Renal System Flashcards
T/f: the renal system gets rid of fluids of the body
True
What is a factor of the renal system that dictate hydration?
Urine color
T/f: it takes a lot to lose a damaging amount of fluids
False, it does not take much
What things does the renal system filter out?
Urea
Creatinine
Uric acid
Ammonia
Bilirubin
Excess ions
Drugs
Toxins
Excess water
What does the renal system reabsorb?
Water
Glucose
Amino acids
Electrolytes
Sodium
Chloride
Potassium
Calcium
Magnesium
Bicarbonate
Phosphate
What process of the renal system is “reabsorption in reverse”?
Tubular secretion
What is urine formed from?
Filtered and secreted substances
Where does secretion occur?
In the DCT (distal convoluted tubules) and collecting ducts
What hormones assist with the process of secretion?
AD
aldosterone
AND
What things make up the content of urine?
Water
Urea
Creatinine
Uric acid
Excess electrolytes
Ammonia
Bilirubin/urobilinogen
Hormone metabolites
Drugs/toxins
Other metabolic waste
What is a normal volume output of urine per day?
1-2L per day
What is the minimum volume of urine output?
400-500mL
What factors affect the volume of urine?
Intake
Diet
Activity
Temp
Health
Medication
Does high temp increase or decrease urine volume excretion?
Increases it
Does fluid volume cause muscle cramps?
Nope
What can we do to help muscle cramping?
Stretch
What is incontinence?
Inability to control urine output (esp women who’ve had children and men with prostate issues)
What is a HUGE issue with incontinence for patients?
QOL/embarrassment
What are the QOL issues that arise from incontinence?
Embarrassment
Burden of care
Risk of falls
Cost
Why are those with incontinence often a fall risk?
Bc they will restrict their fluid intake and then get dizzy when standing up, risking falls
40% of those who are incontinent are in what age range?
60-80 yo
What percent of those who are incontinent had 3 or more children?
36%
26% of those who are incontinent have a BMI over what?
25
26% of those who are incontinent are on what kind of medication?
A diuretic
18% of those who are incontinence have had what kind of procedure?
Hysterectomy or prostate removal
What medications put pts at risk of incontinence?
Diuretics
Calcium channel blockers
Antidepressants
What are risk factors for a UTI?
Immobility and inactivity
Catheterization
DM
Obstructions
Why does immobility and inactivity lead to a risk for UTIs?
Bc the longer urine sits stagnant, the more likely it is to get infected
T/f: UTIs can be caused by any one of five different bacteria
True
What are some s/s of urogenital pathology?
Pain with micturation
Leukocytes and bacteria in urine
Cloudy urine
Back pain
Fever and chills
Nausea
Loss of appetite
Pain with percussion over kidneys
T/f: UTIs can cause cognitive changes in the elderly
True
Is the average time from initial symptom claim to bladder CA dx is longer in men or women?
It is longer in women
T/f: the time from onset of hematuria to bladder CA dx is greater in women than in men
False, it is about the same when hematuria is the sole presenting symptom
What is renal calculi (kidney stones)?
Excess material that accumulates in the kidneys forming stones
T/f: kidney stones tear the ureter when coming out, which causes excruciating pain
True
When is there an infection risk with kidney stones?
When the stone is too large to be passed and causes an obstruction
What are the 3 sites of kidney stone obstruction (don’t really think we need to know this so feel free to skip)?
Ureteropelvic junction
Ureter crosses over illiac vessels
Ureterovesical junction
If a pt presents with ipsilateral pain in the genitals, (+) percussion test of the kidneys, and hematuria, what should we be thinking may be going on?
Kidney stones obstruction
What are the 4 types of kidney stones (again, don’t really think we need to know this).
Ca oxalate (most common)
Mg ammonium phosphate (rarely do people have excess mg)
Uric acid (more likely to manifest as Gout)
Cystine
What are the risk factors for kidney stones?
Males 30-50
Females 60-80
Caucasians
High protein, low fiber diet
Dehydration
Warm climate
Poor mobility
Family hx
Why does dehydration put you at risk for kidney stones?
Bc the body won’t have enough fluids to flush out the system
What are the s/s of kidney stones?
Stabbing pain at the costovertebral angle
Intermittent excruciating pain into the ipsi genitals
Ureter spasms radiate into the medial thigh
Chills, nausea, vomiting
Frequent urge to urinate
Burning sensation with urination
Bloody, cloudy, smelly urine
Increased BP
If we see someone in the waiting room pacing like a tiger, what might we think could be going on?
Kidney stones
When does pain start with kidney stones?
When the stone moves into the narrow ureter and pressure builds up in the kidney
How are kidney stones diagnosed?
US, MRI, CT
urinalysis
What would a urinalysis for kidney stones show?
Hematuria
Infection
Crystals
pH
The formation of various types of kidney stones is strongly influenced by what?
Urinary pH
____ pH favors crystallization of calcium and phosphate containing stones
Alkaline
_____pH promotes uric acid or cystine stones
Acidic
What is the treatment for kidney stones?
Small stones will pass spontaneously
Pain meds
Antibiotics
Medical emergency if they have a fever
Removal
How can kidney stones be removed?
With USE (ureteroscopic stone extraction) or ESWL (extracorporeal shock wave lithotripsy)
T/f: once you get a kidney stone, you are more likely to get another one if you don’t change your lifestyle habits
True
What % of those with kidney stones with get another stone within 5 years?
50%
Is kidney stone pain a mechanical pain?
Nope
T/f: if stone formation is associated with hyperparathyroidism (parathyroid controls calcium), it must be addressed
True
What is polycystic kidney disease?
A genetic disorder that causes cysts to grow in the kidneys leading to degeneration of renal tissues and obstruction of tubular flow
What is a leading cause of end stage kidney disease (ESRD)?
PKD (polycystic kidney disease)
What VS should we watch for with kidney disese?
BP
What is the most common cause of chronic kidney disease (chronic kidney disease)?
DM (44%)
What are the three most common causes of chronic kidney disease (CKD)?
DM
HTN
Glomerulonephritis
What are the functions of dialysis?
Waste removal
Fluid balance
Electrolyte balance
Acid base balance
Who needs dialysis?
Those with kidney fxn <10-15% via ESRD or chronic kidney failure
Those with acute kidney failure temporarily
Those with severe electrolyte/fluid imbalances that can’t be managed with meds alone
What are the two types of dialysis? What is the difference between them?
Hemodialysis (filters the blood)
Peritoneal dialysis (filters abdominal cavity)
T/f: exercise for someone with kidney pathology can help decrease cortisol levels and increase wellbeing
True
What is the typical age range affected by endometriosis?
30-40 yo
What are s/s of endometriosis?
Worse symptoms with pre and during menses
Pain with intercourse
Infertility
Recurrent lumbosacral pain that comes and goes with the menstrual cycle and is non-mechanical
If a female pt presents with lumbosacral pain that comes and goes intermittently and can’t be reproduced with motions, what might we suspect is going on?
Endometriosis
What are the most common primary sites of metastatic tumors?
Prostate
Breast
Lung
Renal
Colon
What are some typical s/s of lung cancer?
Over 60yo
Smoker
Cervical spine, shoulder, and chest pain
TOS symptoms
Chronic cough
Bloody sputum
Weight loss, malaise
Fever
Dyspnea, wheezing
Fecal breath odor
Neural s/s secondary to spinal fluid metastasis
What are some typical s/s of renal cancer?
55-60 yo
Weight loss
Hematuria
Malaise
Fever
Palpable posterior lateral abdominal mass
What are some typical s/s of prostate cancer?
> 50yo
Lumbar spine pain
Frequent urination
Weak urine stream
Difficulty starting urination
Sacral plexus symptoms
T/f: prostate cancer is slow developing and likely to not be the thing that kills the pt
True
T/f: only about 30% of the time does elevated PSA indicate prostate cancer bc it is also increased with age
True
Some guidelines state that men should generally be referred for a prostate tissue biopsy when PSA > ___ ng/mL
3
T/f: the number of false positive PSA tests increases with age
True
If a PSA shows an elevation, what should be done?
A series of more PSA tests b4 a biopsy to make sure the elevation is a pattern
What is one guideline on the cutoff score for PSA to get a biopsy?
> 10 ng/mL
T/f: best evidence supports the use of serum PSA for early detection of prostate cancer
True
Panel members agreed that PSA testing should only be offered to men with what life expectancy?
> 10-15 years
T/f: some say that if someone with a life expectancy less than 5 years wants a prostate screening, it would be useless bc something else will probably kill them before than cancer ever does
True
What are some foods claimed to reduce prostate risk?
Greens
Cooked tomatoes
Citrus fruits
Olive oil
Soy foods
What are some common s/s of prostate cancer?
Men >50 yo
Difficulty starting or stopping urine flow
Change in frequency of urine flow (decreased)
Nocturia
Hematuria
Incontinence
Sexual dysfunction
PSA >4ng/mL
What are some gynecological s/s that may indicate a referral out?
Cyclic pain
Abnormal bleeding
Nausea, vomiting
Vaginal discharge
Chronic constipation
Low BP (blood loss)
Missed/irregular periods
Pain with cough/incontinence
Evan’s sign
What is Evan’s sign?
Hot foot syndrome
Warm, dry foot caused by sympathetic interruption from lumbosacral plexus via tumors or other lesions
Vasodilation with loss of perspiration
Most common in cervical cancer
What is Evan’s sign associated with?
Cervical cancer
