Renal Assessment NEW Flashcards
1
Q
What are the primary functions of the kidneys?
A
The primary functions of the kidneys are to filter blood, remove waste, regulate electrolytes, maintain acid-base balance, and control blood pressure.
2
Q
True or False: The kidneys are located in the abdominal cavity.
A
False: The kidneys are located in the retroperitoneal space, behind the abdominal cavity.
3
Q
Fill in the blank: The outer layer of the kidney is called the _____.
A
cortex
4
Q
What is the functional unit of the kidney?
A
The functional unit of the kidney is the nephron.
5
Q
Multiple Choice: Which part of the nephron is responsible for filtration?
A
A) Glomerulus
6
Q
What structure connects the kidney to the bladder?
A
The ureter.
7
Q
True or False: The renal pelvis collects urine before it is sent to the bladder.
A
True.
8
Q
What is the name of the blood vessel that supplies blood to the kidney?
A
Renal artery.
9
Q
Fill in the blank: The _____ is the innermost layer of the kidney.
A
medulla
10
Q
Multiple Choice: Which hormone is produced by the kidneys to regulate blood pressure?
A
C) Renin
11
Q
What is the role of the loop of Henle in the nephron?
A
The loop of Henle concentrates urine and conserves water.
12
Q
True or False: Each kidney contains about 1 million nephrons.
A
True.
13
Q
What is the primary waste product filtered by the kidneys?
A
Urea.
14
Q
Fill in the blank: The _____ is the area where urine is collected in the kidney.
A
renal pelvis
15
Q
Multiple Choice: Which part of the nephron reabsorbs the majority of water and solutes?
A
B) Proximal convoluted tubule
16
Q
What is the primary function of the renal corpuscle?
A
The renal corpuscle is responsible for the initial filtration of blood.
17
Q
True or False: The kidneys help regulate pH levels in the body.
A
True.
18
Q
What is the term for the outer protective layer of the kidney?
A
Renal capsule.
19
Q
What structure is formed by the convergence of several collecting ducts?
A
Papillary duct.
20
Q
Multiple Choice: Which type of nephron is responsible for concentrating urine?
A
C) Juxtamedullary nephron
21
Q
What is the role of the juxtaglomerular apparatus?
A
It regulates blood pressure and the filtration rate of the glomerulus.
22
Q
How does kidney size and function change with aging?
A
Answer: Kidney size decreases, and renal function gradually declines.
Explanation: The number of functional nephrons decreases, leading to reduced filtration, blood flow, and waste elimination efficiency.
23
Q
What happens to glomerular filtration rate (GFR) in older adults?
A
Answer: GFR declines with age, usually by about 1 mL/min per year after age 40.
Explanation: This reduction slows the clearance of waste products and medications, increasing the risk of drug toxicity.
24
Q
Why are older adults more prone to dehydration?
.
A
Answer: Reduced thirst sensation and decreased kidney ability to concentrate urine.
Explanation: Aging kidneys lose efficiency in water reabsorption, making dehydration more likely, especially if fluid intake is low
25
What changes occur in the urethra with aging, particularly in men and women?
Answer:
Men: Prostate enlargement (BPH) can cause urinary retention and weak stream.
Women: Urethral thinning due to low estrogen increases the risk of incontinence and UTIs.
26
Why are urinary tract infections (UTIs) more common in the elderly?
Answer: Weakened immune response, incomplete bladder emptying, and decreased estrogen in women.
27
What is a suprapubic catheter, and when is it used?
Answer: A suprapubic catheter is inserted through the abdominal wall into the bladder for long-term urinary drainage.
Explanation: It is used when the urethra is blocked or if a long-term catheter is needed, reducing the risk of urethral damage.
28
What is a pessary, and how does it help with urinary incontinence?
Answer: A pessary is a silicone or rubber device inserted into the vagina to support the bladder and prevent leakage.
Explanation: It is used for stress incontinence and pelvic organ prolapse, especially in women who cannot undergo surgery.
29
What are the CDC's guidelines on the frequency of catheter and drainage bag changes?
Answer: The CDC advises against routine changes of indwelling catheters and drainage bags at fixed intervals.
Explanation: Catheters and drainage bags should be changed based on clinical indications such as infection, obstruction, or when the closed system is compromised, rather than on a routine schedule.
30
Name the flow of blood from entering the kidney to exiting the body as urine
Renal Artery
Afferent Arteriole
Glomerulus
Bowman’s Capsule
Proximal Convoluted Tubule (PCT)
Loop of Henle
Distal Convoluted Tubule (DCT)
Collecting Duct
Renal Pelvis
Ureter
Bladder
Urethra
31
Filtration in the Glomerulus
Glomerulus: A network of capillaries inside the Bowman’s capsule filters small molecules ________ (Give examples)
Filtrate Formation: Large molecules like proteins and blood cells remain in the blood, while filtrate (water, solutes, and waste) enters the ____
(water, electrolytes, glucose, waste products).
Bowman’s capsule.
32
Tubular Reabsorption (Essential Substances Reabsorbed into Blood)
Proximal Convoluted Tubule (PCT): _________ are reabsorbed into surrounding capillaries.
Loop of Henle: Water and salts are reabsorbed; the descending limb absorbs water, while the ascending limb absorbs sodium and chloride.
Distal Convoluted Tubule (DCT): Fine-tuning of electrolyte and pH balance occurs here, regulated by hormones like ____.
Glucose, amino acids, and electrolytes
aldosterone
33
Urine Concentration & Excretion
Collecting Duct: Final concentration of urine occurs; _______ regulates water reabsorption.
______: Urine collects here before moving to the ureter.
Ureter: Urine travels from the kidney to the bladder for storage.
Urethra: When the bladder is full, urine is excreted via the urethra during urination.
antidiuretic hormone (ADH)
Renal Pelvis
34
The nephron is composed of...
a renal corpuscle (including the glomerulus and Bowman's capsule) and a renal tubule which consists of the proximal convoluted tubule, loop of Henle, and distal convoluted tubule; essentially
35
Kidney Hormonal Function
Erythropoietin (RBC formation)
Renin (Blood pressure regulation)
Vitamin D activation for calcium absorption
Regulation of parathyroid hormones
36
Renal blood flow per minute...
600 - 1300 ml/min
37
GFR
mL per Min....
mL per day....
Range of excretion per day....
Average....
mL 125mL/ Min
mL 180L / day
1 - 3 L per day
1.5 L average
38
What controls the GFR...
BP & Blood flow
39
GFR
Low Blood Pressure Effect: When systolic pressure drops below ______ mm Hg, the afferent arteriole cannot dilate enough to maintain adequate blood flow to the glomerulus.
Result: Filtration pressure decreases, leading to a decline in GFR, which can cause acute kidney injury (AKI) if prolonged.
65 -70
40
Afferent Arteriole / Efferent Arteriole
Direction of Blood Flow
Brings blood into the the Glomerulus
Takes blood away from the glomerulus
Afferent
Brings blood into the the Glomerulus
Efferent
Takes blood away from the glomerulus
41
Which factors can stimulate the RAAS...
Low
BP
Blood volume
Sodium
Blood oxygen
42
Describe the RAAS
Renin converts Angiotensin to Angiotensin I
Angiotensin I is converted by ACE to Angiotensin II
Angiotensin II
Rapid constriction of systemic arteries & veins
Increases peripheral resistance
Decreases size of vascular bed
Constriction of afferent arterioles
Decreased GFR
Decreased urine formation
Increased absorption of sodium & water
Stimulates secretion of Aldosterone (Increased reabsorption of Na & H²O)
43
Angiotensin II
Rapid constriction of systemic ( arteries or veins )
( Decreased/ Increased peripheral resistance )
( Decreases / Increased)size of vascular bed
(Constriction / Relaxation)of afferent arterioles
( Decreased/ Increased)GFR
(Decreased / Increased) urine formation
( Decreased/ Increased) absorption of sodium & water
Stimulates secretion of _______ (Increased reabsorption of Na & H²O)
Angiotensin II
Rapid constriction of systemic arteries & veins
Increases peripheral resistance
Decreases size of vascular bed
Constriction of afferent arterioles
Decreased GFR
Decreased urine formation
Increased absorption of sodium & water
Stimulates secretion of Aldosterone (Increased reabsorption of Na & H²O)
44
_____ occurs when toxic waste products build up in the blood due to kidney failure. It affects multiple body systems and causes
Uremia
45
SS of uremia
Toxic build up of waste in blood due to kidney failure (Kidneys not able to filter)
General symptoms....
Neurological Symptoms.....
GI Symptoms....
CV Symptoms....
Skin Symptoms....
Respiratory symptoms.....
General Symptoms:
Fatigue & Weakness – Due to anemia and toxin buildup
Loss of Appetite (Anorexia) – Nausea and poor food intake
Weight Loss – Muscle wasting from protein-energy malnutrition
Neurological Symptoms:
Confusion & Difficulty Concentrating – Toxin accumulation affects brain function
Seizures or Coma – In severe cases
Peripheral Neuropathy – Numbness, tingling, or burning sensations in hands/feet
Gastrointestinal Symptoms:
Nausea & Vomiting – Waste products irritate the stomach
Metallic Taste in Mouth – Due to increased blood urea levels
Uremic Breath (Ammonia-Like Odor) – Caused by breakdown of urea in saliva
Cardiovascular Symptoms:
High Blood Pressure (Hypertension) – Due to fluid overload
Edema (Swelling) – Seen in the legs, feet, and around the eyes
Pericarditis (Chest Pain) – Inflammation of the heart lining due to toxins
Skin Symptoms:
Pale or Yellowish Skin – Due to anemia and toxin buildup
Itchy Skin (Pruritus) – Uremic toxins irritate the skin
Easy Bruising or Bleeding – Due to platelet dysfunction
Respiratory Symptoms:
Shortness of Breath (Dyspnea) – Fluid overload can lead to pulmonary edema
Kussmaul Breathing (Deep, Labored Breathing) – Compensation for metabolic acidosis
These symptoms worsen as kidney function declines, and dialysis or kidney transplant is needed in advanced cases.
46
Where would you palpate for suspected upper urinary tract problem...
CVA: Located between 12th rib & Spine
Contain kidneys, renal pelvis, part of the ureters
47
How much blood do the kidneys process per minute...
125 mL per minute/ 180 L per day
48
How do the kidneys affect pH balance....
Controls pH balance by secreting hydrogen ions.
Secretion of H ions Raises the pH
49
Ureter length & width....
Layers....
Segments....
26 cm in length
3-4 mm in diameter
Inner mucosa: Water proofing
Muscularis: peristalsis
Outer adventitia: Point of attachment for blood vessels, nerves, lymphatic
Segments:
Proximal: Close to kidney
Distal; close to bladder
Intramural: Inside bladder wall
50
Supports the bladder neck and urethra, reducing urine leakage during activities like coughing or sneezing.
Helps elevate prolapsed organs, improving bladder control.
Describes....
Pessary
51
Describe how a pessary functions (2)
Supports the bladder neck and urethra, reducing urine leakage during activities like coughing or sneezing.
Helps elevate prolapsed organs, improving bladder control.
52
Normal volume of bladder....
Maximum capacity....
What volume in the bladder will stimulate the urge to void....
Normal volume: Males 700mL Female 500mL
Max capacity: 1000mL
Volume stimulate urge to void: 150 - 250
53
Minimum urine output per hr....
0.5mL/ kg / hr
Exp. Person weights 70KG they will have an output of 30 mL per hour
Also
Teacher said 30mL p/h minimal
54
Length of urethra...
Female 3 - 4 cm
Males 20 cm
55
Burning or painful sensation with urination. Common with UTI, but not always caused by an infection.
Dysuria
56
Adult <400mL in 24 hrs
Child <0.5 mL/Kg/ hr
Infant <1mL/Kg/hr
Term meaning low urine output....
Oliguria
57
Inability to produce urine. Causes: medication, toxin, shock, excessive blood loss, heart / kidney failure....
Anuria
58
Waking up more than 1 time per night to use the bathroom.....
Nocturia
59
Adult >2.5 L in 24 hrs.
Excessive urination....
Polyuria
60
Where and how to ausculate for renal bruit....
Use Bell (Small part) of stethoscope
Upper quadrant of abdomen, lateral to midline
61
Normal value for BUN....
What abnormal value suggest...
6 - 24
Abnormal >24
Kidneys not filtering blood properly
But also, Dehydration, high protein diet, ect
62
Creatinine
A waste products from energy-producing proceess in the muscles.
Normal Values/ What do abnormal suggest...
Men 0.74 - 1.35
Women 0.59 - 1.04
Increases values suggest kidneys not filtering properly
63
GFR
How quickly blood is filtered each minute.
Values....
>90 Normal in healthy peeps
>60 still normal
<60 could be kidney disease
<15 could be kidney failure
64
Which race has GFR decline more rapidly with age...
What risk does this carry...
Blacks
Higher risk of renal failure
65
AGING ISSUES
Cortical tissue loss
Smaller nephrons
Reduced blood flow to kidneys
____ BUN
____ GFR
Decreased ability to concentrate urine
MORE SUSPECTABLE TO MEDICATIONS & DYES
Increased BUN
Decreased GFR
66
Is Incontinence normal in aging...
No, it is more common but should not be considered normal
67
NSAIDS affect this....
Resulting in reduced renal perfusion
COX 1 & 2
68
Percussion of a distended bladder will have this quality...
Dull
69
Define KUB
KUB X-ray is a plain radiograph that provides a simple, non-invasive image of the kidneys, ureters, and bladder.
It is often used to assess renal conditions such as kidney stones, urinary obstruction, or abnormal calcifications.
70
BUN according to teacher
BUN / creatinine ratio according to teacher
10 - 20
6 - 25 (15.5) optimal
71
Serum creatinine according to teacher...
Male 0.6 - 1.2
Female 0.5 - 1.2
72
Blood osmolality
Normal 280 - 300
What does high & low mean in general...
ADH activation in both...
High Blood Osmolality (> 295 mOsm/kg) → Dehydration or Hypernatremia
Triggers antidiuretic hormone (ADH) release → Kidneys reabsorb water → Concentrated urine (↑ osmolality, ↓ volume)
Seen in dehydration, diabetes insipidus, and hyperglycemia.
Low Blood Osmolality (< 275 mOsm/kg) → Overhydration or Hyponatremia
ADH suppression → Kidneys excrete more water → Dilute urine (↓ osmolality, ↑ volume)
Seen in excess IV fluids, SIADH, and kidney failure.
73
eGFR
STAGE
1. GFR 90 - 100
2 GFR 60 -89
3a GFR 45 - 59
3b 30 - 44
4 15 - 29
5 <15
Describe function or lack thereof...
1. GFR 90 - 100 Normal Function
2 GFR 60 -89 Mild Loss
3a GFR 45 - 59 Mild to Moderate
3b 30 - 44 Moderate to severe
4 15 - 29 Sever
5 <15 Failure
74
Defined: abnormalities of kidney structure or function present for >3 months with health implications....
Chronic Kidney Disease
75
CKD
Defined: abnormalities of kidney structure or function present for >3 months with health implications
How is CKD classified...
Cause, GFR category, Albuminuria category (A1 - A3)
76
Serum creatinine of _____ is at risk for AKI from iodine contrast media
>1.5
77
UA when is the best time to collect....
1st void in AM
78
Urine specific gravity
Normal range...
1.005 - 1.030
79
Urine specific gravity range 1.005 - 1.030
What does an increase or decrease mean....
>1.030 =
Dehydration (↓ water intake, vomiting, diarrhea)
SIADH (Syndrome of Inappropriate ADH) → Excess water reabsorption
Heart failure, liver disease → Fluid retention
Diabetes mellitus → High glucose in urine
Proteinuria (kidney disease, nephrotic syndrome)
<1.005
Indicates overhydration or kidney’s inability to concentrate urine.
Causes:
Excess fluid intake (IV fluids, polydipsia)
Diabetes insipidus (↓ ADH, excessive urination)
Kidney failure (inability to concentrate urine)
Diuretic use (increased urine output)
80
High USG → Dehydration, SIADH, diabetes, or kidney disease.
Low USG → Overhydration, diabetes insipidus, or kidney failure.
Give values...
>1.030
High USG → Dehydration, SIADH, diabetes, or kidney disease.
<1.005
Low USG → Overhydration, diabetes insipidus, or kidney failure.
81
_____ causes excess water retention, dilutional hyponatremia, and concentrated urine, requiring fluid restriction and sodium correction to prevent severe neurological complications.
SIADH
82
SIADH causes....
To correct....
excess water retention, dilutional hyponatremia, and concentrated urine,
requiring fluid restriction and sodium correction to prevent severe neurological complications.
83
Average urine pH...
Range....
Average 6
Range 4.6 - 8
84
Normal range of protein in a UA....
0 - 8 mg
85
Normal ketone in UA....
REASONS FOR KETONES...
None
DKA, fasting, anorexia
86
Normal range of
RBC & WBC in UA
RBC 0 - 2 per high power field
WBC 0 - 4 per high power field
87
Glucose in UA....
Glucose in 24 hr urine...
Fresh Negative for glucose
50 - 300 mg / day in 24 hr
88
Normal bacteria amount in UA
<1000 colonies / mL
89
Presence of Leukocyte Esterase in UA suggests...
UTI
90
Nitrates in UA suggest this bacteria....
E coli
91
Creatinine clearance (Most accurate estimate of GFR)
Is measured with these kind of test.
24 hr urine collection
Blood sample
92
How long until bacteria colonize a sterlie urinary catheter
24 hrs
93
Have pt empty bladder before renal US....
(Bladder, Urinary Tract, Pelvic area)
False
Bladder typically needs to be full for a renal ultrasound (US) if the focus is on assessing the bladder, urinary tract, or pelvic area
94
Inform the patient that an IV will be inserted to administer contrast dye. They will be positioned on the examination table, and X-rays will be taken as the contrast moves through the urinary system.
Describes...
iv Urography
95
IV Urography Pre / Post procedure considerations...
Pre: Consent, Contrast Allergy, Preggers?, NPO 4-6 HRS
Post: Monitor, Fluids
96
Examines perfusion, function, & structure of kidneys.
IV injection of radio isotope
Camera records isotope uptake
Describes....
Renal Scan (Renography)
97
Post-Test Instructions: Advise the patient to avoid close contact with pregnant individuals and young children for 24 hours after the procedure to reduce radiation exposure to others.
This test...
Renography/ Renal Scan
98
Cystoscopy
Biopsies can be taken
General or local anesthesia
Pre:
Consent needed
NPO
____
Post
Teach: What is common afterward _______
Bowel prep
Common afterwards: Frequency, pink-tinged 1 or 2 days
99
After kidney biopsy avoid strenuous activity for....
1 - 2 weeks
100
Glomerulus are located here in the kidney....
Outer part (Cortex)
101
Glomerulus located in the outer part of the kidney (cortex) filter blood and transform it to urine.
From the glomerulus the urine drains where....
Inner layer (medulla) - then to the collecting ducts
102
Kidneys activate this vitamin...
Why?
D
To absorb Calcium & regulate parathyroid hormone
103
The build up of nitrogenious waste in the body
Uremia
104
Use of NSAIDS in people on antihypertensive therapy may result in ...
HTN
105
Empty bladder will have this sound when percussed
Tympanic
106
When creatinine value doubles How will this reflect on the GFR....
GFR will reduce by 50%
107
Decreased blood osmolality will release this substance...
Vasopressin.
Water retention & increase BP
108
Stage 4 or 5 of kidney dysfunction may require....
Dialysis
109
Use this value to determine what the Chronic state of the kidneys is...
GFR
110
Use this value to determine Acute problems with kidneys
Creatinine
111
What value of serum creatinine to not expose client to Contrast (Cath Lab / Angiogram)
>1.5
112
Clean the tip of penis / vagina opening with _____ for a clean catch UA
Castille towelette
113
____ is the most accurate estimate of GFR.
How is it collected...
Creatine clearance
24 hr urine collection
&
Blood Sample After
114
Retention/ Obstruction
Critically ill and need exact I & O
Perineal / Sacral wounds
Immobile
Hospice
Before surgical procedure
Are indications for .....
Foley catheter indications
115
KUB is an X ray
What is it looking for. .
Solid structure
Stone
116
Do CT scans ever use contrast
Yes, you gotta know this
117
Metformin & contrast media together Increase risk for...
Lactic acidosis
118
Nursing considerations for US
Full bladder
119
MRI are injections involved...
Yes, gadolinium
Monitor for renal impairment
120
After kidney biopsy monitor for..
Internal bleeding
HTN
121
Normal blood osmolality
What does high or low mean
High >300 Dehydration (Dark,concentrated urine)
Low <280 Fluid overload (Dilute urine)
122
Are X rays Contradicted for preggers...
Yes
123
IV injection of radio radiopaque dye & X-rays
IV injection of radioisotope camera records isotope uptake
Radiopaque is injected into femoral or brachial arteries. - Visualize renal
Renography, IV Urography, Renal arteriography (Angiogram)
IV Urography
IV injection of radio radiopaque dye & X-rays - visualize abmorms in renal system
Renography
IV injection of radioisotope camera records isotope uptake - Perfusion, function, Structure of kidneys
Radiopaque is injected into femoral or brachial arteries. - Visualize renal arteries
