PKD, BPH, Diabetic Nephropathy Flashcards
what is pkd?
Polycystic Kidney Disease
• Fluid –filled cysts develop in the nephrons resulting in enlarged kidneys and causes compression on kidney itself and abdomen
• large abdomen causes pain and pressure on other organs
• kidney enlarges and fails
• These cysts develop as a result of abnormal cell division
3 types of PKD
Autosomal recessive
Autosomal dominant
New mutation/not inherited
most common type of PKD
Autosomal dominant
Type of PKD that results in childhood death usually
autosomal recessive
4 Major issues to consider with PKD
pain
infection
BP
Bleeding
How does PKD lead to HTN?
Kidney Ischemia/ lack of blood flow -> RAAS system activated–> Hypertension
can you have cysts other places with PKD?
yes! ◦ Liver ◦ Blood Vessels (Aneurysms) --> sudden death ◦ Spleen ◦ Thyroid ◦ Pancreas
if you have PKD you are more likely to develop what 3 things- 2 related to other systems , 1 related to urinary system
kidney stones
cardiac problems
colon problems
what does PKD pain feel like
◦ Dull, Aching
◦ Sharp, Intermittent - when cyst ruptures + also have hematuria
what is your pee like with PKD
- Dysuria
- Foul-smelling urine- ruptured infected cyst rupture
- Cola colored urine- ruptured cyst
- Nocturia (early)
- Uremia- later in disease, build up of uric acid
at risk for what electrolyte imbalance with PKD
Na
Assessment findings besides pain and urine changes with PKD
- Distended Abdomen
- Flank Tenderness/ Pain
- Na loss - Only need to manage dietary Na decrease later in disease
- Hypertension- activation of RAAS system
- Edema- kidney’s cant get rid of fluid
- Severe Headache- aneurysm, hypertensive crisis
- Depression &Anxiety- psychosocial assessment
what test are we looking at for long term analysis of stage/progression with PKD? what is normal range?
GFR, >60
If you get diagnosis of PKD then you have stage ____ kidney disease
1
Diagnostics for PKD
- Urinalysis
- Culture if indicated
- **GFR- long term
- Serum Creatinine/ BUN- helpful in the minute
- NA/ Electrolytes
- Ultrasound
- CT
- MRI
what happens to Na levels in PKD (early vs late disease)
◦ Low NA in early disease
◦ High NA in late disease
Interventions for PKD
- **Blood pressure control
- Pain management
- Prevention of infection
- Prevention of constipation
- Support (Dialysis)
pain management for PKD
- Drainage of cyst
- Opioids
- Nephrectomy
- Antibiotics
- Relaxation Techniques
Constipation prevention for PKD
- Adequate Fluid intake
- Increase Fiber
- Exercise
- Stool Softeners
- Bulking agents
- Laxatives
preferred drug to manage HTN for PKD?
Ace inhibitor! (ARB 2nd choice, CCB worst choice)
Blood pressure management for PKD
- Adequate fluid intake
- Restrict Na intake around 2.5 g/day
- Monitor Blood Pressure
- Keep records of readings
- Daily weights
- ACE inhibitors
What is the leading cause of renal failure?
diabetes
what determines someone risk for diabetic nephropathy?
• Severity of kidney disease is related to the degree of hyperglycemia the patient has
◦ High A1C = increase risk of development
first sign of diabetic nephropathy is….
microalbuminuria!
When do we screen urine for protein- type 1 vs type 2 DM
- Screen for protein in urine 5 years after Type I diagnosis
- Screen for protein in urine 1 year after Type II diagnosis
• Check at least 1/year, increase if have higher a1c
if you get a new diagnosis of diabetes you also get diagnosis of stage ____ kidney disease
1
interventions for diabetic nephropathy
• Avoid Dehydration • Avoid Nephrotoxic substances • Overtime, as kidney function declines, hypoglycemic events may become more common ◦ Kidney disease is risk factor for hypoglycemia • Glycemic control • Keep blood pressure under 125/75 • ACE inhibitors and ARB’s • Control lipids
_____ disease is a risk factor for hypoglycemia
kidney!
• Overtime, as kidney function declines, hypoglycemic events may become more common
What causes BPH?
- Related to aging and increasing levels of dihydrotestosterone (DTH)
- Glands in prostate undergo hyperplasia
- Local inflammatory response
What happens to detrusor muscle with BPH?
thickens
What happens to residual urine with BPH?
increases
BPH can lead to chronic urinary _____
retnetion
What kind of incontinence w/ BPH?
overflow
3 affects of BPH on urinary system
- thickened detrusor muscle
- increased residual urine
- Chronic urinary retention
Name some conditions/disease processes BPH can lead to
- Renal stones
- Infection
- Acute urinary retention
- Hydroureter
- Hydronephrosis
- Kidney Disease
Assessment for BPH
- History , screening test asking about quality of life, lower urinary tract symptoms, and current elimination patterns
- Frequency
- Hesitancy
- Intermittency
- Urgency
- Reduced force and stream
- Sensation of incomplete emptying of bladder
- Straining
- Dribbling/ leaking
- Hematuria
- Bladder distension
- Digital rectal exam
- Irritability
- Fear
- Embarrassment
- Depression/ Social Isolation
Diagnostics for BPH
- Urinalysis
- Culture
- Serum Creatinine/ BUN
- Prostate Specific antigen
- Transabdominal/rectal Ultrasound
- Prostate tissue biopsy to rule out cancer
- Cytoscopy
- Residual urine test
- Urodynamic Pressure-Flow tests
5 drug therapies for BPH
◦ 5-alpha reductase inhibitors ◦ Alpha-blockers ◦ Palmetto extract ◦ African plum tree bark (Pygeum) ◦ Rye Pollen
Non surgical interventions for BPH
- Drug Therapy
- Frequent sexual intercourse
- Spread fluids out over time (avoid large volumes at one time)
- Avoid bladder stimulants
- Void as soon as sensation occurs
- Avoid medications that contribute to urinary retention
- TUNA Transurethral needle ablation
- TUMT Transurethral microwave therapy
- ILC Interstitial Laser Coagulation (AKA Contact Laser Prostatectomy)
- EVAP Electrovaporization of the Prostate
What is the purpose of TUNA, TUMT, ILC, EVAP for BPH?
all involve reducing size of prostrate tissue
Who needs surgery for BPH?
• Males who can’t or won’t take medications
• Males who are not candidates for non-invasive procedures
• Males with BPH causing
◦ Acute urinary retention
◦ Chronic UTI
◦ Hematuria
◦ Hydronephrosis
What is a TURP?
- Enlarged portion of the prostate is removed through endoscopic instrument
- Gold Standard for surgical treatment of BPH
- May have to be performed again (Remaining prostate tissue can become enlarged)
- Risk of strictures
TURP puts you at risk for…..
strictures
Peoperative care for TURP
- Education
- Address Anxiety
- Discontinue Anti-coagulants
- Indwelling catheter with traction
- Pain management
- Continuous bladder irrigation (3 way urinary catheter)
Post op care/consideration for TURP
- H & H
- Monitor bleeding
- Presence of blood in urine/ clots/ debris
- Fluid intake (2-2.5 L)
- Painful Urination
- Urinary output
- Infection
- Incontinence short term
- Dribbling
- Sexual Dysfunction
- Retrograde ejaculation
- Kegel Exercises- regain continence
