial cystitis associated with?
With dysfunctions of external sphincter, vaginitis, urethritis, inflammation of vaginal glands, and urethra
73
Who is most likely to have interstitial cystitis?
Women 20-30 years old
| Usually who have multiple sexual encounters
74
Manifestations of interstitial cystitis
Bladder fullness
Frequency
Small urine volume
Chronic pelvic pain
75
How is interstitial cystitis treated?
No antibiotics bc not bacterial
Non-steroidal anti-inflammatories
Force fluids to increase volume (the more they pee the better)
76
Infection inside of kidney
Acute pyelonephritis
77
What is acute pyelonephritis?
Infection of renal pelvis and interstitium
78
Who normally gets acute pyelonephritis?
Women
79
Causes of acute pyelonephritis
Female sex trauma
Pregnancy
Kidney stones
GI reflux (chronic elevated acidity in blood over time)
Neurogenic (neurologic stimuli that causes bladder to spasm)
80
Clinical manifestations of acute pyelonephritis
```
Acute onset
Fever
Chills
Costovertebral (lower back) tenderness
Flank or groin pain
Frequency
Dysuria
Purulent urine
```
81
Patho of acute pyelonephritis
Infiltration of WBC in renal medulla
| Resulting in renal inflammation, renal edema, and purulent urine (cloudy)
82
Bacteria that causes acute pyelonephritis
Usually E. Coli
83
Treatment for acute pyelonephritis
Antibiotics
| True pain control
84
What is chronic pyelonephritis?
Persistent recurrent infection of the kidney leading to scarring. Kidney has trouble doing its job
85
What is the cause of chronic pyelonephritis?
Causative agent difficult to determine
86
Early symptoms of chronic pyelonephritis
Hypertension
Urinary frequency
Dysuria
Flank pain
87
Which UTI can lead to renal failure?
Chronic pyelonephritis
88
Risk factors for chronic pyelonephritis
Renal infections
| Obstructive pathologic conditions
89
Why is hypertension associated with chronic pyelonephritis?
If a pt has high bp, over time it wears out glomerular cells and leads them to be engorged and scarred
90
What is the onset of glomerular disorders like?
Can be sudden or insidious (acute)
91
Are glomerular disorders pre, intra, or post renal?
Intra
92
Signs of glomerular disorders
Hypertension, edema, elevated BUN
Decreased GFR
Increased plasma creatinine
Decreased creatinine clearance
93
What is a GFR that would indicate a glomerular disorder?
70 or below
94
What causes the damage from glomerular disorders?
Results from inflammation
95
What do most glomerular disorders result from?
Immune dysregulation
96
What is glomerulonephritis?
Inflammation of glomerulus
97
What are the causes of glomerulonephritis?
```
Immunological abnormalities (most common)
Drugs or toxins (2nd most common)
Ischemia; vascular disorders
Free radicals
Systemic diseases
```
98
Drugs that cause glomerulonephritis
Myosin drugs (glycosides)
Vanco-
Gent-
Tobra-
99
How does ischemia or vascular disorders cause glomerulonephritis?
Related to low blood volume (MAP <70)
100
Test done when giving glycosides
Peak/trough
101
What is the peak and what is the trough of a peak/trough test?
```
Peak = highest amount of drug in blood stream
Trough = amount left over in blood stream before next dose
```
102
How often is a peak/trough test done?
Usually every 3 days, but renal failure makes this more complicated
103
How to give a peak/trough test
- Do lab work before giving pt next dose of drug to determine trough
- Give next dose of drug
- Pharmacy will give time to test peak (depends on drug)
104
How do you determine if a pt is not metabolizing a drug well?
Their peak during the peak/trough test will be higher
105
What is acute glomerulonephritis caused by?
A streptococcal infection
106
When does acute glomerulonephritis occur?
Abruptly; 7-10 days after strep infection
107
Clinical manifestations of acute glomerulonephritis
```
Hematuria (blood in urine)
RBC casts
Proteinuria
Decreased GFR
Oliguria (low urination amounts)
Hypertension
Edema of eyes or feet/ankles
```
108
What is Goodpasture syndrome?
Rapidly progressive glomerulonephritis where patient rapidly declines into renal failure
109
When does Goodpasture syndrome develop?
Develops over days to weeks
110
Who does Goodpasture syndrome typically affect?
Older people
111
Signs and symptoms of Goodpasture syndrome
Renal insufficiency
Poor prognosis if untreated early
(Pt will need chronic dialysis, may die)
112
What is chronic glomerulonephritis?
Several diseases leading to chronic renal failure
113
What is chronic glomerulonephritis associated with?
Hypercholesterolemia (high cholesterol)
| Proteinuria (protein spillover)
114
Clinical manifestations of chronic glomerulonephritis
Hematuria (blood in urine)
| Proteinuria (protein in urine)
115
What is acute renal failure?
Sudden decline in renal function
116
What would we look at to determine acute renal failure?
Look for increased BUN and creatinine
117
Is acute renal failure reversible?
Most types are, if treated early. But is often misdiagnosed
118
Types of acute renal failure
Prerenal
Intrarenal
Postrenal
119
What is prerenal acute renal failure caused by?
Impaired renal blood flow
| GFR declines due to decrease in filtration pressure
120
What is intrarenal acute renal failure caused by?
Tubular necrosis
Surgery sepsis
Obstruction
121
What is postrenal acute renal failure caused by?
Urinary tract obstruction (bilateral)
122
What is chronic renal failure?
Progressive and irreversible loss of nephrons
| With a decreased GFR, which affects all organ systems
123
When does chronic renal failure become apparent?
Not until < 25% function remains
124
Clinical manifestations of chronic renal failure
- Uremia/azotemia
(Accumulation of urea and other toxins in plasma)
- Hypertension (unable to filter)
- Anorexia
- Nausea
- Vomiting
- Diarrhea
- Weight loss
- Pruritus
- Edema (start of heart failure)
- Anemia (not prod. RBC b/c kidneys not doing job)
- Neurologic changes (caused by ammonia building up, makes them combative with decreased LOC)
- Uremic frost (frost on skin caused by urea making its way through the skin)
125
What is important to remember about chronic renal failure?
The heart, lungs, and kidneys are all tied together, so many of the symptoms of chronic renal failure are going to also affect those organ systems
