Renal/Integumentary Flashcards
_____-Related Changes in the Renal System:
• Decreased kidney size – around age 30. You can actually lose up to 25% of the mass
• Decreased Renal Blood Flow (RBF) and Glomerular Filtration Rate (GFR)
o d/t renal vascular perfusion changes
• Decreased number of nephrons
• Decreased tubular transport response
• Decreased elimination of drugs
• Increased sclerotic glomerular capillaries
• Increased excretion of glucose
• Increased bladder symptoms
o Urgency, frequency, nocturia
Age
this test is for a waste product that is continuously produced during normal muscle breakdown. What your kidneys do is filter that waste product from the blood into the urine where it is then excreted. This process allows for almost no reabsorption. So when you look at this test it tells you simply the amount of blood the kidneys can make creatinine-free each minute. As renal function declines, patient’s ability to clear creatinine will go down.
plasma creatinine concentration
Normal creatinine value is ______ mg/dl
0.7 to 1.2
Test used in glomerular nephritis
creatinine concentration
a protein mainly used to assess kidney function. It also filters out of the blood by the glomeruli and is excreted out. Used when creatinine clearance could be misleading (cirrhosis, obese, malnourished, vegetarians) – individuals may not have the muscle mass to adequately assess their kidney function thru creatinine clearance.
Plasma Cystatin C Concentration
plasma protein that is freely filtered at the glomerulus.
cystatin C
two renal tests used to measure progressive renal dysfunction
creatinine + cystatin C
waste product that kidneys move from blood out of body thru urine
end product of protein metabolism
varies as a result of altered protein intake and protein catabolism
blood urea nitrogen (BUN)
test for hydration status (increases in dehydration and kidney failure)
BUN
normal range for BUN: _____ mg/dL
10-20
test: blood in the body continuously & hundreds of times throughout the day flow thru kidneys – they will push that liquid part of our body thru these tiny filters (nephrons) & the majority of the body’s fluid will be filtered thru nephrons and reabsorbed back into body. If not reabsorbed, it will then become urine
glomerular filtration rate (GFR)
rate of blood flow through the kidneys
glomerular filtration rate (GFR)
test that determines level of kidney function
glomerular filtration rate (GFR)
normal pH of urine
5-6.5
measures solute concentration of urine has a normal value of 1.016- 1.022
specific gravity
measures RBC in urine (there should be none)
sediment
measures accumulations of cellular precipitates in the urine
They are an indication of the type of disease the kidney is experiencing
casts
renal infection (pyelonephritis) will result in ____ casts
WBC
inflammation of the glomerulus (glomerulonephritis) will results in _____ casts
RBC
urine ______ indicate inflammation, infection, or metabolic disorder
crystals
urine test that shows if there is an infection
WBC
urine \_\_\_\_\_\_\_\_\_ tests: • Glucose • Bilirubin • Urobilinogen • Leukocyte esterase • Nitrates • Ketones • Proteins • Hemoglobin and myoglobin
reagent strips
test with flat plain film (one picture of abdomen AP [anterior posterior view])
->targets the kidney, ureter, and bladder (not that great of a diagnostic tool for urinary system – typically just use it when assessing for constipation)
x-ray “KUB”
renal diagnostic test that uses iodine that contain a radiopaque dye that is injected into a vein to circulate throughout the kidney and then excrete in the urine. As it is excreted in the urine a rapid series of x-rays catches the dye as it is being excreted.
o This will give us a good idea of the urinary tract and if there are any underlying complications.
o The dye is nephrotoxic and hydration is recommended prior to the IVP
Intravenous Urography/Pyelography (IVP)
non-invasive, no exposure to radiation, test that allows visualization of the kidneys – measure kidneys, see shape/location, see if there’s kidney stones, tumors, cysts, abscess, etc. [often used in pediatrics for detection of causes of reflux etc]
ultrasound
minimally invasive test that is done under fluoroscopy- an x-ray done in “real time” (allows radiologist to see urinary tract & bladder)
–>will identify if there is any bladder backup to the kidneys [reflux] also if they have reflux and have had surgery, they may repeat to see if surgery was successful. Also if they are suspicious of a blockage in urethra, this test will identify that
o Shows how the lower urinary tract is functioning
o Child is usually catheterized, and the radiopaque material is passed via catheter to the bladder. And when the bladder is full the child is asked to urinate or may do so on his/her own. The fluoroscope pictures are being made as the bladder fills and the child voids
o Used to evaluate bladder size, if there is vesicoureteral reflux and what grade the reflux is
Voiding Cystourethrogram (VCUG)
Masses of crystals or other substances that occur in the kidney and cause obstruction
• Most are made of calcium crystals – calcium oxalate and calcium phosphate
**made of minerals & salts but calcium most common
Nephrolithiasis (“Kidney Stones”)
CM of _____:
• VERY PAINFUL
• Nausea/vomiting
• Diaphoresis
• Pain radiating from flank to lower abdomen or groin
• Pain can come in waves w/fluctuating intensity.
• Pain can occur w/urination
Urine can be red, pink, or even brown in color
Nephrolithiasis (“Kidney Stones”)
Patho of ________:
• Caused by inflammation of the urinary epithelium after invasion and colonization by some pathogen in the urinary tract
• There is a positive retrograde movement of bacteria into the urethra and bladder
• Most of the time, if bacteria enters the urinary tract, our body’s immune system can get rid of the bacteria on its own by protective mechanisms. If body’s natural immune system doesn’t protect us, the bacteria will enter thru urethra, lead to an inflammation of epithelium, and multiply.
• Leading pathogen: E-coli (85% of all UTIs)
Urinary Tract Infection (UTI)
Protective _______ ________:
• Bacteria is washed out of the urethra during micturition
• Low pH & high osmolality of urea, the presence of Tamm-Horsfall proteins, and secretions from the uroepithelium which all provide a bactericidal effect.
• The ureterovesical junction (UVJ) closes during bladder contraction preventing reflux of urine to the ureters and kidneys
• Length of the male urethra is protective
• Common pathogens
• Most common pathogens are Escherichia coli & Staphylococcus
Urinary Mechanisms
Causes of \_\_\_\_\_: Mostly coliforms (e.coli, klebsiella, proteus, pseudomonas)
Acute Cystitis (Bladder Infection)
Risk Factors for \_\_\_\_\_\_\_: Premature infant female gender (including school aged girls) sexually active women [can develop from sexual intercourse] pregnant women women recently treated with antibiotics spermicide use estrogen deficiency in women persons with catheters Diabetes Mellitus bladder dysfunction
Acute Cystitis (Bladder Infection)
CM of \_\_\_\_\_\_\_: Varies w/ age Urinary urgency burning blood in urine voiding small amounts urinary frequency foul urinary odor pelvic discomfort low-grade fever adults dysuria low back pain **May be asymptomatic especially during pregnancy or in the elderly. Symptoms different in children and older sometimes suprapubic pain **In the elderly they may manifest differently: lethargy, anorexia, confusion, anxiety
Acute Cystitis (Bladder Infection)
Evaluation of ____:
• Urine dip or UA with microorganism count of 10,000 mls or more
Acute Cystitis (Bladder Infection)
Chronic bladder inflammation w/ acute cystitis-like symptoms of pelvic pain w/no evidence of bacteria in urine.
***Can be caused by autoimmune reaction, drug-induced, radiation, chemicals (spermicides, bubble baths, lubricants, etc.)
Interstitial Cystitis/Bladder Pain Syndrome [Noninfectious Cystitis]
Causes of _______:
Nonbacterial infection
noninfectious cystitis- radiation, chemical
interstitial cystitis- hypersensitivity
Hunner Ulcers- autoimmune derangement of the bladder mucosa with ulcers
scaring
decreased bladder capacity
Interstitial Cystitis/Bladder Pain Syndrome [Noninfectious Cystitis]
Acute infection of the ureter, renal pelvis, and/or renal parenchyma (most cases occur among women) in which bacteria has continued to travel past the bladder, thru ureters, and into the kidneys to wreak havoc
**Primary organism- E.Coli and other coliforms are the usual infectious agents (e.coli, klebsiella, proteus, pseudomonas
Acute Pyelonephritis (Kidney Infection)
Risk Factors for _______:
female gender
urinary tract blockage (like man w/large prostate)
weakened immune system
spinal cord or nerve damage around bladder
foreign bodies- catheter
”list goes on.”
Acute Pyelonephritis (Kidney Infection)
Cause of \_\_\_\_\_\_: ascending infection (from the lower urinary tract) or sepsis (blood born infection)
Acute Pyelonephritis (Kidney Infection)
CM of \_\_\_\_\_\_\_: very sick flank pain fevers chills costovertebral tenderness purulent urine anorexia dehydration UTI symptoms [urgency, frequency, burning, blood in urine, foul-smelling urine, n/v]
Acute Pyelonephritis (Kidney Infection)
Evaluation for ______:
UA ill show WBC casts- indicating pyelonephritis
Acute Pyelonephritis (Kidney Infection)
Chronic syndrome caused by an overactive detrusor muscle that contracts involuntarily even w/ a low volume of urine in bladder creating urgent need to void
***Symptom syndrome- urgency with/without urge incontinence, urinary frequency and nocturia
Overactive Bladder
Diagnosis of _____:
good medical hx
physical exam
negative urinalysis (may want to send off to lab to make sure urine doesn’t grow anything w/culture)
Overactive Bladder
sudden, intense urge to urinate followed by loss of urine (maybe urinary frequency & nocturia as well)
urge incontinence
urine leaks w/exerted pressure (coughing, sneezing, laughing, exercise)
stress incontinence
frequent or constant dribbling of urine because bladder doesn’t empty completely
overflow incontinence
physical or mental impairment that prevents making it to the toilet on time (dementia, bed-bound that requires assistance to bathroom).
functional incontinence
urine formation and excretion begins in fetus in the ___ month of gestation
3rd
the key to all stages of kidney development & maintenance of kidney function
Wilms Tumor 1 (WT1) gene
Urethral meatus is located on the ventral side or undersurface of the penis
hypospadias
rare malformation of penis but can also develop in famles as well.
o Males: Urethral opening is on the dorsal surface of the penis
o Females: Cleft along the ventral urethra usually extends to the bladder neck
o 2x as many boys are affected as girls
epispadias
absence of one or both kidneys in fetus
o If unilateral (occurs in 1 in 1000 live births) usually the left kidney is absent and the remaining kidney hypertrophies which can lead to a normal/healthy life
renal agenesis
kidneys are absent bilaterally (incompatible with uterine life and is a rare genetic disorder) resulting in low amniotic fluid
**more often in males
Associated with a group of facial anomalies:
• agenesis or hypoplasia
• wide set eyes,
• low set ears,
• receding chin,
• flattened nose with downward turned nasal tip
Potter Syndrome
Autosomal Dominant disorder (each child has 50% chance) that is a mutation of two genes:
• PKD1 on chromosome 16
• PKD2 on chromosome 4
Occurs in 1 in 1000 live births
• Cyst formation and obstruction, accompanied by destruction of renal parenchyma, interstitial fibrosis, and loss of functional nephrons
• Most common form, accounts for 90% of all polycystic disease
• Causes symptoms later in life around 30-40
• Affects both genders and all races
• Cysts will develop in clusters on kidneys, leading to hypertrophy & loss of function over a period of time
Polycystic Kidney Disease (PKD)
CM of \_\_\_\_: HTN flank pain bloating kidney stones kidney failure
Polycystic Kidney Disease (PKD)
Autosomal Recessive disorder (both parents must carry the abnormal gene to pass on, each child will have 25% chance of getting disease, 50% carrier, 25% non-carrier)
that occurs due to gene mutation on chromosome 6 p
• Cystic changes of the kidney and liver are evident at birth
• Renal replacement therapy is typically needed and required during childhood or adolescence.
• Enlarged kidneys with cysts
• Systemic hypertension
• Liver problems
Polycystic Kidney Disease (PKD)
inflammation of tiny filters in kidneys
o Etiology: It is a renal disorder in which proliferation and inflammation of the glomeruli are secondary to an immune mechanism. There will be a sudden onset of hematuria with red blood cell casts and proteinuria
Acute Post Streptococcal Glomerulonephritis
Patho of ______:
The most common acute glomerulonephritis that occurs after a throat (i.e., pharyngitis) or skin infection (i.e., impetigo) with certain strains of group A α-hemolytic streptococci. This occurs because antigen-antibody complexes and complement are deposited in the glomerulus. Immune complexes then initiate inflammation and glomerular injury. This form primarily occurs in children 5 to 15 years of age.
[In English: Usually takes 1-2 weeks after recovering from either strep throat or impetigo to develop this. Immune response that occurs when body produces too many antibodies and extra settle in glomeruli, leading to inflammation]
Acute Post Streptococcal Glomerulonephritis
CM of ______:
• Pink or cola colored urine [from RBCs in urine],
• foamy urine d/t excess protein,
• HTN,
• Water retention,
• edema [face, hands, feet, abdomen], and,
• In severe cases- azotemia will be present [aka increase in BUN,Creatinine]
Acute Post Streptococcal Glomerulonephritis
o Etiology: Unknown
o Pathophysiology: IgA deposited in kidneys, trapped in glomeruli
o The most common form of glomerulonephritis in children and young adults and occurs more in males than females.
o It is characterized by deposition primarily of IgA and complement proteins in the glomerulus
o Most children recover completely. 20-40% may have recurrent symptoms or even renal failure
Glomerulonephritis – Immunoglobulin A (IgA) Nephropathy (Burger’s Disease)
CM of \_\_\_\_\_\_: • Hematuria (may or may not be visible – can be dark-brown cola looking) • Proteinuria • Urinating less • Edema
Glomerulonephritis – Immunoglobulin A (IgA) Nephropathy (Burger’s Disease)
It is common to see recurrent gross hematuria with a concurrent URI (i.e., tonsillitis) or gastroenteritis in __________. Most children continue to have microscopic hematuria between the attacks of gross hematuria and have mild proteinuria. In severe cases, proteinuria, edema and HTN can occur and must be treated swiftly to prevent loss of kidney function
Glomerulonephritis – Immunoglobulin A (IgA) Nephropathy (Burger’s Disease)
Care is supportive for _______ and _________.
Glomerulonephritis – Immunoglobulin A (IgA) Nephropathy (Burger’s Disease)
Acute Post Streptococcal Glomerulonephritis
abnormal immune response in which the immune system makes IgA to protect the body from antigens & chose antigens (bacterial or viral)…typically preceded by infection…Antibodies attack blood …majority occurs in people that have recently had an URI. It can also be associated w/other types of exposures such as meds, foods, insect bites.
Henoch-Schonlein Purpura (HSP)
CM of _______:
hematuria
proteinuria
HTN
can lead to renal failure
Rash (purpura-type) Reddish-purple spots that look like bruises on buttocks, legs, feet – can also appear on arms, face, trunk
Swollen/painful joints
GI symptoms – abdominal pain, n/v, blood in stools
In children:
kidney involvement is usually transient and kidney function returns to normal. Small % have long-term problems, even smaller % have kidney failure
In adults:
more likely to have chronic kidney disease that will eventually lead to kidney failure.
Henoch-Schonlein Purpura (HSP)
____ is a small vessel IgA mediated vasculitis
Henoch-Schonlein Purpura (HSP)
Henoch-Schonlein Purpura (HSP) often results in elevated _____ and _____.
BUN and creatinine
