Renal System and Disorders- Notes from Slideshow (quiz 3) PART 1 Flashcards
Recommended to review slide on fluid and electrolytes acid base. Important and book does not cover them.
Recommended to review slide on fluid and electrolytes acid base. Important and book does not cover them.
The main function of the nephron
To maintain balance/homeostasis of
blood volume
blood pressure
plasma osmolarity
What mechanisms are used by the nephron to maintain balance?
- Filtration
- Reabsorption
- Secretion
Glomeruli generate ultrafiltrate of the plasma
Nephron function: Filtration
Tubules selectively reabsorb substances from the ultrafiltrate
Nephron function: Reabsorption
Tubules secrete substances into the urine
Nephron function: Secretion
Components of the Nephron
Know how to find on diagram
- Afferent arteriole
- Efferent arteriole
- Bowman’s capsule
- glomerulus
- Renal Vein
- Loop of Henle with capillary network
- Tubule
- Collecting duct
(Know how to find on diagram)
- Afferent arteriole
- Efferent arteriole
- Bowman’s capsule
- glomerulus
- Renal Vein
- Loop of Henle with capillary network
- Tubule
- Collecting duct
(Know how to find on diagram)
Parts of the Nephron
Know how to find on diagram
Components of the Urinary System
Know how to find on diagram
- Main vein to the heart
- Main artery from the heart
- Kidneys (R/L)
- Ureters (R/L)
- Bladder
- Bladder Nerves (open/close)
- Bladder Muscle
- Urethra
(Know how to find on diagram)
- Main vein to the heart
- Main artery from the heart
- Kidneys (R/L)
- Ureters (R/L)
- Bladder
- Bladder Nerves (open/close)
- Bladder Muscle
- Urethra
(Know how to find on diagram)
Components of the Urinary System
Know how to find on diagram
Urinary System: Function of the Main vein to the heart
Carries cleaned blood to the heart
Urinary System: Function of the Main artery from the heart
Bring blood with with wastes from the heart
Urinary System: Function of the Ureters
Carry urine
Urinary System: Function of the Bladder
Collects urine
Urinary System: Function of the Bladder Nerves
- one nerve tells the brain the bladder is full
2. second nerve tells the bladder to open
Urinary System: Function of the bladder muscle
To keep bladder closed
How do kidneys work?
- Blood enters kidney through renal artery to nephrons
- Inside each nephron is a vessel (glomerulus)
- Glomerulus strains out extra fluid/wastes and lets blood cells/other substances in
- Wastes produce urine which travels to the ureter then bladder
- Blood enters kidney through renal artery to nephrons
- Inside each nephron is a vessel (glomerulus)
- Glomerulus strains out extra fluid/wastes and lets blood cells/other substances in
- Wastes produce urine which travels to the ureter then bladder
How do kidneys work?
A hormone system within the body that is essential for the regulation of blood pressure and fluid balance
RAAS
What 3 hormones comprise RAAS?
- renin
- angiotensin II
- aldosterone
What system regulates RAAS?
Renal blood flow
What simulates RAAS?
Hypotension
What senses hypotension to stimulate RAAS?
Kidneys
What is stimulated in order to activate RAAS?
Kidneys and blood vessels
What supplies the kidneys with blood? How much blood?
- The renal arteries
2. 20-25% of cardiac output
What is included in the kidney anatomy that is important to RAAS?
- Afferent arterioles
- glomerulus
- juxtaglomular cells
- Efferent arterioles
What do to juxtaglomular cells do in RAAS?
They produce prorenin
What does prorenin do in RAAS?
When BP is low prorenin is converted to renin
What does renin do in RAAS?
It converts Angiotensinogen to angiotensin 1
Where is Angiotensinogen made?
In the liver
What is ACE and where is it found?
- Angiotensin converting enzyme
2. found in lungs
What does ACE do for RAAS?
It converts angiotensin 1 to angiotensin 2
What is angiotensin 2?
- a vasoconstrictor
2. RAAS mediator
What does angiotensin 2 effect in RAAS?
- blood vessels
- Kidneys directly
- Kidneys indirectly
- Pituitary gland
How does angiotensin 2 effect the blood vessels in RAAS?
It constricts the arteries AND veins
What does the constriction of arteries AND veins by RAAS do?
Higher BP
How fast does the constriction of arteries AND veins by RAAS occur?
within mins
How does angiotensin 2 effect the Kidneys directly in RAAS?
constricts afferent vessels to glomeruli
How does the constriction of afferent vessels to glomeruli effect RAAS?
It decreases blood flow to kidneys
How does decreased blood flow to kidneys effect RAAS?
lowers GFR
What is the effect of a lower GFR?
Lowers urine output
How does angiotensin 2 effect the kidneys indirectly in RAAS?
acts on adrenal gland to release aldosterone
What does aldosterone do in RAAS?
increases sodium and water reabsorption
In RAAS what does decreased urine output, increased water reabsorption and increased sodium reabsorption lead to?
- Increased Extracellular fluid (EFC)
- Increased capillary pressure
- Long term increase in arterial pressure
What tests are evaluated to determine renal function?
- Renal concentration test (specific gravity and osmolarity of urine)
- Creatinine clearance
- Serum creatinine
- Serum urea nitrogen (blood urea nitrogen BUN)
- Protein
- Microalbumin/creatinine ratio
- Urine casts
The ratio of the mass of a solution compared to the mass of an equal volume of water
specific gravity
What is specific gravity of urine testing?
The density of urine
What is normal specific gravity of urine?
1.005 to 1.030
If specific gravity of urine is increased what does it indicate?
dehydration
If specific gravity of urine is decreased what does it indicate?
overhydrated
How else can you tell if urine is concentrated?
Just by looking- yellow is concentrated and clear is not concentrated
What is creatinine?
waste product filtered from the blood by the kidneys into the urine
What does creatinine clearance measure
The amount of blood cleaned of creatinine by your kidneys
What is normal creatinine clearance for women?
95 mL/min
What is normal creatinine clearance for men?
120 mL/min
What does high/low creatinine clearance indicate?
kidneys are not filtering as they should
What does serum creatinine measure?
level of creatinine in your blood
What is normal serum creatinine for women?
0.6 to 1.1 mg/dL
What is normal serum creatinine for men?
0.9 to 1.3 mg/dL
What is another name for serum urea nitrogen
Blood urea nitrogen
What does BUN measure?
the amount of nitrogen in your blood
What is does nitrogen levels in a BUN test indicate?
Urea is a waste product that produces nitrogen
What is a normal BUN level?
6 to 20 mg/dL
What does high BUN indicate?
The kidneys aren’t filtering properly
Proteins test
Done to see if there is protein in urine
What does it mean if there is protein in urine?
It means the kidneys are filtering out important blood components. The body needs and uses proteins
What does a microalbumin creatinine ratio measure?
compares the amount of albumin to the amount of creatinine in your urine
What is a normal microalbumin creatinine ratio?
less than 30
Why do we compare albumin and creatinine in urine?
Albumin in urine can carry throughout the day but creatinine is released at a steady rate.
What is albumin?
A protein found in blood
What does high albumin indicate?
The kidneys aren’t working properly and are filtering products (like albumin) needed by the body.
Urinary casts
Particles found when urine is examined under the microscope during a urinalysis.
What is a normal cast range?
There should be NO casts in urine
What are the different types of abnormal casts?
- Fatty
- Granular
- Waxy
- RBC
- WBC
- Renal tubular epithelial cell
What does a test with fatty casts indicate?
- lipids in urine
2. nephrotic syndrome
What does a test with Granular casts indicate?
many types of kidney diseases
What does a test with RBC casts indicate?
microscopic amount of bleeding from the kidney
What does a test with Renal tubular epithelial cell casts indicate?
damage to tubule cells in the kidney
What does a test with Waxy casts indicate?
- advanced kidney disease
- long-term (chronic) kidney failure.
What does a test with WBC casts indicate?
acute kidney infections and interstitial nephritis
Hgb and Hct test
test for levels of RBC
How does a hgb and hct indicate kidney malfunction?
Pts with kidney disease are anemic
Why are kidney disease pts anemic?
they are not producing erythropoietin EPO (made in kidney)
Why test for potassium in kidney disease pts?
Potassium would be high because they retain urine and therefore potassium
Clinical urine test for examination of urine for certain physical properties, solutes, cells, casts, crystals, organisms, or particulate matter, and mainly serves for medical diagnosis.
Urinalysis
Urine culture vs Urinalysis
Culture takes days and analysis is faster
Urinalysis with a positive result may indicate what?: Leukocytes
UTI
Urinalysis with a positive result may indicate what?: Nitrate
UTI
Urinalysis with a positive result may indicate what?: Urobilinogen
Liver disease (hepatitis of cirrhosis)
Urinalysis with a positive result may indicate what?: Protein
infection or kidney damage
Urinalysis with a positive result may indicate what?: pH
high- UTI or kidney damage
low- kidney stones
Urinalysis with a positive result may indicate what?: Blood
kidney damage, liver disease
Urinalysis with a positive result may indicate what?: Specific Gravity
UTI or kidney dysfunction
Urinalysis with a positive result may indicate what?: Ketone
diabetic or ketogenic diet
Urinalysis with a positive result may indicate what?: Bilirubin
liver damage
Urinalysis with a positive result may indicate what?: Glucose
diabetes
Normal Urinalysis: Glucose
negative
Normal Urinalysis: Bilirubin
negative
Normal Urinalysis : ketones
negative
Normal Urinalysis: proteins
negative
Normal Urinalysis Levels: blood
negative
Normal Urinalysis Levels: nitrate
negative
Normal Urinalysis Levels: specific gravity
1.015-1.025
Normal Urinalysis Levels: urobilinogen
0-2
Normal Urinalysis Levels: leukocyte esterase
negative
Normal Urinalysis Levels: RBCs
0-2
Normal Urinalysis Levels: WBCs
0-5
If urinalysis indicates infection what should an APRN do?
Order antibiotics for the pt prophylactical
Etiology for hematuria
- Nephritic syndrome
- Pyelonephritis
- UTI
- Kidney stones
- Enlarged prostate
- Medication their taking
- Someone who strenuously exercises such as a long distance runner
- Family- inherited disorders
Narrowing of one or more arteries that carry blood to your kidneys
Atherosclerotic renal artery stenosis (RAS)
Symptoms of RAS
- HTN before 30yrs
- Sig. HTN after 55
- Abdominal bruit
- Accelerated HTN
- HTN that was easy to control but now resistant
- Recurrent flash pulmonary edema
- Multivessel CAD
- PAD
- Unexplained CHF
- Refectory angina
- Renal failure of certain etiology
- Renal failure involving RAAS treatment
Teachers example of RAS
When the teacher worked in cardiology she knew a pt that was a thin young man with HTN and he was on two HTN medications. His mother was a nurse. Meds could not control his HTN. Mom talked to cardiology friends and got referred to a specialist. He had RAS
What main symptom should prompt the APRN to send their pt to a specialist?
Pt with HTN who is refractory to medication management
Why is it important to identify pt that may have RAS?
If pt is not treated they could have a stroke
What is a treatment for RAS?
Stenting