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Thompson Exam 4 and 5 > Exam 4 Mon 4.4. Kidneys.Part 2 > Flashcards

Exam 4 Mon 4.4. Kidneys.Part 2 Flashcards

1
Q

Big picture concept: what does the renal system regulate?

A

Blood Pressre

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2
Q

Mechanisms by which urine travels to lower urinary system?

A

peristalsis

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3
Q

What happens to prostrate as men age?

A

hypertrophies and can compress on urethra. Men may have difficulty urinating- spurts or slowed irregular stream

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4
Q

6 changes in Kidneys that occur with aging

(Great, another thing to look foward to)

A
  1. Gradual ↓ in blood flow and # of nephrons
  2. Less efficiency in removing waste, volume of urine ↑
  3. Greater risk for hyponatremia, affecting muscular efficiency/strength
  4. Urine production shifts to night > age 60 (daytime production in younger population
  5. Neurological issues will affect continence
  6. Multiple medications affect kidney function
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5
Q

Are renal carcinomas common?

A

No. Rare

Only 3-4% of all cancers

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6
Q

Points re: screening for renal carcinoma (5)

A
  • If working with elderly population, initial screening questions should include urinary function, in addition to unusual weight loss, fatigue, etc.
  • Dr. T said to screen age 50+

Look for:

  • Unexplained abdominal, flank, or back pain
  • Cough or pulmonary systems (RCC mets to sternum)
  • Scarring/loss of tissue mobility/postural changes post-op
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7
Q

Information about renal carcinomas

A
  • Most common is renal cell carcinoma (RCC), usually presenting with flank pain, hematuria, palpable abdominal mass
  • May be silent in early stages, metastatic disease seen in 25-30% of cases at first diagnosis
  • Surgical intervention and chemo (high dose interleukin-2)
  • Variable prognosis
  • Wilm’s Tumor (nephroblastoma) – most common in children, seen in first 6 years of life (500 cases/yr in U.S.)
  • May be seen with some hereditary syndromes
  • Nausea & vomiting, abdominal pain, malaise, loss of appetite, hematuria
  • 5 year survival is 92%
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8
Q

How many categories of renal cysts are there?

A

6

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9
Q

What is the leading cause of ESRD, requiring dialysis and transplantation?

A

polycystic kidney disease (PKD)

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10
Q

True or false: There is no genetic component to polycystic kidney disease (PKD)

A

False.

There is a genetic component

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11
Q

Signs/symptoms and associated increased risks with polycystic kidney disease (PKD)

A
  • ↑ risk for hypertension, UTI, cerebral and aortic aneurysms (weakness in kidney walls and also arterial walls)
  • Same S/S of other kidney disorders, but kidney is greatly enlarged
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12
Q

Points Dr. T made about UTIs (7)

A
  • very common, all ages
  • Urethritis (UTI in urethra)
  • Cystitis (UTI inbladder)
  • Clinical manifestations may include ipsilateral lumbar/shoulder pain
  • Screen should include questions about urination patterns and quality of urine
  • May see fever/chills, malaise, anorexia, mental status changes (frequently in the elderly)
  • many hospital admissions find UTI as base cause
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13
Q

Points Dr. T made about Pyelonephritis (3)

A
  • frequently a sequelae of a UTI
  • In addition to above S/S, pain at costovertebral angle (Murphy’s sign)
  • Chronic infection may cause scarring, eventually lead to ESRD
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14
Q

4 possible locations for upper urinary tract obstructions

A
  1. ureter
  2. renal pelvis
  3. calyces
  4. renal parenchyma
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15
Q

What is Hydroureter?

A

urine accumulates at level of ureter

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16
Q

What is Hydronephrosis?

A

urine accumulates above the ureter

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17
Q

5 causes of obstruction

A
  • compression from inflammation related to infection
  • stones
  • stenosis of urethra (long term indwelling catheter- think SCI as example)
  • problems with sphincter muscles
  • Problems at valves in the tract
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18
Q

If you retain more than 30ccs of urine in your bladder after emptying it, what can happen?

A

bladder infection

Want to completely empty- very important for SCI

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19
Q

5 types of incontinence

A
  1. Urge incontinence
  2. Stress incontinence
  3. Overflow incontinence
  4. Mixed
  5. Functional
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20
Q

A bunch of things to know about kidney stones AKA Calculi including symptoms (12)

A
  • Calculi – mineral deposits that form inside kidney
  • Come in variety of shapes and sizes
  • Severe pain, unilateral, in the side and back, below the ribs, groin, abdomen
  • Murphy’s percussion test usually positive
  • Pain that comes in waves and fluctuates in intensity
  • Pain on urination
  • Pink, red or brown urine; cloudy or foul-smelling urine
  • Nausea and vomiting
  • Persistent need to urinate
  • Urinating more often than usual
  • Fever and chills if an infection is present
  • Urinating small amounts of urine
21
Q

Important to note about taking calcium supplements

A

Too much calcium can build up in the kidneys and form kidney stones. Should consult doc and what is teh best dosage for you.

22
Q

Methods for detecting kidney stones (4)

A
  • Intravenous Pyelogram (IVP)- dye injected into vein then x-ray taken
  • KUB Radiograph (kidney, ureters, and bladder) and ultrasound
  • Kidney Color Doppler
  • CT scan
23
Q

Methods for breaking up the kidney stone (2)

A
  • Ureteroscopy- upper urinary tract endoscopy performed most commonly with an endoscope passed through the urethra, bladder, and then directly into the upper urinary tract.
  • Lithotripsy- using ultrasound shock waves, by which a kidney stone or other calculus is broken into small particles that can be passed out by the body
24
Q

Basic definition of chronic kidney disease

A

Alteration of kidney function/structure for ≥3 months

25
Q

3 most common causes of chronic kidney disease

A
  1. Diabetes (metabolic syndrome)
  2. Hypertension
  3. Glomerulonephritis
26
Q

Analgesic nephropathy

A
  • a caution for people taking OTC meds such as Goody’s or BC powders (aspirin-phenacetin-caffeine), Tylenol, aspirin
  • NSAIDS have more short-term than long-term effect, moderate use considered safe
  • Phenacetin is super bad for the kidneys
  • NSAIDS that are 1 a day do not clear as quickly and is something to think about with regards to long term effects on kidneys
  • Tylenol is worse for kidneys

* in the chronic kidney disease pp

27
Q

Final stage of chronic kidney disease

A

End stage renal disease

*•More than 20 million in U.S. have CKD

28
Q

There are 5 stages of chronic kidney disease

True or False: Both stage 2 and 3 have GFR <30ml/min

A

False

Both stage 4 and 5 have GFR <30ml/min

29
Q

What is going on during stage 1 of CKD (chronic kidney disease)?

A
  • kidney damage
  • normal or slightly elevated GFR
  • May be asymptomatic, or show HTN, anemia
  • may be reversible
30
Q

What’s going on during stage 2 of CKD?

A
  • kidney damage with mildly decreased GFR
  • May see albumin in urine
31
Q

What’s going on during stage 3 of CKD?

A
  • •moderately decreased GFR
  • ↑ creatinine and BUN (azotemia)
32
Q

What’s going on during stage 4 of CKD?

A
  • severely decreased GFR,
  • Systemic complications
  • ↑ proteinuria, BUN, creatinine, renin
  • HTN
33
Q

What’s going on during stage 5 of CKD?

A
  • kidney failure, ESRD
  • Uremia, kidney cannot excrete toxins
  • S/S include nausea, vomiting, lethargy, pruritis, neuropathy, pericarditis, asterixis (“flapping sign”)
  • Dialysis required
34
Q

systemic manifestations of kidney failure (9)

A
  1. Urinary
  2. Cardiopulmonary
  3. GI tract- nausea, vomiting, anorexia
  4. Nervous system- neuropathy (some stocking and glove), mental status
  5. Integument- slow wound healing, itchy
  6. Eyes- retinopathy
  7. Endocrine- aldosterone is inhibited, feedback loop is screwed up
  8. Hematopoietic system- EPO is produced
  9. Skeletal system- osteoporosis, weak bones, affects calcium balance
35
Q

More specific Musculoskeletal Complications with CKD (7)

A
  • Osteomalacia (vitamin D deficiency, softening)
  • Bone pain
  • Demineralization
  • Calcification of vessels and soft tissues due to deposition of calcium
  • Also responsible for skin itching
  • Calcification of tendons, articular cartilage
  • Myopathies and weakness
36
Q

More specific Neurological Complications with CKD (3)

A
  • Sleep disturbances, memory loss, perceptual errors, confusion
  • Peripheral sensory and motor neuropathies
  • Restless leg syndrome (corollary finding)
37
Q

Points on exercise and CKD (9)

A
  • Need strength, balance, mobility/endurance
  • Will require longer course of PT to achieve goals; studies cite 12 week interventions
  • Exercise at 40-70% of target heart rate, with adequate warm-up and cool-down periods
  • ↑risk for cardiac events, especially if coupled with DM
  • Autonomic dysfunction may limit max predicted HR by 20-40 bpm
  • Use rate of perceived exertion (RPE) as guideline for exercise
  • Goals should be aimed at maintaining or improving quality of life
  • Exercise may exacerbate co-morbid conditions
  • Monitor BP, glucose, pulse, PRE, O2 sat, BUN, creatinine (G&F, Table 40-2, p. 1640)
38
Q

Points on exercise and CKD, but specific to dialysis (3, kinda 4)

A
  • If on dialysis, will need to assess impact of dialysis on schedule and patient’s physical ability
  • In theory, blood chemistries will be at peak right after dialysis – patient usually very fatigued, and blood glucose will be variable
  • As electrolyte imbalance is least stable on day prior to renal dialysis, plan for exercise on day of/day after
    • This is not likely problematic with peritoneal dialysis, but do want to plan exercise when abdomen is empty, if possible
39
Q

Two important lab values to monitor when kidney stuff is going on

A
  1. BUN
  2. Creatine
40
Q

Things to know about BUN

A
  • BUN ↑ when renal function ↓, indicates ↓ renal blood flow
  • May also show protein breakdown or ↑dietary protein, GI bleed (another source of protein breakdown)
  • Liver disease can alter these numbers
41
Q

Things to know about Creatine

A
  • Creatinine directly correlates with glomerular filtration and nephron damage
  • Normal product of skeletal muscle regeneration, so should be a constant if kidneys are functioning correctly
  • Can also be a sign of muscle damage (rhabdomyolysis)
  • Abnormal values can also be seen in aging or with acute kidney disease
42
Q

Glomerulonephritis a group of diseases that manifest with hematuria

Name the 4 outlined in the slide

A
  1. Acute glomerulonephritis
  2. Rapidly progressive glomerulonephritis
  3. Chronic glomerulonephritis
  4. Nephritic syndrome (blood in urine)
43
Q

What is Nephrotic Syndrome?

A
  • glomerular injury
  • excretion of 3.5g or more of protein in urine/day
44
Q

What is Nephritis Syndrome?

A

diseases causing hematuria

45
Q

PT precautions for Glomerular Disorders

A

precautions for these patients include potential side effects (diuretics, muscle cramping), exercise precautions as noted previously

46
Q

What is hemoialysis?

A

a machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately.

47
Q

What is Peritoneal dialysis?

A
  • another way to remove waste products from your blood when your kidneys can no longer do the job adequately.
  • During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your kidneys, with the help of a cleansing fluid that flows into and out of the peritoneal space.
  • Done at home. Only people who are capable of being very sterile.
  • Person will have line installed into body.
  • Can be interrupted- benefit for bathroom use.
  • Can do in multiple short bursts or overnight
48
Q

What is a hemodialysis fistula?

A
  • A vascular access is a surgically created vein used to remove and return blood during hemodialysis.
  • An arteriovenous (AV) fistulais a connection, made by a vascular surgeon, of an artery to a vein.
  • Have to wait longer to use fistula but it last longer. This is preferable.
  • It uses body part so rejection is less likely to happen
  • Fistulas are usually done distally so that if dialysis continues and it becomes unusable then will make a proximal fistula.
49
Q

Option besides a fistula in the arm

A
  • graft
  • don’t need to wait as long, but also does not last as long

Thompson Exam 4 and 5 (9 decks)

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