Kidney A&P, GFR, and UTIs

Question 1

what makes up the upper urinary tract?

Answer 1

kidneys and ureters

Question 2

what makes up the lower urinary tract?

Answer 2

urinary bladder and urethra

Question 3

what is the function of the kidney?

Answer 3

1. Maintains osmotic pressure of the body’s fluids
2. Regulates the volume of extracellular fluid
3. Help regulate acid-base balance
4. Helps regulate BP (RASS)
5. Endocrine function
6. Drug excretion

Question 4

how does the kidney maintain osmototic pressures of the body’s fluids?

Answer 4

regulating the blood concentrations of numerous ions including:

Na+, K+, Ca2+, Mg2+, Cl-, and HCO3-, phosphate and sulfate

Question 5

how does the kidney regulate the volume of extracellular fluid?

Answer 5

by controlling Na2+ and water excretion

Question 6

how does the kidney help regulate acid-base balance?

Answer 6

by excreting H+ when there is excess acid, or HCO3- when there is an excess of base

Question 7

the kidney produces what hormones?

Answer 7

erythropoietin and renin

responds to ANG II, aldosterone, and ADH

Question 8

what are the 3 basic mechanisms/processes performed by the kidney?

Answer 8

filtration

reabsorption

secretion

Question 9

what is the role of Bowman’s capsule in the kidney?

Answer 9

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

Question 10

describe the flow of urine in the Urinary system and ID various chokepoints

Answer 10

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

Question 11

why is there a greater incidence/risk of UTIs in females?

Answer 11

proximity of urethra to vaginal and rectal openings allowing for relative ease of bacterial transport

the shorter urethra in females also increases the risk

Question 12

List risk factors for UTIs

Answer 12

1. Age
2. imobility/inactivity
3. instrumentation and urinary catheterization
4. atonic bladder
5. increased sexual activity
6. Obstruction
   
   • renal calculi
7. Postatic hyperplasia
8. constipation
9. femal gender
10. Pregnancy
11. Diabetes

Question 13

describe the etiology and pathogenesis of UTIs

Answer 13

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)

Question 14

list s/s of a UTI

Answer 14

1. frequent urination
2. urinary urgency
3. pain
   
   • shoulder, back, flank, suprapubic, pelvis, lower abdomen
4. Costovertebral tenderness
5. fever and chills
6. Dysuria
7. Hematuria
8. Pyuria (urine containing pus/excessive neutrophils in urine)
9. Dyspareunia (painful sex)

Question 15

where are common sites of infection for a UTI?

Answer 15

1. Cystitis → infection of bladder
2. Urethritis → infection of urethra
3. Pyelonephritis → infection of the kidney

Question 16

what is pyelonephritis?

Answer 16

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

Question 17

list risk factors for pyelonephritis

Answer 17

1. frequent sexual activity
2. recent UTI
3. recent spermicide use
4. diabetes
5. recent incontinence
6. immune compromised individuals
7. urine reflex
8. ureter/bladder obstruction

Question 18

list some causes for chronic pyelonephritis

Answer 18

1. Chronic infection
2. urine reflex
3. ureter/bladder obstruction
4. atonic bladder

Question 19

describe the pathogenesis of chronic pyelonephritis

Answer 19

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

Question 20

List symptoms of acute pylenophritis

Answer 20

1. back or flank pain
2. fever and chills
3. malaise
4. N/V
5. confusion
6. Urine changes
   
   • hematuria
   • cloudy/foul smelling urine
   • painful urination
   • increased frequency or urgency of urination

Question 21

T/F: UTIs rank second only to respiratory tract infections in incidence of bacterial infections possibly as comorbidities

Answer 21

TRUE

Question 22

what is the role of a PT in treatment of UTIs?

Answer 22

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

Question 23

list some potential problems that can arise secondary to kidney disease

Answer 23

1. cognitive problems
2. anemia
3. electrolyte imbalance
4. impaired drug metabolism
5. osteoporosis

Question 24

what if GFR?

Answer 24

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

Question 25

how is GFR directly measured?

Answer 25

assessing the clearance of exogenous filtration markers (inulin, iohexol)

this procedure is generally not routinely performed

Question 26

how can GFR be estimated?

Answer 26

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

Question 27

What are some other tests that may be helpful in detecting kidney damage/evaluating kidney function?

Answer 27

1. urine albumin
2. albumin/creatinine ratio (ACR)
3. urinalysis
4. renal panel

Question 28

increases in what 3 lab values may indicate kidney disease?

Answer 28

serum creatinine

blood urea nitrogen (BUN)

urine albumin