Renal

Question 1

Gerontological considerations

Answer 1

• Sclerosis of glomerulus and renal vasculature
• Decreased blood flow
• Decreased GFR
• Altered tubal function and acid-base balance
• Incomplete emptying of bladder, urinary stasis, decreased nerve interventions
• Decreased drug clearance

Question 2

Functions of the kidneys

Answer 2

• Urine formation
• Excretion of wastes
• Regulation of lytes
• Control of water balance
• Regulation of acid-base balance
• Control of BP
• Renal clearance
• Regulation of RBC production
• Synthesis of vit D to active form
• Secretion of prostaglandins

Question 3

Renal function tests

Answer 3

• Renal concentration: specific gravity (1.010-1.025), urine osmolality (250-900 mOsm/kg/24 hr)
• 24 hr urine: creatinine clearance
• Serum: creatinine (0.6-1.2), BUN (7-18, >60 8-20), BUN to creatinine ratio (10:1)

Question 4

Diagnostic tests

Answer 4

• UA, urine culture
• Renal function tests
• US
• CT/MRI
• Nuclear scans
• Endoscopic procedures
• Biopsies
• IV urography
• Retrograde pyelography
• Cystography
• Renal angiography

Question 5

Stages of kidney failure

Answer 5

• I = GFR > 90 —> kidney damage w/normal or increased GFR
• II = GFR 60-89 —> mild decrease GFR
• III = GFR 30-59 —> moderate decrease GFR
• IV = GFR 15-29 —> severe decrease GFR
• V = GFR < 15 —> ESRD

Question 6

Causes of acute kidney failure

Answer 6

• Hypovolemia
• Hypotension
• Reduce CO, HF
• Obstruction of kidney or lower urinary tract
• Obstruction of renal arteries or veins

Question 7

Causes of chronic kidney failure

Answer 7

• DM
• HTN
• Chronic glomerulonephritis
• Pyelonephritis or other infections
• Obstruction
• Hereditary lesions
• Vascular D/O
• RX’s, toxic agents

Question 8

Acute nephritic syndrome

Causes

Answer 8

Post-infectious glomerulonephritis, rapidly progressive glomerulonephritis, membranous glomerulonephritis

Question 9

Acute nephritic syndrome

S/S

Answer 9

Hematuria, edema, azotemia, proteinuria, HTN

Question 10

Azotemia

Answer 10

Build up of nitrogenous wastes in urine

Question 11

Acute nephritic syndrome

Management

Answer 11

• Supportive care, dietary modifications

- Treat if appropriate: ABX, corticosteroids, immunosuppressants

Question 12

Abnormal lab tests in chronic glomerulonephritis

Answer 12

Urine w/fixed specific gravity, casts, proteinuria, electrolyte imbalances, hypoalbuminemia

Question 13

S/S of nephrotic syndrome

Answer 13

Hypoalbuminemia, edema

Question 14

Nephrotic syndrome

Causes

Answer 14

Chronic glomerulonephritis, DM w/intercapillary glomerulonephritis, amyloidosis, SLE, multiple myeloma, renal vein thrombosis

Question 15

Complications of CKD

Answer 15

Hyperkalemia
Pericarditis 
Pericardial effusion, tamponade 
HTN
Anemia 
Bone disease, metastatic calcifications

Question 16

Complications of PD

Answer 16

Peritonitis, leakage, bleeding, infection

Question 17

Nutrition for CKD

Answer 17

• High calorie, low protein (protein must be of high biological value —> dairy, eggs, meats)
• Fluid allowance is 500-600mL more than previous day’s 24 hr UO
• Restriction of potassium
• Vitamins & supplements due to low protein in diet