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Renal Disease-ALL Flashcards

1
Q

Functional unit of the kidney

A

Nephron

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2
Q

Functional Unit of Kidney: Nephron

Includes 3 components:

A
  1. Glomerulus
  2. Renal tubules
  3. Collecting duct
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3
Q

Kidney Functions

KNOW BOLD!!!

A

Removes metabolic waste products and excess water FROM the body***

  • Excretes metabolic wastes and foreign chemicals
  • Gluconeogenesis* in times of fasting*
  • Acid-base balance
  • Water and electrolyte balances
  • Arterial blood pressure
  • Secretion, metabolism, excretion of hormones
  • Regulation body fluid osmolality and electrolyte conc.
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4
Q

Pathogenesis of Kidney Disease

DM and renal tissue damage?

A

DM→ HypERglycemia→ Renal tissue damage***

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5
Q

Pathogenesis of Kidney Disease

Angiotensin II NORMAL function?

A
  • Vasoconstriction of arterioles and arteries
  • *Must keep pressure adequate for filtration of blood
    • AKA→ manages blood pressure for adequate filtration***
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6
Q

Angiotensin II attracts __________ and this changes structure of the glomerulus in kidney*

aka NOT helpful in kidney disease!

A

Attracts inflammatory cells!

Cascade→

  • Cytokines, growth factors released
  • Changes structure of glomerulus
  • => REDUCED surface area for filtration***
    • SO…we don’t want TOO MUCH angiotensin II***

NOTE: this is ALL due to the inflammation!

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7
Q

Renal Disease

Initial Sx’s

A

Anorexia, malaise, pruritus (itchy), dry skin, wt. loss

NOTE: Sx’s may NOT appear until kidney function <1/10 normal***

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8
Q

Renal Disease Sx’s

W/ Progression of Dis.

A

drowsy/confusion, change skin pigment, excessive thirst, insomnia, edema, peripheral neuropathy (notice trend, LOTS of things can cause this!!! remember this is a circulation/filtration problem so makes sense!!!)

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9
Q

Stages of Chronic Kidney Disease

NOTE: happens slow, 5 stages. In ea, kidneys don’t work as well as the stage before. W/ tx and lifestyle changes, YOU CAN help slow or stop kidney dis. from getting worse!

A
  • Stage 1→ Kidney damage w/ normal kidney function
    • GFR= 90 or higher
  • Stage 2→ Kidney damage w/ mild loss of kidney function
    • GFR= 89-60
  • Stage 3a→ Mild-Moderate loss of kidney function
    • GFR= 59-45
  • Stage 3b→ Mod-Severe loss of kidney function
    • GFR= 44-30
  • Stage 4→ Severe loss of kidney function
    • GFR= 29-15
  • Stage 5→ Kidney failure*
    • GFR= LESS THAN 15*
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10
Q

Stage 1 Kidney Disease

A

Kidney damage w/ normal function

GFR = 90-100

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11
Q

Stage 2 Kidney Disease

A

Kidney damage w/ mild loss of kidney function

GFR= 89-60

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12
Q

Stage 3a Kidney Disease

A

Mild-Moderate loss of kidney function

GFR= 59-45

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13
Q

Stage 3b Kidney Disease

A

Mod-Severe loss of kidney function

GFR= 44-30

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14
Q

Stage 4 Kidney Disease

A

Severe loss of kidney function

GFR= 29-15

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15
Q

Stage 5 Kidney Disease

A

Kidney failure

GFR= Less than 15*

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16
Q

What does GFR # tell you?

A

HOW much kidney function you have. As kidney disease gets WORSE, GFR # goes DOWN***

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17
Q

Chronic Kidney Disease

READ THIS RESOURCE!!!!

A

USE!!!!!!

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18
Q

Chronic Kidney Disease (CKD)

Most COMMONLY caused by:

A

DM and HTN

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19
Q

CKD aka

A

End Stage Renal Disease (ESRD) → Stage 5*

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20
Q

CKD

End-Stage Renal Disease (ESRD)→ Stage 5

A
  • FINAL stage of CKD
  • <10% kidney function
  • REQUIRES dialysis or transplant*
  • HIGH mortality rate
    • 65yrs on dialysis== 7x risk of death*
    • 60yrs starting dialysis== life expect. 5 yrs (normal=20)
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21
Q

CKD aka ______ aka ______

A

End-stage renal disease aka Stage 5

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22
Q

CKD

Risk factors, Sx’s to consider w/ PT

A
  • Risk factors:
    • hereditary defects of kidneys, UTI, age, excess use analgesics
  • Sx’s of renal failure to consider w/ PT:
    • Anemia, Diminished O2 transport*, DECd ability to maint. blood volumes
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23
Q

Chronic Kidney Disease (CKD)

Comorbid w/ _____ and ______ ===== what?

A

Comorbid w/ HTN and heart disease

=> Significant precautions for exercise programs****

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24
Q

CKD

Comorbid w/ HTN and heart disease==> Sig. precautions for exercise programs

Recommended Activities→

A
  • 40-70% target HR (USE RPE**)
  • self-paced walking, TM, cycle erg
  • 4-6x/week
  • LOW intensity, Goal→ work up to 30mins activity
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25
Q

CKD

*remember requires dialysis or transplant

Can a Pt Exercise on Dialysis?

Rule to follow if PT AFTER DIALYSIS

A

PRIORITIZE YOUR EXERCISES/INTERVENTIONS!!!

MOST IMPORTANT THINGS FIRST!!!

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26
Q

CKD

*remember requires dialysis or transplant

Can a Pt Exercise on Dialysis?

A

PRIORITIZE!

  • TM, cycle erg, bed/chair ex’s
  • physical and cardiopulm function
  • *INC exercise on NON-dialysis days→ you’ll have better luck w/ them!!!
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27
Q

Physical Activity Promotion in CKD

Instead of HR….USE _____-

A

RPE****

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28
Q

Promotion of Phys Activity in CKD

A
  • VITALS ARE VITAL!
    • BP and RPE
  • Long warmup (when approp.)→ aerobic, strength
  • Cool-down
    • return of fluid and BP
  • RPE NOT HR***
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29
Q

Promotion of Phys Activity in CKD

Contraindications/Stop Exercise

A

Lightheadedness, dizzy, pain, dyspnea

30
Q

Promotion of Phys Activity in CKD

WHY????????

A

Long-term adoption of exercise behaviors to maintain functional capacities and QoL***

SO IMPORTANT!!!

31
Q

Skeletal Changes in CKD

PRIMARY hormone responsible for this????

A

Parathyroid***

32
Q

Skeletal Changes in CKD

****SEE FIG. 18-7, GOODMAN, P.971

GFR, Phosphate retention, Calcitrol

This is what you think of initially as soon as you see “Skeletal changes in CKD”

A

DEC GFR

INC Phosphate retention

DEC Calcitrol

Know this!!!!!!!

33
Q

Skeletal Changes in CKD

DEC GFR, INC phosphate retention, DEC calcitrol

Explain the cascade of events that follows!

BE ABLE TO EXPLAIN VERBATIM!!!

A
  1. Changes impair normal processes of bone mineralization
  2. Parathyroid hormone (PTH) mobilizes calcium from SK system to “help”→ mobilizes all this Ca+ bc thinks its doing good and helping!
  3. Results→ HypERphosphatemia and HypERcalcemia

**Progression of vicious cycles leads to Bone Turnover===> rickets, osteomalacia, osteopenia, soft tissue calcification

34
Q
  1. Changes impair normal processes of bone mineralization
  2. Parathyroid hormone (PTH) mobilizes calcium from SK system to “help”→ mobilizes all this Ca+ bc thinks its doing good and helping!
  3. Results→ HypERphosphatemia and HypERcalcemia

**Progression of vicious cycles leads to Bone Turnover===> rickets, osteomalacia, osteopenia, soft tissue calcification

All of this means that WHAT is important w/ our CKD pts?????

A

WEIGHT-BEARING EXERCISES!!!!!!!!!

partial wall sits, step ups, mini squats, wt bearing!!!!

35
Q

Type I Diabetes & Kidney Disease

Albumin

A
  • MICROalbuminuria
    • 20-30% after 15yrs
    • <50% progress to nephropathy
  • MACROalbuminuria
    • PRO >300 mg/day
    • *MAJORITY progress to ESRD
36
Q

Type I Diabetes & Kidney Disease

End Stage Renal Disease

A

16% @ 30yrs

37
Q

Type I Diabetes & Kidney Disease

IF no proteinuria (PRO in urine) after 25yrs……

A

Risk only 1% per year

38
Q

TI DM & Kidney Disease go

A

Go hand-in-hand!!!!

39
Q

Type II Diabetes & Kidney Disease

10 yrs after Dx….. Albumin?

A

MICROalbuminuria→ 25%

MACROalbuminuria→ 5%

*Yearly progression from MICROalbuminuria 2-3%

40
Q

Type II Diabetes & Kidney Disease

Some ethnic groups @ HIGHER risk of progression

A
  1. African-Americans*
  2. Mexican-Americans
  3. Native Americans (Pima Indians)
41
Q

Prevention of Nephropathy

ALL (then broken down)

A
  • Glycemic control
  • HTN control
    • BP <130/80
  • Meds
    • ACE Inhibitors
    • Angiotensin Receptor Blockers-ARBs (bc inflamm response)
  • Dyslipidemia control
42
Q

MOST COMMON ADULT RENAL NEOPLASM

*90% OF ALL RENAL TUMORS

A

Renal Cell Carcinoma

43
Q

What should you remember about Renal Cell Carcinoma?

A

MOST COMMON adult renal neoplasm

*90% of all renal tumors

44
Q

Renal Cell Carcinoma (RCC)

Pathogenesis:

A

Urine contains waste products, Obesity contributes to inflammation (and release of Angio II)

45
Q

Renal Cell Carcinoma (RCC):

Overview

A
  • *MOST COMMON adult renal cell neoplasm
  • M>F; people of color>Caucasian
  • Risks:
    • smoking, mod-heavy drinking, obesity/HTN/bbq meat, occupational exposure (dust), organic solvents, asbestos, gene abnorms
  • Pathogen: Urine contains waste products, obesity=inflammation
46
Q

Renal Cell Carcinoma (RCC):

Clinical Presentation

DEFINITELY REMEMBER THESE ONES!!!!

A

Flank pain, Hematuria (blood in urine), palpable abdom. mass

*Cough and/or bone pain commonly reported→ IMPORTANT!

*NOTE: Flank pain= pain either side of low back bw pelvis & ribs

47
Q

Renal Cell Carcinoma RCC:

Clinical Presentation

Metatstatic sites: in order

A
  • Lungs→ regional lymph nodes→ bone→ liver
48
Q

Renal Cell Carcinoma RCC:

More clinical presentation

A
  • 50% cases discovered incidentally bc renal cx’s are silent
  • NON-specific sx’s→ malaise, anemia, wt loss
  • Fever, HTN, hepatic dysf and hypERcalcemia occur bc hormone production by tumors
  • 25-30% have metastatic dis by time of dx→ 5yr survival of 0-7% in presence of mult. mets
49
Q

Renal Cell Carcinoma: Summary of Medical Mx:

PRIMARY FEATURE

A

Renal parenchymal mass

50
Q

Renal Cell Carcinoma: Summary of Medical Mx:

PRIMARY TX:

A

SURGERY

  1. Radical nephrectomy
  2. Removal of metastatic lesions does not improve survival*
51
Q

Renal Cell Carcinoma: Summary of Medical Mx:

More on this..

A
  • Dx imaging→ abdominal US, MRI, CT
  • Chemo NOT gen. effective
  • 40% of locally removed renal tumors recur***
52
Q

RCC: Staging

ALL

A
  • I= tumor w/in capsule
  • II= tumor invades perirenal fat
  • III= tumor extends into renal vein or regional lymphatics
  • IV= distant mets present
53
Q

Bladder Cx:

Overview

A
  • 4th leading cause of cx in men, 8th leading cause in all of U.S.A
  • Risk Factors:
    • smoking (2x more likely to dev.), male/Euro descent/55+ yrs old, exposure to chemicals/toxins, bladder conditions, chronic inflamm, chemo/radiation
54
Q

Bladder Cx:

Pathogenesis

A
  • Contact chemical carcinogenesis (urine-soluble carcinogens contact urinary epithelium for long pds time), genetic defects in tumor-suppressed gene, inability to repair DNA w/ damage

Aka waste products/carcinogens keep contacting bladder wall= irritation***

55
Q

Bladder Cx: Clinical Presentation

MOST COMMON SIGN

A

PAINLESS hematuria

  • SUDDEN onset, intermittent freq, may lead to clots (pass clots in urine)
  • *Degree of hematuria is NOT INDICATIVE of stage of cx
56
Q

Bladder cx: more on Clinical Presentation

A
  • MOST COMMON→ Painless hematuria
  • Voiding dysf.
    • INCd freq, urgency
  • When more severe→ lymphedema of LEs, LBP (referral from bladder)
57
Q

Bladder Cx:

Prevention & Dx Testing

A
  • Prevention→ mitigate risk factors (ex. smoking)
  • Dx Testing→ limtd dx screening available
    • Dx initially made thru tests of urine and bladder cells
      • or inconclusive→ CT or US
58
Q

Bladder Cx: Summary of Med Intervention

ALL DETAILS

A
  • Depends on staging of tumor→ depends on depth of tissue invasion
  • Unclear optimal tx for non-invasive dis.
  • Transurethral resection→ BCG immunotherapy==> Primary tx for Early stage dis.
  • Cysectomy and/or chemo=> Primary tx for Invasive disease
59
Q

Bladder Cx: Summary of Med Intervention

Depends on ______, which depends on_______

A

Depends on staging of tumor, which depends on depth of tissue invasion

60
Q

Bladder Cx: Summary of Med Intervention

PRIMARY TX for Early Stage Disease

A

Transurethral resection, f/b BCG Immunotherapy

61
Q

Bladder Cx: Summary of Med Intervention

PRIMARY Tx for Invasive Disease

A

Cysectomy and/or Chemo

62
Q

Bladder Cx: Staging using TNM

Tumor staging (TNM) depends on……

A

DEPTH of Tissue invasion

63
Q

TNM explained:

A
  • T (Tumor) = how far the main (primary) Tumor has grown thru the bladder wall AND whether it has grown into nearby tissues
  • N (Nodes) = any cx spread to lymph nodes near the bladder
  • M (Metastasized) = if cx has spread to distant sites (mets)
64
Q

TNM:

T=

65
Q

TNM

N=

66
Q

TNM

M=

A

Metastases

67
Q

Bladder Cx Staging:

T= Tumor

T1 vs T2

A

74% of bladder tumors= T1 or T2

  • T1→ tumors thru basement memb. and invaded into submucosa/lamina propria but NOT muscularis propria
  • T2→ tumors invade muscular propria
68
Q

Bladder Cx Staging

N= Nodes

N0, N1, N2

A
  • N0→ NO involvement
  • N1→ nodes near bladder
  • N2→ nodes further away
69
Q

Bladder Cx Staging:

M= Mets

Order for mets???

A

Lung→ Liver→ Bone

LLB!!!!

70
Q

Bladder Cx: Surgical Intervention for Early Stage

Stage 0,1

A

Transurethral Resection (remember from pelvic health!)

  • For early, superficial tumors
  • scope thru urethra→ remove lesions
  • tumor bed tx’d w/ laser/electric current to destroy tissue

*F/b BCG= intravesical immunotherapy

71
Q

Bladder Cx: Surgical Intervention for Early Stage

Transurethral Resection Complications:

Short-term vs. Long-term

A
  • Short-term→ bleeding, pain
  • Long-term→ fibrosis of bladder, loss of cont.
72
Q

Albumin lvls and the Kidney

Medcon Rehab IV (18 decks)

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