Renal Disorders PP Flashcards
Kidney Cortical tissue loss
Small nephron
Decline blood flow to kidney
Low GFR, # of nephrons, low creatinine clearance
Increased BUN
Ureter, bladder, Urethra
Decreased bladder capacity, elastic, tone of detrusor
Weak urinary sphincter
Retain urine
Prostate enlargement males
UTI, Pelvic muscle weakness, Urethral/ Vag weakness/ dryness female
Associated with…
Aging
3 mechanism maintaining ECF & electrolyte balance…
Glomerular filtration, tubular reabsorption, tubular secretion
Prostaglandins dilate afferent artery having this affect on GFR….
NSAIDS can block Prostaglandin having this effect on GFR…
Increased GFR (GOOD)
NSAIDS can Lower GFR (BAD)
NSIADS Affect Afferent Arteriole how…
ACE / ARBS affect Efferent Arteriole how….
NSAID Afferent vasoconstriction = Lower GFR
ACE/ARB Efferent Vasodilation = Lowered GFR
CORRECT
Hormones
Bradykinins…
Prostaglandins…
Activated vit D….
Increase Bloodflow (vasodilation) and permeability
Regulate intrarenal blood flow by vasodilation/ constricting
Promote calcium absorption
Name problem….
Bacterial infection starts at bladder and progress towards kidneys
Acute or chronic
Local & systemic inflammation
URINE REFLUX COMMON CULPRIT
Edema, tubular cell necrosis, abcess formation
Pyelonephritis
Acute pyelonephritis
Flank / back pain
CVA tenderness
NV
Fever chills tachycardia/ penia
Fatigue
Burning urgency frequency
WBC in urine increased
Chronic
Hypertension causes ….
Decreased ability to concentrate urine….(this problem)
Hyponatremia/ Hyperkalemia
Acidosis
Scar tissue/fibroids, strictures
Nocturia
Immunological damage to the renal corpuscle….
Glomerulonephritis
Acute glomerulonephritis
Sudden onset about 10 days after…
Strep infection
Caused by excessive immune response in the kidney
Acute glomerulonephritis
An immune response 10 days after a strep infection.
Associated with these problems…(4)
HTN
Leads to CKD
Edema
Anemia
Recent travle / infection/ virus
Skin lesions facial piercing
Facial edema
Fluid overload
Hematuria common
Mild / mod HTN
Fatigue
Acute glomerulonephritis
Acute glomerulonephritis
UA: Color…
Increase…
Serum albumin….
Serum creatinine & BUN….
Hypercholesterolemia
Reddish color
RBC, Protein, albumin
Serum albumin Decreased
GFR Decreased
Why fluid restriction with acute glomerulonephritis…
If HTN
When would you give dialysis fir a pt with glomerulonephritis…
Uremia present
Chronic glomerulonephritis
Always leads to…
End stage renal disease
Uremic symptoms (4)
Ataxia ( a lack of muscle coordination affecting movements such as walking, speech, and eye movements)
Tremors
Asterixis ( flapping tremor )
Pruritis
Urine output with chronic glomerulonephritis
Decreased
Chronic glomerulonephritis
Will dialysis or transplant be needed….
Yes
Symptoms of chronic glomerulonephritis mimic this problem in the elderly…
CHF
Patho
Immunological disease
Glomeruli permeability increase due to damage
Massive protein loss
Edema
Nephrotic Syndrome
Minimum change disease most common cause in children
_____rare condition characterized by the accumulation of abnormal proteins, known as amyloid fibrils, in various tissues and organs.
Found in which problem…
Amyloidosis
Nephrotic Syndrome
Systemic conditions such as
Lupus
Diabetes
Amyloidosis
HIV
May lead to this problem…
Nephrotic syndrome
Assessment
Edema
Foamy urine
Anorexia
Weight gain
Fatigue
HTN
RISKS.
Blood clots / Infection
Nephrotic syndrome
Diagnostic
Severe proteinuria >3.5 / 24 hrs
Low serum albumin
Hyperlipidemia
Edema
HTN
Renal vein thrombosis
This problem…
Nephrotic syndrome
Kidney biopsy to diagnose cause
Steroids & cytotoxics
ACE
Statins
Heprin
Increased protein if GFR normal
Decreased protein if GFR low
Nephrotic syndrome
Benign nephrosclerosis will have this surface in the kidney…
Fine, leathery, granularity
Patho
Degenerative disorder
Thickening of nephron blood vessels
Decreased kidney blood flow
Tissue chronically hypoxia, ischemia/ fibrosis occurs
Nephrosclerosis
Causes:
HTN
Diabetes
Atherosclerosis
Genetic: Apolipoprotein L 1 (APOL 1)
Nephrosclerosis
Control HTN & reduce albuminuria
ACE Inhibitors / ARBS combined
Diuretics
Nephrosclerosis
Narrowing of renal artery lumen
Reduced blood flow to kidney
Ischemia, atrophy, scarring
Impaired Fluid, Electrolyte, Acid-Base balance
CAUSES:
Renal vein thrombosis
Renal artery stenosis
Atherosclerosis
Aneurysms
Renovascular disease
Renovascular disease
Diagnostic…(4)
MRA, Renal US, Renal Arteriography, Renal scan
Renovascular Disease
Caused by Renal Artery Stenosis
Treatment….
Antihypertensive
Endovascular procedure -
Stent placement
Ballon angioplasty
Renal artery bypass
2 months recovery
Vascular complications caused by atherosclerosis, HTN, neuropathy from DM
Leading cause if CKD
Degree of disease is relat3d to glycemic control
Diabetic nephropathy
Genetic disorder / Dominate (more common) & recessive
Overgrowth of fluid filled cysts in the nephron
Progressive kidney enlargement
Cysts damage glomerular & tubular membranes
Polycystic Kidney Disease
Complications
Infection
Pain
Ab fullness
Hematuria
Kidney STONES
HTN
Cysts in liver / blood vessels
Correlation with Kidney Stones & cerebral aneurysms
Polycystic Kidney Disease
Why ask about family history of Polycystic Kidney Disease…
Its genetic
Autosomal Dominate
Physical assessment
Abdominal girth increased
Abdominal/ flank pain
Nocturia
HA
Hematuria
CONSTIPATION
HTN
Polycystic Kidney Disease
Diagnostic
US primary tool
MRI / CT for confirmation & potential donor
UA: Proteinuria, RBC, Bacteria (infection of cyst)
Polycystic Kidney Disease
Priority management in Polycystic Kidney Disease
Other interventions…(3)
HTN management
Pain (Opiods)
Infection
Prevent constipation
Obstruction causes fluid backup
Hydronephrosis
Kidney enlarged as fluid collects in _____
Pressure in kidney causes damage to vessels/tubules
Hydroureter
Pressure backs up to kidney
Dilation & enlargement above Obstruction
Causes: Stones (common), tumor, strictures, fibrosis, abcess, cysts, BPH
Permanent damage can occur in _____
48 hrs
Hydronephrosis / Hydroureter
____ to diagnose obstruction/ stones
CT
Can ston3s be removed by cystoscopy/ retrograde urogram
Used for Hydronephrosis/ Hydroureter
Yes
Hydronephrosis/ ureter
Nephrostomy tube placement
Pre-Procedure (3)…
Post-Procedure (3) report to HCP
NPO, Consent, Clotting Study
Blood/ Urine from insertion site
Absent or low drainage
Back pain
Renal cell carcinoma affects
RBC…
Ca….
Renin…
hCG…
RBC increased or decreased
Ca >10.5
Renin Increased HTN
hCG Increased (Lower libido)
Risk factors for renal cell carcinoma
(6)
Male
Black
Fat
HTN
Smoker
Exposure to cadmium/ heavy metal, asbestos, benzene
Renal cell carcinoma
Physical assessment (3)
Late signs (3)
Flank pain, hematuria, palpable kidney mass
Muscle wasting, weight loss, weakness
Goal prevent spread & management of complications
Microwave ablation/ cryoablation
Chemotherapy- limited effectiness
Biological response modifiers; increase survival
Radiation: Palliative
Surgery:
Nephrectomy (Tumor highly vascular, increased bleed risk)
Renal cell carcinoma
Biological Response Modifiers (BRMs) are substances that modify the body’s immune response to various diseases, including cancer, autoimmune disorders, and infections.
Happens over time
Thickening of nephron blood vessels - due to deceased blood flow in kidney
Causes: HTN, DM, atherosclerosis
Nephrosclerosis
To diagnose nephrosclerosis…
US possible CT
Type of medication most given for nephrosclerosis…
ACE
Never give diuretics for nephrosclerosis…
False it is given sometimes
Sudden onset HTN in a client >50 maybe this problem
Renal vascular disease
Why give an ACE before a renal scan with renovascular disease…
It alows better visualize the artery blood flow and determine the occuled part
Diabetic nephropathy is microscopic damage inside the kidney.
1# cause of CKD
T OR F
T
Mineral corticoid receptor are non steroidal drugs that reduce scaring.
Used in this problem….
Diabetic neuropathy
Berry aneurism in the brain are associated with….
Polycystic Kidney Disease
Distended abdomen
Flank pain
Constipation
Nocturia
Head aches
Are associated with…
Polycystic Kidney Disease
Headaches from ruptured aneurysms in brain
Berry aneurysms
Diagnostic tool for Polycystic Kidney Disease
US primary tool
Polycystic Kidney Disease
Early: Hyperfiltration (Describe)
Late: Discuss diet…
Hyperfiltration = Lots of urine 3L daily - Hyponatremia is a risk
Late: Low protein (renal diet)
What does it mean if during palpation of bladder that urine dribbles out…
Blockage and possibly back flow of urine into ureter / Kidney.
Emergency: can lead to severe damage in 48 hrs
Pyelonephritis
CVA / Flank pain
NV
Fever,chills
Tachycardia/ Tachypnea
Describe urine output…
WBC increased
Urgency/ Frequency
Caused by bacteria entering urethra & making it to the kidney causing infection…
Pyelonephritis
Sudden onset 10 days post strep infection…
Glomerulonephritis
Describe Pathophysiology of glomerulonephritis…
Immune response 10 days post strep infection
Causes injury and inflammation of the glomerulus
Allows protein & blood into the urine
Facial / Periorbital edema is associated with…
Glomerulonephritis
Diagnostic of glomerulonephritis…
Kidney biopsy
Meds for glomerulonephritis
Antibiotics
Diuretics
Corticosteroids
Cytotoxic drugs
Fluid restriction
Low sodium, K, protein diet
I & O
Daily weight
Massive protein loss in urine
Immunological disease
Glomerulus more permible due to damage
Edema
Causes
Minimum change disease in children
Systemic condition
Lupus
Diabetiñes
AmyloidosisHIV
Nephrotic syndrome
Foamy urine is seen with…
Nephrotic syndrome
Diagnostic of nephrotic syndrome is…
Severe proteinuria (>3.5 / 24hrs)
Low serum albumin
Hyperlipidemia
edema
HTN
Renal vein thrombosis
Delayed clotting/ Increased bleeding
_______ is a non-invasive imaging technique used to evaluate renal arteries for stenosis (narrowing) or occlusion in suspected renovascular disease (e.g., renal artery stenosis).
Used to diagnose Renovascular Disease
MRA (Magnetic Resonance Angiography)
Vascular complication caused by atherosclerosis, HTN & Neuropathy from DM
Diabetic Nephropathy
Leading cause of CKD
Diagnostic
UA increased RBC
Lowered Hgb & Hct
Increased calcium, ESR, (Hormones) hCG, renin, PTH
INCREASED BUN & Cr
CT & MRI
Kindey Biopsy
Renal cell carcinoma
