GU Flashcards
How much blood do the kidneys cycle through per minute?
1200 ml/min (20-25% of CO)
What is the glomerular function (GFR)?
Amount of blood filtered by the glomeruli in a given time (125 mL/min)
Define what the proximal convoluted tubule does and what is reabsorbed here
80% of electrolytes reabsorbed, all glucose, amino acids, small proteins, using active transport
What does the Loop of Henle do? What is absorbed here?
Conserves water, concentrates filtrate, and resorption continues
What part of the kidney do Lasix target?
Loop of Henle
What does the distal tubule do?
Final regulation of water balance and acid-base balance
What test will recognize the acid-base balance in the distal tubules?
ABGs - they detect acid-base
What does the collecting duct do?
Any more water to reabsorb/final reabsorption
What is erythropoietin? Where is it produced? What triggers its release?
Stimulates the production of RBCs in the bone marrow
Produced in the kidney in response to hypoxia in the body and decreased renal flow
Where does the second step of Vitamin D activation occur?
Kidney
How much urine in the bladder would cause distention and urge to urinate?
200-250 mL
How much urine causes an individual to become uncomfortable?
400-600 mL
How much urine does the average individual excrete per day?
1500 mL/day
How long are male and female urethras?
Male - 20 to 25 cm long
Female - 3 to 5 cm long
Does GFR increase or decrease with age?
Decreases
Define BUN, creatinine, and GFR blood tests
- BUN - Measures the amount of urea nitrogen in blood
- Creatinine - Measures amount of protein digestion and normal muscle breakdown
- GFR - Checks how well kidneys are functioning
Define urinalysis, C&S, cytology, and uric acid studies
- Urinalysis - Detect a wide range of disorders
- Urine C&S - Checks for bacteria that could be causing an infection
- Urine cytology - Screens for cells
- Uric acid - Occurs during the breakdown of purines
Why should we know if a client has had a hysterectomy prior to a bladder scan?
Use the male key for gender on the scanner because the bladder will sit lower
What is a cystoscopy?
Scope up the urethra to the bladder
What is radiography-KUB?
Evaluates the urinary system and its surrounding structures
What is renal pyelography? What do we need to be cognizant of?
Uses contrast material to evaluate kidneys, ureters, and bladder
Dye allergies
What is acute pyelonephritis?
Inflammation of the renal pelvis and kidney - swelling and increased blood flow
How does acute pyelonephritis begin?
Begins with colonization and infection of the lower urine tract, ascends upward
Usually starts in the renal medulla and spreads to the cortex
What is colonization and when does it become problematic?
organisms are present and they are staying where they are, which causes no issues or problems, but when they begin to move is when a problem occurs
What is a pre-existing factor for acute pyelonephritis?
vesicoureteral reflux or dysfunction of lower urinary tract function
if the sphincter is not tight enough, organisms and urine can back flow which can cause an infection
What is the most common cause of acute pyelonephritis?
E. coli that comes from stool due to improper wiping
What is urosepsis resulting from acute pyelonephritis?
The infection has gone from the kidneys into the entire body
What conditions are the two many causes of sepsis in elderly patients?
acute pyelonephritis and pneumonia
Define vesicoureteral reflux
backflow from an incomplete sphincter of the ureter
What are the clinical manifestations of acute pyelonephritis?
Symptoms will vary across individuals
Mild fatigue to sudden onset of chills, fever, vomiting, malaise, flank pain, emptying and storage symptoms, costovertebral tenderness (pain on the back with light tapping)
What is costovertebral tenderness?
Pain on the back with light tapping
What would a urinalysis show in someone with acute pyelonephritis?
It will show pyuria (pus in the urine), bacteriuria, hematuria, and WBCs
Urine may be so infected you won’t be able to see through it
What is pyuria?
Pus in the urine
Why would we not use a pyelography or CT in the early stages of pyelonephritis?
These tests are too invasive/hard on the kidneys because they would need to work to breakdown the contrast
What 4 things would the team do to manage mild symptoms of acute pyelonephritis?
- Outpatient treatment - antibiotics and hydration via IV
- Maintain hydration
- Antibiotics for 14-21 days, initially IV route
- Follow-up culture and imaging
How long would someone with mild symptoms of acute pyelonephritis be on antibiotics? How long after treatment would they require a follow-up culture?
14-21 days
can be 6 weeks to 6 months to look for any residual damage
How would a team manage severe symptoms of acute pyelonephritis?
NSAIDs and antipyretics, parenteral antibiotics then switch to oral, and follow-up culture/imaging
What do we need to ensure prior to administering NSAIDs/antipyretics to someone with acute pyelonephritis?
These meds can be damaging to the kidneys and create issues with excretion - we need to know kidney function prior to admin
What is chronic pyelonephritis?
The kidney has shrunk, resulting in lost function due to scarring/fibrosis
It is the outcome of recurring infections - need to determine the route of recurring infections
What condition often leads to end-stage renal disease?
Chronic pyelonephritis
Where in Canada has higher rates of urinary tract calculi?
Higher on the east coast than west, likely due to diet
Is urinary calculi more common in men or women?
Men
What type of urinary calculi is higher in women than men?
Struvite - a renal calculi that has calcium, magnesium, phosphate, and ammonia
What is the age range for urinary calculi?
20-55 years
What seven factors are related to urinary calculi?
Genetics, seasonal variation/climate (more common in summer due to dehydration), metabolic, dietary, lifestyle, and occupation
Why do urinary calculi lead to obstructions?
The GU cannot reverse peristalsis, so the individual will end up with back flow and distention/expansion
What is the differences between a calculus and lithiasis?
Calculus - abnormal stone formed in body tissues by an accumulation of mineral salts
Lithiasis - stone formation