Kidneys and UTIS Flashcards
Norm level for BUN and Creatine
BUN 7-18
Creatinine 0.6-1.2
Normal Hematocrit MEN and Woment
Men 38.8-50
Women 34.9-44.5
Normal Postassium, Sodium, Calcium Levels
K 3.5
NA 135-145
CA 8.6
What is the Proper name for Kidney Stones
Urolithiasis/ Urinary-Renal Calculi
Kidney Stones are made up of what, And what are some causes of them
Calcium Oxalate
Dietary Factors, High Doeses of Vit D, Intestinal Bypass.
Oxalate is found in foods, what are some foods to avoid if you have regular kidney stones to decrease your oxalate levels
Nuts, Chocolate, Some fruits and Veggies
What Med might your MD prescribe to Prevent Calicum Stones?
A thiazide Diurectic or a Phospate-containing preperation.
Uric acid Stones(GOUT). Your MD may prescribe Zylopirm or Aloprim to treat. What is the generic name for these meds
(allopurinaol)
What is a major factor to monitor if a person is developing stones
Persons should avoid large intakes of protiens.
Prevention Techniques for Stones
Drink Plenty of Water (2-3 Liters) per day
Eat fewer oxalate foods( Rhubarb, beets, okra, spinach, sweet potatoes, nuts, black tea, chocolate, soy)
Diet low in salt
Eat calcium rich foods, but avoid calcium supplements
Clinical Manifestations of Renal Calculi
Pain( Severe)
Nausea
Vomiting
Fever
Hematuria
Bladder Distention
Diagnostic Tests For Renal Calculi
KUB (xray of Kidneys ureturs and bladder)
IVP( Intravenous Pyelogram) Detremines size and location of stones
Renal Ultrasound reveals obstructions
UA(urianalysis) will reveal issues in urine(blood, odor, turbitity)
Treatment for Stones
Analgesia(VIP) Opoids, then NSAIDS/Tylenol(avoid nsaids if pt is to have lithotripsy due to platelet/bleeding)
HYDRATION (2-3 L/day)
Urine straining(24-48 hours)
Minimally invasive surgical procedures may include Stenting nephroliotomy
What is a Nephrolithotomy
nephrolithotomy (PCNL) is a minimally-invasive procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin. It is most suitable to remove stones of more than 2 cm in size and which are present near the pelvic region.
What are the two types or Urinary tract infections
Upper or Pyelonephritis (kidneys) Ureters (Ureteritis).
Lower which consist of the bladder(cystitis) and urethra (urethraitis)
Name some risk factors for UTI’s in everyone.
Incomplete emptying of bladder
Obstructed urinary flow from Cogentical abnorms
Intruments being placed in system
Diabetes(due to increased urine glucose)
Some Elderly risk factors for UTI include
Frequent use of antimicrobials
immuno compromised
cognetive imparment leading to poor hygine
Immobility and imcomplete emptying of bladder
Routes of infection include
Transurethral (ascending) MOST COMMON
Bloodstream(hematogenous spread)
Fistulas from the intestine(direct extension)
Most common organism to cause UTI
E. Coli
Upper UTI’s Clinical Manifestations
Acutely ill, chills, fever, low back pain, flank pain, n/v.
Physical exam reveals Pain and tenderness in the area of the constovertebral angle
Lower UTI SYS
Inablility to urinate despite urge, Frequent need to urinate(polyuria), painful urination(dysuria) Suprapubic or pelvic pain.
Lower UTIS elderly. Elderly often lack s/s of UTI and Sepsis. although frequency and urgency may occur, non specific s/s may also occur these include:
Altered senses, lethargy, anorexia, new incontinece, hyperventialation, and lowgrade fevers.
Uncomplicated UTIS Lower or upper are
Generally cured with one antibiotic, a commuinity accquired infection, common in young women, and not usually recurent
Complicated UTIS are:
Often Nosocomial due to catherters and are regularly recurent
occur in pts with abnormalities of renal sys
pregnacy
immunosupressed pts
diabetes
obstructions (ie Prostate)
MAY NEED Culture and Sensativity and MULTIPLE antibiotics
Tests done to determine UTI’s
U/A, urine culture(C+S)
Presence of Nitrates and leukocytes in urine,
CT Scans, ultrasound, iv Pyelogram for uppers
cystoscopy for lower
Drugs Commonly used for Uncomplicated UTIS
Sulfamethoxazole-trimethoprim(Bactrim) Usually first offered.
Amoxicillin
ampicillin
Cipro
Levoflaxacin
Analgesic used with UTI
Phenazopyridine(pyridium) relieves pain and burning turns urine orange
Medications for Upper UTI (yelonephritis)
IV or PO cipro
IV cefriaxon(rocephin)
IV amnioglycociedes(may be nephrotoxic)
Mycin’s(Tobra, genta, neo)
These have a longer course of tx
Prevention is key, name some ways to prevent UTI in catherterized pts
strict aseptic techinique when inserting
using smallest cath possible
securing cath to avoid movement
frequent inspection of urine
Meticulous daily cleaning
Prevetion of UTI’s In non cathed pts includes
avoid products that irritate urethra
cleanse before intercourse
change soild diapers promptly
Increased fluid consumption
Do not routienley resist urge to urinate
take showers instead of baths
urinated after intercourse
Wipe from front to back
Functions of the Kidney include
Regulation of Water, electrolyte function, acid base balance, blood pressure, and RBCs as well as Vit D synthesis
Blood pressure is regulated with renin-angio-aldos-sys
RBC’s regulated by Erthropoetin secretion
Caclium is not metabolized if Vit D is down
What medication would you give if the Kidneys were not properly regulating the RBC’s in the body. What precautions may be needed
Epogin or procrit which stimulates Erythropoesis( Rbc production)
With Epogin Seziure precautions may be needed
There are three types of diuretics, what are then and where do they function
Manitols(Very strong) first part of nephrons K depleting
Loop Diuretics(furosomide) In the loops K depleting
aldosterones after loops K sparing
What are the hormones that affect renal function
Renin- Raises BP so blood in Glomerous
Erthopoietin
Anti Diuretic Hormone (ADH)
Aldosterone- Promotes NA reabsorbtion and K excretion
Natriuretic hormones released from the Cardiac atria and Brain
Due to hormone actions some meds are used to protect the kidneys these may be
Ace inhibitors to decrease blood pressure.
Pre-renal problems are treated-
and is what type of problem-
Inter-renal problems are treated-
and is what type of problem-
Before the Kidneys( ie blood systems)
Usually a volume or horomone problem
Inter renal is within the kidneys
Generally a structure or nephron problem, can be made worse by nephrotoxins or metabolites
What is the normal GFR
125 ml/min
There are five stages for Kidney disease they are characterized by GFR what are they and there ranges
After 40 how much does GFR decline
about 1 ml/min per year
What is the number 1 cause of CKD
Diabetes
Elderly considerations for the kidneys
Decrease in GFT, Multiple medications can become toxic metabolites, Dimished sense of thirst increasing risk of dehydration, Urinary issues that can lead to infectious damage
Renal Function TESTS ***MUST KNOW***
Urine osmolarity changes can be seen in early stages which results in decrease concentration of urine
Creatinine clearance- amount of creatinine cleared in one min reflects GFR
Serum Creatinine levels should be between 0.6-1.2 this is a prime measure of renal effectiveness
BUN is also a funtion test but is not as accurate, should be between 7-18
Why is BUN obtained
Liver function is key to proper renal function. The liver produces nitrates, BUN measure the amount in the blood, if it is elevated, the kidneys are not processing it out which is an indication of a problem
Urine Specific Gravity is the concentration of urine. This correlates with Osmolarity how does this relate to volume
More fluid lower concentration, less fluid more concetrated..by fluid I mean preload fluid
Creatinine Clearance
is calcuated by GFR over 24 hours where at the midway point a serum Creatinine level is taken then a calcuation is completed.
(Volume of urine x urine creatinine)
Serum Creatinine
Factors that can give elevated BUN levels not related to Kidney issues include
Dehydration, Low blood volume, Low BP
when these occure BUN raises more rapidly then Creatinine
Creatinine and BUN should be similar in ration and proportion otherwise it is most likely a volume not kidney issue
Kidneys can be images to diagnose issues these tests include..
What drug may need to be held
KUB
Ultrasound(most common)
CT/MRI
Nuclear Scans
IV Urography, pt must be NPO and get Bowel Prep(this is nephrotoxic)
HOLD METFORMIN IF DIES ARE NEEDED FOR 48 hours pre testing
Kidneys can be treated with scope procedures they include
Cystoscopy
Ureteral brush biopsy
kidney biopsy
