🏥- Renal Test Flashcards
Normal BUN level
8-21 mg/dL
Normal serum creatinine level
0.5-1.2 mg/dL
Oliguria
Decreased amount of urine output, 100-400 mL in 24hrs
What are the 3 ways the kidneys maintain homeostasis
Urine formation and waste excretion
Regulatory function (fluid, acid-base balance, electrolytes)
Hormonal function
List 3 hormones produced by the kidney
Renin
Erythropoietin
Activated vitamin d
Glycosuria
Glucose in urine as a result of blood sugar greater than 220 mg/dL
Kidneys function to maintain balance of
Water
Electrolytes
Acid-base
Regulatory intake
2,500 mL/day
Metabolic water- 200mL
Food- 700mL
Drink- 1,600mL
Regulatory output
2,500 mL/day
Feces- 200mL Expired air- 300mL Cutaneous transpiration- 400mL Sweat- 100mL Urine- 1,500mL
Water balance by the kidneys prevents what
Enable the kidneys to control the volume and concentration of urine independently from fluid intake
Prevent dehydration when fluid intake is low
Prevent volume overload when fluid intake is excessive
Acid base balance - acidosis
Kidneys excrete H+ and reabsorb bicarb to INCREASE pH (make less acidic)
Acid base balance- alkalosis
Kidneys reabsorb H+ and excrete bicarb to DECREASE pH (make less alkolodic)
What causes renin to be produced
When receptors in the kidneys sense a decrease in blood flow, volume or pressure AND/OR when decreased levels of Na+ in the blood is detected
What is the flow of angiotensin II formation
Renin from kidneys + angiotensinogen from liver = angiotensin I
Angiotensin I + angiotensin-converting enzyme (ACE) from lungs = angiotensin II
Angiotensin II
Constricts blood vessels, causing increased BP
Stimulates adrenal gland to release aldosterone
Stimulates the hypothalamus to stimulate thirst
Aldosterone
Causes increased Na+ reabsorption and subsequent water reabsorption in the DCT
Activated vitamin d
- vitamin d is obtained from diet and UV radiation
- vitamin d is converted to calcidiol in the liver
- calcidol is converted to calcitriol in the kidneys
- ACTIVATED FORM OF VITAMIN D IS REQUIRED FOR CA+ TO BE ABSORBED IN THE GI TRACT*
Which electrolyte has an inverse relationship with Ca+
Phosphate
Low Ca+ in renal impairment usually has increased phosphate
How many times a day should an average adult void
5-6
And doesn’t regularly need to void overnight
Anuria
Total urine output of less than 100 mL in 24hrs
Normal BUN/creatinine ratio
10:1 - 20:1
Polyuria
Increased urine output ; greater than 2,000 mL in 24hrs
Normal range of specific gravity
1.005 - 1.030
Normal pH of urine
4.5-8
Bacteria in urine
Should be less than 1,000 colonies/mL
An increased osmolality can mean what
Indicates diabetes mellitus, dehydration, fever
A decreased osmolality can mean what
Indicates renal insufficiency, diabetes insipidus, diuretic use
Composite urine collection
Collecting all urine voided for a defined period of time ranging between 2 and 24hrs
*sample should be refrigerated or kept on ice for the duration of collection
Urine cytology
Used to identify any abnormal cells preset in the urine
Intravenous urography
Requires the administration of radiographical dye (contrast) via an IV line
Preprocedure instructions for IV urography
- bowel preparation and NPO approximately 8hrs before
- may feel brief flushing sensation and a salty taste in mouth during injection of contrast
- signed informed consent
- baseline serum creatinine (nephrotoxic)
- allergies
Postprocedure instructions for IV urography
- increase fluid intake
- Monitor for changes in urine output, irritation at IV site and delayed signs of reaction to contrast
Cystography and urethrography
Contrast is used, guided by a lighted instrument inserted into the bladder (cystogram) or urethra (urethrogram) to assess for abnormalities
Voiding cystourethrogram VCUG
Performed to determine if vesicoureteral reflux is present
Void after bladder is filled with contrast , if reflux is present urine is backflowing from the bladder into the ureters/kidney increasing risk of developing infections
Signs of internal bleeding after a renal biopsy include
Flank pain, decreased urine output, decreased BP and other signs of hypovolemia and shock
What is the most common complication following a renal biopsy
Hematuria
Should resolve within 48-72hrs , notify provider if lasts beyond 72 hrs
Lithotomy position
a supine position of the body with the legs separated, flexed, and supported in raised stirrups, originally used for lithotomy and later also for childbirth.
Cystitis
Lower urinary tract , affecting only the bladder
Pyelonephritis
Upper urinary tract , affecting the kidneys
Pathophysiology of UTI’s
Occurs when bacteria enters the sterile bladder causing inflammation
Clinical manifestations of cystitis
Bladder irritability or painful urination
Dysuria, urinary frequency, urgency, urinate in small volumes
Hematuria and suprapubic pain
Clinical manifestations of pyelonephritis
Fever, nausea and vomiting, flank pain
What 2 drugs are common antibiotics prescribed for UTI
Trimethoprim/sulfamethoxazole (bactrim)
Ciprofloxacin (Cipro)
What changes in vital signs should be expected with an UTI
Elevated temperature, elevated heart rate and decreased BP - may indicated upper urinary tract and dehydration
What signs can indicated UTI from an abdominal examination
Suprapubic tenderness - can indicate lower tract infection
Costovertebral tenderness - can indicate upper tract infection
What should you educate patients on in regards to phenazopyridine (pyridium) use
It turns the urine an orange/red color
Urolithiasis
Calcification in the urinary system aka kidney stones
Nephrolithiasis - stones in the kidney
Ureterolithiasis - stones in the ureter
What population is at greatest risk of developing kidney stones
Caucasian males .. in the southeastern United States and summer months
What are kidney stones made of
80% are made of calcium
Other 20% are made of a combination of cystine, Uric acid and xanthine
Clinical manifestations of urolithiasis
Severe pain causing distension and obstruction of urine flow. Concomitant nausea and vomiting
Upper ureteral stones would cause pain where
Referred pain to the flank
Lower ureteral stones would cause pain where
Lower abdominal, genital pain along with irritative voiding symptoms
Hydronephrosis
Swelling of the kidneys, occurs when urine flow is blocked causing urine to accumulate in the kidney
What type of medication is given to aid in the passage of kidney stones 5mm or less
Alpha-adrenergic blockers
Tamsulosin (flomax), doxazosin (cardura) and terazosin (hytrin)
What type of diet should be consumed for kidney stone prevention
Increase intake of citrate - lemons and lemonade
Decreased intake of oxalate - spinach, rhubarb, chocolate, tea, coffee and nuts
Sympathetic vs parasympathetic NS regarding micturition
Sympathetic- mediate bladder storage
Parasympathetic- provides motor stimulation to the bladder and mediates bladder construction
Urge incontinence
Is the involuntary loss of larger amounts of urine accompanied by a strong urge to void overactive bladder
Causes:
Exposure to bladder irritants such as caffeine, artificial sweeteners or nicotine
Stress incontinence
An involuntary loss of small amounts of urine with activities that increase intraabdominal pressure i.e. Laughing, coughing, lifting, sneezing
Causes:
- Childbirth which causes stretching and relaxing of pelvic floor muscles, ligaments and urethra
- smoking, obesity
Mixed incontinence
A combination of urge and stress incontinence
Overflow incontinence
Loss of urine in combination with a distended bladder
Causes:
Flaccid/enlarged bladder due to obstruction, spinal injury, stroke, diabetes or neuro
Manifestations:
Frequent urination
Functional incontinence
The untimely loss of urine when no urinary or neuro cause is involved
Causes:
Inability to get to the toilet or communicate the need to do so
Reflex incontinence
Loss of urine when the person doesn’t realize the bladder is full and has no urge to void
Causes:
Disorders that affect the nervous impulse for voiding such as MS, brain tumors or stroke
What medications are used to help overactive bladder
Anticholinergics - calm an overactive bladder
Ex: oxybutynin (ditropan), tolterodine (Detrol), darifenacin (enablex) and trospium (sanctura)
Block nervous stimulation from the parasympathetic nervous system to help relax and control bladder muscle contractions
Imipramine (tofranil)
Tricyclic antidepressant used to treat mixed urge and stress incontinence; has anticholinergic effect
How do anticholinergics work to treat urinary incontinence
Block impulses from the parasympathetic nervous system to relax and control the bladder
What is the most important risk factor for bladder cancer in the United States
Smoking
Clinical manifestations of pkd
Hypertension Hematuria Pain in the back, abdomen or flank area Headaches UTI Urinary stones Palpable, bilateral enlarged kidneys
Would a H/H be increased or decreased with pkd
Decreased due to no erythropoietin production
Electrolytes and pkd
Increased Na, K, Phos
Decreased Ca
What is the most common cause of pyelonephritis
Bacterium escherchia coli
Clinical manifestations of pyelonephritis
Signs of infection, which include fever, chills and nausea/vomiting
Back and/or flank pain , costovertebral tenderness and enlarged kidneys
Symptoms include signs of UTI such as frequent and painful urination and hematuria
What are the early signs of urosepsis
Changes in mental status Fever Tachycardia Tachypnea Hypotension Oliguria Leukopenia
Risk factors associated with glomerulonephritis
Strep infections Lupus Vasculitis Hypertension Diabetes
Glomerulonephritis
Damage to glomeruli causes decreased gfr and increased permeability to larger proteins
Clinical manifestations of glomerulonephritis
Headache Increased BP Edema Lethargic Low grade fever Proteinuria Hematuria Oliguria Dysuria
What is the most common type of renal cancer
Renal cell carcinoma
Occurs more often in males 50 to 70, blacks and Alaskan/Indian natives
What is the biggest risk factor of developing renal cancer
Smoking .. chewing tobacco, cigars, snuff
Others:
Familial association, obesity, hypertension, asbestos, cadmium, gasoline
What is the classic triad associated with renal cancer
Flank mass
Flank pain
Hematuria
Myopia
Nearsightedness , image falls in front of the retina
Hyperopia
Farsightedness, image falls behind the retina
Cataract
Clouding of the eyes crystalline lens
