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Pathophysiology > Exam 3 - Alterations In Renal And Urinary Tract Function > Flashcards

Exam 3 - Alterations In Renal And Urinary Tract Function Flashcards

1
Q

What does MAP stand for?

A

Mean Arterial Pressure

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2
Q

How is MAP calculated?

A

From blood pressure

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3
Q

How much Cardiac Output is in the kidneys?

A

25% or 12,000 mL/min

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4
Q

What measurement should MAP be at for blood to properly diffuse the kidneys?

A

70-90 mmHg

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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

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6
Q

What does a MAP >90 mean?

A

Pt has high blood pressure

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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

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8
Q

What measurement should the GFR be?

A

80-125 mL/min

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9
Q

If pt has a GFR of 80-125 mL/min, how much filtrate would they have per day?

A

180 L

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10
Q

What is filtrate?

A

Waste and reabsorption from the kidneys

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11
Q

How much GFR is in the tubules?

A

99%

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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

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13
Q

How much should normal kidneys produce each hour?

A

At least 30 ml/hr

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14
Q

What is a normal urine output?

A

0.5-1 mL/kg

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15
Q

How much urine output is normal per hour?

A

30-60 mL/hour

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16
Q

When should you add fluids for your pt?

A

If their urine output is 29 mL or less per hour

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17
Q

What color should urine be?

A

Amber - yellow

Shouldn’t be bright, unless pt takes multivitamin

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18
Q

What should turbidity of urine be?

A

Clear (no sediment)

May be strands of protein

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19
Q

What should specific gravity of urine be?

A

1.0-1.02

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20
Q

Lab value for normal pH of urine

A

4.6 to 8.0

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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)

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22
Q

What is urinary chemistry checking for?

A

If there is any spill-over (things consumed in excess that body cannot absorb)

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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

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24
Q

What normal serum values do we look at?

A

BUN

Creatinine

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25
Q

Why do we test BUN and creatinine?

A

To test kidney function

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26
Q

How do we test BUN and creatinine?

A

Through a blood sample, not urine sample

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27
Q

What is specific gravity?

A

The weight of urine (how heavy it is)

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28
Q

What does specific gravity represent?

A

Concentration ability of urine in relation to density of water

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29
Q

When is specific gravity of urine high?

A

When it contains glucose/protein

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30
Q

When is specific gravity of urine low?

A

When it is dilute

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31
Q

What does BUN stand for?

A

Blood
Urea
Nitrogen

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32
Q

What is BUN?

A

A blood test that measures the amount of urea in the blood

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33
Q

Where is urea formed?

A

In the liver

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34
Q

What is urea?

A

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

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35
Q

What does the BUN test tell us?

A

The metabolic function of liver

And excretory function of kidneys

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36
Q

What is a normal value for BUN?

A

10-20 mg/dL

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37
Q

What would a critical BUN value be?

A

> 100

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38
Q

What does a BUN value of >100 indicate?

A

Serious impairment of renal function (renal failure)

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39
Q

What are the two waste products from urine?

A

BUN & creatinine

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40
Q

How is creatinine formed?

A

From metabolism of creatine

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41
Q

What is creatine?

A

Nitrogenous compounds from metabolism

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42
Q

Where is creatinine found?

A

Blood
Urine
Muscle tissue

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43
Q

What do creatinine levels tell us?

A

Level of kidney function

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44
Q

What is the purpose of a Creatinine clearance test?

A

Measures the rate at which creatinine is cleared from the blood by the kidney

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45
Q

Explain the relationship between creatinine and BUN

A

They go together, if one is up, the other will be too

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46
Q

Explain the process for a creatinine clearance test

A

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

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47
Q

When is a creatinine clearance test ordered?

A

If pt has a normal BUN, but a slightly elevated creatinine level

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48
Q

What is a hydroureter?

A

Dilation of ureter due to an accumulation of urine

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49
Q

Is hydroureter pre, intra, or post renal?

A

Post renal

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50
Q

What is hydronephrosis?

A

Dilation of renal pelvis and calyces which results in enlargement of the kidney

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51
Q

How can hydronephrosis be detected?

A

By a KUB

52
Q

Is hydronephrosis pre, intra, or post renal?

A

Intra renal

53
Q

What is postobstructive dieresis?

A

Obstruction is cleared, and body is catching up on filtering and restoring fluid and electrolyte balance

54
Q

Is hydroureter pre, intra, or post renal?

A

Post renal

55
Q

Is compensatory hypertrophy pre, intra, or post renal?

A

Could be pre or intra

56
Q

Risk factors for kidney stones

A

Top 2: fluid intake and diet

Also: age, gender, race, geographic location, seasonal factors, occupation

57
Q

Where is renal calculi usually located?

A

In ureter, heading to bladder

58
Q

Clinical manifestations of renal calculi

A 
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
Q

Types of evaluation for renal calculi (to see where blockage is located)

A

Stone and UA analysis
Intravenous pyelogram (IVP)
KUB (kidney, ureter, bladder) X-ray
Spiral abdominal CT scan

60
Q

Ways to treat a kidney stone

A

1- pee it out
2- go in and get it
3- break it up so pt can pee it out

61
Q

What is a UTI?

A

Inflammation of urinary tract

62
Q

What are UTIs normally caused by?

A

Bacteria

Usually E. Coli

63
Q

How is cystitis caused?

A

By a UTI

64
Q

What is cystitis?

A

Inflammation of the bladder

65
Q

Signs and symptoms of cystitis

A

1: frequency of urination

Dysuria
Urgency
Lower abdominal pain/suprapubic pain

66
Q

How do the clinical manifestations of a UTI differ with age?

A 
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
Q

What does uncomplicated UTI mean?

A

A healthy pt with normal urinary system

Who is having their first infection, or hasn’t had a UTI in one year

68
Q

What does complicated UTI mean?

A

Pt with abnormal urinary system, or compromised health

69
Q

What does recurring UTI mean?

A

Initial infection that is successfully treated, but reinfected within 5 to 10 days after resolution

70
Q

What does persistent UTI mean?

A

Persistent infection despite 3 days of treatment

71
Q

Type of UTI that is no bacterial and has an obscure cause

A

Interstitial cystitis

72
Q

What is interstitial cystitis associated with?

A

With dysfunctions of external sphincter, vaginitis, urethritis, inflammation of vaginal glands, and urethra

73
Q

Who is most likely to have interstitial cystitis?

A

Women 20-30 years old

Usually who have multiple sexual encounters

74
Q

Manifestations of interstitial cystitis

A

Bladder fullness
Frequency
Small urine volume
Chronic pelvic pain

75
Q

How is interstitial cystitis treated?

A

No antibiotics bc not bacterial
Non-steroidal anti-inflammatories
Force fluids to increase volume (the more they pee the better)

76
Q

Infection inside of kidney

A

Acute pyelonephritis

77
Q

What is acute pyelonephritis?

A

Infection of renal pelvis and interstitium

78
Q

Who normally gets acute pyelonephritis?

A

Women

79
Q

Causes of acute pyelonephritis

A

Female sex trauma
Pregnancy
Kidney stones
GI reflux (chronic elevated acidity in blood over time)
Neurogenic (neurologic stimuli that causes bladder to spasm)

80
Q

Clinical manifestations of acute pyelonephritis

A 
Acute onset
Fever
Chills
Costovertebral (lower back) tenderness
Flank or groin pain
Frequency
Dysuria
Purulent urine
81
Q

Patho of acute pyelonephritis

A

Infiltration of WBC in renal medulla

Resulting in renal inflammation, renal edema, and purulent urine (cloudy)

82
Q

Bacteria that causes acute pyelonephritis

A

Usually E. Coli

83
Q

Treatment for acute pyelonephritis

A

Antibiotics

True pain control

84
Q

What is chronic pyelonephritis?

A

Persistent recurrent infection of the kidney leading to scarring. Kidney has trouble doing its job

85
Q

What is the cause of chronic pyelonephritis?

A

Causative agent difficult to determine

86
Q

Early symptoms of chronic pyelonephritis

A

Hypertension
Urinary frequency
Dysuria
Flank pain

87
Q

Which UTI can lead to renal failure?

A

Chronic pyelonephritis

88
Q

Risk factors for chronic pyelonephritis

A

Renal infections

Obstructive pathologic conditions

89
Q

Why is hypertension associated with chronic pyelonephritis?

A

If a pt has high bp, over time it wears out glomerular cells and leads them to be engorged and scarred

90
Q

What is the onset of glomerular disorders like?

A

Can be sudden or insidious (acute)

91
Q

Are glomerular disorders pre, intra, or post renal?

A

Intra

92
Q

Signs of glomerular disorders

A

Hypertension, edema, elevated BUN
Decreased GFR
Increased plasma creatinine
Decreased creatinine clearance

93
Q

What is a GFR that would indicate a glomerular disorder?

A

70 or below

94
Q

What causes the damage from glomerular disorders?

A

Results from inflammation

95
Q

What do most glomerular disorders result from?

A

Immune dysregulation

96
Q

What is glomerulonephritis?

A

Inflammation of glomerulus

97
Q

What are the causes of glomerulonephritis?

A 
Immunological abnormalities (most common)
Drugs or toxins (2nd most common)
Ischemia; vascular disorders
Free radicals
Systemic diseases
98
Q

Drugs that cause glomerulonephritis

A

Myosin drugs (glycosides)
Vanco-
Gent-
Tobra-

99
Q

How does ischemia or vascular disorders cause glomerulonephritis?

A

Related to low blood volume (MAP <70)

100
Q

Test done when giving glycosides

A

Peak/trough

101
Q

What is the peak and what is the trough of a peak/trough test?

A 
Peak = highest amount of drug in blood stream
Trough = amount left over in blood stream before next dose
102
Q

How often is a peak/trough test done?

A

Usually every 3 days, but renal failure makes this more complicated

103
Q

How to give a peak/trough test

A
  • 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
Q

How do you determine if a pt is not metabolizing a drug well?

A

Their peak during the peak/trough test will be higher

105
Q

What is acute glomerulonephritis caused by?

A

A streptococcal infection

106
Q

When does acute glomerulonephritis occur?

A

Abruptly; 7-10 days after strep infection

107
Q

Clinical manifestations of acute glomerulonephritis

A 
Hematuria (blood in urine)
RBC casts
Proteinuria
Decreased GFR
Oliguria (low urination amounts)
Hypertension
Edema of eyes or feet/ankles
108
Q

What is Goodpasture syndrome?

A

Rapidly progressive glomerulonephritis where patient rapidly declines into renal failure

109
Q

When does Goodpasture syndrome develop?

A

Develops over days to weeks

110
Q

Who does Goodpasture syndrome typically affect?

A

Older people

111
Q

Signs and symptoms of Goodpasture syndrome

A

Renal insufficiency
Poor prognosis if untreated early
(Pt will need chronic dialysis, may die)

112
Q

What is chronic glomerulonephritis?

A

Several diseases leading to chronic renal failure

113
Q

What is chronic glomerulonephritis associated with?

A

Hypercholesterolemia (high cholesterol)

Proteinuria (protein spillover)

114
Q

Clinical manifestations of chronic glomerulonephritis

A

Hematuria (blood in urine)

Proteinuria (protein in urine)

115
Q

What is acute renal failure?

A

Sudden decline in renal function

116
Q

What would we look at to determine acute renal failure?

A

Look for increased BUN and creatinine

117
Q

Is acute renal failure reversible?

A

Most types are, if treated early. But is often misdiagnosed

118
Q

Types of acute renal failure

A

Prerenal
Intrarenal
Postrenal

119
Q

What is prerenal acute renal failure caused by?

A

Impaired renal blood flow

GFR declines due to decrease in filtration pressure

120
Q

What is intrarenal acute renal failure caused by?

A

Tubular necrosis
Surgery sepsis
Obstruction

121
Q

What is postrenal acute renal failure caused by?

A

Urinary tract obstruction (bilateral)

122
Q

What is chronic renal failure?

A

Progressive and irreversible loss of nephrons

With a decreased GFR, which affects all organ systems

123
Q

When does chronic renal failure become apparent?

A

Not until < 25% function remains

124
Q

Clinical manifestations of chronic renal failure

A
  • 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
Q

What is important to remember about chronic renal failure?

A

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

Pathophysiology (14 decks)

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