Renal System Flashcards
Anuria
Urine output of <100mL per day
Arteriovenous fistula definition
Surgical creation of an anastomosis of a fistula between an artery and vein.
Azotemia
Retention of nitrogenous wast products in the blood
Disequilibrium syndrome
Rapid change in the composition of ECF that occurs during dialysis. Solutes are removed from the blood faster than from the CSF pulling fluid into the brain causing cerebral edema.
Nephrolithiasis
Formation of kidney stones.
Oliguria
<400mL of urine output per day
Urolithiasis
Formation of urinary stones.
Definition of Serum Creatinine
An end product of protein and muscle metabolism which reflects GFR and is an indicator of kidney disease when elevated.
Normal serum creatinine level
0.6-1.3
Normal Blood Urea Nitrogen Level
8-25
Normal serum uric acid
2.5-8.0
Definition of Blood Urea Nitrogen
Indicates renal clearance of nitrogenous waste products.
Factors which affect BUN
- Dehydration
- Poor renal perfusion
- High protein diet
- Stress
- Infection
- GI bleeding
- Muscle breakdown
Specific gravity of urine - lab value
1.016-1.022
Specific gravity of urine - what it tells you
Measures the ability of the kidneys to concentrate urine. Increase indicates dehydration, decreased renal perfusion or increased ADH.
Creatinine clearance test
Evaluates how well the kidneys remove creatinine from the blood. Involves taking a blood sample and timed urine sample. Provides the best estimate of GFR.
Normal GFR Rate
125 ml/min
Acute Kidney Injury
Rapid loss of kidney function from renal cell damage. Can be pre-renal, intra-renal or post renal.
Phases of AKI
- Onset
- Oliguric phase (Increase in BUN and SC levels, decrease in SG, GFR and creatinine clearance)
- Diuretic phase (gradual decrease in BUN and SC, low CC and slight increase in GFR)
- Recovery phase (increase GFR and stabilization of BUN and SC).
CKI - at risk
GFR >90 ml/min
CKI - Mild
GFR 60-89 ml/min
CKI - Moderate
GFR 30-59 ml/min
CKI - Severe
GFR 15-29 ml/min
CKI - End Stage
GFR <15 ml/min
CKI - diet
- Low protein
- High carb
- Low K
- High Phosphate
Common problems that accompany kidney disease
- Activity intolerance and insomnia
- Anemia
- GI bleeding
- Hyperkalemia
- Hypermagnesemia
Uremic syndrome
Accumulation of nitrogenous waste products in the blood cause by the kidneys inability to filter out wast products.
Symptoms of uremic syndrome
- Oliguria
- RBC and protein in urine
- Increase urea, uric acid, K and Mg in urine
- n and v
- diarrhea and constipation
6 hyper and hypotension
Subclavian and femoral catheter
Used for short term or temporary use in AKI hemodialysis. Used until the fistula or graft matures (6 weeks).
External arteriovenous shunt
Two cannulas are surgically inserted one into the artery and one into the vein in the forearm or leg to form an external blood path. Patentcy is tested by palpating for a thrill or listening for a bruit.
Internal arteriovenous fistula
Connection of an artery to a vein using an internal, artificial graft. This can be gore-tex, or bovine and is used for clients who do not have adequate blood vessels for creation of a fistula. Graft can be used 2 weeks after insertion. Needle inserted through the skin into the graft.
Arterial steal syndrome
Too much blood is diverted into the vein and arterial perfusion to the hand is compromised. To check for patentcy palpate for a thrill or auscultate for a bruit.
Signs and symptoms of Peritonitis
- Fever
- Cloudy outflow
- Abdominal pain (common for first 2 weeks)
- Malaise
- Nausea and vomiting
Hyperacute kidney rejection
Rejection occurs when the organ is attached
Acute kidney rejection
Happens in the first 6 weeks
Chronic kidney rejection
Occurs slowly over months and years
Clinical signs of kidney rejection
- Temperatue >100
- Pain at graft site
- 2-3 lb weight gain in 24 hours
- Edema
- Hypertension
- Malaise
- Increase BUN and SC
- Decreased CC
- Increased WCC
10 Rejection indicated on ultrasound or biopsy
Urosepsis
Bacteremia originating in the urinary tract usually caused by Ecoli. Can lead to septic shock if not treated. Usually infection comes from a catheter. Fever is the earliest manifestation.
Urethritis
Inflammation of the urethra usually associated with an STI.
Symptoms of Urethritis
- Pain/Burning during urination
- Frequency/ Urgency
- Nocturne
- Difficulty voiding
- Males have clear to micropurulent discharge
Polycystic kidney disease
Cysts form which cause hypertrophy of the kidneys leading to cystic rupture, infection, formation of scar tissue and damaged nephrons.
Symptoms of polycystic kidney disease
- Flank, lumbar or abdo pain relieved by lying down
- fever and chills
- recurrent UTIs
- Hematuria, proteinuria and pyuria
Hydronephrosis
Distention of the renal pelvis due to a stone blockage and urine backing up behind it. Surgery required to remove the stone.
Symptoms of hydronephrosis
- Dull flank pain radiating to the groin
- Hypertension
- Headhead
Cytoscopy
Insertion of a catheter to move or bypass renal stone.
Extracorporeal shock wave therapy
Ultrasonic waves used to break up renal stones (non-invasive)
Percutaneous lithotripsy
Guide inserted and ultrasonic wave emitted near renal stone to break it up (invasive)
Epididymitis
Acute or chronic inflammation of the epididymis that occurs as a result of an STI, UTI, prostatitis and long term catheter use.
Benign Prostatic Hypertrophy
Slow enlargement of the prostate gland with hypertrophy and hyperplasia of normal tissue.
Where is pain referred with bladder trauma?
The shoulder
How do you determine the patentcy of an arteriovenous fistula?
Palpate for a thrill or listen for a bruit.
What are the symptoms of urethritis?
- Dysuria
- purulent discharge
Symptoms of epididymitis
- fever
- nausea
- vomiting
- scrotal pain
- chills
Kock’s pouch
Continent internal reservoir, patient will self-catherize in order to void.
Typical time and length of hemodialysis
3 days a week, 3-4 hours per day
Dialysis precautions for infection risk
Mask for nurse and patient
Common symptom of Polycystic Kidney Disease
Flank pain and hematuria
How is fluid given amount established after a transplant
Number of mls given at a rate equal to the number of mls of the previous hours output.
Transurethral resection of prostate syndrome
Increased absorption of non-electrolyte fluid used during surgery.
Symptoms of transurethral resection of prostate syndrome
- bradycardia
- confusion
- disorientation
- muscle twitching
- visual disturbance
Fluids that acidify urine
- prune, apricot, cranberry and plum juice
Peritoneal dialysis good for patients with these conditions:
- Heart disease
- Diabetes
Good because of slow shift in fluid, fast in hemodialysis.
Hypovolemia, what blood product prescribed?
Albumin as a plasma expander.
