Renal Function (Ch. 33)-- Definition First Flashcards
- Amount of urea in blood
- Waste product of metabolism
- Not specific to kidneys
- Influenced by protein intake, GI bleed, dehydration
- Included on Basic Metabolic Panel (BMP)
Blood Urea Nitrogen (BUN)
-
Filter blood and reabsorb substances
- Electrolytes
-
Regulate pH
- Conserve or eliminate HCO3- & H+
-
Regulate osmolality of ECF & urine
- ADH
- Aldosterone (RAAS)
-
Endocrine functions
- Renin
- Erythropoietin
- Vitamin D
Functions of the Kidneys
- Average urinary output: 125 mL/hr
- Neural & humoral mechanisms
-
SANS, ADH, & Angiotensin II (RAAS) → Vasoconstriction
- ⇣ renal blood flow
-
Dopamine & NO → Vasodilation
- ⇡ renal blood flow
-
SANS, ADH, & Angiotensin II (RAAS) → Vasoconstriction
Renal Regulation
- Urinary obstruction
-
Renal pelvis
- Renal calculi (kidney stones)
- Pregnancy
-
Ureter
- Neurogenic bladder
- Uretovesicle junction stricture
-
Bladder & urethra
- Bladder stones
- BPH
-
Renal pelvis
Obstructive Disorders of Renal Function
- Volume of plasma filtered per minute
- BEST index of kidney function
Glomerular Filtration Rate (GFR)
Supersaturation → Solute precipitates → Stone formation
Urinary stasis → Crystal aggregation (around organic material) → Stone formation
Renal Calculi Mechanisms
- PAIN
-
Renal colic
- Acute, intermittent, excruciating
- N/V
-
Non-colicky
- Dull, deep, continuous ache
- Mild → Severe
-
Renal colic
Renal Calculi Clinical Manifestations
Drug exposure (NSAIDS, contrast media, diuretics, immunosuppressants) → Structural or functional changes in kidneys
NSAIDS/ASA → ⇣ PGs (renoprotective) → ⇣ Renal blood flow
Hypersensitivity (Methicillin + Furosemide/Thiazide Diuretic) → Tubulointerstitial nephritis
- High blood flow and filtration pressure in kidneys
- Exposed to toxins in blood
- Kidneys involved in metabolism of drugs
- Exposed to toxic drug metabolites
- Tolerance factors:
- Age
- ⇡ Risk: Elderly
- Renal function
- Hydration status
- Blood pressure
- Urinary pH
- Age
Drug-Related Nephropathies
-
[Solutes] in urine
- Normal range: 1.010-1.025
- High– Dehydration
- Low– ⇣ Renal function
- Normal range: 1.010-1.025
Specific Gravity
- Abrupt onset of shaking, chills, or fever
-
Constant ache in lower back
- Unilateral or bilateral
- Malaise
- N/V
- Abdominal pain
- Lower urinary tract symptoms
- Dysuria
- Increased urinary frequency
- Urgency
Acute Pyelonephritis Clinical Manifestations
- Calcium salts → Calcium stones (oxalate or phosphate)
- 70-80%
- Hyperparathyroidism, High fructose beverages
- Uric acid → Uric acid stones
- Gout, Tumor lysis syndrome, High purine diet
- Magnesium ammonium phosphate → Struvite
- Alkaline urine, Bacteria that split urea → ammonia & CO2
- Normal urine pH: 4.5-8
- Alkaline urine, Bacteria that split urea → ammonia & CO2
- Cystine → Cystine stones
- Cystinuria (autosomal recessive genetic defect)
- ⇡ Cystine resorption
- Cystinuria (autosomal recessive genetic defect)
Types of Renal Calculi
Expansion of the kidney with urine
- ⇡ Pressure inside renal capsule
- Compartment syndrome
- Blood vessels compressed
- Renal ischemia
- Necrosis of tissue
- Chronic renal failure
Hydronephrosis
-
Hematuria w/ red cell casts
- Sudden onset
-
Oliguria
- <20 mL/hr
- ⇣ GFR
- Azotemia
- ⇡ BUN
- Cola-colored urine
Acute Nephritic Syndrome Clinical Manifestations
- Acute nephritic syndrome
-
Rapidly progressive glomerulonephritis
- Goodpasture Syndrome
- Nephrotic Syndrome
Disorders of Glomerular Function
Determined by site, degree, and duration of obstruction
Urinary stasis → Infection & Renal Calculi
Dilation of renal collecting ducts → Hydronephrosis → Renal ischemia → Necrosis of kidney tissue
Acute emergency → Chronic renal failure
Urinary Obstruction Mechanisms