Renal Disorders

Question 1

Function of the Renal System (6)

Answer 1

1.Filters waste products—peeing out ammonia
2.Regulates ion levels in the plasma—slight increase in K+ can occur with kidney problems
3. Regulates blood PH—bicarb comes from the kidneys to create a buffer
4. Conserves valuable nutrients— kidney absorbs 100% of glucose DM—glycemic values in blood
5. Regulates blood volume—maintains water balance
6. Regulates RBC production – kidneys make a hormone to up regulate the production of RBC

Question 2

The kidney is divided into ___ and ___. The functional unit of the kidney is the ___. Located in both.

Answer 2

outer cortex and inner medulla. The nephron is the functional unit.

Question 3

Explain filtration in the kidneys:
Role of the Glomerulus/proximal tubule/loop of henle

Answer 3

1. Glomerulus- ball of capillaries that filters out H2O sugar salt K+ and then the filtrate enters the nephron
2. Once in the nephron the proximal tubule- 90% of the filtrate is absorbed the filtrate is what comes out of the blood into the nephron
3. Filtrate then is pushed to the loop of henle where 10% of the filtrate is fine-tuned depending on the specific individuals blood values- more water can be released or uptake of more K+
   The nephron is surrounded by capillaries b/c the need for exchange is so necessary for the kidney to do its job

Question 4

Explain the process of 1.Filtration 2.Reabsorption 3. Secretion 4. Excretion by the nephron

Answer 4

1. Filtration: blood is filtered in the glomerulus  tubule
2. Tubular Reabsorption: solutes (glucose, na, K+, h2o) are transported from the tubular lumen into peritubular capillaries and returned to the circulation
3. Tubular Secretion: filtrate in the renal tubule is further modified by secretion of substances from the peritubular capillaries into tubular lumen
4. Urinary Excretion: filtrate (urine) is transported to the bladder for storage and elimination

Question 5

Normal Urinary Output and Color

Answer 5

800-2,000 milliliters a day pale yellow
Dark yellow: dehydration
hematuria: may indicate RBC in urine
Cloudy: could indicate infection or WBC presence

Question 6

Polyuria

Answer 6

production of abnormally large volumes of diluted urine >3 Liters a day

Question 7

Oliguria

Answer 7

Daily urine output <400ml
when present in acute renal failure, increase mortality

Question 8

Anuria

Answer 8

no urine production
ominous finding

Question 9

3 Cause of Acute Renal Failure

Answer 9

1. Pre- Renal: condition that decrease renal blood flow
2. Intra- Renal: injury or inflammation within the kidneys
3. Post- Renal: condition that obstruct urine outflow

Question 10

Define Pyelonephritis and Signs and Symptoms

Answer 10

Pyelonephritis: results when a UTI progresses to involve the upper urinary system (kidney and ureters)

Common Signs and Symptoms of Pyelonephritis
 Back pain or flank pain
 Fever/chills
 Feeling sick
 Nausea vomiting
 Confusion-especially in elderly
 Changes in urine:
Hematuria
Cloudy or foul smelling
Pain when urinating
Increased frequency

Question 11

Define renal stones and common signs/symptoms

Answer 11

increased concentration of salt in blood
SS: Renal colic-pain (flank radiating ant and inf)
nausea/vomiting
hematuria
Treatment: manage pain & hydration

Question 12

Explain Rhabdomyolysis and how it can result in acute kidney injury

Answer 12

Breakdown of muscle fibers specifically of the sarcolemma of skeletal muscle resulting in release of myoglobin

Release of myoglobin may cause acute kidney injury and ultimately renal failure

Shift of extracellular fluid into injured muscles resulting in under perfusion of the kidneys and risk of compartment syndrome

Question 13

Triad of Signs and Symptoms of Rhabdomyolysis

Answer 13

muscle pain, weakness, reddish brown urine

Question 14

What Lab Value helps determine Rhabdo

Answer 14

CK value >5x Normal Limit
The higher the CK value the greater risk of acute kidney injury
CK is a marker of muscle injury

Question 15

Causes of Chronic Renal Disease (5)

Answer 15

1. Diabetic Nephropathy
2. Hypertension
3. Glomerulonephritis
4. Polycystic Kidney Disease
5. Kidney infection, obstruction, renal vascular disease

Question 16

Glomerular Filtration Rate
Creatinine
Albumen
in relation to kidney function and easy of assement

Answer 16

Glomerular filtration rate- difficult to measure need 24 hrs
measures the number of functioning nephrons
low GFR= bad kindey function

Creatinine- easy to measure by blood test
amino acid filtered by glomerulus
high creatinine level= bad kidney function

Albumin- urine test
should not be found in urine

Question 17

Hyperkalemia

Answer 17

normal 3.5-5.0 meq/L
muscle weakness, paralysis, paresthesias, cardiac arrest
increased K+

Question 18

Hypercalcemia

Answer 18

normal: 8.5-10.5
increase Ca++
sones bones groans thrones

Question 19

Metabolic acidosis

Answer 19

normal: 22-28 meq/L
decrease bicarb
fatigue, muscle weakness, decrease cardia contractility

Question 20

Explain hemodialysis

Answer 20

HD promotes the correction of fluid and electrolyte abnormalities, removal of toxic materials, and maintenance of acid based balance.
Very patient centered based on what the individual is needing in their blood

Question 21

What to avoid if a patient has a fistula or graft

Answer 21

NO BP on same arm as fistula or graft
protect arm from injury
control obvious hemorrhage
a thrill will be felt and this is NORMAL

Question 22

Continuous Renal Replacement Therapy

Answer 22

Use of extracorporeal blood circuit through a small volume, low resistance filter
Provides continuous removal of solutes and fluid
Patients are usually critically ill

Question 23

Peritoneal dialysis

Answer 23

o Peritoneum as the semipermeable membrane and the dialysate is infused directly into the abdomen
o Allows waste products and fluid to pass from the blood into the dialysis solution
o Dialysate is infused into the abdomen and allowed to remain for several hours prior to drainage

Question 24

What should you look for after dialysis in pt participating in PT

Answer 24

assess fluid and electrolyte status
expect potential dehydration/hypervolemia/hypotension