GU

Question 1

Age-Related Changes

Answer 1

Nephrons lost with aging
- Reduces kidney mass and GFR
Less urine concentration
- Risk for dehydration when combined with diminished thirst
Potassium excretion decreased at times
- Potential fluid and electrolyte imbalance

Question 2

Diagnostic Tests

Answer 2

Urine Studies
- C&S
Renal Clearance
- BUN, creatinine and creatinine clearance, protein
Imaging studies
- Abd. X-ray - KUB
- IVP, Retrograde Pyelography
- CT
- Renal scan
- US
- Cystoscopy

Question 3

Incontinence

Answer 3

Incontinence
- Loss of voluntary control of the bladder
Stress
Overflow incontinence
Functional

Question 4

UTIs

Answer 4

Affect up to 20% of women
Incidence increases with aging - both sexes
Nosocomial infections (common)
Affect any portion of the urinary tract - classified according to region and primary site affected
- Lower Urinary Tract (Urethritis, prostatitis, cystitis)
- Upper Urinary Tract (Pyelonephritis: kidney, renal pelvis)

Question 5

UTIs: Risk Factors

Answer 5

Incontinence with incomplete emptying of the bladder
Retention of urine in the bladder
Obstruction to urine flow (scar tissue, renal calculi)
Decreased host resistance
Direct contamination from decal incontinence
Introduction of bacteria by use of instruments or catheters

Question 6

Risk Factors

Answer 6

Male
- Enlarged prostate gland
Female
- Short, straight urethra
- Proximity meatus to vagina
- Tissue trauma/ contamination sexual intercourse
- Diaphragm
- Personal hygiene
- Voluntary urinary retention

Question 7

Cystitis

Answer 7

Most common UTI, inflammation of the bladder
Bladder mucosa inflamed and congested with blood
Bladder wall is irritable and bladder capacity is usually reduced
S&S
- discomfort in the lower abdomen
- dysuria
- frequency, urgency, nocturia
- hematuria
- pyuria (cloudy with an odour)
- systemic signs of infection (fever, malaise, nausea, leukocytosis)

Question 8

Cystitis

Answer 8

Generally uncomplicated and resolves spontaneously
Can ascent to the kidneys
Older adults or those with impaired immunity bacteria, sepsis and shock are possible complications

Question 9

Pyelonephritis

Answer 9

Inflammatory disorder of renal pelvis and parenchyma
Risk factors include: pregnancy, obstruction (renal calculi) and congenital malformation, vesicoureteral reflex (common in children)
Acute
- caused by bacterial infection in E. coli
Chronic
- Associated with other disorders

Question 10

Pyelonephritis S&S

Answer 10

Acute
- Rapid onset
- Chills, fever
- Malaise, vomitting
- Flank pain (dull and aching), costovertebral tenderness
- Cystitis (dysuria)
Chronic
- Leads to fibrosis, scarring, renal failure as tubules are gradually destroyed

Question 11

UTIs: Diagnostic Tests

Answer 11

Urinalysis
Urine C&S
CBC with differential
IVP (intravenous pyelography)
Voiding cystourethrography
Cystoscopy

Question 12

Urolithiasis: Calculi or Kidney Stones

Answer 12

Calculi can develop anywhere in the urinary tract
Stones can be small or large
Formed from materials normally excreted in urine: 75% made from calcium salts with the remainder consisting mainly of uric acid, urates, struvite (Mg, phosphate) or cystine
Form when poorly soluble salt crystallizes

Question 13

Urinary Calculi: Risk Factors

Answer 13

Family Hx
Dehydration 
Excess calcium, oxalate, protein intake
Uric acid stones gout
Hyperparathyroidism and immobility (hypercalcemia)
Urinary stasis
Alkaline pH of urine (calcium stones)

Question 14

Urinary Calculi: S&S

Answer 14

General Symptoms:

• UTI symptoms
• Chills and fever
• Frequency, urgency, and dysuria

Question 15

Urinary Calculi: S&S

Answer 15

Kidney/ Pelvis
- May be asymptomatic
- Dull, aching flank pain
Ureter
- Acute serve flank pain may radiate (renal colic)
- N/V
- Pallor, cool moist skin
- Hematuria
Bladder
- May be asymptomatic
- Dull suprapubic pain
- Hematuria

Question 16

Urinary Calculi: Diagnostic Tests

Answer 16

Urinalysis
KUB X-ray
IVP
Renal ultrasound
CT scan or MRI
Cystoscopy

Question 17

Renal Failure

Answer 17

Condition where the kidneys are unable to remove waste products from blood
Acute or chronic
Characterized by azotemia, fluid, electrolyte, acid-base imbalances

Question 18

Acute Renal Failure

Answer 18

Rapid decline in function with an abrupt onset
Often reversible with prompt treatment
Dialysis may be used to replace kidney function until primary problem dealt with
Failure of the kidney function r/t:
- blood flow into the kidney
- inflammation and necrosis of the tubules (leading to obstruction, back pressure and greatly reduced GFR and reduced or no urine output)

Question 19

Etiology and Pathophysiology

Answer 19

3 sites of disruption:
- Renal perfusion (prerenal)
- Circumstances within the kidney blood vessels, tubules, glomeruli, or interstitium (intrarenal)
- Urine flow distal to the kidney (post renal)
Distinction between the sites of disruption helps determine appropriate therapy

Question 20

Acute Renal Failure

Answer 20

Prerenal failure: decreased blood flow to glomeruli (kidney)
Intrarenal failure: nephrotoxic agents, kidney infections, occlusion of infrarenal arteries, hypertension, DM, or direct trauma to the kidney
Postrenal failure: obstructions beyond the kidneys that cause urine to back up

Question 21

Acute Renal Failure

Answer 21

Initiation phase:
- Kidney injury is evolving
- Prevention of injury is possible
Maintenance phase:
- Established kidney injury and dysfunction
- Urine output is lowest during this phase and serum creatinine and blood urea nitrogen both increase
Recovery phase:
- Injury repaired and normal renal function re-established
- Diuresis common
- Decline in serum creatinine and urea
- Increase in creatinine clearance

Question 22

Renal Failure: Diagnostic Tests

Answer 22

Serum creatinine, BUN
Creatinine clearance
Serum electrolytes, ABGs, CBC
Urinalysis
Kidney biopsy

Question 23

Chronic Renal Failure

Answer 23

Involves progressive, irreversible destruction of the nephrons in both kidneys
End result is a systemic disease involving every organ
Up to 80% of the GFR may be lost with few changes in the functioning of the body
Remaining nephrons hypertrophy to compensate
Stages defined based on level of kidney function

Question 24

Chronic Renal Failure

Answer 24

Leading causes of End Stage Renal Disease:

• DM
• Hypertension

Question 25

Causes of CRF

Answer 25

Result from chronic kidney disease
- Bilateral pyelonephritis
- Congenital polycystic kidney disease
Exposure to nephrotoxins
- Gentamycin

Question 26

Stages of CRF

Answer 26

Early

• Dec. reserve - 60% nephron loss
• Dec. GFR
• Inc. serum Creatinine levels - high normal
• Serum urea (BUN) normal
• Remaining nephrons adapt and inc. capacity for filtration

Question 27

Middle (Renal Insufficiency)

Answer 27

75% nephron loss
GFR dec. to 20% of normal
Inc. retention of nitrogen wastes (BUN, CRS)
Tubule function decreased
Failure to concentrate urine - large volumes of dilute urine

Question 28

End stage - Uremia

Answer 28

90% nephron loss
GFR negligible
Fluid, electrolytes and wastes retained in body
All body systems affected
Marked oliguria or anuria

Question 29

Classical Manifestatiosn

Answer 29

Retained Substances:
- Urea
- Creatinine
- Phenols
- Hormones
- Electrolytes
- Water
Uremia:
- Incorporates all the signs and symptoms seen in the various systems throughout the body

Question 30

Diagnostic Studies

Answer 30

Serum creatinine
Protein-to-creatinine ratio
Random urine specimen
Urinalysis
Ultrasound imaging

Question 31

Chronic Kidney Disease: Gerontological Considerations

Answer 31

About 48% of ERSD clients are 65 or older
Most common diseases leading to renal failure in the older adult:
- Hypertension
- DM

Question 32

Chronic Kidney Disease: Gerontological Considerations

Answer 32

Diminished cardiopulmonary function
Bone loss
Immunodeficiency
Altered protein synthesis
Impaired cognition
Altered drug metabolism

Question 33

Chronic Kidney Disease: Gerontological Considerations

Answer 33

Most common cause of death in the elderly ESRD client:

• Cardiovascular disease (MI, stroke)
• Withdrawal from dialysis