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PNP #2 > RENAL > Flashcards

RENAL Flashcards

1
Q

Urinary System: Review

A

Removes metabolic wastes
Removes hormones from the body
Removes drugs other foreign material from body
Regulates water, electrolyte, acid-base balance
Secretes erythropoietin
Activates vitamin D
Regulate blood pressure through the renin-angiotensin-aldosterone system

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2
Q

Each kidney has over a million nephrons.

A

Renal corpuscles:
Glomerulus
Bowman capsule

Renal tubules:
Proximal convoluted tubules
Loop of Henle
Distal convoluted tubules
Collecting duct
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3
Q

Formation of Urine

A

Filtration
In renal corpuscles
Large volume of fluid passes from glomerular capillaries into the tubule (Bowman capsule)
Wastes, nutrients, electrolytes, other dissolved substances
Cells and protein remain in the blood.

Reabsorption
Reabsorption of essential nutrients, water, and electrolytes into the peritubular capillaries
Control of pH and electrolytes

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4
Q

Proximal convoluted tubules

A

Most of water reabsorption
Glucose reabsorption
Nutrients and electrolytes to maintain homeostasis

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5
Q

Antidiuretic hormone (ADH)

A

Secreted by the posterior pituitary

Reabsorption of water in distal convoluted tubules and collecting ducts

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6
Q

Aldosterone

A

Secreted by adrenal cortex

Sodium reabsorption in exchange for potassium or hydrogen

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7
Q

Atrial natriuretic hormone

A

Hormone from the heart

Reduces sodium and fluid reabsorption

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8
Q

Afferent and efferent arterioles of the glomerulus

A

Autoregulation and hormones control pressure in the glomerular capillaries by:

Vasoconstriction of afferent arteriole
Decreased glomerular pressure—decreased filtrate

Dilation of afferent arteriole
Increased pressure in glomerulus—increased filtrate

Vasoconstriction of efferent arteriole
Increased pressure in glomerulus—increased filtrate

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9
Q

Control of arteriolar constriction by three

factors:

A

Autoregulation
Local adjustment in diameter of arterioles
Made in response to changes in blood flow in kidneys

Sympathetic nervous system
Increases vasoconstriction in both arterioles

Renin
Secreted by juxtaglomerular cells when blood flow to afferent arteriole is reduced
Renin-angiotensin mechanism

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10
Q

Incontinence

A

Loss of voluntary control of the bladder

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11
Q

Enuresis

A

Involuntary urination by child age older than 4 years

Often related to developmental delay, sleep pattern, psychosocial aspect

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12
Q

Stress incontinence (more common in women)

A

Increased intra-abdominal pressure forces urine through sphincter.
Coughing, lifting, laughing
Multiple pregnancies

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13
Q

Overflow incontinence

A

Incompetent bladder sphincter

Older adults
Weakened detrusor muscle may prevent complete emptying of bladder—frequency and incontinence

Spinal cord injuries or brain damage
Neurogenic bladder—may be spastic or flaccid
Interference with CNS and ANS voluntary controls of the bladder

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14
Q

Retention

A

Inability to empty bladder
May be accompanied by overflow incontinence
Spinal cord injury at sacral level blocks micturition reflex
May follow anesthesia (general or spinal)

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15
Q

Straw colored with mild odor

A

Normal urine, specific gravity 1.010 to 1.050

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16
Q

Cloudy

A

May indicate the presence of large amounts of protein, blood, bacteria, and pus

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17
Q

Dark color

A

May indicate hematuria, excessive bilirubin, or highly concentrated urine

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18
Q

Unpleasant or unusual odor

A

Infection or result from certain dietary components or medication

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19
Q

Urinalysis: Urinary Infection

A

Heavy purulence and presence of gram-negative and gram-positive organisms

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20
Q

Urinalysis: Abnormal Constituents of Urine

A

1.Blood (hematuria)-
—Small amounts:
Infection, inflammation, or tumors in urinary tract
—Large amounts:
Increased glomerular permeability or hemorrhage

2.Elevated protein level (proteinuria, albuminuria)
Leakage of albumin or mixed plasma proteins into filtrate

3.Bacteria (bacteriuria)
Infection in urinary tract

4.Urinary casts
Indicate inflammation of kidney tubules

5.Specific gravity
Indicates ability of tubules to concentrate urine
Low specific gravity—dilute urine (with normal hydration)
High specific gravity—concentrated urine (with normal hydration)
Related to renal failure

6.Glucose and ketones
Found when diabetes mellitus is not well controlled

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21
Q

Blood Tests

A

• Elevated serum urea and serum creatinine levels
Indicate failure to excrete nitrogen wastes
Caused by decreased GFR

• Metabolic acidosis*
Indicates decreased GFR
Failure of tubules to control acid-base balance

• Anemia*
Indicates decreased erythropoietin secretion and/or bone marrow depression
*In the absence of other problems.

• Electrolytes
Depend on related fluid balance

• Antibody level
Antistreptolysin O or antistreptokinase titers
Used for diagnosis of poststreptococcal glomerulonephritis

• Elevated renin levels
Indicate kidney as a cause of hypertension

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22
Q

Radiologic tests

A

Radionuclide imaging, angiography, ultrasound, CT, MRI, intravenous pyelography

Used to visualize structures and possible abnormalities, flow patterns, and filtration rates

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23
Q

Clearance tests

A

Examples: creatinine or inulin clearance

Used to assess GFR

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24
Q

Cystoscopy

A

Visualizes lower urinary tract

May be used to perform biopsy or remove kidney stones

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25
Q

Biopsy

A

Used to acquire tissue specimens

26
Q

Diuretic DrUGS

A

• Used to remove excess sodium ions and water from the body

o Increased excretion of water though the kidneys
o Reduces fluid volume in tissues and blood
o Prescribed for many disorders
—— Renal disease, hypertension, edema, congestive heart failure, liver disease, pulmonary edema
o Several different mechanisms to increase urine volume based on specific drug
o Some drugs are potassium-wasting and some are potassium-sparing.

27
Q

Hemodialysis

A

Patient’s blood moves from an implanted shunt or catheter in an artery to machine

Exchange of wastes, fluids, and electrolytes

Semipermeable membrane between blood and dialysis fluid (dialysate)

After exchange is completed, blood returned to patient’s vein

Usually required three times a week

Potential complications!!!
Shunt may become infected.
Blood clots may form.
Blood vessels involved in shunt may become sclerosed or damaged.
Patient has an increased risk of infection with hepatitis B, hepatitis C, or HIV if Standard

28
Q

Peritoneal Dialysis

A

Catheter with entry and exit points is implanted into the peritoneal cavity

Takes more time than hemodialysis

Major complication!!!!
Infection resulting in peritonitis

29
Q

With both types of dialysis

A

Prophylactic antibiotics with either form of dialysis
Any additional problem occurring in patient such as infection may alter dialysis requirements
Caution is required with many drugs because toxic level buildup can occur.

30
Q

Urinary Tract Infections (UTIs)

A

Common causative organism
Escherichia coli

More common in women because of:
Shortness of urethra
Proximity to anus

Other common predisposing factors:
Incontinence
Retention of urine
Direct contamination with fecal material

31
Q

Cystitis and Urethritis

A

• Bladder wall (cystitis) and urethra (urethritis) are inflamed.
o Hyperactive bladder and reduced capacity
• Pain is common in pelvic area
• Dysuria, urgency, frequency, and nocturia
• Systemic signs may be present.
o Fever, malaise, nausea, leukocytosis
• Urine often cloudy, with unusual odor
• Urinalysis indicates bacteriuria, pyuria, microscopic hematuria

32
Q

Pyelonephritis

A

One or both kidneys involved
From ureter into kidney
Purulent exudate fills pelvis and calyces

33
Q

Pyelonephritis S&S

A

Signs of cystitis plus pain associated with renal disease
Dull, aching pain in lower back or flank area

Systemic signs include high temperature

Urinalysis
Similar to cystitis
Urinary casts are present.
Reflection of renal tubule involvement

Treatment with antibacterials

34
Q

Inflammatory Disorders: Glomerulonephritis

A

Presence of antistreptococcal (ASO) antibodies
IN RESPONSE- Inflammatory response in glomeruli
Increased capillary permeability—leakage of some protein and large numbers of erythrocytes

35
Q

Disorders—Glomerulonephritis MANIS

A 
•	Urine becomes dark and cloudy
•	Facial and periorbital edema—initially 
o	General edema follows
•	Elevated blood pressure
o	Caused by increased renin secretion and decreased GFR
•	Flank or back pain
o	Edema and stretching of renal capsule
•	General signs of inflammation
•	Decreased urine output
36
Q

Inflammatory Disorders: Glomerulonephritis

TESTS

A

Blood tests
Elevated serum urea and creatinine levels
Elevation of anti-DNase B, streptococcal antibodies, antistreptolysin, antistreptokinase
Complement levels decreased (use in renal inflammation)

Metabolic acidosis

Urinalysis
Proteinuria, hematuria, erythrocyte casts
No evidence of infection

37
Q

GLOME TREATMENT

A 
Sodium restriction possible
Protein and fluid intake decreased in severe cases
Drug treatment:
1.Glucocorticoids to reduce inflammation
2.Antihypertensives
38
Q

Urolithiasis (Calculi)

A

Can develop anywhere in urinary tract
Stones may be small or very large.

Tend to form with:
Excessive amounts of solutes in filtrate
Insufficient fluid intake—major factor for calculi formation
Urinary tract infection

  • Calculi composed of calcium salts, High urine calcium levels, Form readily with highly alkaline urine
  • Uric acid stones- Hyperuricemia, Gout, high-purine diets, cancer chemotherapy, Especially with acidic urine
  • Struvite and cystine stones
  • Stone formation depends on predisposing factor.
39
Q

Urolithiasis (Calculi) MANIS

A

Manifestations only occur with obstruction of urine flow.

May lead to infection
Hydronephrosis with dilation of calyces
If located in kidney or ureter and atrophy of renal tissue

Stones in kidney or bladder often asymptomatic

  • Frequent infections may lead to investigation.
  • Flank pain possible caused by distention of renal capsule

Renal colic caused by obstruction of the ureter

  • Intense spasms of pain in flank area,Radiating into groin area, Lasts until stone passes or is removed
  • Possible nausea and vomiting, cool moist skin, rapid pulse
  • Radiological examination confirms location of calculi.
40
Q

Urolithiasis (Calculi) (Cont.)

TREATMENT

A

Small stones will be passed eventually.
Extracorporeal shock wave lithotripsy (ESWL)
Laser lithotripsy
Drugs may be used to dissolve stones partially.
Surgery

41
Q

Urolithiasis (Calculi) (Cont.)

PREVENTION

A

Treatment of underlying condition
Adjustment of urine pH through dietary modifications
Consistent increased fluid intake

42
Q

Hydronephrosis

A

Secondary problem caused by:
Complication of calculi (Tumors, prostatic enlargement, Developmental abnormalities)

Frequently asymptomatic in early stages

Can be diagnosed with ultrasonography, radionucleotide imaging, CT, or renal scan

If cause is not removed—chronic renal failure

43
Q

Tumors: Renal Cell Carcinoma

A

arising from the tubule epithelium

Tends to symptomatic in early stages

Often has metastasized to liver, lung, bone, or central nervous system at time of diagnosis

Treatment!!! is removal of kidney.

44
Q

Tumors: Renal Cell Carcinoma

MANIS

A

Painless hematuria initially- Gross or microscopic
Dull, aching flank pain
Palpable mass
Unexplained weight loss
Anemia or erythrocytosis
Paraneoplastic syndromes- Hypercalcemia or Cushing’s syndrome

45
Q

Tumors: Bladder Cancer

A

Most bladder tumors are malignant and commonly arise from transitional epithelium of the bladder.
!!!Diagnosed by urine cytology and biopsy

46
Q

Tumors: Bladder Cancer MANIS

A

Early signs
Hematuria, dysuria
Infection common
Tumor is invasive through wall to adjacent structures.
Metastasizes to pelvic lymph nodes, liver, and bone

47
Q

Predisposing factors

Tumors: Bladder Cancer

A

Working with chemicals in laboratories and industry
Particularly aniline dyes, rubber, aluminum
Cigarette smoking
Recurrent infections
Heavy intake of analgesics

48
Q

Treatment

Tumors: Bladder Cancer

A

Surgical resection of tumor
Chemotherapy and radiation
Photoradiation successful in some early cases

49
Q

Vascular Disorders: Nephrosclerosis

A

Thickening and hardening of the walls of arterioles and small arteries
Narrowing of the blood vessel lumen

Stimulation of renin
Increased blood pressure

Treatment 
Antihypertensive agents 
Diuretics
Beta blockers 
Sodium intake should be reduced.
50
Q

Congenital Disorders

A

Vesicoureteral reflux

Agenesis
-Failure of one kidney to develop

Hypoplasia
-Failure to develop to normal size

Ectopic kidney
-Kidney and ureter displaced out of normal position

“Horseshoe” kidney
-Fusion of the two kidneys

51
Q

Adult Polycystic Kidney

A

Autosomal dominant gene on chromosome 16

First manifestations usually around age 40 years
Multiple cysts develop in both kidneys.
Enlargement of kidneys

52
Q

Wilms’ Tumor

A

Most common tumor in children

Defects in tumor suppressor genes on chromosome 11

53
Q

Acute Renal Failure

CAUSES

A

Acute bilateral kidney diseases
Severe, prolonged circulatory shock or heart failure
Nephrotoxins (Drugs, chemicals, or toxins)
Mechanical obstruction (occasionally)
Calculi, blood clots, tumors (Block urine flow beyond kidneys)

54
Q

Acute Renal Failure (Cont.)

A

Sudden onset

Blood tests
-Elevated serum urea nitrogen and creatinine levels
Metabolic acidosis and hyperkalemia

Treatment
-Identify and remove or treat primary problem.
To minimize risk of necrosis and permanent kidney damage
-Dialysis
To normalize body fluids and maintain homeostasis

55
Q

Chronic Renal Failure

A

Gradual irreversible destruction of the kidneys over a long period of time

Asymptomatic in early stages

56
Q

Chronic Renal Failure: Stages

A

Decreased renal reserve

  • Decrease in GFR
  • Higher than normal serum creatinine levels
  • No apparent clinical symptoms

Renal insufficiency

  • Decreased GFR to about 20% of normal
  • Significant retention of nitrogen wastes
  • Excretion of large volumes of dilute urine
  • Decreased erythropoiesis
  • Elevated blood pressure

End-stage renal failure

  • Negligible GFR
  • Fluid, electrolytes, and wastes retained in body
  • Azotemia, anemia, and acidosis (three As)
  • All body systems affected
  • Marked oliguria or anuria
  • Regular dialysis or kidney transplantation To maintain patient’s life
57
Q

Early signs OF CRF

A

Increased urinary output

General signs:
Anorexia
Nausea
Anemia
Fatigue
Unintended weight loss
Exercise intolerance

Bone marrow depression and impaired cell function
Caused by increased wastes and altered blood chemistry

Elevated blood pressure

58
Q

Complete failure

OF CRF

A 
•	Oliguria
•	Dry, pruritic, hyperpigmented skin, easy bruising
•	Peripheral neuropathy
•	Impotence in men, menstrual irregularities in women
•	Encephalopathy
•	Congestive heart failure, dysrhythmias
•	Failure to activate vitamin D
•	Possible uremic frost on the skin
•	Systemic infections
•
59
Q

Diagnostic tests

A

Anemia, acidosis, and azotemia are the key indicators of chronic renal failure.

60
Q

Treatment—all body systems are affected.

A
  • Difficult to maintain homeostasis of fluids, electrolytes, and acid-base balance
  • Drugs to stimulate erythropoiesis
  • Drugs to treat cardiovascular problems
  • Intake of fluid, electrolytes, protein must be restricted
  • Dialysis or transplantation

PNP #2 (10 decks)

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