Renal and Urinary Assessment Flashcards
The function of the Kidney and Urinary System?
Regulates fluid and electrolytes, removing wastes and providing hormones involved in red blood cell production, bone metabolism, and control of blood pressure
Structures of the Kidney and Urinary Systems
Structures
Kidneys
Ureters
Bladder
Urethra (Verra) The passage out.
Renal Anatomy :
The main ones are the:
- Each kidney is held by facia.
- They are held by fascia.
- They are quite vulnerable, not protected by the rib cage.
Nephrons
Renal vein and renal artery:
- The flow rate the kidneys receive is about 1200 ml a min (it’s a lot)
Kidneys, Ureters, and Bladder anatomy picture:
Internal Structure of the Kidney picture:
Structure Nephron:
We have about of a million of them in each kidney.
-80% of them are known as cortical nephrons fount on the most outside part of the
kidney. They are really short.
- The dialysis machine is very similar in structure to a nephron
Functions of the Nephron:
- Functional unit of the kidney
- 1-2 million in each kidney
- Glomerulus within Bowman’s capsule
———— Afferent arteriole caries blood to the glomerulus
———— Efferent tubule caries blood from glomerulus - Proximal convoluted tubule
- Loop of Henle
- Distal convoluted tubule
- Collecting duct
- 1 in a 1000 people is born with only one kidney.
- If you only have one kidney you are more prone to kidney problems. So we follow them for a couple of years after a donation.
Renal VasculatureIt’s all about perfusion!
- Highly vascular organ: receives 20-25% of Cardiac output
- Intricate vascular system with capillaries that surround all parts of the nephron
- Afferent (arrive) & efferent (exit) at level of glomerulus
- Autoregulation-perfusion impaired outside of these pressures:
**SBP 180-80 mmHg
- If the BP is too high it can damage the kidneys and lead to kidney failure.
- When BP is too low the renal perfusion is low as well and we don’t perfuse the kidneys.
- We also look at the pt fluid volume status or their central venous pressure which is much more accurate in determining AKI
**MAP we want the mean arterial pressure to be above 65 and ideally between 75-85 mmHg (this insures that most or all organs are getting perfused well)
**Diastolic perfusion pressure (DPP, mean perfusion pressure (MPP) along with CVP are more accurate in preventing AKI.
**A decreased Diastolic perfusion Pressure was associated with AKI (Because it’s not getting oxygenated) while a decreased MAP was not. So MAP going down is less dangerous. (it’s not the hallmark)
As a conclusion the best way to find out about how the kidneys are working is checking the fluid volume status and the perfusion pressure.
Pre-renal problem.
Pre-renal problems refer to conditions that affect blood flow to the kidneys, leading to a decrease in renal perfusion and ultimately compromising kidney function. These conditions may include:
It means that the blood doesn’t make it to the kidneys. Low BP etc…
Normal renal function?
The kidney is NOT just a filter
Regulation, removal of toxins, hormonal functions
Functions of the Renal System
- Fluid balance (absorbs/reabsorbs water)
- BP control (renin)
- Acid/base [hydrogen (H+)] and bicarbonate (HCO3)
- Electrolyte balance (sodium, potassium, calcium, phosphorus)
- Removal of wastes (urea, metabolites, toxins(drugs for example ), uric acid: which can form stones and cause gout. (If you have too much Ca and uric acid you are high for kidney stones)
- Erythropoietin (promotes the formation of RBCs in the bone marrow)
- Vitamin D activation
- Production and release of bradykinin and prostaglandins
Check slide 11 and 12
Urine needs to be concentrated with toxins that we get rid of. If not we are going to be constantly peeing. As a matter of fact the first sign of AKI is the low concentration of the urine. This is means that water is not reabsorbed and this is why the urine is very diluted. It’s called the diuretic phase of AKI (first phase).
-Sometimes conditions such as diabetes, renal failure make the membrane of the nephron bigger which in turn lets escape RBC and proteins which in turn leads to anemia.
-When blood enters the capillaries of the glamorous, this filter is formed due to hydrostatic pressure. And this pressure forces particles like urea nitrogen, creatinine and glucose from the blood across that glomerular capsule.
- The amount of blood filtered by the glomeruli in 1min is called GFR (glomeural filtration rate). A normal GFR is 125 ml a min. About a 180L a day. which means that the amount of liquid that we reabsorb is huge because we filter 180L a day and we only pee out 1L to 2L a day.
- The afferent and efferent arterioles can constrict and regulate BP. The afferent a little bit more.
- A systolic under 70 means that there is no perfusion to the kidneys anymore and the GFR drops off very quickly.
- The reabsorption of the kidneys is selective. The way it works is that it depends of the permeability of the membrane. ADH (antidiuretic hormone aka vasopressin) and aldosterone control that permeability at the distal convoluted tubule.
-Bicarbonate is reabsorbed which depends on serum PH. This is why it’s important to keep the PH in normal range.
- Glucose can also be reabsorbed by the kidneys but it can only do so much and that’s why we say that there is a renal threshold. If there is a lot of glucose in the blood and the threshold has been reached the blood glucose in the body goes up. A lot of glucose all the time stresses the kidneys. The glucose has to be under 200 for the kidneys to be able to reabsorb it. If it can be reabsorbed the kidneys start crashing glucose into the urine.
Check slide 13 and print the angiotensin RAAS system
- Rennin in the kidneys is produced when the receptors in the kidneys detect that blood flow/blood volume is decreased. It’s also released when there is low Na levels in the renal blood.
Vitamine D, we get some of it from the sun but it needs to be activated. The activation process starts in the liver and then it goes to the kidneys where it is converted into its active form. The active form of vitamin D is required for Ca to reabsorbed in the GI tract. So if we have renal failure we actually get Ca replacement. Also remember that Ca has a reverse relation with phosphate when one goes up the other one goes down. so in renal impairment we limit phosphate intake. - prostaglandins are made in the kidney and they are pretty much everywhere in the body and they trigger vasodilatation. Ex if they are not getting perfused they release them. Prostaglandins can also reduce systemic BP. People with renal failure don’t produce enough prostaglandins which increase in turn BP.
Also when we talk about bradykinin increases the permeability of the capillary membrane in the kidneys. so that it lets certain solutes in.
Gerontologic Considerations
- Older adults susceptible to kidney injury because the renal structural and function themselves change:
*They lose nephron functionality. - Sclerosis of the glomerulus and renal vasculature (hardening and thickening) much more severe with people who have diabetes and HBP.
- Decreased blood flow. This is why older people need higher BP to maintain renal blood flow.
- Decreased GFR because the functional units don’t work as well.
- Altered tubal function and acid base balance
- Incomplete emptying of bladder, urinary retention, incontinence, urinary stasis, decreased nerve innervations which causes the problems above, sometines it’s a central nervous sytem problem related to dementia, stroke, Benign prostatic hyperplasia (BPH) in men.
- Decreased drug clearance = Increased drug in the blood and drug interactions
What does chronic inflammation lead to in patients with Gerontologic. Considerations? 2.0
1- Impaired kidney repair
2- Endothelium disfunction
3- Oxidative stress: Oxidative stress is a state in which there is an imbalance between the production of reactive oxygen species (ROS) and the ability of the body to detoxify or repair the damage caused by these harmful molecules.
Gerontologic Considerations 3.0
- Race, socioeconomic status etc…
- Genetic factors
- Gender
- Angiotensin 2
- Atherosclerosis vascular dammage
Macroscopic changes in Gerontologic Considerations?
Decreased size: The kidneys can shrink in size as a person ages due to a reduction in the number of functioning nephrons.
Calcifications: Calcium deposits can accumulate in the kidneys as a person ages, which can lead to renal calculi (kidney stones) and other complications.
Renal masses: As people age, they may develop benign or malignant tumors in the kidneys, which can affect kidney function.
Renal cysts: Simple renal cysts are common in older adults and are usually benign. However, complex renal cysts may be a sign of a more serious underlying condition and require further evaluation.
Glomerular changes Gerontologic Considerations?
- Decrease in the number of glomeruli
- Glomerulosclerosis
- Glomerular Hypertrophy (Aging: As we age, the glomeruli in our kidneys may naturally enlarge as a result of wear and tear over time.
Hypertension: High blood pressure can cause the walls of the blood vessels to thicken and narrow, which can lead to increased pressure within the glomeruli and result in hypertrophy.)
- Podocytes alterations (Podocytes are specialized cells that are found in the glomeruli of the kidneys)
- Increased mesangial space (The mesangial cells are specialized cells that provide structural support for the glomerular tuft and regulate blood flow through the capillaries. )
Tubular changes Gerontologic Considerations?
- Decreased tubular length
- Tubular atrophy
- Interstitial fibrosis
- Increased diverticula (Diverticula in the kidneys are small pouches or sacs that form in the renal pelvis, which is the central collecting area of the kidney. They occur when weak spots in the intestinal wall allow the inner lining of the intestine to push through, creating small pockets or sacs that protrude outward.)
Vascular changes Gerontologic Considerations?
- Agiomerular circulation (a state in which blood flow to the glomeruli of the kidneys is reduced or compromised)
- Atherosclerosis
- Intimal/medial hypertrophy
- Increase in vessel turtuosity (bnormal twisting, bending, or curving of blood vessels.)
Endocrine changes (Gerontologic Considerations?)
- Decrease plasma Renin Angiotenesin and aldosterone
- Increased EPO”erythropoietin” (in the healthy elderly) coz the body goes crazy
- Decreased EPO response to anemia
- Decrease vitamin D activation
Other Gerontologic Considerations?
- Decreased fluid intake (old people lose sense of thirst a little bit)
- Decreased CO
HTN or higher SBP (130-150 mmHg) - Females
Cytocele (Cystocele, also known as a prolapsed bladder, is a condition in which the supportive tissue between a woman’s bladder and vaginal wall weakens, allowing the bladder to droop or bulge into the vagina. This can result in discomfort, urinary problems, and difficulty emptying the bladder fully.)
Urinary incontinence or leakage
Difficulty or discomfort during urination
Recurrent bladder infections
Pain during sexual intercourse
)
Estrogen protects & slows progression of CKD
- Males
BPH
Androgen deprivation slows progression of CKD
- Decreased bladder tone
Incontinence
Retention
Diagnostic Studies. We always start with the least invasive /quick and doesn’t involve any dye test and the cheapest.
Urinalysis and urine culture: These tests help to determine the presence of infection or other abnormalities in the urine.
Renal function tests: These include blood tests to measure creatinine, blood urea nitrogen (BUN), and electrolyte levels, which can help determine kidney function.
Ultrasonography: This test uses sound waves to produce images of the kidneys, ureters, and bladder. It is useful in detecting the presence of stones, tumors, or other abnormalities.
CT and MRI: These imaging tests can provide more detailed images of the urinary tract, allowing for the detection of smaller stones, tumors, or other abnormalities.
Nuclear scans: These tests involve the injection of a radioactive substance that is taken up by the kidneys and can help identify abnormalities in kidney function.
Endoscopic procedures: These involve the use of a scope to visualize the urinary tract and can be used to diagnose and treat various urinary tract disorders.
Biopsies: These involve the removal of a small tissue sample for examination under a microscope and are used to diagnose kidney disease or cancer.
IV urography: This test involves the injection of a contrast dye into a vein, which travels to the kidneys and urinary tract and can help identify abnormalities.
Retrograde pyelography: This involves the injection of a contrast dye into the urinary tract through a catheter and can help identify abnormalities in the ureters and kidneys.
Cystography: This test involves the injection of a contrast dye into the bladder and can help identify abnormalities in the bladder.
Renal angiography: This test involves the injection of a contrast dye into the blood vessels supplying the kidneys and can help identify abnormalities in the blood vess
Urinalysis?
Color
Clarity
Sediment sometimes you will see you mucus
Specific gravity 1.002-1.035
We want it to change throughout the day and not be fixed because that tells us that the kidneys are not working and can’t concentrate urine it can also mean that the pt is dehydrated.
We need pH 4.5-8.0 for acid base stability
Bacteria & leukocytes
Protein
Glucose
Ketones
Nitrites
Bilirubin/urobilinogen so the urine is gonna look a little greenish. Blue = dye
Toxins
We try to get the first void of the day because it’s the most concentrated and we have to get it tested within an hour and we don’t we have to refrigerate it.
We also look at osmolality it tells us more about the solute concentration which is more precise than specific gravity and it’s done in the lab.
We don’t want RBC in the urine that’s not normal. because there could be bleeding in the urinary system or there could be inflammation due to infection and we are rupturing little capillaries. WBC are not supposed to be there either.
We use chlorehexdine before we get a urine simple to clean the area. YOu can void stop to clean the urethra and then we get a sample.
Casts and bacteria are not normal either, urine is steril actually.
Check slide 19
Glomerular Filtration Rate (GFR)?
- Normal GFR 100-125 mL/min
*Also referred to as creatinine clearance (CrCl) - GFR decreases by 10% every 10 years or one mL/min/year after age 40
Abrupt decrease in GRF will show an increase in creatinine (Cr)
-Gradual decrease in GFR and renal blood flow (RBF) with aging will show little change in GFR
40% of people with decreased GFR have a serum creatinine WNL
Is the following statement true or false?
Urea is an abnormal constituent of urine
they truck to trick you with the word ABONORMAL CAREFUL
False. Urea is a normal constituent of urine. about 5%.
Glucose en cambio is an abnormal constituent of urine
Nursing Process: The Care of the Patient Undergoing Testing of the Renal–Urologic System—Assessment
- Patient knowledge : do they know what the test is for , do they know if insurance cover it etc…
- Psychosocial and emotional factors; fear; anxiety
- Urologic function, include voiding habits/pattern. How often, do they have burning, do they leak all the time etc…
- Fluid intake and what?
-Hygiene
-Presence of pain or discomfort
-Allergies
What is the normal adult bladder capacity?
50 to 100 mL
100 to 200 mL
300 to 500 mL
600 to 800 mL
300 to 500 mL
- The normal adult bladder capacity is 300 to 500 mL of urine
Nursing Process: The Care of the Patient Undergoing Testing of the Renal–Urologic System—Diagnosis
-Knowledge deficient
-Pain
-Fear
-Refer to Chart 47-4 must read
Nursing Process: The Care of the Patient Undergoing Testing of the Renal–Urologic System—Planning
- Patient goals may include:
*Understanding of procedures, tests, and expected behaviors
*Decreased pain or absence of discomfort
*Decreased apprehension and fear - Patient education:
*Provide a description of the tests and procedures in the language the patient can understand
Nursing Process: The Care of the Patient Undergoing Testing of the Renal–Urologic System—Interventions
- Encourage fluid intake unless contraindicated (Improves test accuracy: )
- Instruct in methods to reduce discomfort; sitz baths, relaxation techniques
- Administer analgesics and antispasmodics as prescribed
- Assess voiding and provide instructions related to voiding practices and hygiene
- Provide privacy and respect when they go pee to give u a sample
- Refer to Chart 53-4
A 24-hour urine collection is scheduled to start at 0100. When should the nurse start the procedure?
1. At 0100, with or without a specimen 2. At the first specimen that was voided at 0400 3. 2 hours after the urine was discarded 4. After discarding the 0100 specimen
After discarding the 0100 specimen
A 24-hour urine collection that starts at 0100 begins after discarding the 0100 specimen
which means 4 pm lol
Assessment of the Urinary System -Subjective
BODY TERRAIN JUST MEANS BODY DIFERENCES BETWEEN MALE AND FEMALE. FANCY WORD
- Important health information
Body terrain (Includes male versus female length of urethra, post gender affirming surgery)
**Anatomical factors
****Obesity, Congenital, Fistulas
**Things that compromise the immune system
**Aging, diabetes, HIV, medications, cancer, poor nutrition, what’s thier exercise like. - Foreign bodies like indwelling urinary catheters, anything that has been put in thier urinary system
- Functional disorders: problems walking, is the toiled high
- Environment, are there toxins, do they have a toilet
- Past health history
- Medications
- Surgery or other treatments
- Other
**Pregnancy, menopause, sexual activity, poor or misconceptions about personal hygiene, use of spermacides, bubble baths, diaphragm (women) , sprays
Assessment of Urinary System- Objective
Physical examination:
- Inspection
**Skin, mouth, face, extremities, abdomen
**Weight, general state of health - Palpation
**Left kidney rarely palpable we don’t fuck with the left wing
** So we palpate the right kidney and Bladder for distention - Percussion there should be no pain
**Kidney
**Bladder
-Auscultation
**I’m sorry for the confusion earlier. To clarify, auscultation with a stethoscope is not typically used to assess the urinary system, as sounds from the urinary tract are usually not audible with a stethoscope.
However, bowel sounds can be assessed with a stethoscope as part of a general abdominal exam to assess the gastrointestinal system. It is important to assess bowel sounds to ensure that the gastrointestinal tract is functioning properly, and to identify any potential obstructions or ileus.
Normal Physical Assessment of the Urinary System
-No costovertebral angle tenderness. Meniang no pain. No news is good news here.
-Nonpalpable kidney and bladder
-No palpable masses
Kidney & Urinary Assessment Nursing Priorities-Inspection
- Inspection for kidney injury focuses on the flanks and abdomen
**Bleeding: bruising, abdominal distention, guarding (when palpating), urinary meatus
**Volume depletion or overload: JVD (first supine then @ 45-degree angle/semi-Fowlers) If flat when supine it means dehydrated. If we put them at a 45(normal sitting position) degree postion and they are distended it means that there is fluid overload.
-Edema: dependent, eyes, hands, cheeks, feet, over bony prominences,
**pitting (scale of 1-4)
**check weight, **hypoalbuminemia
Kidney & Urinary Assessment Nursing Priorities-Auscultation
- Auscultation for someone with kidney injury focuses on the heart, lungs and blood pressure since we can’t auscultate the kidneys
**Heart: rate, rhythm and extra heart sounds (S3 & S4 FVE) use bell; pericardial friction rub (3rd intercostal space to the left of sternum, lean forward)
**Lungs: Crackles, new dyspnea upon mild exertion, orthopnea, PND
**Blood pressure: FVD either fluid or hemorrhage losses
***Orthostatic hypotension
Kidney & Urinary Assessment Nursing Priorities – Percussion
- Percussion priorities focus on the kidneys and abdomen to assess for trauma which often manifestas pain or accumulation of air or fluid. Percussion should not hurt.
- Abdomen: Helps with determining fluid status, presence of ascites or distention.
- kidney: patient side-lying or sitting with examiner’s hand over the costovertebral angle: then striking the hand with the other fist which produces a normal dull thud
Kidney & Urinary Assessment Nursing Priorities –Fluid Balance
-Fluid balance priorities focus on weight, intake and output, vital signs
-Fluid status assessment: skin turgor, mucous membranes, I & O, presence of edema or ascites, neck and hand engorgement, lung sounds (crackles due to edema), dyspnea, tachycardia, hypo/hypertension, S3 or S4 heart sounds, HA (headache = increased tension ), blurred vision, vertigo on rising, mental changes, serum osmolality (measures dilution of vascular fluid)
Assessment of Electrolyte & Waste Product Status
- CBC
- Serum electrolytes
- BUN
- ECG (K, Ca, Mg levels)
- Behavioral and mental status changes (Na and BUN levels)
- Chvostek’s and Trousseau’s signs Calcium
-Changes in peripheral sensation (numbness tremor) (Na K and Ca levels ) - Muscle strength (K and BUN levels)
- GI changes (N/V BUN)
- Itching (Ca, Phosphorus, BUN)
- Therapies (NG suction diuretics antihypertensives, Ca channel blockers can alter electrolytes)
CBC: A complete blood count can help detect anemia, which may be caused by decreased kidney function.
Serum electrolytes: Sodium, potassium, chloride, and bicarbonate levels are important electrolytes to monitor.
Blood Urea Nitrogen (BUN): BUN is a waste product that is filtered by the kidneys. Elevated levels may indicate decreased kidney function or dehydration.
ECG: Electrocardiogram can help detect abnormalities in potassium, calcium, and magnesium levels, which can affect cardiac function.
Behavioral and mental status changes: Sodium and BUN levels can affect mental status and cause confusion, lethargy, and seizures.
Chvostek’s and Trousseau’s signs: These are signs of hypocalcemia and can indicate problems with calcium levels.
Changes in peripheral sensation: Numbness and tremors can be caused by imbalances in sodium, potassium, and calcium levels.
Muscle strength: Potassium and BUN levels can affect muscle strength and cause weakness.
GI changes: Nausea and vomiting can be caused by elevated BUN levels.
Itching: High levels of calcium, phosphorus, and BUN can cause itching.
Therapies: Certain medications and therapies such as NG suction, diuretics, and antihypertensives can alter electrolyte levels and need to be monitored closely.
Erythropoietin?
H for hormone
Erythropoietin (EPO) is a hormone produced by the kidneys that stimulates the production of red blood cells (RBCs) in bone marrow. EPO is essential for maintaining the normal oxygen-carrying capacity of the blood.
EPO is primarily used medically to treat anemia, which is a condition where there is a shortage of RBCs in the body. It may also be used to increase RBC production in individuals with certain types of cancer, kidney disease, or HIV infection.
Bradykinin ?
In the context of inflammation, prostaglandins promote vasodilation and increase vascular permeability, similar to bradykinin.
Costovertebral angle tenderness ?
Costovertebral angle tenderness is a medical sign that refers to pain or discomfort elicited by pressure over the area where the lower ribs meet the vertebral column on the back, known as the costovertebral angle. It is often associated with kidney or urinary tract problems, such as pyelonephritis or kidney stones, but can also be caused by other conditions affecting the musculoskeletal or nervous systems. Costovertebral angle tenderness is a common finding in patients with urinary tract infections, and its presence can help diagnose and guide treatment of these conditions
white blood cell cast?
WBC casts are not typically seen in cases of anywhere but in infection within the kidneys , which is an inflammation or infection of the bladder.
The presence of white blood cell casts in the urine indicates an inflammatory process within the kidneys, such as pyelonephritis (a bacterial infection of the kidneys) or interstitial nephritis (an inflammation of the kidney tissue).
White blood cell casts can be identified through a urine test called a urinalysis, which involves examining a sample of urine under a microscope. The presence of white blood cell casts, along with other factors such as the presence of bacteria and elevated levels of white blood cells, can help a doctor diagnose a kidney infection or other kidney-related conditions.
Nitrites?
Nitrites are NOT typically found in the blood. Nitrites are a form of nitrogen that are naturally produced by certain bacteria, particularly those that are commonly found in the gastrointestinal tract. When these bacteria break down nitrate, they convert it into nitrite.
In medical settings, the presence of nitrites in the urine can be a sign of a bacterial infection, particularly a urinary tract infection (UTI). During a UTI, bacteria convert nitrates in the urine to nitrites, which can then be detected in a urine test.
Leukocyte esterase?
Leukocyte esterase is an enzyme produced by white blood cells (leukocytes) that is commonly used as a marker for inflammation or infection in the body, particularly in the urinary tract.
During a urinalysis, a small strip of paper or plastic is dipped into a sample of urine, and the color change on the strip is used to detect the presence of leukocyte esterase. If leukocyte esterase is detected, it can indicate the presence of white blood cells in the urine, which may be a sign of a bacterial infection in the urinary tract.
What is Cystitis?
Cystitis is a medical condition characterized by inflammation or infection of the urinary bladder. It is more common in women than men and can be caused by a variety of factors, including bacterial infection, irritants, or other underlying medical conditions.
neutrophils into the renal interstitium, causing pyelonephritis. Why?
The presence of neutrophils in the renal interstitium indicates an active immune response to the infection.
However, if the infection is not properly treated, the ongoing inflammation and presence of immune cells like neutrophils can cause damage to the kidney tissue, leading to scarring and impaired kidney function.
The presence of neutrophils in the renal interstitium ?
The presence of dead neutrophils in the renal interstitium indicates an active immune response to the infection.
As neutrophils die off or are broken down, they release their contents into the surrounding tissue and bloodstream. These breakdown products can make their way into the urine, where they can be detected through a urine test.
What is a WBC cast? kidney nothing else
A WBC cast, also known as a leukocyte cast, is a type of urinary cast that is made up primarily of white blood cells (WBCs). Urinary casts are cylindrical structures that form in the kidneys and can be excreted in the urine. They are typically composed of various substances, such as proteins or cells, that are present in the urine.
Why does impaired bladder emptying cause cystitis ?
Impaired bladder emptying can cause cystitis because of bacterial growth
What is a A dipstick test?
A dipstick test is a quick and simple diagnostic test used to detect certain substances in bodily fluids such as urine, blood, or saliva. It involves dipping a plastic strip (the dipstick) into a sample of the fluid and observing the color changes that occur on the stick.
In the case of a urine dipstick test, the strip is dipped into a urine sample, and the chemical pads on the strip react to different substances in the urine, producing a color change. The color changes indicate the presence or absence of various substances, such as glucose, protein, ketones, blood, leukocytes, and nitrites.
The dipstick test is commonly used in medical settings as a preliminary screening tool for various conditions such as urinary tract infections, diabetes, liver and kidney disorders, and certain types of cancer. The test is quick, inexpensive, and easy to perform, making it a valuable tool for routine check-ups and initial diagnostic evaluations. However, it should be noted that dipstick tests are not always definitive, and further testing may be necessary to confirm a diagnosis.
what is the etymology of pyelonephritis?
The term “pyelonephritis” comes from two Greek words: “pyelo” meaning “pelvis” and “nephros” meaning “kidney”, combined with the suffix “-itis” meaning “inflammation”.
Therefore, pyelonephritis literally means “inflammation of the renal pelvis and kidney”. The condition is typically caused by a bacterial infection that starts in the lower urinary tract and then spreads to the kidneys, leading to inflammation and potentially serious complications if left untreated.
Why can pregnancy cause urinary stasis leading to a UTI?
Pregnancy: During pregnancy, the growing uterus can put pressure on the bladder and cause urinary stasis.
Urinary stasis ?
Urinary stasis is a condition where urine does not flow properly through the urinary tract, causing it to stagnate or accumulate in the bladder or kidneys. This can lead to an increased risk of urinary tract infections (UTIs) and other complications.
Vesicoureteral reflux (VUR)? can cause a UTI !
Vesicoureteral reflux (VUR) is a condition in which urine flows backward from the bladder into the ureters and sometimes up into the kidneys.
Why does diabetes mellitus cause pyelonephritis?
Diabetes mellitus (DM) is a chronic condition that can increase the risk of pyelonephritis, which is a type of kidney infection caused by bacteria. There are several reasons why diabetes can lead to pyelonephritis:
Immune system dysfunction: Diabetes can impair the immune system, making it harder for the body to fight off infections. This can increase the risk of bacterial infections, including pyelonephritis.
Urinary tract abnormalities: High blood sugar levels in diabetes can damage the nerves that control the bladder, leading to incomplete emptying of the bladder and increasing the risk of urinary tract infections. Additionally, high blood sugar levels can increase the glucose concentration in urine, which can promote bacterial growth and increase the risk of infections.
Urinary stasis: Diabetes can lead to urinary stasis, which is a condition where the urine does not flow properly through the urinary tract, causing it to stagnate. This can increase the risk of bacterial growth and infections.
Decreased blood flow to the kidneys: High blood sugar levels in diabetes can damage the blood vessels that supply the kidneys, leading to decreased blood flow and impairing the kidneys’ ability to filter waste products from the body. This can increase the risk of infections and kidney damage.
Neuropathy: Diabetes can cause neuropathy, which is damage to the nerves that control the bladder and urinary tract. This can lead to incomplete emptying of the bladder, urinary stasis, and increase the risk of urinary tract infections, including pyelonephritis.
People with diabetes should be aware of the increased risk of pyelonephritis and other urinary tract infections and take steps to prevent them, such as maintaining good blood sugar control, practicing good hygiene, drinking plenty of water, and seeking prompt medical attention if they experience any symptoms of infection. Early diagnosis and treatment are important to prevent complications and preserve kidney function.
how is a urinalysis done ?
A urinalysis is a test that examines the urine for various substances and can provide important information about a person’s overall health. The test involves collecting a sample of urine and analyzing it in a laboratory.
Here are the steps for a typical urinalysis:
Clean catch: Before collecting the urine sample, the patient is instructed to clean the genital area with a special wipe and to collect a “clean catch” midstream urine sample in a sterile container.
Visual inspection: The urine sample is visually inspected for color, clarity, and odor.
Dipstick test: A dipstick, which is a plastic strip with several chemical pads, is dipped into the urine sample. The chemical pads on the dipstick change color in the presence of various substances in the urine, such as protein, glucose, ketones, and blood.
Microscopic examination: A small amount of the urine sample is placed on a microscope slide and examined under a microscope for the presence of red blood cells, white blood cells, bacteria, and other abnormal cells or structures.
Culture and sensitivity: If the urinalysis suggests the presence of a bacterial infection, a culture and sensitivity test may be performed to identify the type of bacteria causing the infection and determine the most effective antibiotic treatment.
The results of a urinalysis can provide important information about kidney function, urinary tract infections, diabetes, liver disease, and other conditions. It is important to discuss the results of a urinalysis with a healthcare provider, who can provide further interpretation and guidance on any necessary follow-up tests or treatments.
what are leukocyte esterase?
Leukocyte esterase is an enzyme found in white blood cells (leukocytes) that is commonly used as a marker for the presence of inflammation or infection in the urinary tract. The leukocyte esterase test is often included as part of a urinalysis to help diagnose urinary tract infections (UTIs).
During a urinalysis, a dipstick with a chemical pad is dipped into the urine sample. The chemical pad on the dipstick changes color in the presence of leukocyte esterase, indicating the presence of white blood cells and inflammation in the urinary tract.
The leukocyte esterase test is a quick and easy way to screen for UTIs, but it is not always accurate. False positives can occur if there is contamination of the urine sample, vaginal discharge, or if the patient is taking certain medications. False negatives can also occur if the urine sample is dilute or if the infection is caused by bacteria that do not produce leukocyte esterase.
Therefore, if a leukocyte esterase test is positive, a healthcare provider may order additional tests, such as a urine culture, to confirm the presence of a UTI and determine the most appropriate treatment.
What are uroepithelial cells ? are found all over the urinary tract
Uroepithelial cells, also known as transitional cells, are a type of cell that line the urinary tract. These cells are named for their transitional shape, ( round and pear-shaped)which allows them to stretch and change shape as the bladder fills and empties.
Uroepithelial cells are found throughout the urinary tract, including the bladder, ureters, and renal pelvis. They play an important role in maintaining the integrity of the urinary tract lining, as well as protecting against infection and other damage.
What is renal interstitium ?
The renal interstitium is a type of connective tissue.
The renal interstitium is the tissue that surrounds the functional units of the kidney, called nephrons. It is a complex network of cells, extracellular matrix, and fluid that fills the spaces between the nephrons, blood vessels, and collecting ducts of the kidney.
The renal interstitium plays a critical role in maintaining the proper function of the kidney. It provides support and structural integrity to the nephrons, as well as helps to regulate the flow of blood and fluids through the kidney.
Why do neutrophils die after doing their job?
they undergo a process called apoptosis, which is programmed cell death. This process helps to prevent the release of potentially harmful chemicals and enzymes that could damage surrounding tissues.
Dysuria? It’s not little urine. Heads up!
Dysuria is a medical term that refers to painful or difficult urination. It is a common symptom of many urinary tract infections and other urinary system conditions, such as bladder inflammation (cystitis), urethritis, and prostatitis.
Dysuria can be caused by a variety of factors, including inflammation, irritation, or infection of the urinary tract, as well as urinary stones, tumors, or other obstructions. Symptoms of dysuria may include a burning or stinging sensation during urination, frequent urination, and a strong urge to urinate.
Etymology of pyuria?
The term “pyuria” comes from two Greek words: “pyo” meaning “pus” and “ouron” meaning “urine”. Therefore, pyuria refers to the presence of pus in the urine. Pus is a thick, yellowish or greenish fluid that is produced in response to infection or inflammation and is composed of dead white blood cells, bacteria, and tissue debris. Pyuria is often a sign of a urinary tract infection or other underlying condition affecting the urinary system.
Why do we have urinary urgency and frequency with all UTI upper and lower ?
why do we have urinary urgency and frequency with Pyelonephritis?
Urinary urgency and frequency are common symptoms of pyelonephritis, which is an infection of the kidneys and the upper urinary tract. These symptoms occur because the infection causes inflammation and irritation of the urinary tract, which can stimulate the bladder to contract and produce the sensation of urgency and the need to urinate frequently.
In addition, the infection can also affect the nerves and muscles that control bladder function, leading to bladder spasms and involuntary contractions that can cause urinary urgency and frequency.
It is important to note that urinary urgency and frequency are not specific to pyelonephritis and can occur with other urinary tract infections and conditions, such as cystitis and urethritis. If you are experiencing these symptoms, it is important to seek medical attention to determine the underlying cause and receive appropriate treatment.why do we have urinary urgency and frequency with Pyelonephritis?
What does tenderness up on examination mean? This can be palpation and percussion
tenderness refers to that is felt over the area
What is a CBC for ?
A CBC (complete blood count) test is a common blood test that is used to evaluate and monitor various aspects of a person’s blood and overall health. It measures the levels of different components in the blood, including:
Red blood cells (RBCs): These carry oxygen throughout the body. Abnormal RBC levels can indicate anemia or other blood disorders.
White blood cells (WBCs): These help fight infection and disease. Abnormal WBC levels can indicate an infection or an immune system disorder.
Platelets: These help the blood to clot. Abnormal platelet levels can indicate a bleeding disorder.
Hemoglobin: This is a protein found in red blood cells that carries oxygen. Abnormal hemoglobin levels can indicate anemia or other blood disorders.
Hematocrit: This measures the proportion of red blood cells to the total volume of blood. Abnormal hematocrit levels can indicate anemia or other blood disorders.
A CBC test is typically ordered as part of a routine physical exam or to evaluate symptoms such as fatigue, weakness, fever, or unexplained bleeding or bruising. It can also help diagnose and monitor various medical conditions, such as infections, anemia, leukemia, and other blood disorders.
What is tubule atrophy ? Esta hablando de convoluted tubule, loop of henele etc
La perdida de las celulas que lo forman y ocurre con la edad
tambien con otras condiciones pero le tengo que decir a la profe lo que quiere escuchar
What is tubule atrophy ?
Tubule atrophy refers to the degeneration and loss of the tubules in the kidney, which are responsible for filtering and processing the blood to produce urine. This condition can occur as a result of various kidney diseases and disorders, including chronic kidney disease, pyelonephritis (infection of the kidney), and nephrotic syndrome (a group of kidney disorders that cause damage to the glomeruli).
When tubule atrophy occurs, the tubules become damaged and gradually lose their ability to filter the blood and remove waste products from the body. This can lead to a variety of symptoms and complications, including decreased urine output, fluid retention, high blood pressure, electrolyte imbalances, and kidney failure.
What is urospesis ?
Urosepsis is a serious medical condition that occurs when a bacterial infection in the urinary tract spreads to the bloodstream, causing a systemic infection. It is a type of sepsis, which is a potentially life-threatening condition that can cause organ failure and death if left untreated.
Urosepsis typically occurs as a complication of a urinary tract infection (UTI), such as cystitis or pyelonephritis. When bacteria enter the urinary tract and are not effectively treated, they can multiply and spread to other parts of the body through the bloodstream. This can lead to symptoms such as fever, chills, rapid heartbeat, low blood pressure, confusion, and organ failure.
Urosepsis is a medical emergency and requires immediate treatment.
What is urospesis ?
Urosepsis is a serious medical condition that occurs when a bacterial infection in the urinary tract spreads to the bloodstream, causing a systemic infection. It is a type of sepsis, which is a potentially life-threatening condition that can cause organ failure and death if left untreated.
Urosepsis typically occurs as a complication of a urinary tract infection (UTI), such as cystitis or pyelonephritis. When bacteria enter the urinary tract and are not effectively treated, they can multiply and spread to other parts of the body through the bloodstream. This can lead to symptoms such as fever, chills, rapid heartbeat, low blood pressure, confusion, and organ failure.
Urosepsis is a medical emergency and requires immediate treatment.
Urosepsis etymology?
The term “urosepsis” is a medical term that is derived from the combination of two words: “uro-“ meaning relating to the urinary system, and “-sepsis” meaning a potentially life-threatening condition caused by the spread of infection throughout the body. “Sepsis” comes from the Greek word “sepsis” which means putrefaction or decay. Therefore, urosepsis refers specifically to sepsis caused by an infection in the urinary system, which has spread to other parts of the body through the bloodstream.
What does a Complete Metabolic Panel test?
A Complete Metabolic Panel (CMP) is a blood test that provides information about a person’s overall health and organ function. It measures several substances in the blood, including:
Electrolytes: such as sodium, potassium, chloride, and bicarbonate. These are important for maintaining proper fluid balance, pH balance, and nerve and muscle function.
Glucose: this measures the amount of sugar in the blood and can help diagnose diabetes and monitor blood sugar levels.
Kidney function: this includes blood urea nitrogen (BUN) and creatinine levels, which can help assess how well the kidneys are filtering waste products from the blood.
Liver function: this includes tests such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP), which can help assess how well the liver is functioning.
Total protein and albumin: these tests can help assess overall nutritional status and liver and kidney function.
Calcium: this can help assess bone health and can be used to monitor certain medical conditions.
A CMP is commonly used as a routine screening test during a physical exam, or it may be ordered to help diagnose or monitor certain medical conditions, such as diabetes, liver disease, kidney disease, or electrolyte imbalances.
what do the kidneys do ?
Ace inhibitors and NSAIDs , diuretics antibiotics are really hard on the kidneys
why does a uti cause delirium?
A urinary tract infection (UTI) can cause delirium in some cases, particularly in older adults. This is because UTIs can lead to a variety of physiological changes that affect brain function.
When bacteria infect the urinary tract, they can cause inflammation and release toxins that can enter the bloodstream and affect brain function. The resulting inflammation and toxins can disrupt normal neurotransmitter activity in the brain and cause delirium, a state of confusion and disorientation.
Additionally, UTIs can lead to dehydration and electrolyte imbalances, which can also contribute to delirium. Older adults are particularly vulnerable to delirium due to age-related changes in the brain and increased susceptibility to infections.
why does a UTI cause delirium more in older people than younger ?
why does a uti cause delirium more in older people than younger ?
UTIs can cause delirium more frequently in older people than younger people because of several factors. As we age, the immune system weakens, making older adults more susceptible to infections such as UTIs. Additionally, older adults may have other medical conditions or take medications that further weaken the immune system, making it harder for the body to fight off infections.
Furthermore, as we age, our brains become more susceptible to damage from inflammation and toxins that are released by the infection
Abdominal distention, also known as bloating, is a condition in which the abdomen becomes swollen or enlarged. It is a common symptom that can be caused by a variety of factors, including:
.
Distention?
In medical terminology, distention refers to the condition of being distended or swollen. It is the act of stretching or expanding beyond normal limits.
In the context of the abdomen, abdominal distention refers to the condition of the abdomen being visibly swollen or enlarged. This can be caused by a variety of factors, such as gas, constipation, or fluid accumulation, as mentioned in the previous answer.
Distention can also occur in other parts of the body, such as the bladder (bladder distension), the blood vessels (vascular distension), or the lungs (pulmonary distension), among others.
The bladder should not normally be palpable especially if we are looking for a disorder such as incontinence. You push they pee if it’s full jejejejejejej Always ask before.
If I push on your bladder I should not feel it. It should never get to the point where I can feel it. If I do feel it it means something is wrong !
There should be no protein in the urine
Infection or inflammation: Urinary tract infections or other inflammatory conditions in the urinary tract can cause proteinuria.
Kidney disease: Damage to the kidneys or underlying kidney disease can lead to proteinuria.
true
What does a Urinalysis test consist of ?
What does a Urinalysis test consist of ?
A urinalysis is a common laboratory test that examines a urine sample for various components and properties. A typical urinalysis test can include the following:
Visual examination: A technician or healthcare provider will visually examine the color, clarity, and odor of the urine sample.
Dipstick test: A dipstick, which is a narrow plastic strip with several pads or squares that change color in the presence of certain substances, is dipped into the urine sample. The dipstick can test for various components, including pH, protein, glucose, ketones, bilirubin, and blood.
Microscopic examination: A small amount of the urine sample is examined under a microscope to look for cells, bacteria, crystals, and other elements that may not be visible to the naked eye.
Based on the results of these tests, a urinalysis can provide information about various health conditions, such as urinary tract infections, kidney disease, diabetes, liver problems, and other conditions that affect the urinary system. The interpretation of the results may depend on the individual’s age, gender, medical history, and other factors, and may require further testing or evaluation by a healthcare provider.
what is a Ultrasonography ? CPMC but for kidneys instead of heart
what is a Ultrasonography in simple terms
Ultrasonography, also known as ultrasound imaging or sonography, is a medical test that uses high-frequency sound waves to create images of the inside of the body. The sound waves are sent into the body through a device called a transducer, which is placed on the skin over the area being examined. The sound waves bounce back off the internal structures and are picked up by the transducer, which then creates an image of the internal structures in real time. Ultrasonography is a safe and painless procedure that can be used to diagnose and monitor a wide range of medical conditions.
what is specific gravity?
The normal range for specific gravity in urine is typically between 1.002 and 1.035, although the exact range may vary depending on the laboratory and the methods used for testing. Values below this range may indicate overhydration or a condition that leads to dilute urine, while values above this range may indicate dehydration or a condition that leads to concentrated urine.
-Specific gravity is a measure of the concentration of dissolved substances in a liquid compared to the concentration of those same substances in pure water. In the context of urinalysis, specific gravity refers to the concentration of dissolved solids and solutes in urine compared to the concentration of those same substances in pure water.
Normal GFR 100-125 mL/min
is allso referred to as: creatinine clearance (CrCl)
creatinine clearance (CrCl)
Creatinine is a waste product produced by muscles during their normal metabolism. It is transported to the kidneys through the bloodstream, where it is filtered out of the blood and excreted in the urine. Creatinine is a commonly measured parameter in blood and urine tests as it provides an estimate of kidney function.
Apprehension can refer to a feeling of anxiety or fear, often about something that is going to happen in the future or about something unknown.
Antispasmodics are a class of medications that are used to relieve spasms, cramps, and involuntary contractions of smooth muscles in various parts of the body
helps with incontienence
PND? PND stands for paroxysmal nocturnal dyspnea,
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Bicarbonate (HCO3) and kidneys ?
Bicarbonate (HCO3) is an important electrolyte in the body that helps regulate the pH balance of blood and other bodily fluids. The kidneys play a crucial role in maintaining the body’s bicarbonate levels by filtering the blood and reabsorbing bicarbonate ions back into the bloodstream while excreting other acids and hydrogen ions into the urine.
uric acid: which can form stones and cause gout. (If you have too much Ca and uric acid you are high for kidney stones)
Erythropoietin (EPO) correlation to kidney and bone marrow ?
Erythropoietin (EPO) is a hormone produced primarily by the kidneys that stimulates the bone marrow to produce red blood cells (RBCs). EPO plays a crucial role in maintaining the body’s oxygen balance by regulating RBC production in response to changes in oxygen levels.
When the body’s oxygen levels are low, such as during high-altitude exposure, anemia, or chronic kidney disease, the kidneys increase their production of EPO, which in turn stimulates the bone marrow to produce more RBCs. This helps to increase the oxygen-carrying capacity of the blood and improve tissue oxygenation.
