Kidney A&P, GFR, and UTIs Flashcards
what makes up the upper urinary tract?
kidneys and ureters
what makes up the lower urinary tract?
urinary bladder and urethra
what is the function of the kidney?
- Maintains osmotic pressure of the body’s fluids
- Regulates the volume of extracellular fluid
- Help regulate acid-base balance
- Helps regulate BP (RASS)
- Endocrine function
- Drug excretion
how does the kidney maintain osmototic pressures of the body’s fluids?
regulating the blood concentrations of numerous ions including:
Na+, K+, Ca2+, Mg2+, Cl-, and HCO3-, phosphate and sulfate
how does the kidney regulate the volume of extracellular fluid?
by controlling Na2+ and water excretion
how does the kidney help regulate acid-base balance?
by excreting H+ when there is excess acid, or HCO3- when there is an excess of base
the kidney produces what hormones?
erythropoietin and renin
responds to ANG II, aldosterone, and ADH
what are the 3 basic mechanisms/processes performed by the kidney?
filtration
reabsorption
secretion
what is the role of Bowman’s capsule in the kidney?
site of glomerular filtration
within the capsule, in the glomerular basement membrane, there are podocytes with slits between them that allow for fluid to pass from the capillaries in Bowman’s capsule into the kidney tubules
describe the flow of urine in the Urinary system and ID various chokepoints
kidney → renal pelvis → ureter →urinary bladder → urethra
there is a potential chokepoint at every one of those transitions
could be caused by an enlarged prostate or weakened detrusor muscle
why is there a greater incidence/risk of UTIs in females?
proximity of urethra to vaginal and rectal openings allowing for relative ease of bacterial transport
the shorter urethra in females also increases the risk
List risk factors for UTIs
- Age
- imobility/inactivity
- instrumentation and urinary catheterization
- atonic bladder
- increased sexual activity
- Obstruction
- renal calculi
- Postatic hyperplasia
- constipation
- femal gender
- Pregnancy
- Diabetes
describe the etiology and pathogenesis of UTIs
most of the bacteria responsible for UTIs are fecal-associated gram-negative organisms
these pathogens are able to adhere to urinary tract mucosa, colonize, and cause infection
they are then able to migrate upwards through the urinary tract to the kidney (opposed by urine stream)
list s/s of a UTI
- frequent urination
- urinary urgency
- pain
- shoulder, back, flank, suprapubic, pelvis, lower abdomen
- Costovertebral tenderness
- fever and chills
- Dysuria
- Hematuria
- Pyuria (urine containing pus/excessive neutrophils in urine)
- Dyspareunia (painful sex)
where are common sites of infection for a UTI?
- Cystitis → infection of bladder
- Urethritis → infection of urethra
- Pyelonephritis → infection of the kidney
what is pyelonephritis?
a kidney infection often secondary to a UTI traveling upstream
can also be a chronic inflammatory disease involving the kidney parenchyma or renal pelvis
chronic pyelonephritis is defined by scarring in the calices
list risk factors for pyelonephritis
- frequent sexual activity
- recent UTI
- recent spermicide use
- diabetes
- recent incontinence
- immune compromised individuals
- urine reflex
- ureter/bladder obstruction
list some causes for chronic pyelonephritis
- Chronic infection
- urine reflex
- ureter/bladder obstruction
- atonic bladder
describe the pathogenesis of chronic pyelonephritis
scarring resulting in deformity of the calices (abnormal movement of urine)
responsible for upwards of 25% of cases of end stage renal disease → dialysis and transplanation
List symptoms of acute pylenophritis
- back or flank pain
- fever and chills
- malaise
- N/V
- confusion
- Urine changes
- hematuria
- cloudy/foul smelling urine
- painful urination
- increased frequency or urgency of urination
T/F: UTIs rank second only to respiratory tract infections in incidence of bacterial infections possibly as comorbidities
TRUE
what is the role of a PT in treatment of UTIs?
recognizing the risk factors and presenation of UTIs
may limit participation in rehab
UTIs increase risk for developing sepsis
communicate importance of personal hygiene
pelvic floor PT
recondition pts on dialysis
infection control
list some potential problems that can arise secondary to kidney disease
- cognitive problems
- anemia
- electrolyte imbalance
- impaired drug metabolism
- osteoporosis
what if GFR?
glomerular filtration rate
an estimate of the rate at which materials in the blood are filtered out by the kidneys
an assessment of kidney function
normal GFR = >90
how is GFR directly measured?
assessing the clearance of exogenous filtration markers (inulin, iohexol)
this procedure is generally not routinely performed
how can GFR be estimated?
via results of blood creatinine test, the patient’s age, body size, gender and race
serum creatine and urea levels increase in the presence of kidney dysfunction
What are some other tests that may be helpful in detecting kidney damage/evaluating kidney function?
- urine albumin
- albumin/creatinine ratio (ACR)
- urinalysis
- renal panel
increases in what 3 lab values may indicate kidney disease?
serum creatinine
blood urea nitrogen (BUN)
urine albumin
