🏥- Renal Test Flashcards
0
Q
Normal BUN level
A
8-21 mg/dL
1
Q
Normal serum creatinine level
A
0.5-1.2 mg/dL
2
Q
Oliguria
A
Decreased amount of urine output, 100-400 mL in 24hrs
3
Q
What are the 3 ways the kidneys maintain homeostasis
A
Urine formation and waste excretion
Regulatory function (fluid, acid-base balance, electrolytes)
Hormonal function
4
Q
List 3 hormones produced by the kidney
A
Renin
Erythropoietin
Activated vitamin d
5
Q
Glycosuria
A
Glucose in urine as a result of blood sugar greater than 220 mg/dL
6
Q
Kidneys function to maintain balance of
A
Water
Electrolytes
Acid-base
7
Q
Regulatory intake
A
2,500 mL/day
Metabolic water- 200mL
Food- 700mL
Drink- 1,600mL
8
Q
Regulatory output
A
2,500 mL/day
Feces- 200mL Expired air- 300mL Cutaneous transpiration- 400mL Sweat- 100mL Urine- 1,500mL
9
Q
Water balance by the kidneys prevents what
A
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
10
Q
Acid base balance - acidosis
A
Kidneys excrete H+ and reabsorb bicarb to INCREASE pH (make less acidic)
11
Q
Acid base balance- alkalosis
A
Kidneys reabsorb H+ and excrete bicarb to DECREASE pH (make less alkolodic)
12
Q
What causes renin to be produced
A
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
13
Q
What is the flow of angiotensin II formation
A
Renin from kidneys + angiotensinogen from liver = angiotensin I
Angiotensin I + angiotensin-converting enzyme (ACE) from lungs = angiotensin II
14
Q
Angiotensin II
A
Constricts blood vessels, causing increased BP
Stimulates adrenal gland to release aldosterone
Stimulates the hypothalamus to stimulate thirst
15
Q
Aldosterone
A
Causes increased Na+ reabsorption and subsequent water reabsorption in the DCT
16
Q
Activated vitamin d
A
- 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*
17
Q
Which electrolyte has an inverse relationship with Ca+
A
Phosphate
Low Ca+ in renal impairment usually has increased phosphate
18
Q
How many times a day should an average adult void
A
5-6
And doesn’t regularly need to void overnight
19
Q
Anuria
A
Total urine output of less than 100 mL in 24hrs
20
Q
Normal BUN/creatinine ratio
A
10:1 - 20:1
21
Q
Polyuria
A
Increased urine output ; greater than 2,000 mL in 24hrs
22
Q
Normal range of specific gravity
A
1.005 - 1.030
23
Q
Normal pH of urine
A
4.5-8
24
Bacteria in urine
Should be less than 1,000 colonies/mL
25
An increased osmolality can mean what
Indicates diabetes mellitus, dehydration, fever
26
A decreased osmolality can mean what
Indicates renal insufficiency, diabetes insipidus, diuretic use
27
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
28
Urine cytology
Used to identify any abnormal cells preset in the urine
29
Intravenous urography
Requires the administration of radiographical dye (contrast) via an IV line
30
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
31
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
32
Cystography and urethrography
Contrast is used, guided by a lighted instrument inserted into the bladder (cystogram) or urethra (urethrogram) to assess for abnormalities
33
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
34
Signs of internal bleeding after a renal biopsy include
Flank pain, decreased urine output, decreased BP and other signs of hypovolemia and shock
35
What is the most common complication following a renal biopsy
Hematuria
Should resolve within 48-72hrs , notify provider if lasts beyond 72 hrs
36
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.
37
Cystitis
Lower urinary tract , affecting only the bladder
38
Pyelonephritis
Upper urinary tract , affecting the kidneys
39
Pathophysiology of UTI's
Occurs when bacteria enters the sterile bladder causing inflammation
40
Clinical manifestations of cystitis
Bladder irritability or painful urination
Dysuria, urinary frequency, urgency, urinate in small volumes
Hematuria and suprapubic pain
41
Clinical manifestations of pyelonephritis
Fever, nausea and vomiting, flank pain
42
What 2 drugs are common antibiotics prescribed for UTI
Trimethoprim/sulfamethoxazole (bactrim)
Ciprofloxacin (Cipro)
43
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
44
What signs can indicated UTI from an abdominal examination
Suprapubic tenderness - can indicate lower tract infection
Costovertebral tenderness - can indicate upper tract infection
45
What should you educate patients on in regards to phenazopyridine (pyridium) use
It turns the urine an orange/red color
46
Urolithiasis
Calcification in the urinary system aka kidney stones
Nephrolithiasis - stones in the kidney
Ureterolithiasis - stones in the ureter
47
What population is at greatest risk of developing kidney stones
Caucasian males .. in the southeastern United States and summer months
48
What are kidney stones made of
80% are made of calcium
Other 20% are made of a combination of cystine, Uric acid and xanthine
49
Clinical manifestations of urolithiasis
Severe pain causing distension and obstruction of urine flow. Concomitant nausea and vomiting
50
Upper ureteral stones would cause pain where
Referred pain to the flank
51
Lower ureteral stones would cause pain where
Lower abdominal, genital pain along with irritative voiding symptoms
52
Hydronephrosis
Swelling of the kidneys, occurs when urine flow is blocked causing urine to accumulate in the kidney
53
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)
54
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
55
Sympathetic vs parasympathetic NS regarding micturition
Sympathetic- mediate bladder storage
Parasympathetic- provides motor stimulation to the bladder and mediates bladder construction
56
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
57
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
58
Mixed incontinence
A combination of urge and stress incontinence
59
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
60
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
61
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
62
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
63
Imipramine (tofranil)
Tricyclic antidepressant used to treat mixed urge and stress incontinence; has anticholinergic effect
64
How do anticholinergics work to treat urinary incontinence
Block impulses from the parasympathetic nervous system to relax and control the bladder
65
What is the most important risk factor for bladder cancer in the United States
Smoking
66
Clinical manifestations of pkd
```
Hypertension
Hematuria
Pain in the back, abdomen or flank area
Headaches
UTI
Urinary stones
Palpable, bilateral enlarged kidneys
```
67
Would a H/H be increased or decreased with pkd
Decreased due to no erythropoietin production
68
Electrolytes and pkd
Increased Na, K, Phos
Decreased Ca
69
What is the most common cause of pyelonephritis
Bacterium escherchia coli
70
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
71
What are the early signs of urosepsis
```
Changes in mental status
Fever
Tachycardia
Tachypnea
Hypotension
Oliguria
Leukopenia
```
72
Risk factors associated with glomerulonephritis
```
Strep infections
Lupus
Vasculitis
Hypertension
Diabetes
```
73
Glomerulonephritis
Damage to glomeruli causes decreased gfr and increased permeability to larger proteins
74
Clinical manifestations of glomerulonephritis
```
Headache
Increased BP
Edema
Lethargic
Low grade fever
Proteinuria
Hematuria
Oliguria
Dysuria
```
75
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
76
What is the biggest risk factor of developing renal cancer
Smoking .. chewing tobacco, cigars, snuff
Others:
Familial association, obesity, hypertension, asbestos, cadmium, gasoline
77
What is the classic triad associated with renal cancer
Flank mass
Flank pain
Hematuria
78
Myopia
Nearsightedness , image falls in front of the retina
79
Hyperopia
Farsightedness, image falls behind the retina
80
Cataract
Clouding of the eyes crystalline lens
