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Renal Flashcards

1
Q

Why do renal dz pts have low hct

A

Bc their kidneys can’t stimulate RBC production with erythropoeitin

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2
Q

KUB/Flat plate of abdomen

A 
Scan of urinary system
K-kidneys
U-ureters
B-bladder
U-urethra
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3
Q

3 main areas of kidneys

A

Pelvis, Medulla, Cortex

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4
Q

Where do kidney stones occur

A

In the pelvis, urine backs up in that area first (hydronephrosis)

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5
Q

Where are pyramids located

A

In the medulla

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6
Q

The cortex houses what

A

Glomeruli and nephrons

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7
Q

Functioning unit of kidney

A

Nephron

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8
Q

3 major functions of nephron

A
  1. Filter water soluble substances from blood
  2. Reabsorb filtered nutrients, water, and electrolytes (reabsorb about 90%)
  3. Secrete waste products
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9
Q

Site where fluid filtration form blood to nephron (osmosis) takes place

A

Glomerulus

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10
Q

Characteristics of glomerulus

A
  • More permeable than other capillaries

- Prevents transport of blood cells and proteins

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11
Q

GFR

A

R/t bp and blood flow

-Normal is 125 mL/min

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12
Q

What is GFR determined by

A

Filtration pressure within glomeruli

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13
Q

How does each glomeruli regulate its own GFR

A

High/Low bp, NaCl, glucose (thats why pts w/ high BG pee a lot)

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14
Q

What is the most important factor with GFR

A

Blood volume

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15
Q

Formed and released when theres decreased blood flow, volume, or pressure

A

Renin

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16
Q

What stimulates the production of angiotensin II

A

Renin

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17
Q

Causes vasoconstriction and the release of aldosterone

A

Angiotensin II

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18
Q

Increases reabsorption of Na

A

Aldosterone

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19
Q

What is the result of renin-angiotensin system vasoconstricting?

A

Tank will be smaller so pressure is higher. CVP and SVR will increase.

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20
Q

Produced in the kidney and regulate GFR, renal vascular resistance, and renin production

A

Prostaglandins

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21
Q

Angiotensin II stimulates the release of what?

A

Bradykinin

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22
Q

Dilates renal vasculature to maintain renal blood flow

A

Bradykinin

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23
Q

Triggers RBC formation in marrow

A

Erythropoietin

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24
Q

Converted to active form in the kidney

A

Vitamin D

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25
Q

Most direct measure of overall hydration as a reflection of GFR and why

A

Creatinine, no other pathologic condition increases Creat than renal dz

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26
Q

Indirect measure of overall hydration

A

BUN

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27
Q

BUN can also elevate with what besides renal dz?

A

Diet, GI bleed, tissue breakdown

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28
Q

RCC stats

A
  • In men 2x more than women
  • 20% more in AA
  • 5 year survival is
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29
Q

S/S of RCC

A
  • Often asymptomatic till late dz
  • Costovertebral angle tenderness
  • Hematuria as a late sign
  • Palpable abd mass
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30
Q

Late signs from metastatic dz of RCC

A

Bone pain, SOB, chest pain

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31
Q

Metastasis of RCC

A

Tumors spread quickly and grow up superior vena cava into right atrium

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32
Q

Sx removal of RCC

A

Nephrectomy, you only need one kidney

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33
Q

Chemo w/ RCC

A

Limited effectiveness, metastasis is usually unresponsive to chemo

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34
Q

Problem w/ urinary stasis

A

Bacterial growth, predisposes to UTIs

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35
Q

Renal obstruction can lead to what?

A

Post-renal acute renal failure and acute tubular necrosis

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36
Q

Congenital link to renal obstruction

A

Anatomical malformations, seen more in children

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37
Q

Changes secondary to renal obstruction

A

Depend on location and size, the higher up the worse

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38
Q

What increases proximal to the renal obstruction

A

Hydrostatic pressure

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39
Q

Why does GFR reduce with obstructions?

A

Dilation

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40
Q

Hydroureter

A

Complete obstruction of ureter

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41
Q

Hydronephrosis

A

Enlarged kidney due to dilation

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42
Q

Stent placement for treatment of obstruction

A

To retrieve stone. Done in the OR

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43
Q

Nephrostomy for obstruction

A

Like a foley cath but instead of going into the bladder the drainage tube goes into the kidney

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44
Q

ileal conduit

A

Ureters lead out of the skin like a colostomy bag

45
Q

Micturation

A

Unidirectional flow

46
Q

What host defenses in women prevent infections

A

Urethral secretions

47
Q

What host defenses in men prevent infections

A

Prostatic secretions

48
Q

How does the urine prevent infection

A

Acidic pH and urea, epithelial cells provide additional protective barrier

49
Q

Major risk factor for acute pyelonephritis

A

Pregnancy due to alterations in urinary tract

50
Q

Urinary reflux w/ kidney infection

A

Due to catheter bag not being below pt

51
Q

Acute pyelonephritis is usually caused by what?

52
Q

Acute pyelonephritis is usually what type of infection?

A

Ascending, unilateral. Can rarely be blood borne

53
Q

Patho of acute p

A

Bacteria binds to epithelial cells inside the kidneys, hard to get rid of

54
Q

S/s of acute p

A

Differentiates from regular infection w/ high fever and CVA tenderness.

  • dysuria, freq, urge, burn, nocturia
  • sudden onset
  • back, flank, loin pain
  • abd discomfort, n/v, fatigue
55
Q

Tx of acute p

A

ABX for 7-10 days, broad first, assume e coli

-Hospitalized for severe cases, usually preg. When admitted: urine culture, IV abx, fluids bc n/v

56
Q

Chronic p is characterized by what?

A

Small atrophied kidneys w/ diffuse scarring

57
Q

Risks for chronic p

A

Urinary obstruction, reflux, neurogenic bladder

58
Q

Patho of chronic p

A

Chronic infections, interstitial inflammation, reduced number of functional nephrons

59
Q

S/s of chronic p

A
  • Minimal symptoms
  • Flank pain less intense than in acute
  • HTN
  • UTI
  • ^ creatinine
  • Frequency bc inability to conserve Na
  • Decreased ability to concentrate urine (nocturia)
  • Hyperkalemia and acidosis
60
Q

Tx of chronic p

A
  • Correct underlying problem
  • Prolonged abx (6-8 wks)
  • Support existing renal function
61
Q

Renal TB

A

TB invades kidneys through bloodstream, inflammatory response forms scar tissue that replaces normal kidney tissue, difficulty w/ elimination

62
Q

Primary glomerulopathies

A

Only the kidney is involved

  • Acute glomerulonephritis
  • Chronic g
  • Nephrotic syndrome
63
Q

Secondary glomerulopathies

A

Injury due to drug exposure, infection, systemic or vascular pathology

  • Lupus
  • Goodpasture’s syndrome
  • amyloidosis
  • diabetic glomerulopathy
  • hepatitis b and c
  • cirrhosis
  • sickle cell
  • mult. myeloma
64
Q

Assessment w/ acute glom

A

Ask if they’ve had a sore throat, BP, changes in urinary pattern, breathing patterns

65
Q

Patho of acute glom

A
  • Infection occurs
  • S/s don’t appear for 10 days
  • Seen a lot in men after an acute strep infection
66
Q

Acute glom s/s

A
  • Dark, tea colored urine
  • Proteinuria
  • Hematuria
  • Edema
  • HTN
  • Oliguria
  • Increased BUN/creat
67
Q

Tx for acute glom

A

ABX, prevent complications, supportive care, temporary dialysis

68
Q

Chronic glom progresses into what? Why?

A

Chronic end stage renal dz, bc nephrons atrophy, become scarred and non-functioning

69
Q

S/s of chronic glom

A

Circulatory overload: edema, weight gain, JVD, crackles, uremia

70
Q

Uremia assessment findings

A

Slurred speech, tremors, asterixis, *skin changes (uremic deposits=dry, flaky skin that itches) Don’t let them itch cause they’ll break their skin

71
Q

Tx of chronic glom

A

Focuses on slowing the progression of dz (diet changes, maintaining sufficient fluids, drugs for s/s)

72
Q

Nephrotic syndrome

A

Increased permeability of glomeruli allows bigger molecules to pass through. Leads to massive loss of protein in urine, Na follows protein, water follows Na

73
Q

Main feature of nephrotic syndrome

A

Severe proteinuria (3.5 g protein/24 hr)

74
Q

S/s of nephrotic syndrome

A 
Hypoalbuminemia
Hyperlipidemia
Edema
Hypercoagulability
Renal insufficiency
75
Q

Tx of nephrotic syndrome

A 
Treat underlying process, renal biopsy
Immunosuppressive therapy
ACE inhibitors decrease proteinuria, watch for nephrotoxicity
Cholesterol lowering drugs
Mild diuretics
Na restriction, diet changes
76
Q

What is the leading cause of ESRD in the US?

A

Diabetes, diabetic nephropathy (microvascular damage)

77
Q

What is the first manifestation of diabetic nephropathy?

A

Albuminuria

78
Q

What would a UA reveal for acute p?

A

Positive leukocyte esterase and nitrite dipstick test, presence of white blood cells (WBCs) and bacteria; urine culture and sensitivity (C&S); blood cultures; C-reactive protein; erythrocyte sedimentation rate.

79
Q

What is the primary care plan for a pt with acute p?

A

Acute pain

80
Q

Tx of acute p

A

Nitrofurantoin (macrodantin) 50mg with meals and at bedtime is a urinary antiseptic drug that also helps w/ comfort. Fluid intake should be 2-3 L per day

81
Q

Which imaging test is ordered for acute p?

A

IV urography or KUB x-ray

82
Q

Difference in acute and chronic renal failure

A

Acute is potentially reversible

83
Q

Acute renal failure is characterized by what?

A

Abrupt deterioration of renal function, happens overnight, so BUN and creatinine will be ordered every day in the hospital

84
Q

Oliguria

85
Q

Anuria

86
Q

Pre-renal acute renal failure

A
  • Diminished perfusion to kidney

- Decrease in blood volume

87
Q

If pre-renal is uncorrected

A

Hypoperfusion will lead to ischemia of renal parenchyma and acute tubular necrosis

88
Q

Infra-renal acute renal failure

A
  • Acute glomerulonephritis
  • Drug induced nephrotoxins (contrast media, ace inhibitors, bacterium, renal artery stenosis)
  • Acute tubular necrosis (renal cellular hypoxia)
89
Q

Post-renal acute renal failure

A

-Obstruction of normal urine outflow from kidney

90
Q

Most common causes of post renal failure

A

BPH, kinked catheters, tumors, strictures, calculi

91
Q

Which renal failure is the easiest to identify and fix?

A

Post-renal

92
Q

Stages of acute renal failure

A
  1. Oliguric phase
  2. Diuretic phase
  3. Recovery phase
93
Q

Oliguric phase

A

May require temp. dialysis to survive 1-2 times in a few days. Volume overload, hyperkalemia, uremia, metabolic acidosis

94
Q

Diuretic phase

A

UOP normalizes over a few days, at risk for dehydration, not actively trying to die but thinking about it
-Hypovolemia, hypokalemia, uremia

95
Q

Recovery phase

A

1 week to 1 year, normal creatinine is marker for full recovery

96
Q

Hallmark of acute renal failure

A

Elevated creatinine

97
Q

Signs of fluid overload

A

Edema, JVD, crackles, SOB

98
Q

Tx of acute renal failure

A
  • Treat underlying cause

- Optimize BP, manage fluids, support other body systems-hard to do, ventilation, vasoactive meds

99
Q

Chronic kidney dz

A

Progressive and irrevocable loss of functioning nephrons

-75% lost before s/s

100
Q

Risk factors for ESRD

A

Diabetes and HTN

101
Q

Stages of CKD

A

Decreased reserve 90%

102
Q

Renal osteodystrophy with CKD

A

High phosphorus and low calcium

103
Q

Tx of CKD

A

ACEII/ARB to reduce proteinuria, BG control, BP control, evaluation for CV risk factors

104
Q

vascath

A

Ventral line in IJ or subclavian, shouldn’t stay for longer than 7 days, curved or straight cath

105
Q

Difference in native and gortex fistulas

A

Native can’t be used until 3-4 weeks, vortex clots more but can be used right away

106
Q

Normal adult bladder capacity

A

400-500 mL

107
Q

Usual urge to void

A

At about 150-300 mL

108
Q

Post void residual normal volume

A

About 50 mL

Adult 2 (8 decks)

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