Renal disease Flashcards
functions of the kidneys
maintain acid base balance
- filter and excrete waste products of the body
- control fluid and electrolyte balance
- regulate B/P
- excrete: bacterial toxins, water soluble drugs& metabolites, waste
- Secrete: renin, erythropoietin
- synthesize vit D
Diagnostic tests
- blood urea nitrogen (BUN)
- serum creatinine level
- creatinine clearance test
- urinalysis
- specific gravity
- uric acid test
- KUB (kidneys, ureters, bladder)
- bladder ultrasonography
- intravenous pyelogram
- renal angiography
- renal scanning
- cystoscopy and biopsy of kidney
- renal biopsy
BUN
end product of protein metabolism
normal: 8-20 mg/dL
tells how much protein is in blood
could be high due to kidney issues, dehydration, high protein diet, infection, stress, muscle breakdown
serum creatinine level
end product of muscle cell metabolism normal: 0.7-1.4 mg/dL only see increase once 50% of kidney function is gone how much creatinine in blood? increases with kidney malfunction
creatinine clearance test
evaluates how well kidneys remove creatinine from the blood
how much creatinine in urine?
decreases with renal malfunction
a decrease is unexpected with unilateral kidney disease because the other kidney takes up the slack
urinalysis
- test for evaluation of renal system and renal disease
- can be done as dip stick test
specific gravity
measures ability of kidneys to concentrate urine
normal: 1.002 and 1.030
uric acid test
24 hour collection to diagnose gout and kidney disease
normal: 2.5-8.0 mg/dL
KUB
X-ray to detect urinary calculi
bladder ultrasonography
- noninvasive method to measure volume of urine in bladder
- bladder scanning is a form of this
intravenous pyelogram
to visualize and identify abnormalities in the renal system
renal angioigraphy
to examine the renal blood vessels and renal arterial supply
renal scanning
visual imaging of renal blood flow, glomerular filtration, tubular function, and excretion
cystoscopy and biopsy of bladder
mucosa examined for inflammation, calculi, tumors
renal biopsy
needle sample of tissue for examination
Glomerular filtration rate
- strong determinant of renal function
- measures the amount of plasma volume that can be cleared of any given substance within a certain time frame
- normal: 125mL/ minute
- gfr formula derived from plasma creatinine, age, gender, BUN, BP- very specific
urinary tract infection
- 2nd most common bacterial disease
- highest percent in women
- upper or lower
- pyeltonephritis- upper (kidneys)
- cystitis & urethritis- lower (bladder & below)
- involves only bladder- uncomplicated
- involves coexisting conditions- complicated
upper UTI
- renal parenchyma, pelvis, ureters
- typicaly causes fever, chills, flank pain
- pyelonephritis
lower UTI
LUTS
emptying symptoms: hesitancy, intermittency, post-void dribble, pain on urination
-storage symptoms: urinary frequency, urgency, incontinence, nocturia
acute pyeonephritis
- commonely starts in renal medulla and spreads to adjacent cortex- upper uti
- mid fatigue to chills, fever, vomiting
- urinalysis, C&S, CBC, blood culture
- IVP, CT
- braod spectrum antibiotics then sensitivity guided therapy
- fluorquinolones
- cipro, floxin, noroxin, tequin
chronic pyelonephritis
kidneys small, atrophic, shrunken, decreased function due to scarring or fibrosis
- AKA reflux nephropathy (backward fow), chronic atrophic pyelonephritis associated with HTN
- often progresses to end stage renal failure
urethritis/ cystitis
lower urinary tract infections
- inflammation of bladder wall (cystitis)
- inflammation of urethra (urethritis)
- bacterial or viral
- STDs
glomerulonephritis
-immunological disorder
-3rd eadin cause of renal failure
-classifications: extent of damage( diffuse or local)
initial cause of disorder (lupus, strep)
extent of changes ( minimal or widespread)
-types: acture poststreptococcal, goodpasturesyndrome, rapidly progressive, chronic, nephrotic syndrome.
obstructive uropathies
- urinary tract calculi
- stricture
- renal trauma
urolithiasis (kideny stones)
- causes by urinary stagnation or supersaturation of urine with poorly soluble crystalloids
- most stones originate in the kidney and move distally before becoming lodged in narrow areas
types of kideny stones
-calcium (75%)
struvite (15%)
uric acid(6%)
cystine (2%)
nephrosclerosis
-renal vascular problem
-sclerosis of small arteries and arterioles of kidneys
decreases blood flow resulting in patchy necrosis of renal parenchyma
renal artery stenosis
- partial occlusion of one or both renal arteries
- abrupt hypertension
- renal vascular problem
renal vein thrombosis
unilateral or bilateral
- trauma, renal cell carcinoma, nephrotic syndrome, extrinsic compression
- flank pain, hematuria, fever
- anticoagulation
- renal vascular problem
polycystic kidney disease (PKD)
-most common life- threatening genetic diease in the world
no specific treatment
-dialysis and transplant to treat
medullary cystic disease (autosomal dominant)
hereditary
polyuria, progressive renal failure, severe anemia, metabolic acidosis
-genetic counselling
-ESRD treatment
alport syndrome
kidney, hearing loss, eye abnormalities -chronic hereditary nephritis -inherited sex linked disorder or inherited as autosomal trait -treatment supportive does not recur after transplantation
renal failure: end-stage renal disease (ESRD)
southern states hardest hit: diabetes, obesity
-chronic or acute
acute kidney failure
- develops within hours or days, includes chance of kidney function recovery
- possible causes: traumatic, acute intoxication, part of multiorgan failure, various other disease (infections, etc)
chronic kidney failure
develops over years, irreversible at the end.
-causes: secondary to hypertension, diabetes; chronic bacterial inflammation of the kidneys; cystic kidneys; various autoimmune disorders
acute kidney injury
rifle criteria
-S/S of acute renal injury are primarily caused by the retention of nitrogenous wastes and fluids, and the inability of the kidneys to regulate electrolytes
AKI description
-rapid loss of kidney function from renal cell damage
-occurs abruptly and can be reversed
-leads to hypoperfusion, cell death, decomposition of renal function
-prognosis depends on cause and condition of client
-near normal or normal kidney function may resume gradually
can be pre-renal, intrarenal, or post renal
pre-renal
before the kidney
causes: intravascular fluid depletion, dehydration, decreased cardiac output, decreased vascular resistance, decreased renovascuar blood flow(thrombosis or drug-related), prerenal infection or obstruction, hypotension
Intra-renal (intrinsic)
the kidney
-causes: tubular necrosis, prolonged renal ischemia, intrarenal infection or obstruction, nephrotoxicity, primary renal diseases
post-renal
-after the kidney
mechanical obstruction of urinary outflow causing reflux and damage to renal tissue
causes: bladder neck obstruction, bladder cancer, calculi, post-renal infection
acute tubular necrosis (ATN)
AKI
- risk factors for ischemic ATN
- hypovolemia
- major surgery
- sepsis
- trauma- FLUIDS (NS)
- burns
- *ischemia lasting more than 2 hrs leads to severe, irreversible damage to kidney tubules
AKI phases
-initiation (hours to days)
-maintenance (significant fall in GFR)
recovery (may take 1 year to recover)
initiation phase
- often symptomatic
- may last hours- days
- ends when tubular injury occurs
- if recognized and treated prognosis is good
maintenance phase
- significant fall in GFR
- oliguria may develop
- azotemia(high nitrogen content in blood)
- fluid retention
- metabolic acidosis
- electrolyte imbaances: hyperkalemia, hyponatremia, hypocalcemia
recovery phase
increased GFR
- diuresis
- stabilization/ continual decline in BUN and serum creatinine levels toward normal
- renal function improve rapidly during first 5-25 days of recovery phase
- full recovery may take 1 year
clinical manifestations/ therapies for ARF
- anemia: iron supplement/ epoetin/ blood transfusion
- fluid volume excess: fluid/sodium restrictions/ diuretics/ dialysis
- hyperkalemia: decrease potassium (dietary, IVF, admin, meds such as glucose and insulin [drive K+ into cells])
Chronic renal failure
-slow, progressive, irreversible loss in kidney function
-affects all major body systems and requires dialysis/transplant to maintain life
-GFR = 60 mL/min for 3 months or longer
occurs i stages
-results in uremia or end-stage renal disease
-hypervolemia- kidneys unable to excrete Na+ or H20
causes of CRF
- AKI
- DM or other metabolic disorders
- chronic hypertension
- chronic urinary obstruction
- recurrent infections
- renal artery occlusion
- autoimmune disorders
uremic syndrome
accumulation of nitrogenous waste products in the blood
uremic frost
