Renal Alterations Flashcards
Mean Arterial Pressure
Amount of pressure needed to perfuse the kidneys.
Calculated off of the BP
What is the minimum MAP to maintain normal kidney function?
70mmHg
What is the normal range for MAP?
70-90mmHg
What does Glomerular Filtration Rate (GFR) do?
Facilitates adequate reabsorption and waste removal.
What is the normal GFR?
80-125 mL/min (180L/day)
What is the normal urine output?
0.5-1 mL/kg or 30-60mL/hr
Where do pre renal issues happen?
Before the kidney.
Where do intrarenal issues occur?
Inside the kidney.
Where do post renal issues occur?
After the kidney.
What are the normal Urine Diagnostics?
- Color
- Turbidity
- ph
- Specific Gravity
- Blood
- Bacteria
- BUN and Creatinine
- Ketones
What is normal urine color?
Amber-yellow
What is normal urine turbidity?
Clear
What is normal urine pH?
4.6-8.0
If urine pH is closer to 8, what does that indicate?
Alkalinity which means bacteria is present.
What is normal urine Specific Gravity?
1.0 - 1.02
Do we expect to see blood in normal urine?
Negative for males
Possibly positive for females due to menstruation
How is bacteria represented in normal urine?
As a Yes/No instead of a value
What do we do if bacteria is present in the urine?
Culture it
What is Specific Gravity?
The weight of urine.
When Specific Gravity is High, what does that mean?
Contains bacteria, glucose, protein
When Specific Gravity is low, what does that mean?
The urine is dilute (clear)
BUN goes hand in hand with what?
Creatinine goes hand in hand
What does BUN stand for?
Blood, Urea, Nitrogen
How do we collect BUN and Creatinine?
Through a blood sample
What is BUN and Creatinine used to evaluate?
Normal kidney function
What does BUN measure?
Measures Urea in the blood
Where is Urea made?
In the liver
What is the normal range of BUN?
10-20mg/dL
What is the critical value of BUN?
> 100
What are the two markers of renal function?
BUN and Creatinine
Creatinine measures what?
Waste products of creatine in the blood
What is the normal range for Creatinine?
0.5-1.1 mg/dL
What is Creatinine Clearance?
How much creatinine the kidneys produce in a 24 hr period.
What is the process for obtaining Creatinine Clearance
Obtain a red basin and place it in ice in order to slow bacterial growth and decrease odors. We skip the first void but collect every void afterwards, including the last one.
What happens if we miss a void in the 24 hr Urine Process?
We must start over
What is a Hydroureter?
Dilation of one of the ureters filled with urine.
Is Hydroureter pre, intra, or post renal?
Hydroureter is post renal
What is the Patho for a Hydroureter?
Accumulation of urine in the ureter due to a blockage.
What is Hydronephrosis?
Dilation of a kidney
AKA Renal Pelvis and Calysis
How do we usually find Hydronephrosis?
With an X-ray (KUB)
Is Hydronephrosis pre, intra, or post renal?
Hydronephrosis is intra-renal
What is the Patho for Hydronephrosis?
Enlargement of the renal pelvis and calyces
What is Post-Obstructive Diuresis?
A brief period of diuresis after obstruction relief in a kidney.
What is the Patho for Post-Obstructive Diuresis?
Large amounts of waste excreted once an obstruction in the kidneys is relieved. Restores electrolyte and fluid balance.
What are the risk factors for Renal Stones?
- Fluid intake***
- Diet***
- Age
- Gender
- Race
- Geographic location
- Seasonal factors
- Occupation
What are the Signs and Symptoms of Renal Stones?
- Moderate to sever pain in the flank area that radiate to the groin (mostly men)
- Colic pain
- Urine Urgency
- Frequent voiding
- Urge incontinance
What is colic pain?
Pain associated with Renal Stones and it is described as ‘‘achy’’ and ‘‘uncomfortable’’.
How do we evaluate Renal Stones?
- Stone and UA analysis
- Intravenous pyelogram (IVP)
- KUB x-ray
- Spiral Abdominal CT
What is a UTI?
Inflammation of the urinary epithelium from a pathogen.
What is the most common bacteria that causes a UTI?
Escherichia coli is the most common cause
What are the Signs and Symptoms for young adults with a UTI?
- Dysuria
- Frequency
- Suprapubic and LBP
- Odiferous urine
- Cloudy urine
What are the Signs and Symptoms for elderly people with a UTI?
- Confusion
2. Abdominal discomfort
What is an Uncomplicated UTI?
A first infection found in a healthy individual, mostly women.
What is a Complicated UTI?
An infection that develops in someone with an abnormal urinary tract or someone who lives with some type of immunocompromise.
What is a Recurring UTI?
An initial infection that was successfully treated but is reinfected with 5-10 days afterward.
What is a Persistent UTI?
A persistent infection despite 3 days of treatment.
What is Cystitis?
Inflammation of the bladder.
What are the Signs and Symptoms of Cystitis?
- Frequency
- Dysuria
- Urgency
- Lower abdominal pain
- Suprapubic pain
What is Interstitial Cystitis?
An unpleasant sensation perceived to be related to the urinary bladder.
Who is the most common to suffer from interstitial cystitis?
Women are the most common
What is Interstitial Cystitis caused by?
Uknown but an autoimmune reaction may be responsible
What are the signs and symptoms of Interstitial Cystitis?
- Bladder fullness
- Frequency
- Small urine volume
- Chronic pelvic pain
What is Pyelonephritis?
Infection of the renal pelvis and interstitium. Can be in one or both kidneys.
What causes Acute Pyelonephritis?
- Female sex trauma
- Kidney stones
- Pregnancy
- Reflux (due to the chronic acidity of blood)
- Neurogenic Bladder
- E. coli
What are the Signs and Symptoms of Acute Pyelonephritis?
- Acute onset
- Fever
- Chills
- Flank/groin pain
- Frequency
- Dysuria
- Costovertebral tenderness
Is Pyelonephritis pre, intra, or post renal?
Intra-renal
What is Chronic Pyelonephritis caused by?
Unknown but it can be linked to persistent infections because of scarring.
What are the EARLY symptoms of Chronic Pyelonephritis?
- HTN
- Frequency
- Dysuria
- Flank pain
What are the late symptoms of Chronic Pyelonephritis?
- Renal failure
What is glomerulonephritis?
Inflammation of the glomerulus.
What causes glomerulonephritis?
- Immunocompromise
- Hypotension
- MAP<70
- Drugs and toxins
Is glomerulonephritis pre, intra,post renal
Intrarenal
What is the peak of Mycin drugs?
6-12 hours after the drugs is given, it is the height of the drug in the blood.
What is the trough of mycin drugs?
The trough is the amount of drug left over right before the next dose.
What causes Acute Glomerulonephritis?
Streptococcal infection
How many days after infection does Acute Glomerulonephritis happen?
7-10 days.
What are the Signs and Symptoms of Glomerulonephritis?
- Hematuria
- RBC Casts
- Proteinuria
- Decreased GFR
- Oliguria
- HTN
- Edema of lower extremities and eyes
What causes Chronic Glomerulonephritis?
Several conditions and it is associated with hypercholesterolemia and proteinuria.
What are the Signs and Symptoms of Chronic Glomerulonephritis?
- Hematuria
2. Proteinuria
What is Acute Renal Failure?
Sudden decline in renal function
What are the signs and symptoms of Acute Renal Failure?
- Elevated BUN and Creatinine
- Oliguria- may be normal though, depends on how long the patient has had it
- Most types are reversible if treated early
What is Chronic Renal Failure?
Progressive and irreversible loss of nephrons.
What is Uremia?
High level of Urea in the blood.
