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
