Renal and Urological Disorders Flashcards
1
Q
the kidneys are organs of _____ and ______
A
filtration and secretion
2
Q
alterations in kidney function will impair
A
- acid/base balance
- blood pressure regulation
- RBC formation
- drug metabolism
- hormone metabolism
- vitamin D synthesis (therefore calcium out of balance)
- glucose homeostasis
3
Q
if not treated, kidney dysfunction leads ultimately to….
A
end stage renal disease
4
Q
pre renal dysfunction
A
- happens before getting to the kidney
- decreased blood flow and perfusion to the kidney
5
Q
examples of pre-renal dysfunction
A
- hypovolemia
- heart failure
- shock
- injury that results from ischemia
6
Q
what is important to remember about pre-renal dysfunction
A
sufficient blood pressure is needed to maintain GFR and urine output
7
Q
intra-renal dysfunction
A
direct damage to the kidney itself
8
Q
examples of intra-renal dysfunction
A
- trauma:
pyelonephritis
autoimmune antibody/antigen complexes - kidney infection:
Strep! - Nephrotoxic drugs:
- NSAIDs
- ACE inhibitors
- angiotensin-receptor blockers
- statins
- some antibiotics
9
Q
post renal dysfunction
A
obstruction of urine outflow from the kidney
10
Q
examples of post-renal dysfunction
A
- obstructive uropathy
- hydronephrosis
- urine back up in kidneys
- examples: kidney stones, prostate gland
hyperplasia
11
Q
how do we assess a client with renal dysfunction
A
- 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
12
Q
labs to test for renal dysfunction
A
- pH (normal 7.0)
- specific gravity (normal 1.001-1.030)
- glucose
- ketones
- leukocyte esterase
- nitrite
- protein
- bilirubin
- urobilinogen
- crystals
- casts
13
Q
BUN/Creatinine will be ____ with kidney dysfunction
A
elevated
14
Q
why shouldn’t BUN alone be used as a kidney function indicator
A
it will be elevated with decreased GFR, but also with dehydration and high muscle mass/high protein diet
15
Q
how do we treat kidney disfunction
A
must try to maintain renal function but it can be treated with meds and dialysis
16
Q
acute glomerulonephritis
A
immune response to strep infection
17
Q
important things to remember about acute glomerulonephritis
A
- 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
18
Q
how is acute glomerulonephritis treated
A
- antibiotics
- dietary modifications
- diuretics
19
Q
nephrotic syndrome
A
- glomerular damage resulting in proteinuria and edema
- most commonly caused by DM, amyloidosis, and SLE
20
Q
what will nephrotic syndrome present like
A
- massive albuminuria
- facial edema
- hematuria
- hypertension
- oliguria
21
Q
why might hyperlipidemia develop in someone with nephrotic syndrome?
A
massive loss of albumin triggers liver to synthesize more lipids (LDL)
22
Q
nephrolitiasis
A
stones in the kidneys or urinary tract
23
Q
risk factors for kidney stones
A
- genetic susceptibility
- dehydration
- hypercalcemia
- hyperparathyroidism
- gout
- hyperuricemia
- urinary tract infection
- immobility
24
Q
treatment for kidney stones
A
- 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)
25
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
26
pyelonephritis
- infection of renal pelvis- KIDNEY INFECTION
- sometimes called an upper UTI or ascending UTI
27
why does pyelonephritis happen
stasis of urine
28
s/s of pyelonephritis
- FEVER!
- abdominal or CVA tenderness
- flank pain
- dysuria
- urinary frequency
- microscopic hematuria
- WBCs in urine (pyuria)
29
how is pyelonephritis diagnosed
- urine culture- E. COLI!!!
- urinalysis
- pyuria
- positive leukocyte esterase
- CT scan, ultrasound
30
treatment for pyelonephritis
- antibiotics
- analgesics if needed
- fluid intake greater than 3 L/day
- remove obstruction (if present)
31
acute kidney injury
abrupt insult to the kidney caused by decreased perfusion (decreased blood volume)
32
s/s acute kidney injury
- elevated creatinine
- fluid retention
- azotemia (elevated levels of urea in blood)
33
prerenal causes of acute kidney injury
- renal ischemia
- hemorrhage
- shock
34
intrarenal causes of acute kidney injury
- nephrotoxic drugs
- infections
- excess hemoglobin
- purine breakdown
35
postrenal causes of acute kidney injury
- nephrolithiasis
- prostatic hyperplasia
36
how is acute kidney injury treated
by treating the underlying cause
37
what are the 4 phases of acute kidney injury
- initial insult (prerenal, intrarenal, postrenal)
- oliguria
- diuresis
- recovery
38
what is happening in the oliguria stage of AKI
- low GFR
- lack of urine output
- fluid overload
39
what is happening in the diuresis stage of AKI
- large unconcentrated urine outflow
- kidney is not concentrating urine properly
40
what is happening in the recovery stage of AKI
- healthy nephrons take over function of damaged nephrons
- kidney function resumes
41
chronic renal failure
- gradual onset
- irreversible
- progressive
- usually d/t ESRD
42
how is chronic renal failure diagnosed
- CBC
- BUN
- Creatinine
- urinalysis
- albumin levels
- imaging (CT, u/s)
43
treatment for chronic renal failure
- fluid and electrolyte management
- BP management
- dialysis
- transplant as disease progresses
44
what stage of CRF do symptoms start
3
45
obstructive uropathy
most common pathophysiological problem in urinary tract- renal stones that move out of kidneys into other part of urinary tract
46
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
47
what is UTI commonly caused by
- E. coli
- stagnant urine increases risk for infection
48
are women or men at high risk for UTI
women because of their anatomy
49
what is normal GFR
90-120
- decreases with age
50
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
51
risk factors for men for UTI
- chronic dehydration
- diabetes
- BPH (obstructs flow of urine)
- bladder cancer
- urinary catheterization
52
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
53
s/s UTI
- increased urinary frequency
- dysuria
- urgency
- hematuria (sometimes)
- usually no fever
54
how is UTI diagnosed
urinalysis, urine culture
55
how is UTI treated
- antibiotics
- HYDRATION!
56
stress in continence
- most common incontinence
- caused by weakened pelvic muscles
ex. after childbirth
57
overactive bladder
- also called urge incontinence
- results in frequent urination, many times a day, but may be small amounts
58
overflow incontinence
- urinary retention in bladder caused by overdistension
- detrusor muscle of bladder loses strength and elasticity
59
neurogenic bladder
r/t spinal cord disorders, lack of bladder control
60
functional incontinence
inability to hold urine r/t CNS problems- stroke/delirium
61
how is urinary incontinence diagnosed
- multiple imaging
- cystoscopy
- post void residual
- history/physical
- ask client about bladder habits
62
treatment for urinary incontinence
- depends on type of incontinence
- kegel exercises
- anticholinergics
- transvaginal mesh
- botox injections into bladder
63
risk factors for incontinence
- age
- pregnancy/childbirth
- obesity
- DM2
- stroke
- neurological factors
- prostate disease
