Renal System Flashcards
What is the main function of the kidneys?
- Get rid of waste (acid-base balance)
- keep your salt and potassium levels (electrolytes)
- produce hormones that make red blood cells
- Control BP with renin
- Activation VitD and Ca+
How much of the kidney can you lose before experiencing symptoms?
90%
About how much blood do kidneys filter every day? how much urine do they excrete?
200 quarts; 1.5L (10% of blood filtered)
How big is the kidney?
About the side of the fist
What triggers the release of renin?
- Low BP
- Sympathetic Stimulation
- Low sodium
What does renin do?
Splits the protein angiotensinogen into angiotensin I, which is converted into angiotensin II.
What does angiotensin II do?
Causes vasoconstriction, stimulates release of vasopressin (ADH) from PP, and the release of epinephrine, NE, and aldosterone from adrenal gland
What is the difference between ADH and Aldosterone?
ADH reeuptakes water from renal tubules WITHOUT influencing Na or K whereas aldosterone stimulates tubules to reuptake Na and water follows the electrolyte to be reabsorbed into the body
What organ does angiotensin, aldosterone and vasopressin have an effect on and can cause problems?
Heart (ultimately can lead to heart failure)
What do ACE inhibitors block?
block the enzyme that is needed for formation of angiotensin II (to prevent further heart damage from RAAS)
Where is renin produced?
granular cells of adrenal gland
How do kidneys activate VitD and maintain Ca+ balance?
Produce calcitrol from VitD; regulate phosphate levels and excrete excess (if they’re too high, low Ca+ will result)
Where does the formation of urine take place?
The nephron (about 2.5 mil per kidney)
Kidneys and ureters are innervated by ______ and _____ fibers.
Sympathetic and parasympathetic
Bladder innervation through sympathetic NS causes _____ while parasympathetic NS causes ______.
Urine storage (sphincters contract, bladder relaxes); urination (sphincters relax, bladder contracts)
What are basic renal pathologies?
- Prerenal, renal, postrenal causes
- Sensitive to bacteria
- Glomeruli exposed to noxious plasma components
- Glomeruli affected by vascular pathologies
- Renal tubules sensitive to toxins and dec.O2
- Sensitive to malignant transformation
What causes pre renal pathology? is it curable?
heart insufficiency and shock; usually reversible if cause is cured
What causes intrarenal pathology? is it curable?
tubular necrosis (lack of oxygen, drugs, etc.); can also be reversed
What causes postrenal pathology? is it curable?
kidney stone, infection of ureter, enlarged prostate; can be reversed if antagonist is removed
What are the effects of aging on the kidneys?
- dec blood flow to kidneys
- dec nephrons
- vol of urine increases
- sodium reg. not as efficient
- increased night production urine
- dec bladder capacity
- inc UT disease
What pain might accompany genitourinary disease?
- posterior subcostal and costovertebral regions
- ipsilateral shoulder pain (pressure on diaphragm)
- low back/ inner thigh
- typically aching pain but can be severe
poisoning with urine (retention of water, minerals, organic substances); cardiac arrest secondary to hyperCa+ or hyperK+, coma or death
Uremia (urine in blood)
What are systemic sx of GU disease?
- Fever, shivering, malaise, anorexia/weight loss
- Uremia
- Skin hypersensitivity
What is pain that is affected by body position?
psuedorenal pain (referred pain is not altered with change in position)
What are risk factors for GU disease?
- > 60
- Personal/family hx diabetes/HyperTensionN
- Personal/family hx kidney dz, HA, CVA
- Personal hx kidney stones, UTI, autoimmune dz
- African, Hispanic, Pacific Islander, Native American
- Exposure to chemicals
- Low birth weight
What are the types of lower UTIs?
- Cystitis
2. Urethritis
About ____ of women have been diagnosed with a UTI by the age of 24.
⅓
What can happen if a a UTI is not taken care of?
it can ascend and infect the kidney
What is the name for an upper UTI?
Pyelonephritis
Used to check for upper UTIs; indirect fist percussion to cause tissue to vibrate; shouldn’t hurt but will if person has UTI
Murphy’s percussions
Where do renal cell carcinomas metastasize to?
- bone
- liver
- regional lymph notes
What is the “classic triad” of RCC?
- hematuria
- abdominal/flank pain
- palpable abdominal mass
In addition to the classic triad, what are other sx of Wilm’s tumor?
- HTN
- fever
- anorexia
What are the 2 types of Renal disease that obstruct the tubules?
- renal cystic disease (6 categories, dealing with cell abnormalities)
- Renal calculi (stones)
What are causes of renal calculi?
- Diet, family hx, obesity, digestive diseases and surgery, medical conditions
- Calcium, magnesium
ammonium phosphate,
uric acid, cystine - Renal colic, hematuria
What is a very common hereditary condition (renal cystic disease type) that leads to hematuria and enlarged kidney
polycystic renal cystic disease
What are the treatments of kidney stones?
- let it pass
- surgery
- shockwave lythotripsy
What are the 4 stages of kidney failure?
1st – GFR 50% of normal (Kidneys will adapt)
2nd – GFR 20-35% of normal (anemia, HTN can appear)
3rd – renal failure. GFR 20-25% of normal (Kidneys can’t regualte volutme and solute composition; Edema, matabolic acidosis, hypercalcemia)
4th – ESRD 90% of kidney function lost
What are the 2 major forms of dialysis?
- hemodialysis (machine filters blood)
2. Peritoneal (solution put into abdomen and captures waste products, can be performed at home)
What is the leading cause of ESRD? causes of this include nephrotic and nephritic syndromes, inflammatory type conditions (diabetes, SLE, HTN)
Inflammatory glomerular lesions
What protein do impaired kidneys fail to separate from wastes?
Albumin
Condition in which protein is present in urine
Proteinuria
_____ is a waste product in the blood created by the normal breakdown of muscle cells during activity; builds up in blood when kidneys are not working well
Creatin
What is the normal range of Creatin levels?
.6-1.2 mg/dL
Calculation uses the patient’s creatinine measurement along with age and values assigned for sex and race
eGFR
What is the BUN a measurement of?
Urea in the blood
How much urea does a normal dL of blood contain?
7-20mg (>20mg = kidney not working at full strength)
_______ during hemodialysis improves dialysis efficacy and physical performance
Exercise training (low-intensity, intradyalytic ex. program resulted in sign improvement in urea clearance due to incr, blood flow to wking m.’s)
What does end stage renal disease do?
It fucks you up - everything is affected.
Skin, hematologic, body fluids, ear/nose/throat, CV, Pulm, GI, GU, skeletal, and nero ALL affected (too many sx to count)
95% of uriniary tract cancers; Sx: Hematuria, frequency, urgency, dysuria, back pain, lymphedema (if it has metastasized)
Bladder cancer
Innervation interrupted at multiple levels; Decr. Capacity, constricted sphincter, atonic, loss of perception of fullness; due to CVA, dementia, MS, brain/spinal cord tumors, SCI, HNP, myelitis
Neurogenic Bladder disorders
Incontinence due to increased abdominal pressure and the sphincters don’t have the control to stop urine flow; holding pelvic floor is cause
Stress
Sudden feeling you need to go to the bathroom; Bladder is getting neural input to contract; Increase breathing and retrain neural input
Urge
Incontinence when you can’t get to the bathroom in time
Functional
What are the types of incontinence?
- Stress
- Urge
- Functional
- Overflow
What type of incontinence are drugs ineffective for?
stress
What are the 2 types of drugs used for incontinence?
- Anticholinergic drugs (atropine, vesicle, enablex, toviaz)
- Cholinergic drugs (bethanechol)
Drugs that decrease spasticity in the bladder allowing resting tone to not overreact and cause frequent urination.
Allows bladder to fill
Anticholinergic drugs
Drugs that stimulate smooth muscle contraction (stimulates bladder to empty); Prevents over distension
Cholinergic drugs (Bethanechol**)
What else is used to treat urge incontinence?
- Botox into bladder
- Stim to peroneal nerve
- implant in LB
What antibiotic is used to treat UTI
Ampicillin
