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Med Con II > GU Renal Disorders > Flashcards

GU Renal Disorders Flashcards

1
Q

what are the functions of the renal system

A
  1. filters waste products
  2. regulates ion levels in plasma
  3. regulates blood pH
  4. conserves valuable nutrients
  5. regulates blood volume
  6. regulares RBC production
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2
Q

how much CO do kidneys receive

A

25%

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3
Q

why doesn’t pH fall

A

bc compensate w/ bicarbonate from kidneys

Co2 and bicarb normall even and buffer eachother but with a kidney issue, you don’t produce bicarb=
excess cO2=acidosis

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4
Q

discuss the anatomy of the kidney

A

-paired organs that lie retroperitoneal
-R lower than L
-bean shaped
-concave surface- renal hlium
-divided into outer renal cortex and inner medulla

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5
Q

talk about the renal cortex

A

-outer portion
-contains glomeruli and certain tubules
-75% of renal parenchyma is cortex

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6
Q

talk about the renal medulla

A

-inner portion
-coned shaped
-8-18 renal pyramids per kidney
-contains loop of henle and collecting ducts

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7
Q

talk about the organization of the medullary pyramids

A
  1. renal papilla empty urine into minor calyx
  2. minor calyces empty into major calyx
  3. major calyx empty into renal pelvis
  4. becomes ureter
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8
Q

what is the functional unit of the kidney

A

nephron

located in both cortex and medullary areas

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9
Q

talk about how arterial blood flows through

A
  1. arterial blood comes into nephron then into glomerulus
  2. filters out water, sugar, salt, potassium, waste products
  3. filtrate enters nephron
  4. as filtrate winds through, 95% of everything filtered at level of prox convoluted tubule
  5. fine tuning 10% occurs in loop of henle: absorb water, gluocse, conserve minerals
  6. distal tubule
  7. collecting duct
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10
Q

what are the functions of a nephron

A
  1. filtration
  2. tubular reabsorption
  3. tubular secretion
  4. urinary extrection
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11
Q

talk about filtration

A

blood is filtered in the glomerulues > tubule

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12
Q

talk about tubular reabsorption

A

solutes and water transported from tubular lumen into peritubular capillaries and returned into circulation

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13
Q

talk about tubular secretion

A

filtrate in rental tubule is further modififed by secretion of substances from peritubular capillaries into tubular lumen

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14
Q

talk about urinary excretion

A

filtrate is transported to bladder for storage and elimination

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15
Q

define polyuria

A

production of abnormally large volumes of dilute urine
ex: DM in crisis mode

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16
Q

define urinary frequency

A

need to urinate many times during the day or night but in normal or less than normal volumes
-either problem can include nocturia

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17
Q

define nocturia

A

nocturnal polyuria

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18
Q

define oliguira

A

-daily urine output less than 400 ml
-when present in acute renal failure, increased mortality

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19
Q

define anuria

A

no urine production

20
Q

what is pre-renal ARF

A

most common
-conditions that decrease renal blood flow
ex: HF, shock, sepsis, hemorrhage, hypovolemia
excessive vomitting, diarhhea, use of dieruetics

21
Q

what is post-renal ARF

A

conditions that obstruct urine flow
ex: kidney stones, prostatic hypertrophy, bladder cancer, prostate or cervix, blood clots

22
Q

what is intra-renal ARF

A

injury and or inflammation within kidneys
ex: intersitital nephritis, acute glmoerleuoneprhtisi, acute tubular necrosis, ischemia, toxins

23
Q

what causes acute kidney injury

A

infection
-most UTIs involve only the bladder and urethra

pyelonephritisi: results when UTI progresses to involve the upper urinary system (kidneys and ureters)

24
Q

what are commons signs and symptoms of pyelonephritisi

A

-back or flank pain
- fever/chills
-feeling sick
-nausea./vomit
-confusion
-changes in urine

25
Q

what causes renal and urinary tract calculi (stones)

A

-increased concentration of salt in blood: calcicum salts or uric acid

-UTI

-urinary tract obstruction

26
Q

what are renal and urinary tract calculi (stones) manifestations

A

-renal colic: pain
-nausea/vomit
-hematuria

27
Q

what is the treatment of renal and urinary tract calculi (stones)

A

-manage pain
-hydration
-cystoscope: remove stone
-lithotripsy: US

28
Q

what is rhabdo

A

-breakdown of muscle fibers, specifically sacrolemma of skeletal muscle = increased myoglobin
-releases waste products into blood stream
-influx of water and calicum into muscle fibers= underperfusion of kidneys and risk of compartment syndrome
-released myoglobin can cause acute kidney injury and renal failure

29
Q

what causes rhabdo

A
  1. trauma: crush injury, surgery, coma, immobilization
  2. extertional: exercise, heat illness, seizures, metabolic myopathies, hyperthermia
  3. nonextertional: ETOH, drugs, infection, electrolytes
30
Q

what are the signs of rhadbo

A

“traid” muscle pain, weak, dark urine
-compartment syndrome due to inflammation and fluid shift

31
Q

what are the rhabdo lab findings

A

high creatine kinase numbers

CK marker of muscle injury
-CK rises within 2-12 hours and peak 24-72 hours. decline 3-5 days after injury

-higher CK=greater risk AKI

-hypovolemia due to ECF influx into injured muscle
-hyperkalemia and hyperphosphatemia due to damaged muscle
-hypocalcemia due to influx into injured muscle
-metabolic acidosis due to kidney injury

32
Q

what causes chronic renal failure

A

-diabetic nephropathy
-hypertension
-glomerulonephritis
-polycysitc kidney disease
-kidney infections, obstructions, renal disease

33
Q

what does a high GFR mean

A

healthy kdiney

34
Q

what is glomerular filtration rate (GFR)

A

-flow rate of filtered fluid (blood) through kidney over time
-gives a rough measure of number of functioning nephrons
-difficult to measure

35
Q

what is creatninine

A

-biomarker of kidney health
-amino acid, primarily found in skeletal muscle
-freely filtrered in the glomerulus and readily excretede by the kindey, easily measured in plasma
-as plasma creatninine increases, GFR decreases
-higher value=more damage to kidney

36
Q

what is albumin

A

most important protein in body
-made by liver, found in blood
-if in the urine=bad

37
Q

how does hyperkalemia manifest

A

-heart rhythym issues #1
-muscle weakness
-flaccid paralysis

38
Q

how does hypercalcemia manifest

A

stones
bones
groanes
thrones

39
Q

how does metabolic acidosis manifest

A

-lethargy
-weakness
-decreased cardiac contractility and decreased CO
-dysrthymias

40
Q

what is temporary access

A

-tunneled catheter
-placed in central vein, such as internal jug
-least durable

41
Q

what is AV fistula

A

-surgeon constructs access by combining artery and vein
-durable

42
Q

what is AV graft

A

-man made tube inserted by surgeron to connect a and v
-2-6 weeks mature
-less durable than fistula

43
Q

what do types of access mean to us?

A

-no BP on same arm as fistula or graft
-protect arm from injury
-control hemorrhage
-a thrill will be felt= normal

44
Q

what is continuous renal replacement therapy (CRRT)

A

-use of extracorporal blood circuit through a small-volume, low ressitnace filter
-provide continuous removal of solutes and fluid
-pt usually critically ill
-therapy may/may not be contraindicated

45
Q

what is peritoneal dialysis

A

-uses peritoneum as semipermeable memrane and it is infused into abs
-peritoneum highly vascularized allowing waste products and fluids to pass the blood into solution

-therapy held during infusion/removal

46
Q

what are the implications of dialysis

A

-mobilization activities usually contraindicated during but CRRT exception depending on status
-assess fluid and electrolyes
-expect potential dehyration and hypotesnion after dialysis

Med Con II (12 decks)

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