Kidney Flashcards
How much urine is excreted by the kidney each day?
1-3L
How much blood supply does the kidney get?
1200 ml
Functions of the Kidney?
Filtration of solutes water balance, renin production, electrolyte balance, acid base balance, erthropoeitin production, renin production, activation of Vitamin D
What is the normal range for BUN?
10MG/DL
What does an increase BUN mean?
Reduced kidney function, glomerulonephritits, pyelonepritis, urinary obsturction, dehydration, low protein,
What does a decrease BUN mean?
Malnutrition, severe hepatic disease
What are some upper UTI’s?
Pyelonephritis, glomerulonephritis, pyelitis.
What are some lower UTI’s?
Cystistis, urethritis
What normally causes lower UTI’s?
E.coli
What are some risk factors for UTI’s?
Catherization, Incontintce, increase age
What are the Signs & Symptoms of UTI”S?
Frequency, urgency, burning, bacteria, RBC and WBC in urine, increase serum WBC.
How do you treat a lower UTI?
Urine and blood cultures needed, antibiotics, antispasmodics, urinary tract antispectics, sulfanomides, urinary tract analgesic-Pyridium
If a nigga comes in with sepsis what would you do?
IV fluid replacement, antibiotics, and nutritional support.
What are the nursing interventions?
CGS to determine appropriatness of antibiotic, increase fluids to 3-4 L daily, empty bladder every 3-4 hrs, pernial care.
For indwelling cather what should you do?
Surgical asepsis during insertion closed system, secure to leg to prevent movement in and out of urethra, keep bag lover than bladder.
What is the patho for an upper UTI? (Pyenophritis)
Urine reflux from bladder into ureter or ostruction causes inflammation of the renal pelvis.
What are the risk factors for upper UTI’S?
Calcui, stricture, enlarged prostate, incompent uterovesical valve
What are the S& S of upper UTI?
Temp, chills, nausea & vomiting, tender costoverterbral angle and flank pain,
Urinary tract above the urethra is normally?
Sterile
What are defenses of preventing UTI?
Normal voiding, normal antibacterial ablility of the bladder mucosa and urine uterovesical junction compentence, peristalic activity that propels urine towards the bladder.
Urethral stricture is narrowing of the urthehra? What are the causes?
Complication of STD’s, trauma during catherization, urologic prodcue or childbirth, 1/3 have no cause.
Urethral stricture occurs in who the most?
Men
What is the most common symptom of urtheral stricture?
Obstruction of urine flow.
How do you treat urethral stricture?
Treatment is surgical but temporary
Urinary incontinence is most common in who?
Women
What causes urinary incontinence?
Stress, urge, overflow, functional mixed form
What are the treamentt for incontience?
Estrogen, anticholingenics.antispasmodics, tricyclic antidepressants
What are the other interventions for incotnence ?
Surgery, behavorial interventions/education
What is used to treat incontitence?
Ditropan
What is Urotlithais?
Presences of stones in the urinary tract and severe flank pain/hematuria
Nephrolithasisis?
Formation of stones in kidney
Ureterolithiasis
Formation of the stones in the ureter
What are some location stones can be?
Calyx, staghorn, pelvis, urtheral, bladder
What is the patho of Urothlithiasis
Urinary stasi or chemcial enviroment, precipatation and crystallization of minerals. Stoens form which obstruct the ureter and result in hydorureter and hydronephrosis.
What are the different type fo stones?
Calcium with phosphorus or oxalate (75%), uric acid (10%), struvite (15%), or cystine (1%)
Who are at risk getting these stones?
30-50 years old male, dehydration, diet with increase dairy and vitamin D. UTI, (struvite), hyperparathyrodis, gould and myelophoric disease.
What are the S& S you would espect for stones?
Pain, little or no pain, severe pain radiating from flank to bladder or genitals, N&V, hematuria, Pallor, diaphoresis, UTI
How do you treat stones?
Opiods, NSAIDS, Hydration, lithotripsy
How would you treat calcium stones?
Ammonium chloride to acity urine, thiazide diuretics
How do you treat Uric Acid stones?
Allopurionol and increce urine ph
What interventions should you do regarding stones?
Monitor S&S, strain urine, increase fluids to 3-4Liters daily and control pain
What do you do to control CALCIUm stones?
Acid ash diet with low dairy, protein, and sodium intake
What do you do to treat oxalate stones?
decrease tea, spincach, nuts, chochalte,
What is UTI’s with uria called?
Splitting bacteria
Urinary calculi is most common in males and what else?
20-55 and recors in 80 and rare in African Race
What are some contributing factors to kidney stones?
Slow urine flow, damage to lining of the urinary tract, decreased inhibitor substance in urine that prevent supersatuuration and crystan aggregation, high urince acidity or alkanity, medication problems and metabolic problems
What is renal colic?
Severe pain that usually begins SUDDENTLY AND is described as unbrearable.
What is renal colic accompained by?
Nausea, vomitting, pallor, and diaphoresis
If the patient has flank pain, how is that related to renal colic?
Flank pain suggest the stone is in the kidney or upper ureter
What does it mean when the Flank Pain extends to the abdomen, scrotum, and vulva?
It suggest that the stones are in the uteters or bladder.
Pain regarding renal colic is most intense when?
The stone is moving or the ureter is obstructed
Uric acid stones is monst common in who?
Jewish Men
People with uric acid stone should avoid?
Sardines, ETOH, anchovies, liver, kidney, vension, meat, soups, milk, dairy, and citrus fruits
What type of diet do you need to get rid of uric acid stones?
Increase urine PH for patients
What drug can you give them for uric acid stones?
Allupurionol which reduces uric acid levels.
What type of stones are seen in alkaline urine?
Calcium oxalate stones
What do people with calcium oxalate stones need to avoid?
Tea, beer, excess dairy products, spinach, asparagus, cabbage, tomatoes, celery, instant coffee, chococalte,
What are indications for surgery or lithotrispy?
Stones too large, stones associated with bacteria in urine , stone cause impaired renal function, persisten pain, inability of pt to be managed medically clinet with one kidney.
What are some complications with lithotripsy?
Hemorrhage, retained fragmenets and infection
What is urothelia cancer?
Malignacy cancers of the urothelium linking of the transitionla cells in the kidney, renal pelvis, ureter, urinaly bladder and urehtra. Highly invassive once pass by the kidney layer, recurrence may happen up to 10 years
How do you treat urothelial cancer?
Excision, chemotherapy, and
The greatest risk for bladder cancer is?
SMOKING
What is obsturctive uropathy?
Blockage in urinary tract causing dmage to kidney
What causes obsttructive uropathy?
Prostate enlargement, tumors, bladder neck contracture
What is hydronephrosis
Enlarged kidney as a reslut of urine collecting in the pelvis and kidney tissue?
A patient has hydrourtere, what does that mean
Enlargement of the ureter
Urethral Stricture
Obstruction very low in the Urinary tract causing bladder distention befor hydroureter and hydronephrois. CAUSES include tumors, stones, trauma, structural defects and fibrosis.
Why is there no prevnetion for polyctic kidney disease?
Because it is genecting.
How do you treat polycystic kidney disease?
Early detection and managing hypertension may slow progress.
PKD is…
Childhood form is rare autosomal RECESSIVE disorder that is often progressive. Adult form is AUTOSOMAL DOMINANT.
What are symptoms of PKD?
Cyst begin to enlarge= abdominal or flank pain which is steady and dull or abrubt in onset as well as episdiodic. Pain is often caused by bleeding in urine
A patient comes in to the ER with constipating, bloody urine, proteinuria, and a elevated BUN. After assessing you notice she has HTN as well. What do you suspect?
PKD. They also have abdominal girth.
What is the 3rd leading cause of end stage kidney disease?
Glomerulonephritis which has anit-antibody reaction and glomeruli is injured from inflammation.
Glomerulonephritis
Signs/sx: Hematuria Proteinuria Increased BUN & Creatinine Signs/sx: Hematuria Proteinuria Increased BUN & Creatinine
Who is most likely do develop Acute Post-Streptococcal?
Preschool and grade school children
Niggas with Acute Post-Streptoccal Glomerulonephritis
Hypertension Peripheral Edema of Entire Body Periorbital edema Oliguria output < 400 mL/day Hematuria Smoky colored urine
Proteinuria
About 95% recovery rate
How would you diagnose Acute Streptococcal Glomerulonephritis?
Culture throat or skin lesions antistreptolysisin O titers Renal biopsy Culture throat or skin lesions antistreptolysisin O titers Renal biopsy
What is the common strain in Acute Post Streptoccal Glomerulonephritis?
GROUP A BETA-HEMOLYTIC STREPTOCOCCAL
What is the etiology of Acute Post-Streptococcal Glomerulonephritis?
: What happens: the pt. produces antibodies to the streptococcal antigen (specific mechanism is unknown); the antigen-antibody complex deposits on the GBM activating Complement and the inflammatory response. Results in decreased glomerular filtration of waste products and increased permeability of the glomeruli allowing large protein molecules to pass through.
What are the clinical manifestations of APSG?
Anasarca [generalized body edema], periorbital edema, HTN, Oliguria, Hematuria (smokey/rusty), proteinuria, Flank pain, costovertebral area tenderness. Some are asymptomatic = no symptoms. High recovery rate = 95%
What should you monitor with niggas with APSG?
get throat/skin cultures to determine if strep. is still present, UA, CBC, increased BUN & Creatinine, monitor serum Albumin (Protein), ASO titer (recent strep. exposure), Complement levels, Renal Biopsy
How do you treat APSG?
Antibiotics (if strep. still present); Antihypertensives, Loop Diuretics; Diet: low protein & low sodium; Fluid Restriction; and Bedrest
Nephrotic Sydnrome
Condition of increased glomerular permeability allowing larger molecules to pass thru the membrane into urine, then excreted
Immune or inflammatory process
Severe proteinuria, possible altered liver function
Low serum albumin, high lipid levels, lipiduria, edema, HTN
Renal Cell Carcinoma
Adenocarcinoma of the kidney
Healthy tissue is damaged and replaced by cancer cells
Anemia or erythrocytosis (cancer cells produce large amts of erythropoietin)
Hypercalcemia
4 distinct cell types: genetic predisposition
Could cause urinary obstruction
Exact cause is unknown
Higher risk for smokers, occurs most between age 55-60
~51,000 new cases and 13,000 deaths per year
How is acute renal failure and chronic renal failure similar?
Both interfere with kidney’s ability to meet human need for urinary elimination and maintaining fluid volume, blood pressure, electrolytes, wastes, and acid-base balance
Incidence expected to increase with aging population and increase in Type 2 DM
Inability to excrete metabolic waste products & water
Classified acute or chronic
Acute renal failure….
↓ Glomerular filtration rate due to ↓ kidney perfusion, tubular or glomeruli damage, obstruction.
Moves from anuria (< 100 mL) or oliguria (< 400 mL) to diuresis (↑ urine output)
Progresses to recovery or ESRD
What are the risk factors of ARF?
Hemorrhage, septic shock, ↓ cardiac output, myoglobinuria due to burns or crush injury, nephrotoxic agents, transfusion reaction, calculi, BPH, infections.
What is end stage renal disease?
Chronic kidney failure or ESRD due to progressive, irreversible ↓nephron function -> uremia, retention of Na+, H20, K+, Phosphate
Metabolic acidosis due to inability to excrete ammonia and reabsorb bicarbonate
What are the risk factors for ESRD?
Diabetes, ↑BP, chronic infections (pyelonephritis and glomerulonephritis), polycystic kidney disease, nephrotoxic agents (aminoglycosides, lead, mercury, NSAIDs).
What are the S&S for both ARD and ESRD?
↓ urine output, ↑ BUN, ↑ Creatinine, ↑ K+, ↑ phosphate, ↓calcium
Metabolic acidosis: ↓ pH, ↓ HCO3, and ↓CO2; ↑BP, Kussmaul respirations, proteinuria, lethargy, confusion, headache, seizures, nausea, anemia due to ↓ erythropoietin, fluid excess (dyspnea, crackles, ↑Pulse, ↑respirations, distended neck veins)
How do you treat both ARD and ESRD?
Erythropoietin; calcium carbonate; antihypertensive
↓ fluid, sodium, potassium intake; ↓dietary protein, (↓ nitrogenous wastes)
Hemo- or peritoneal dialysis, continuous renal replacement therapy
ESRD: Renal transplant with immunosuppressives to prevent rejection.
What should be the nursing interventions for niggas with ARD anda ESRD?
Monitor patency of graft/fistula if present (auscultate bruit, palpate thrill; do not take BP in arm with access)
Monitor S&S and dietary compliance; weigh before and after dialysis
Complications of hemodialysis: ↓ BP, air embolism, dysrhythmias, atherosclerosis, exsanguination
Complications of peritoneal dialysis: Peritonitis, ↑ triglycerides, hernias due to ↑ abdominal pressure
Kidney transplant: Explain need for lifelong immunosuppressive drugs -> ↑ infection risks.
S&S of rejection: Oliguria, ↑ Temp, ↑ creatinine, flank pain
Acute Renal Failure [ARF]
A sudden, rapid, deterioration of renal function leading to collection of wastes in the body
Results from:
Prerenal failure: conditions that reduce blood flow to the kidneys
Intrarenal/intrinsic renal failure: damage to the glomeruli, interstitial tissue, or tubules
Postrenal failure: obstruction of urine flow
Can lead to end-stage kidney disease (ESKD)
Declining renal function starts phases of ARF:
Onset phase, oliguric phase, diuretic phase, and recovery phase
Major causes of Acute Renal Failure?
ischemia and nephrotoxicity Renal vasoconstriction Cellular edema Decreased glomerular capillary permeability Intratubular obstruction Leakage of glomerular filtrate
Nephrotoxic Substances for ARF
Heavy metals Antibiotics: aminoglycosides Contrast media Myoglobin Acetaminophen NSAIDs Organic solvents Diuretics Other Meds Captopril Anti-fungals cyclosporine
What type of assessment findings would you look for in a patient that has ARF?
Clinical manifestations depend on underlying conditions
Altered urine output
Oliguria Anuria Polyuria
Hypertension or hypotension
Tachypnea
Signs of fluid overload or ECF depletion
ARF Clinical Course: 3 Phases
Oliguric phase – Decreased UOP
Diuretic phase – Increased UOP
Recovery phase
What type of diagnostic studies should you look for in a patient with ARF?
Most important a good history
review of recent clinical events
Medication
History of illness that impairs renal function
Urinalysis
KUB, Renal ultrasound, renal scan, cystoscopy, retograde pyelogram, CT (without contrast), MRI, nuclear medicine study MAG3
Renal bx: if cause is uncertain
Systemic Effects of ARF:
Fluid & electrolyte imbalances Metabolic Acidosis Increased susceptibility to infection Anemia Platelet dysfunctions GI disturbances Pericarditis Uremic encephalopathy
What type of labs do you expect to see in ARF?
Elevated serum BUN, Cr, potassium, magnesium, and phosphorus
Serum calcium decreased
Serum HCO3 decreased; arterial HCO3 decreased
Arterial blood pH decreased (metabolic acidosis) or normal
Arterial Paco2 decreased
Hgb & Hct decreased
What is Chronic Kidney Disease?
Progressive, irreversible kidney injury in which kidney function does not recover-ESKD results
What is the patho of CKD?
Decreased renal reserve: renal function 40% to 50% of normal; homeostatic maintained
Renal insufficiency: 20% to 40% of normal; GFR, clearance & concentration decreased; homeostasis altered
ESKD: <10 to 15%; all renal functions severely decreased; homeostasis significantly altered
What are the complications of CKD?
Kidney
Increased BUN, Cr-at risk for fluid overload
Metabolic
Hyponatremia, Hyperkalemia, Metabolic acidosis w/resp compensation: kussmaul resp, Hyperphosphatemia, Hypocalcemia
Hematologic
Anemia
Gastrointestinal
Halitosis (from uremia), stomatitis, PUD
Cardiac
HTN, Hyperlipidemia, Heart failure, Pericarditis
What is the patho of CKD?
End products accumulate in blood not urine Retention of Na & H2O edema, CHF, HTN Metabolic acidosis Decreased GFR Erythropoietin production decreases Neurological complications Final stage dialysis or transplant
What are the labs for CKD?
Anemia Elevated BUN, serum creatinine Elevated serum phosphorus Decreased serum calcium Decreased serum proteins Particularly albumin Low blood pH
Hemodialysis
one of several renal replacement therapies used for treatment of ESKD and kidney failure
What does hemodialysis do?
removes metabolic waste products across an artificail semipermeable membrane to perform the filtering and excretion of the kidneys
Dependent on symptoms, not GFR (fluid overload, pericarditis, uncontrolled HTN, neurologic problems, bleeding
Passive transfer of toxins by diffusion
What is peritoneal diaylis used for?
who can not tolerate anticoagulation therapy
has a lack of vascular access due to inadequate vessels.
is waiting for their fistula to mature may use PD temporarily
elderly
pediatric
Who are some patients who can’t use Peritoneal diaylsis?
those with peritoneal adhesions
intra-abdominal surgery in the peritoneal cavity because often the surface area of the membrane has been reduced too much to allow for adequate dialysis exchange.
Peritoneal membrane fibrosis-may occur after repeated infections, which decrease membrane permeability despite adequate surface area.
Ureters
direct urine from kidneys to the bladder. They have 1-5 peristaltic contractions per minute to assist in the transportation of urine. They have parasympathetic and sympathetic nerve fibers. Vesicoureteral valves prevent backflow of urine from the bladder to the kidney when the bladder contracts. Renal pelvis holds 2-5 mL of urine
Bladder
Bladder.is a collapsible storage bag. Very stretchy… transitional epithelium. Average person will feel urge to urinate with 200-250 mL of urine with moderate distention. 400 mL uncomfortable. Capacity related to height. Mine is 750 mL..
What is the urethra primary function?
to discharge urine. Distal 1/3 normally contains some bacteria but flow of urine flushes it free of debris and bacteria
Cortex:
outer portion containing the glomerulus, tubules, and part of the loop of Henle
Medulla
middle portion containing part of the loop of Henle and the collecting ducts
Pelvis
inner portion where urine is collected; the narrow portion becomes the proximal aspect of the ureter as it approaches the hilum
Minor & Major Calyces
recesses of the pelvis that receive urine from papillae of collecting ducts
Proximal Convoluted Tubule:
Reabsorption of ~65% of total filtrate (Na+, H2O, Cl-, K+, Glucose, amino acids, HCO3-, phosphate, & Urea)
Loop of Henle:
Function: H2O reabsorption in the descending loop, but ascending is not permeable to H2O
Filtrate leaves hypotonic
Distal Convoluted Tubule:
Na+ and electrolyte reabsorption through the presence of ADH and aldosterone; Hydrogen & K+ excreted
Filtrate leaves hypotonic or isotonic
Blood analysis: Serum creatinine
MALES 0.6 -1.2mg/dL
FEMALES 0.5-1.1mg/dL
ELDERLY- may be decreased
Produced when protein or muscle breaks down
Increased level indicates renal impairment
Decreased level may indicate decreased muscle mass
Increase BUN?
Increased level may indicate hepatic or renal disease, dehydration, decreased renal perfusion, a high protein diet, infection, stress, steroid use, G.I.bleed, or situations in which there is blood in body tissues
Increase BUN/CREATINE ratio?
Increase in ratio may indicate fluid volume deficit
decrease in ratio may indicate fluid volume excess or malnutrition
no change in ratio with increases in both the BUN and creatinine indicates renal impairment
