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MS2 exam1 > Renal disease > Flashcards

Renal disease Flashcards

1
Q

functions of the kidneys

A

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
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2
Q

Diagnostic tests

A
  • 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
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3
Q

BUN

A

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

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4
Q

serum creatinine level

A 
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
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5
Q

creatinine clearance test

A

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

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6
Q

urinalysis

A
  • test for evaluation of renal system and renal disease

- can be done as dip stick test

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7
Q

specific gravity

A

measures ability of kidneys to concentrate urine

normal: 1.002 and 1.030

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8
Q

uric acid test

A

24 hour collection to diagnose gout and kidney disease

normal: 2.5-8.0 mg/dL

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9
Q

KUB

A

X-ray to detect urinary calculi

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10
Q

bladder ultrasonography

A
  • noninvasive method to measure volume of urine in bladder

- bladder scanning is a form of this

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11
Q

intravenous pyelogram

A

to visualize and identify abnormalities in the renal system

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12
Q

renal angioigraphy

A

to examine the renal blood vessels and renal arterial supply

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13
Q

renal scanning

A

visual imaging of renal blood flow, glomerular filtration, tubular function, and excretion

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14
Q

cystoscopy and biopsy of bladder

A

mucosa examined for inflammation, calculi, tumors

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15
Q

renal biopsy

A

needle sample of tissue for examination

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16
Q

Glomerular filtration rate

A
  • 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
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17
Q

urinary tract infection

A
  • 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
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18
Q

upper UTI

A
  • renal parenchyma, pelvis, ureters
  • typicaly causes fever, chills, flank pain
  • pyelonephritis
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19
Q

lower UTI

A

LUTS
emptying symptoms: hesitancy, intermittency, post-void dribble, pain on urination
-storage symptoms: urinary frequency, urgency, incontinence, nocturia

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20
Q

acute pyeonephritis

A
  • 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
21
Q

chronic pyelonephritis

A

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
22
Q

urethritis/ cystitis

A

lower urinary tract infections

  • inflammation of bladder wall (cystitis)
  • inflammation of urethra (urethritis)
  • bacterial or viral
  • STDs
23
Q

glomerulonephritis

A

-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.

24
Q

obstructive uropathies

A
  • urinary tract calculi
  • stricture
  • renal trauma
25
Q

urolithiasis (kideny stones)

A
  • 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
26
Q

types of kideny stones

A

-calcium (75%)
struvite (15%)
uric acid(6%)
cystine (2%)

27
Q

nephrosclerosis

A

-renal vascular problem
-sclerosis of small arteries and arterioles of kidneys
decreases blood flow resulting in patchy necrosis of renal parenchyma

28
Q

renal artery stenosis

A
  • partial occlusion of one or both renal arteries
  • abrupt hypertension
  • renal vascular problem
29
Q

renal vein thrombosis

A

unilateral or bilateral

  • trauma, renal cell carcinoma, nephrotic syndrome, extrinsic compression
  • flank pain, hematuria, fever
  • anticoagulation
  • renal vascular problem
30
Q

polycystic kidney disease (PKD)

A

-most common life- threatening genetic diease in the world
no specific treatment
-dialysis and transplant to treat

31
Q

medullary cystic disease (autosomal dominant)

A

hereditary
polyuria, progressive renal failure, severe anemia, metabolic acidosis
-genetic counselling
-ESRD treatment

32
Q

alport syndrome

A 
kidney, hearing loss, eye abnormalities
-chronic hereditary nephritis
-inherited sex linked disorder or inherited as autosomal trait
-treatment supportive 
does not recur after transplantation
33
Q

renal failure: end-stage renal disease (ESRD)

A

southern states hardest hit: diabetes, obesity

-chronic or acute

34
Q

acute kidney failure

A
  • 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)
35
Q

chronic kidney failure

A

develops over years, irreversible at the end.
-causes: secondary to hypertension, diabetes; chronic bacterial inflammation of the kidneys; cystic kidneys; various autoimmune disorders

36
Q

acute kidney injury

A

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

37
Q

AKI description

A

-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

38
Q

pre-renal

A

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

39
Q

Intra-renal (intrinsic)

A

the kidney
-causes: tubular necrosis, prolonged renal ischemia, intrarenal infection or obstruction, nephrotoxicity, primary renal diseases

40
Q

post-renal

A

-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

41
Q

acute tubular necrosis (ATN)

A

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
42
Q

AKI phases

A

-initiation (hours to days)
-maintenance (significant fall in GFR)
recovery (may take 1 year to recover)

43
Q

initiation phase

A
  • often symptomatic
  • may last hours- days
  • ends when tubular injury occurs
  • if recognized and treated prognosis is good
44
Q

maintenance phase

A
  • significant fall in GFR
  • oliguria may develop
  • azotemia(high nitrogen content in blood)
  • fluid retention
  • metabolic acidosis
  • electrolyte imbaances: hyperkalemia, hyponatremia, hypocalcemia
45
Q

recovery phase

A

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
46
Q

clinical manifestations/ therapies for ARF

A
  • 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])
47
Q

Chronic renal failure

A

-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

48
Q

causes of CRF

A
  • AKI
  • DM or other metabolic disorders
  • chronic hypertension
  • chronic urinary obstruction
  • recurrent infections
  • renal artery occlusion
  • autoimmune disorders
49
Q

uremic syndrome

A

accumulation of nitrogenous waste products in the blood

uremic frost

MS2 exam1 (10 decks)

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