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FNP boards > Renal and urinary tract disorders > Flashcards

Renal and urinary tract disorders Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

What are the most common causes of acute kidney injury (AKI)?

A

Prerenal - hypoperfusion

  • Decreased circulating volume due to dehydration (vomiting, diarrhea), overdiuresis, acute blood loss
  • Decreased CO (HF, burns)

Kidney function returns to normal once underlying cause is addressed

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2
Q

AKI clinical presentation (general)

A

Similar to CKD, but occur over shorter time period (days versus over months)

  • Fatigue
  • Weight loss
  • Anorexia
  • Nocturia
  • Sleep disturbance
  • Pruritus
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3
Q

AKI clinical presentation (prerenal, intrinsic, post renal)

A

Prerenal → thirst, diminished urine output, dizziness, orthostatic hypotension

Intrinsic → hematuria, edema, hypertension

Post renal → urgency, frequency, hesitancy (if renal stones, flank pain and hematuria)

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4
Q

AKI diagnostic tests

A
  • Creatinine
  • eGFR
  • BUN
  • Renal US or CT to rule out outflow tract obstruction
  • Bladder scan for older men with known BPH
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5
Q

Chronic kidney disease clinical presentation

A

Usually without symptoms with stages 1-3 (eGFR >30)

Stages 4 and 5 (associated with anemia and worsening renal failure) have associated comorbidities (HF)

  • Fatigue
  • LE or diffuse edema
  • SOB
  • Decreased urine output
  • Urine become foamy with altered color
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6
Q

True/false: An elevated BUN level with normal creatinine is occasionally found in patients with healthy kidneys but with severe dehydration

A

True - BUN derives from breakdown of protein from dietary or other sources

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7
Q

CKD diagnostic testing

A

Similar to AKI (creatinine, BUN, eGFR) but eGFR provides more accurate assessment of kidney function than creatinine alone

  • Additionally, spot albumin-to-creatinine ratio (ACR)
    • ACR >300 requires referral to nephrologist
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8
Q

CKD staging

A

Stage 1 - eGFR 90 or greater

Stage 2 - eGFR 60-89

Stage 3a - eGFR 45-59

Stage 3b - eGFR 30-44

Stage 4 - eGFR 15-29

Stage 5 - eGFR less than 15 (kidney failure)

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9
Q

Lab testing for stage 4+ CKD

A

Calcium, phosphorus, PTH, alkaline phosphatase, vitamin D

  • Electrolyte disorders are common with AKI and advanced CKD (stages 4 and 5) → hyperkalemia, hypercalcemia, hypernatremia
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10
Q

Glomerulonephritis clinical presentation

A
  • New onset edema of face, hands, feet, abdomen
  • Newly elevated BP or worsening previously present hypertension
  • Headache (acute)
  • SOB
  • Pink or cola colored urine (hematuria)
  • Foamy urine (proteinuria)
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11
Q

Glomerulonephritis diagnostic testing

A
  • UA
    • RBCs and RBC casts, WBCs, elevated protein
  • Serum creatinine and BUN
  • CT scan or kidney US to determine stage of renal damage
  • Kidney biopsy to determine diagnosis
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12
Q

Acute glomerulonephritis treatment and management

A

Goal: manage underlying cause and protect kidneys from further damage

Self limiting with supportive therapy

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13
Q

Complications of GN - what is the recommended treatment?

A

Nephrotic syndrome: excessive proteinuria, hypoalbuminemia, HLD, edema)

  • Monitor renal function, BP, edema, serum albumin, proteinuria
  • Antihypertensive medication
  • Antibiotics if infection
  • Systemic corticosteroids
  • Consider dialysis and renal transplant
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14
Q

Important findings to look out for on UA dipstick for suspected UTI

A
  • Leukocyte esterace → >5 WBC/hpf is positive
  • Nitrates
    • Causative agents: e. coli, proteus, klebsiella
  • Protein → trace to 30 mg/dL (1+)
  • Blood
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15
Q

Acute, uncomplicated UTI in non pregnant women treatment

A
  • TMP-SMX (Bactrim)
    • If sulfa allergy, nitrofurantoin (Macrobid)
  • Add phenazopyridine (Pyridium) for dysuria relief
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16
Q

Recurrent UTI (2+ within 6 months or 3+ in one year) treatment

A

Continuous TMP-SMX, cephalexin, or ciprofloxacin

  • Alternative: postcoital prophylaxis with meds above
  • Postmenopausal → topical/vaginal estrogen (encourage lactobacilli recolonization)
17
Q

Acute uncomplicated pyelonephritis (outpatient therapy)

A

Ceftriaxone 1 g IV then ciprofloxacin or levofloxacin for 7 days

18
Q

Bladder cancer clinical presentation

A
  • Gross, painless hematuria without dysuria
  • Irritative voiding symptoms and urinary frequency without fever
19
Q

Bladder cancer diagnostic testing

A
  • UA to confirm RBCs in urine
  • Referral to urology for cystoscopy
    • Confirmed with biopsy sample
20
Q

Bladder cancer risk factors

A
  • Smoking (most common cause)
  • Male
  • Family history
  • Arsenic exposure (outside of U.S. mainly)
  • Exposure to industrial chemicals
21
Q

Bladder cancer treatment

A
  • Transurethral resection
  • Partial cystectomy
  • Single immediate instillation of intravesical chemo
22
Q

Urinary incontinence diagnostic testing

A
  • UA and culture
  • Urology referral indicated if these are ordered
    • Cough stress test
    • Postvoid residual urine volume
    • Cystoscopy
23
Q

Urge incontinence

  • Etiology
  • Clinical presentation
A

Cause: detrusor overactivity causing uninhibited bladder contractions

Clinical presentation:

  • Strong sensation of needing to empty bladder that cannot be suppressed
  • Involuntary loss of urine
24
Q

Urge incontinence treatment

A

Behavioral therapy

  • Avoid stimulants (caffeine, alcohol)
  • Gentle bladder stretching by increasing voiding interval by 15-30 minutes after establishing a half-hour voiding schedule
  • Sips of fluid

Medications

  • Selective muscarinic receptor antagonists → tolterodine (detrol), solifenacin succinate, darifenacin (enablex)
  • Mirabegron (myrbetriq), botulinum toxin injection
25
Q

Stress incontinence

  • Etiology
  • Clinical presentation
A

Cause: weakness of pelvic floor, urethral muscles

Clinical presentation:

  • Loss of urine with activity that causes increase in intra abdominal pressure (coughing, sneezing, exercise)
26
Q

Stress incontinence treatment

A
  • Support to area with vaginal tampon, urethral stents, periurethral bulking agent injections, pessary
  • Pelvic floor rehabilitation
  • Bladder training
  • Kegel exercises
27
Q

Medications that can lead to urinary incontinence

A
  • Diuretics
  • Anticholinergics/antimuscarinics
    • First gen antihistamines
    • TCAs
    • Antipsychotics
  • Opioids
  • Alcohol
  • Sedatives, hypnotics, benzos
28
Q

Renal stones risk factors

A
  • Male
  • Family history
  • Poor fluid intake
  • Dehydration
  • Diet high in protein, sodium, sugar
  • Overweight or obese
  • Health conditions
    • Hypercalciuria, cystic kidney disease, hyperparathyroidism, renal tubular acidosis, cystinuria, gout
  • Medications
    • Calcium based antacids, sulfa drugs
29
Q

Composition of four different renal stones and their causes

A
  • Calcium oxalate or phosphate
    • Oxalate found in fruits and vegetables, nuts, chocolate
  • Uric acid → acidic urine, eat high protein diet, have gout, purine rich diet
  • Struvite → kidney infections
  • Cystine → genetic disorder
30
Q

Renal stone (stone in ureter) clinical presentation

A
  • Sudden onset severe flank pain
  • Radiates anteriolohy and inferiorly, towards groin, testicles, vulva on side of stone
  • N/V
  • Waves of pain (renal colic)
  • Pink, red, brown urine
31
Q

Renal stone (stone in ureteropelvic junction) clinical presentation

A
  • Mild to deep flank pain without radiation to the groin
  • Irritative voiding symptoms
  • Urinary frequency and urgency
  • Dysuria
  • Bowel symptoms
32
Q

Renal stone (stone in the bladder) clinical presentation

A

Typically asymptomatic but can lead to urinary retention

33
Q

Renal stones diagnostic testing

A
  • UA to confirm hematuria
  • 24 hour urine sample for stone analysis and guide prevention strategy
  • CBC w/ diff, blood culture, urine culture
  • Creatinine
  • US or CT scan
    • US can miss smaller stones (less than 5 mm)
  • X-ray (KUB) can help assess total stone burden
    • Can miss small stones and specific stones of composition
34
Q

Renal stone treatment and management

A
  • Urology referral
  • IV hydration for N/V and unable to maintain hydration with oral intake
  • Stones in ureter
    • Stone less than 4 mm
      • Analgesics (acetaminophen)
      • Alpha blocker
    • Stone greater than 8 mm
      • Extracorporeal shock wave lithotripsy (ESWL)
      • Ureteroscopy
  • Stones in uteropelvic junction
    • Internal ureteral stents
    • Percutaneous nephrostomy
    • ESWL for larger stones
35
Q

Renal stone prevention

A
  • Proper hydration (2-3 liters/day)
  • Diet high in fruits and vegetables
  • Reduce sodium and animal protein if calcium composition of stone
  • Calcium oxalate → reduce intake of oxalate rich foods
    • Rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, soy products
  • Thiazide diuretics to prevent calcium stones

FNP boards (20 decks)

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