renal 1 Flashcards
amt of blood going to kidneys
20-25% circulates 12 x hr
nephrons
initial formation of urine
if less than 20% need RRT
bladder capacity
400-500mL but can distend larger
changes ass w aging-6
- reduced blood flow to kid
- thickened glomerular and tubular basement membranes
- decreased tubule length
- decreased GFR
- nocturnal polyuria
- risk for dehydration
risks ass w aging
The decrease in glomerular filtration, combined with the use of multiple medications that are cleared by the kidney, puts the older person at higher risk for adverse drug effects and drug-drug interactions.
assessment methods-6
- demographic info
- SES
- nutrition hx
- medication hx
- fy/genetic risk
- current health prob
african americans and kid disease
more rapid age related decreases in GFR
daily fluid intake
2 L
nutrition changes
change in appetite, taste, thirst
-ass protein intake
palpation of the kidneys
usually not palpable, but could indicate enlargement
-rt kidney easier-lower
abdomen ass
ascities
-tenderness over costovertebral angle
deep tendon reflex of knee
- quality and symmetry
- test for neuro causes of bladder dys
creatinine-5
- produced from muscle/protein breakdown
- indicator of kid function
- kid disease has higher cr
- increase after 50% loss of funct, decrease loss of muscle
- 0.6-1.2 male, 0.5-1.1 female
BUN
10-20
- does not always indicate kid problem
- dehydration if only BUN increase
labs indicate kid dysfunction
BUN and Cr raise at same rate
increase BUN-7
- liver/kid disease
- dehydration
- decrease kid perfusion
- increase protein diet
- infection/stress
- steroid use
- GI bleed
decrease BUN-3
malnutrition, fluid volume excess, severe hepatic damage
BUN/Cr ratio
- BUN divided by Cr
- 6-25
urine osmolarity
the most accurate measurement of the kindney’s ability to dilute and concentrate urine. Concentrating ability is lost early in kidney disease
specific gravity-5
- concentration of particles in urine
- 1.005-1.030
- increase-> concentrated, dehydration
- decrease->diluted, DM, renal damage
- kid disease->does not change w fluid intake
urine pH more alkaline-3
left unrefridgerated, bacteria present, left uncovered
urine pH affected by-4
diet, drugs, acid/base disturbance, kid tubular function
abnormal urine-7
protein, ketones, glucose, nitrites (e coli), bilirubin, casts, crystals (allowed to stand)
24 hr urine collection
Cr. clearance detects and evaluates progression of renal disease-best indication of overall kid function
renal impairment labs
Cr greater than 1.5
GFR lower than 45
bladder scanner
use male setting on female w hysterectomy
CT dye-4
- increase fluid intake
- contrast-induced nephroplasty (fail 24-72hrs)
- metformin-stop 24 hrs prior and 48 hrs after eval kid funct=>lactic acidosis
- sodium bicarb in L of fluid/ acetylcysteine for prevention
MRI
- will be able to communicate through microphone
- all metal credit cards removed
- avoid alcohol, caffiene, smoking 2 hrs prior and food 1 hr post
3 things kid filter
hydrogen ions, urea (toxins from liver), creatine
=> not filtered drops HnH from no erythropoitin
hydrogen ions not filtered
metabolic acidosis
GFR
85-125
- controlled by BP and blood flow
- decrease w age, DM, HTN
