1. What is the expected GFR in clinical settings? 2. What is the normal GFR in laboratory setting?

1. eGFR > 60 ml/min 2. GFR = 125 ml/min

Renal System Flashcards by Simon L

What are five abnormal findings in urine

Glucose
Hematuria
Proteinuria
Bacteriuria
WBC

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What gives urine the color?

Urobilinogen

byproduct of bilirubin

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Dark urine can be an indicator of?

Hepatic (liver) failure or rhabdomyolysis

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Define

glomerulonephritis

What would it cause?

inflammation of the tiny filters in the kidneys (glomeruli) leading to increased permeability of abnormal constituents.

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What 3 conditions can cause AKI pre-renal?

Hypovolemia
Hypotension
Obstruction or vasoconstriction

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What can causes issues post-renal (bladder/urethra)

Obstruction (e.g., kidney stones, inflammation of those structures)

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What are 3 commonly used nephrotoxic agents?

Contrast dyes
Antibiotics
NSAIDS

acetaminophen-induced nephrotoxicity is rare, more likely to dmg liver.

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What are signs of renal (kidney) compromise?

Decreased urine output
Elevated Renal labs (BUN and Creatinine)

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What is the treatment for AKI?

Acute Kidney Injury

Treat underlying cause (may use temporary dialysis, take away antibiotics)

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What are the 4 causes of anemia in CKD?

Chronic Kidney Disease (CKD)

Loss of ability to activate vitamin D.
Loss of ability to produce erythropoietin
Blood loss through damaged glomerulus
Increased fluid retention dilutes the blood

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What are the 3 causes of CKD?

Chronic Kidney Disease (CKD)

Diabetes mellitus
Hypertension
AKI

2/3 of all cases of CKD is associated w/ DM and HTN.

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What causes itching in CKD?

Chronic Kidney Disease

Uremic frost (build of up urea)

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Why would patients w/ CKD experience difficulty concentrating?

Patients may state “fogginess or trouble remembering”

Build up of waste products in the blood (e.g., increase ammonia, uric acid)

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What are 2 causes of fatigue in patients w/ CKD?

Main reason is anemia.
Secondary, low BP during dialysis

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What causes HTN in patients w/ CKD?

CKD patients hold onto fluid increasing workload on heart.

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What are the directions for completing a 24 hour urine test?

Discard the first urine output; then start the 24 hour clock. All subsequent urine is stored in refridgerator.

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What is the expected GFR in clinical settings?
What is the normal GFR in laboratory setting?

eGFR > 60 ml/min
GFR = 125 ml/min

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What are two types of dialysis systems?

Hemodialysis and peritoneal dialysis

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What should fistulas be assessed for?

Thrills (vibratory movement through stethoscope)
Bruit (ascultation should heart turbulent blood flow)

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what should be avoided with fistulas?

IV sticks on fistula
Assessing BP on that area

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What are the 3 signs of peritonitis?

Pain, firmness in abdomen area
Cloudy dialysate
Signs of infection (fever, WBC, malaise)

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What intervention is recommended for patients of peritoneal dialysis that is experiencing SOB or difficulty emptying dialysate?

Repositioning

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Where is the cather inserted for hemodialysis?

Superior vena cava

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What is a fistula?

the fusion of a vein and artery as a permanant solution to dialysis through cath

makes vessel able to handle large blood flow from dialysis

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What 4 things should be conisidered before a patient undergoes hemodialysis?

1. Low BP (give vasopressors if low) 2. Temperature 3. Low electrolytes 4. Hold antibiotics/medications that decrease BP | Monitor nutrition and fluid levels

What 4 medications are commonly prescribed to dialysis patients?

1. Synthetic EPO (darbepoetin alfa) 2. Iron (ferrous sulfate) 3. Electrolyte supplement (especially potassium) 4. BP medication can go either way

What is sodium polystyrene (Kayexalate) used for?

Treats hyperkalemia (exchanges sodium with potassium ions from the intestinal cells) | Decreases K+ levels

What is the relationship b/w phosphorus and calcium?

Phosphorus in plasma takes calcium from bone and put it into plasma. | Risk of brittle bones

What foods should be avoided to decrease phosphorus?

* Processed food (*fast food, deli meats, pizza*) * **Dark cola, beer** * Deli meats * Diary P W/ 3 Ds

What would be the expected GFR for ESRD patient?

GFR < 15 ml/min

How is GFR collected in laboratory setting vs clinical setting?

* Laboratory through 24-hr urine test * Clinical through blood test (eGFR)

What are the two normal UO measures?

* 1mL/kg/hr * > 30 mL/hr* | *used when weight of patient is unknown

What are the parameters for anuria?

UO < 50 mL/**day**

* Define oliguria * What are the parameters?

* Below normal UO levels * oliguira = 0.5 ml/kg/hr or < 30 ml/hr

# Convert the following: * 1 cup = ? oz * 30 ml = ? oz * 1 cup = ? ml * 1 L = ? ml

* 1 cup = 8 oz * 30 ml = 1 oz * 1 cup = 240 ml * 1 L = 1000 ml

Optimal daily **fluid** intake

3 L | Not just water

# Define dysruia

Pain or difficulty voiding

# Define Hesitancy

Delay, difficulty in **initiating** voiding

# Define Azotemia

Accumulation of nitrogenous waste in blood

# Define Uremia

Accumulation of urea in blood

# Define Incontinence

Involuntary loss of urine

# Define Urgency

strong desire to void

What is BUN?

* A BUN test measures the amount of **urea**, **nitrogen** that's **in** your **blood**.

Normal BUN range

5 to 20 mg/dL | 5 digits per limb. 20 digits total.

What two factors can elevate BUN levels, **but have normal creatinine level**

1. Dehydration 2. Increased protein intake | Dehydration causes a concentration of waste products in the blood

* Normal Creatinine range * What range would cause worry?

* 0.6 to 1.2 mg/dL * ≥ 1.5 mg/dL

What are 3 demographics that can affect creatinine levels? How is affected?

* Age (Increased w/ age) * Sex (Increased in males) * Race (Increased in african-americans)

What is the difference is specific gravity of urine compared to water? | Can help determine how well your kidneys are diluting your urine.

Specific gravity of urine: 1.003 to 1.030 (water is 1) | Urine is slightly higher

Where do majority of UTI originate from?

E. coli located in rectum

What are 3 common irritants that can increase risk of UTIs?

1. Baths 2. Nylon underwear 3. Scented toilet tissue

What the mininum ____ ml of urine needed for urinalysis

10 ml

What are the 3 **lower** UTI's in ascending order?

1. Cystitis (bladder) 2. Prostatits (prostate) 3. Urethritis (urethra)

Define Pyelonephritis

Inflammation of the **kidney** due to a bacterial infection. | Upper UTI infection

Which UTI is associated w/ more blood in the urine compared to the other?

Pyelonephritis (Upper UTI)

What is a s/sx of glomerulonephritis in urine?

Proteinuria (albumin)

What would be a **s/sx** if the provider is **unsure the patient has AKI** after **administering fluids** for elevated renal labs?

Pulmonary edema

Patient w/ elevated BUN and Creatinine. What is suspected?

AKI or CKD | Acute Kidney Injury or Chronic Kidney Disease

What are 3 s/sx would indicate a UTI is becoming **complicated**?

**Systemic signs** *Fever *Increase WBC in blood not just urine *malaise

What are 3 additional s/sx of pyelonephritis compared to lower UTI?

1. Flank pain (often unilateral) 2. nausea, vomitting

which is the most common lower UTI?

Cystitis = inflammation of the **bladder**, usually caused by a bladder infection.

What is the nursing priority for urinary calculi (kidney stones)?

Acute pain unless stone prevents urination

What are 3 possible medications a patient with kidney stones may be prescribed besides analgesics?

1. Diuretics (increase UO) 2. Anti-biotics 3. Alpha-blocker (relaxes muscles in bladder) | Rarely given

What nutritional recommendations would be made for a patient w/ **reoccurring** calcium oxalate stones?

* Reduce oxalate foods (*dark leafy greens [Spinach], soy products, potatoes*) * Keep **normal** calcium intake (calcium binds to oxalate for removal)

What nutritonal recommendations would be made for a patient w/ reoccuring calcium oxalate stones?

* Reduce oxalate foods (*dark leafy greens [Spinach], soy products, potatos*) * Keep **normal** calcium intake

What is recommended for large kidney stones?

Lithotripsy

What are 3 normal findings s/p lithotripsy?

1. Pain still occurs as fragments pass 2. Hematuria (blood in urine) 3. Brusing at site of procedure

# Define Benign Prostatic Hyperplasia

non-cancerous enlargement of prostate

at which age are 50% of men dx w/ BPH? Which age for 90%? | Benign Prostatic Hyperplasia

50% by age 60, 90% by age 85.

What serves as an indicator for the development of BPH?

elevation of Prostate specific antigen (PSA)

What are the 3 different s/sx of BPH compared to UTI? | Both genitourinary conditions have similar s/sx

**BPH urine** 1. Weak stream 2. Hesitancy 3. Nocturia

Identify the drug class that is quick acting and slow acting for the treatment of BPH.

* Alpha Blocker (quick) * 5-alpha reductase inhibitor (slow)

What conditions are Tamsulosin (Flomax) indicated for? | Alpha blocker

1. **Benign Prostatic Hyperplasia (BPH)** 2. Kidney stones | Relaxes bladder

* What condition is Finasterid (Proscar) indicated for? * What is the MOA?

* BPH * Blocks an enzyme that changes testosterone to another hormone that causes growth of prostate

What are 3 normal findings s/p TURP | Transurethral Resection of the Prostate

1. Hematuria 2. Temporary incontinece 3. Retrograde ejaculation

* What is the purpose of flushing the catheter s/p TURP? * What is the expected finding w/ the flush?

* Prevent blood chunks * Clear to light pink

What should be checked before use of contrast dyes?

* Renal Labs (BUN/Creatinine) * Urinary output

Which antibiotics are considered "heavy hitters" on renal function?

1. Mycins 2. Aminoglycocides

Which analgesic is known to be toxic to renal (kidney) vs hepatic (liver)

* NSAIDS (ibuprofen) = renal impairment * Acetaminophen = hepatic impairment | Question use during impairment

Which BP abnormality affects AKI vs CKD?

**Hypo**tension = AKI **Hyper**tension = CKD

Calculate the minimum UO per hour

**0.5 (x) kg**= how much they should urinate an hour **minimum**