Renal and Urological Disorders Flashcards
the kidneys are organs of _____ and ______
filtration and secretion
alterations in kidney function will impair
- acid/base balance
- blood pressure regulation
- RBC formation
- drug metabolism
- hormone metabolism
- vitamin D synthesis (therefore calcium out of balance)
- glucose homeostasis
if not treated, kidney dysfunction leads ultimately to….
end stage renal disease
pre renal dysfunction
- happens before getting to the kidney
- decreased blood flow and perfusion to the kidney
examples of pre-renal dysfunction
- hypovolemia
- heart failure
- shock
- injury that results from ischemia
what is important to remember about pre-renal dysfunction
sufficient blood pressure is needed to maintain GFR and urine output
intra-renal dysfunction
direct damage to the kidney itself
examples of intra-renal dysfunction
- trauma:
pyelonephritis
autoimmune antibody/antigen complexes - kidney infection:
Strep! - Nephrotoxic drugs:
- NSAIDs
- ACE inhibitors
- angiotensin-receptor blockers
- statins
- some antibiotics
post renal dysfunction
obstruction of urine outflow from the kidney
examples of post-renal dysfunction
- obstructive uropathy
- hydronephrosis
- urine back up in kidneys
- examples: kidney stones, prostate gland
hyperplasia
how do we assess a client with renal dysfunction
- determine medications client is taking– are they nephrotoxic??
- assess illnesses and comorbidities- DM2, HTN, HF, strep infections
- assess urine for color, content, clarity, etc. also ask about voiding patterns
- ask about pain- quality, location, etc, CVA tenderness indicates infection
labs to test for renal dysfunction
- pH (normal 7.0)
- specific gravity (normal 1.001-1.030)
- glucose
- ketones
- leukocyte esterase
- nitrite
- protein
- bilirubin
- urobilinogen
- crystals
- casts
BUN/Creatinine will be ____ with kidney dysfunction
elevated
why shouldn’t BUN alone be used as a kidney function indicator
it will be elevated with decreased GFR, but also with dehydration and high muscle mass/high protein diet
how do we treat kidney disfunction
must try to maintain renal function but it can be treated with meds and dialysis
acute glomerulonephritis
immune response to strep infection
important things to remember about acute glomerulonephritis
- can be autoimmune
- left untreated it can progress to ESRD
- BUN/Creatinine elevated
- serum albumin low
- urinalysis will show protein, WBCs, blood, and sometimes antibodies to streptococcal bacteria
how is acute glomerulonephritis treated
- antibiotics
- dietary modifications
- diuretics
nephrotic syndrome
- glomerular damage resulting in proteinuria and edema
- most commonly caused by DM, amyloidosis, and SLE
what will nephrotic syndrome present like
- massive albuminuria
- facial edema
- hematuria
- hypertension
- oliguria
why might hyperlipidemia develop in someone with nephrotic syndrome?
massive loss of albumin triggers liver to synthesize more lipids (LDL)
nephrolitiasis
stones in the kidneys or urinary tract
risk factors for kidney stones
- genetic susceptibility
- dehydration
- hypercalcemia
- hyperparathyroidism
- gout
- hyperuricemia
- urinary tract infection
- immobility
treatment for kidney stones
- pain relief
- prevent recurrence
- strain urine to catch stone for analysis
- prevent UTI
- high fluid intake- greater than 3 L/day
- lithotripsy (if stone does not pass/resolve on own)
- surgery (last resort)
what kind of dietary changes should someone with kidney stones make
- limit calcium, sodium, and alcohol
- increase fluids
- be mindful of where your proteins are coming from
pyelonephritis
- infection of renal pelvis- KIDNEY INFECTION
- sometimes called an upper UTI or ascending UTI
why does pyelonephritis happen
stasis of urine
s/s of pyelonephritis
- FEVER!
- abdominal or CVA tenderness
- flank pain
- dysuria
- urinary frequency
- microscopic hematuria
- WBCs in urine (pyuria)
how is pyelonephritis diagnosed
- urine culture- E. COLI!!!
- urinalysis
- pyuria
- positive leukocyte esterase
- CT scan, ultrasound
treatment for pyelonephritis
- antibiotics
- analgesics if needed
- fluid intake greater than 3 L/day
- remove obstruction (if present)
acute kidney injury
abrupt insult to the kidney caused by decreased perfusion (decreased blood volume)
s/s acute kidney injury
- elevated creatinine
- fluid retention
- azotemia (elevated levels of urea in blood)
prerenal causes of acute kidney injury
- renal ischemia
- hemorrhage
- shock
intrarenal causes of acute kidney injury
- nephrotoxic drugs
- infections
- excess hemoglobin
- purine breakdown
postrenal causes of acute kidney injury
- nephrolithiasis
- prostatic hyperplasia
how is acute kidney injury treated
by treating the underlying cause
what are the 4 phases of acute kidney injury
- initial insult (prerenal, intrarenal, postrenal)
- oliguria
- diuresis
- recovery
what is happening in the oliguria stage of AKI
- low GFR
- lack of urine output
- fluid overload
what is happening in the diuresis stage of AKI
- large unconcentrated urine outflow
- kidney is not concentrating urine properly
what is happening in the recovery stage of AKI
- healthy nephrons take over function of damaged nephrons
- kidney function resumes
chronic renal failure
- gradual onset
- irreversible
- progressive
- usually d/t ESRD
how is chronic renal failure diagnosed
- CBC
- BUN
- Creatinine
- urinalysis
- albumin levels
- imaging (CT, u/s)
treatment for chronic renal failure
- fluid and electrolyte management
- BP management
- dialysis
- transplant as disease progresses
what stage of CRF do symptoms start
3
obstructive uropathy
most common pathophysiological problem in urinary tract- renal stones that move out of kidneys into other part of urinary tract
what does the blockage in the nephrons in obstructive uropathy cause
increased hydrostatic pressure in the nephrons, decreasing GFR
- results in hydronephrosis which can be reversible with full recovery
what is UTI commonly caused by
- E. coli
- stagnant urine increases risk for infection
are women or men at high risk for UTI
women because of their anatomy
what is normal GFR
90-120
- decreases with age
risk factors for women for UTI
- improper perineal hygiene
- tight, restrictive clothing
- chronic dehydration
- diabetes
- use of irritating bath products
- sexual intercourse
- urinary catheterization
- use of contraceptives
- pregnancy
- bacteriuria
risk factors for men for UTI
- chronic dehydration
- diabetes
- BPH (obstructs flow of urine)
- bladder cancer
- urinary catheterization
What education should be provided about UTI
WOMEN: how to wipe (front to back), cotton underwear, void before and after sex
MEN: BPH with age
s/s UTI
- increased urinary frequency
- dysuria
- urgency
- hematuria (sometimes)
- usually no fever
how is UTI diagnosed
urinalysis, urine culture
how is UTI treated
- antibiotics
- HYDRATION!
stress in continence
- most common incontinence
- caused by weakened pelvic muscles
ex. after childbirth
overactive bladder
- also called urge incontinence
- results in frequent urination, many times a day, but may be small amounts
overflow incontinence
- urinary retention in bladder caused by overdistension
- detrusor muscle of bladder loses strength and elasticity
neurogenic bladder
r/t spinal cord disorders, lack of bladder control
functional incontinence
inability to hold urine r/t CNS problems- stroke/delirium
how is urinary incontinence diagnosed
- multiple imaging
- cystoscopy
- post void residual
- history/physical
- ask client about bladder habits
treatment for urinary incontinence
- depends on type of incontinence
- kegel exercises
- anticholinergics
- transvaginal mesh
- botox injections into bladder
risk factors for incontinence
- age
- pregnancy/childbirth
- obesity
- DM2
- stroke
- neurological factors
- prostate disease
