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Tests various > 🏥- Renal Test > Flashcards

🏥- Renal Test Flashcards

1
Q

Normal BUN level

A

8-21 mg/dL

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2
Q

Oliguria

A

Decreased amount of urine output, 100-400 mL in 24hrs

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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

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4
Q

List 3 hormones produced by the kidney

A

Renin

Erythropoietin

Activated vitamin d

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5
Q

Glycosuria

A

Glucose in urine as a result of blood sugar greater than 220 mg/dL

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6
Q

Kidneys function to maintain balance of

A

Water

Electrolytes

Acid-base

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7
Q

Regulatory intake

A

2,500 mL/day

Metabolic water- 200mL
Food- 700mL
Drink- 1,600mL

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8
Q

Regulatory output

A

2,500 mL/day

Feces- 200mL
Expired air- 300mL 
Cutaneous transpiration- 400mL 
Sweat- 100mL 
Urine- 1,500mL
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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

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10
Q

Acid base balance - acidosis

A

Kidneys excrete H+ and reabsorb bicarb to INCREASE pH (make less acidic)

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11
Q

Acid base balance- alkalosis

A

Kidneys reabsorb H+ and excrete bicarb to DECREASE pH (make less alkolodic)

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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

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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

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14
Q

Angiotensin II

A

Constricts blood vessels, causing increased BP

Stimulates adrenal gland to release aldosterone

Stimulates the hypothalamus to stimulate thirst

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15
Q

Aldosterone

A

Causes increased Na+ reabsorption and subsequent water reabsorption in the DCT

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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*
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17
Q

Which electrolyte has an inverse relationship with Ca+

A

Phosphate

Low Ca+ in renal impairment usually has increased phosphate

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18
Q

How many times a day should an average adult void

A

5-6

And doesn’t regularly need to void overnight

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19
Q

Anuria

A

Total urine output of less than 100 mL in 24hrs

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20
Q

Normal BUN/creatinine ratio

A

10:1 - 20:1

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21
Q

Polyuria

A

Increased urine output ; greater than 2,000 mL in 24hrs

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22
Q

Normal range of specific gravity

A

1.005 - 1.030

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23
Q

Normal pH of urine

A

4.5-8

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24
Q

Bacteria in urine

A

Should be less than 1,000 colonies/mL

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25
Q

An increased osmolality can mean what

A

Indicates diabetes mellitus, dehydration, fever

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26
Q

A decreased osmolality can mean what

A

Indicates renal insufficiency, diabetes insipidus, diuretic use

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27
Q

Composite urine collection

A

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

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28
Q

Urine cytology

A

Used to identify any abnormal cells preset in the urine

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29
Q

Intravenous urography

A

Requires the administration of radiographical dye (contrast) via an IV line

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30
Q

Preprocedure instructions for IV urography

A
  • 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
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31
Q

Postprocedure instructions for IV urography

A
  • increase fluid intake

- Monitor for changes in urine output, irritation at IV site and delayed signs of reaction to contrast

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32
Q

Cystography and urethrography

A

Contrast is used, guided by a lighted instrument inserted into the bladder (cystogram) or urethra (urethrogram) to assess for abnormalities

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33
Q

Voiding cystourethrogram VCUG

A

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
Q

Signs of internal bleeding after a renal biopsy include

A

Flank pain, decreased urine output, decreased BP and other signs of hypovolemia and shock

35
Q

What is the most common complication following a renal biopsy

A

Hematuria

Should resolve within 48-72hrs , notify provider if lasts beyond 72 hrs

36
Q

Lithotomy position

A

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
Q

Cystitis

A

Lower urinary tract , affecting only the bladder

38
Q

Pyelonephritis

A

Upper urinary tract , affecting the kidneys

39
Q

Pathophysiology of UTI’s

A

Occurs when bacteria enters the sterile bladder causing inflammation

40
Q

Clinical manifestations of cystitis

A

Bladder irritability or painful urination

Dysuria, urinary frequency, urgency, urinate in small volumes

Hematuria and suprapubic pain

41
Q

Clinical manifestations of pyelonephritis

A

Fever, nausea and vomiting, flank pain

42
Q

What 2 drugs are common antibiotics prescribed for UTI

A

Trimethoprim/sulfamethoxazole (bactrim)

Ciprofloxacin (Cipro)

43
Q

What changes in vital signs should be expected with an UTI

A

Elevated temperature, elevated heart rate and decreased BP - may indicated upper urinary tract and dehydration

44
Q

What signs can indicated UTI from an abdominal examination

A

Suprapubic tenderness - can indicate lower tract infection

Costovertebral tenderness - can indicate upper tract infection

45
Q

What should you educate patients on in regards to phenazopyridine (pyridium) use

A

It turns the urine an orange/red color

46
Q

Urolithiasis

A

Calcification in the urinary system aka kidney stones

Nephrolithiasis - stones in the kidney

Ureterolithiasis - stones in the ureter

47
Q

What population is at greatest risk of developing kidney stones

A

Caucasian males .. in the southeastern United States and summer months

48
Q

What are kidney stones made of

A

80% are made of calcium

Other 20% are made of a combination of cystine, Uric acid and xanthine

49
Q

Clinical manifestations of urolithiasis

A

Severe pain causing distension and obstruction of urine flow. Concomitant nausea and vomiting

50
Q

Upper ureteral stones would cause pain where

A

Referred pain to the flank

51
Q

Lower ureteral stones would cause pain where

A

Lower abdominal, genital pain along with irritative voiding symptoms

52
Q

Hydronephrosis

A

Swelling of the kidneys, occurs when urine flow is blocked causing urine to accumulate in the kidney

53
Q

What type of medication is given to aid in the passage of kidney stones 5mm or less

A

Alpha-adrenergic blockers

Tamsulosin (flomax), doxazosin (cardura) and terazosin (hytrin)

54
Q

What type of diet should be consumed for kidney stone prevention

A

Increase intake of citrate - lemons and lemonade

Decreased intake of oxalate - spinach, rhubarb, chocolate, tea, coffee and nuts

55
Q

Sympathetic vs parasympathetic NS regarding micturition

A

Sympathetic- mediate bladder storage

Parasympathetic- provides motor stimulation to the bladder and mediates bladder construction

56
Q

Urge incontinence

A

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
Q

Stress incontinence

A

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
Q

Mixed incontinence

A

A combination of urge and stress incontinence

59
Q

Overflow incontinence

A

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
Q

Functional incontinence

A

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
Q

Reflex incontinence

A

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
Q

What medications are used to help overactive bladder

A

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
Q

Imipramine (tofranil)

A

Tricyclic antidepressant used to treat mixed urge and stress incontinence; has anticholinergic effect

64
Q

How do anticholinergics work to treat urinary incontinence

A

Block impulses from the parasympathetic nervous system to relax and control the bladder

65
Q

What is the most important risk factor for bladder cancer in the United States

A

Smoking

66
Q

Clinical manifestations of pkd

A 
Hypertension 
Hematuria 
Pain in the back, abdomen or flank area 
Headaches 
UTI 
Urinary stones 
Palpable, bilateral enlarged kidneys
67
Q

Would a H/H be increased or decreased with pkd

A

Decreased due to no erythropoietin production

68
Q

Electrolytes and pkd

A

Increased Na, K, Phos

Decreased Ca

69
Q

What is the most common cause of pyelonephritis

A

Bacterium escherchia coli

70
Q

Clinical manifestations of pyelonephritis

A

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
Q

What are the early signs of urosepsis

A 
Changes in mental status 
Fever 
Tachycardia 
Tachypnea 
Hypotension 
Oliguria 
Leukopenia
72
Q

Risk factors associated with glomerulonephritis

A 
Strep infections
Lupus 
Vasculitis 
Hypertension 
Diabetes
73
Q

Glomerulonephritis

A

Damage to glomeruli causes decreased gfr and increased permeability to larger proteins

74
Q

Clinical manifestations of glomerulonephritis

A 
Headache 
Increased BP 
Edema 
Lethargic
Low grade fever 
Proteinuria 
Hematuria 
Oliguria 
Dysuria
75
Q

What is the most common type of renal cancer

A

Renal cell carcinoma

Occurs more often in males 50 to 70, blacks and Alaskan/Indian natives

76
Q

What is the biggest risk factor of developing renal cancer

A

Smoking .. chewing tobacco, cigars, snuff

Others:
Familial association, obesity, hypertension, asbestos, cadmium, gasoline

77
Q

What is the classic triad associated with renal cancer

A

Flank mass
Flank pain
Hematuria

78
Q

Myopia

A

Nearsightedness , image falls in front of the retina

79
Q

Hyperopia

A

Farsightedness, image falls behind the retina

80
Q

Cataract

A

Clouding of the eyes crystalline lens

81
Q

Normal serum creatinine level

A

0.5-1.2 mg/dL

Tests various (20 decks)

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