Lust 2 Flashcards
1
Q
What are the indicators we use for Kidney Function?
A
Blood
- Serum Creatinine
- creatinine= breakdown product of muscle
- completely excreted
- measure of kidney filtration
- High Serum Creatinine=Kidney Dysfunction
- BUN=Blood Urea Nitrogen
- High plasma BUN=Azotemia
- Bad indicator of GFR bc it rises with dehydraiton, high protein diet, or muscle breakdown
- Serum Creatinine=better measure of kidney fxn
2
Q
Other Common Signs of Kidney Disorder
A
- Physical
- CVA tenderness
- Urine:
- Proteinuria (microalbuminuria)
- Hematuria
-
positive leukocyte esterase
- __measures the amount of enzyme secreted by WBCs
- high amount=bladder or kidney infection
- Caution:
- IV contrast enhanced imaging studies
- avoid=radiopaque dye cause renal failure
- Dehydration
- increases the risk
- IV contrast enhanced imaging studies
3
Q
Guide to renal disease classification:
A
- Pre-renal causes
- Cardiovascular
- Glomerular Diseases
- Filtration at glomerular capillaries
- Reabsorption at peritubular capillaries
- Tubular/Interstitial Diseases
- Epithelial Transport
- Post-renal causes
- Ureter
- bladder
- urethra
- micturition reflex
4
Q
Acute Kidney Injury
A
- Aka Acute Renal Failure
- decreased glomerular filltration of blood in AKI leads to azotemia, High serum creatinine, and fluid retention
- Abrupt insult to the kidney that causes a rapid decrease in renal filtration funciton (Decrease GFR)
- Accumulation of nitrogen waste products in body due to decline in function
- Common cause
- ischemia of kidney
- Other causes:
- prerenal
- intrarenal (Glomerular or tubular)
- post renal
- With Proper interventions, normal renal function can return
- 2 weeks to 3 months of initial event
5
Q
Postrenal Dysfunction
A
- Caused by:
- obstructive uropathy
- prevents urine outflow from kidneys
- obstructive uropathy
- Examples:
- kidney stone
- prostate gland hyperplasia
6
Q
Nephrolithiasis
A
- formation of Calculi/stones in the kidney
- stones can travel down ureter or bladder
7
Q
Most common Renal Calculi
A
- Calcium Stones
- Struvite uric acid stones
- Cystine Stones
8
Q
Renal Calculi
A
- 75% consist of calcium
- most composed of calcium oxalate
9
Q
What are the different types of Kidney Stones
A
- Agony
- Pain
- Misery
- Calcium Stones
- Uric Acid Stones
- Struvite Stones
- Cystine Stones
10
Q
Uric Acid Stones
A
- 10% of kidney stones
- Seen in patients with:
- low urine pH
- low urine volume
- Associated with:
- Chronic Diarrhea
- volume depletion
- high animal protein diet
- myeloproliferative disorders
11
Q
Calcium Oxalate Stones
A
- 60-80% of kidney stones
- Most preventable cause:
- dehydration
- low urine output
- Other factors:
- Diet
- high sodium intake
- high oxalate intake
- high protein oxalate
- Diet
12
Q
Symptoms of Nephrolithiasis
A
- Pain
- Severe Abdominal Pain
- Flank pain around to groin
- Colicky pain caused by ureter spasms
- Hematuria
- Crystalluria
13
Q
Nephrolithiasis: Risk Factors
A
- Genetic Susceptibility
- Dehydration
- Hypercalcemia-excessive calcium intake
- Hyperparathyroidism
- GOUT
- Hyperuricemia
- Urinary Tract Infection; proteus
- Immobility
- Large quantities of soft drinks
14
Q
Nephrolithiasis: Treatment
A
- High fluid intake (>3L/day) to flush out stone
- Lithotripsy
- Surgery if not relief
- Strain urine to catch stone
- Save stones for analysis
- Dietary changes to keep urine acidic or alkaline
- depends on stone composition
15
Q
Lithotripsy
A
- When stone will not pass by itself
- ultrasound shock waves
- breakdown into smaller parts to pass through ureters
16
Q
Nephrolithiasis: Complications
A
Infection of Hydronephrosis
- Hydronephrosis
- stone causes back pressure in renal pelvis
- occurs when edema and distention of renal pelvis occurs
- Prolonged hydronephrosis causes:
- compressin of kidney tissue
- ischemia
- irreversible kidney damage
17
Q
recall: Urination after ureter
A
- Default mode is to automatically void bladder when stretched
- Basic reflex is a spinal reflex arc
- Over-ride on external sphincter is CNS controlled
- external sphincter
- skeletal muscle
- voluntary control
- Bladder at rest: Sympathetic Input Dominant
- relaxed
- Detrusor muscle
- Contracted:
- ureteral sphincter and internal sphincter
- ureter
- relaxed
- Micturition Reflex: PNS tone
- actiavted by stretch receptors
- relaxed:
- sphincters
- Contracts:
- Detrusor
18
Q
Neurogenic Bladder
A
- Lack of nerve supply to the bladder
- Person can’t feel when bladder is full
- Must use catheter to void
- Brain
- Cerebral Palsy
- Dementia
- Parkinson’s
- Stroke
- Spinal Cord
- AIDS
- MS
- Polio
- Spinal Cord injury
- Peripheral Nerve/NMJ
- Diabetic neuropathy
- Myathenia Gravis
- Pelvic Plexus injury
19
Q
Types of Incontinence
A
- Stress Incontinence
- increased abdominal pressure under stress
- weak pelvic floor musclees
- increased abdominal pressure under stress
- Urge Incontinence
- involuntary contraction of bladder muscles
- Overflow
- blocked urethra
- Neurogenic
- impaired nervous system
20
Q
Abnormal Prostate
A
- Prostatitis
- acute symptoms of urinary infeciton
- Obstructive symptoms
- Perineal or suprapubic pain
- Benign Prostatic Hyperplasia
- Most common benign tumor in men
- Obstructive or irritative voiding symptoms
- Prostate Cancer
- PSA unreliable
- typically asymptomatic
21
Q
Overactive Bladder
A
Sympathetic nerve damage
22
Q
Atonic Bladder
A
Aka Paralytic Bladder
Damage to parasympathetic nerve
23
Q
Signs and symptoms of bladder dysfunction
A
- Hesitancy
- Urgency
- Frequency
- Incontinence
