PKD, BPH, Diabetic Nephropathy

Question 1

what is pkd?

Answer 1

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

Question 2

3 types of PKD

Answer 2

Autosomal recessive
Autosomal dominant
New mutation/not inherited

Question 3

most common type of PKD

Answer 3

Autosomal dominant

Question 4

Type of PKD that results in childhood death usually

Answer 4

autosomal recessive

Question 5

4 Major issues to consider with PKD

Answer 5

pain
infection
BP
Bleeding

Question 6

How does PKD lead to HTN?

Answer 6

Kidney Ischemia/ lack of blood flow -> RAAS system activated–> Hypertension

Question 7

can you have cysts other places with PKD?

Answer 7

yes! 
	◦ Liver
	◦ Blood Vessels (Aneurysms) --> sudden death
	◦ Spleen
	◦ Thyroid
	◦ Pancreas

Question 8

if you have PKD you are more likely to develop what 3 things- 2 related to other systems , 1 related to urinary system

Answer 8

kidney stones
cardiac problems
colon problems

Question 9

what does PKD pain feel like

Answer 9

◦ Dull, Aching

◦ Sharp, Intermittent - when cyst ruptures + also have hematuria

Question 10

what is your pee like with PKD

Answer 10

• Dysuria
• Foul-smelling urine- ruptured infected cyst rupture
• Cola colored urine- ruptured cyst
• Nocturia (early)
• Uremia- later in disease, build up of uric acid

Question 11

at risk for what electrolyte imbalance with PKD

Answer 11

Na

Question 12

Assessment findings besides pain and urine changes with PKD

Answer 12

• 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

Question 13

what test are we looking at for long term analysis of stage/progression with PKD? what is normal range?

Answer 13

GFR, >60

Question 14

If you get diagnosis of PKD then you have stage ____ kidney disease

Answer 14

1

Question 15

Diagnostics for PKD

Answer 15

• Urinalysis
• Culture if indicated
• **GFR- long term
• Serum Creatinine/ BUN- helpful in the minute
• NA/ Electrolytes
• Ultrasound
• CT
• MRI

Question 16

what happens to Na levels in PKD (early vs late disease)

Answer 16

◦ Low NA in early disease

◦ High NA in late disease

Question 17

Interventions for PKD

Answer 17

• **Blood pressure control
• Pain management
• Prevention of infection
• Prevention of constipation
• Support (Dialysis)

Question 18

pain management for PKD

Answer 18

• Drainage of cyst
• Opioids
• Nephrectomy
• Antibiotics
• Relaxation Techniques

Question 19

Constipation prevention for PKD

Answer 19

• Adequate Fluid intake
• Increase Fiber
• Exercise
• Stool Softeners
• Bulking agents
• Laxatives

Question 20

preferred drug to manage HTN for PKD?

Answer 20

Ace inhibitor! (ARB 2nd choice, CCB worst choice)

Question 21

Blood pressure management for PKD

Answer 21

• Adequate fluid intake
• Restrict Na intake around 2.5 g/day
• Monitor Blood Pressure
• Keep records of readings
• Daily weights
• ACE inhibitors

Question 22

What is the leading cause of renal failure?

Answer 22

diabetes

Question 23

what determines someone risk for diabetic nephropathy?

Answer 23

• Severity of kidney disease is related to the degree of hyperglycemia the patient has
◦ High A1C = increase risk of development

Question 24

first sign of diabetic nephropathy is….

Answer 24

microalbuminuria!

Question 25

When do we screen urine for protein- type 1 vs type 2 DM

Answer 25

* 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

Question 26

if you get a new diagnosis of diabetes you also get diagnosis of stage ____ kidney disease

Answer 26

1

Question 27

interventions for diabetic nephropathy

Answer 27

``` • 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 ```

Question 28

_____ disease is a risk factor for hypoglycemia

Answer 28

kidney! • Overtime, as kidney function declines, hypoglycemic events may become more common

Question 29

What causes BPH?

Answer 29

* Related to aging and increasing levels of dihydrotestosterone (DTH) * Glands in prostate undergo hyperplasia * Local inflammatory response

Question 30

What happens to detrusor muscle with BPH?

Answer 30

thickens

Question 31

What happens to residual urine with BPH?

Answer 31

increases

Question 32

BPH can lead to chronic urinary _____

Answer 32

retnetion

Question 33

What kind of incontinence w/ BPH?

Answer 33

overflow

Question 34

3 affects of BPH on urinary system

Answer 34

1. thickened detrusor muscle 2. increased residual urine 3. Chronic urinary retention

Question 35

Name some conditions/disease processes BPH can lead to

Answer 35

* Renal stones * Infection * Acute urinary retention * Hydroureter * Hydronephrosis * Kidney Disease

Question 36

Assessment for BPH

Answer 36

* 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

Question 37

Diagnostics for BPH

Answer 37

* 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

Question 38

5 drug therapies for BPH

Answer 38

``` ◦ 5-alpha reductase inhibitors ◦ Alpha-blockers ◦ Palmetto extract ◦ African plum tree bark (Pygeum) ◦ Rye Pollen ```

Question 39

Non surgical interventions for BPH

Answer 39

* 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

Question 40

What is the purpose of TUNA, TUMT, ILC, EVAP for BPH?

Answer 40

all involve reducing size of prostrate tissue

Question 41

Who needs surgery for BPH?

Answer 41

• 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

Question 42

What is a TURP?

Answer 42

* 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

Question 43

TURP puts you at risk for.....

Answer 43

strictures

Question 44

Peoperative care for TURP

Answer 44

* Education * Address Anxiety * Discontinue Anti-coagulants * Indwelling catheter with traction * Pain management * Continuous bladder irrigation (3 way urinary catheter)

Question 45

Post op care/consideration for TURP

Answer 45

* 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