Renal Up to Chronic Kidney Disease Flashcards by Julie Kinard

What are the 3 major roles of the kidney?

Maintain osmotic pressure by regulating blood concentrations of many ions
regulates the volume of the extracellular fluid by controlling Na2+ and water excretion
Helps regulate the acid-base balance by excreting H+ when there is excess acid and HCO - when there is an excess base.

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How does the kidney help regulate blood pressure?

activates the RAS system to regulate fluid volume

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How does the kidney help with endocrine fxn?

helps produce erythropoietin and renin
responds to ANG II, aldosterone, ADH

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The kidney receives ____% of CO and ____% of O2

20%, 7%

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What is the glomerulus?

network of small blood vessels located at the entrance to individual nephrons in the kidney.

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what is the glomerulus surrounded by?

bowman’s capsule

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what is the glomerulus surrounded by?

bowman’s capsule

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What are the glomerular filtration barriers?

endothelial cells
glomerular basement membrane
slit processes of the podocytes

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The renal corpuscle is made up of the:

glomerulus and bowman’s capsule

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What is the functional unit of the kidney

nephron

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What is the passageway of urine through the urinary tract?

kidney -> renal pelvis -> ureter -> urinary bladder -> urethra

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A chokepoint at any of the points along the urinary pathway may result in:

An enlarged prostate and weakened detrusor muscle

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What are the issues secondary to kidney disease?

cognitive issues
inc. cardiac problems
anemia
electrolyte imbalance
impaired drug metabolism
impaired muscle function
osteoporosis

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Why are females more prone to UTI’s?

The urethra lies closer to vaginal and rectal openings and the urethra is shorter.

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What are the risk factors for UTI’s?

Age
immobility
instrumentation and urinary catheterization
frequent catheterization
atonic bladder
urinary tract obstructions
renal calculi
Prostatic hyperplasia
gender
pregnancy diabetes

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What is the bacteria most responsible for UTI’s?

E. coli 80%
staphylococcus saprophyticus 5 - 15%

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What is the bacteria most responsible for UTI’s?

E. coli 80%
staphylococcus saprophyticus 5 - 15%

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The migration of the UTI-causing bacteria is opposed by what?

a urine stream

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What is a major Sign and Symptoms of UTIs

Hematuria
painful urination
pyuria (increased # of neutrophils in urine)
Dyspareunia

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Define pyelonephritis.

infection of the kidney

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define cystitis.

infection of the bladder

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define urethritis.

infection of the urethra

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When a UTI progresses to the upper urinary system, this is called:

pyelonephritis

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what can chronic pyelonephritis lead to?

scarring of the calyces of the kidney

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what can chronic pyelonephritis lead to?

scarring of the calyces of the kidney

what are the important symptoms of a chronic kidney infection?

fever pus or blood in the urine painful urination chills fatigue

What are the risk factors of pyelonephritis?

sex UTIs Diabetes urine reflux immunocompromised patients urinary incontinence ureter obstruction

what are the causes of chronic pyelonephritis?

chronic infection urine reflex ureter obstruction atonic bladder

What is urine reflux?

A blockage in the kidney where urine cannot leave the kidney

What is the pathogenesis of pyelonephritis?

scarring resulting in the deformity of the calyces

How do PT's help manage renal/urinary tract infections?

recognize risk factors and presentations of UTI's

What are the implications for the PT regarding UTI infections?

1. limit participation in rehab 2. be aware of N and V, temp >102 degrees 3. Be aware of changes in mental status 4. Be aware of sudden onset of back pain 5. UTI increases risk of sepsis 6. AMS 7. Personal Hygiene of pt.

How do we manage urinary incontinence as a PT?

Great for pelvic floor pts to improve pelvic floor muscles and alleviate pain, weakness, and dysfunction.

What is GFR?

A direct measure or an estimate of the rate at which materials in the blood are filtered by the kidneys

what is normal GFR?

> 90 ml/min.

GFR can be estimated from what type of test?

blood creatine test

An increase in which two bodily substances may be indicative of kidney dysfunction due to decreasing GFR rates?

serum creatine and urea levels

Other than a blood creatine test, what other tests can be done to help detect kidney damage or evaluate kidney function?

urine albumin (microalbumin) albumin/creatinine ration (ACR) Renal Panel

What is acute renal failure?

an abrupt decrease in renal function sufficient enough to result in retention of nitrogenous waste and disrupt fluid and electrolyte homeostasis.

How do we diagnose acute renal failure?

1. increase in serum creatinine levels 2. decreased urine output (presence of oliguria or anuria) 3. Lab results 4. clinical findings (edema, altered mental status)

What big drugs are associated with renal failure?

NSAIDS and ACEi, aminoglycosides, methotrexate

What are the 3 mechanisms regarding drugs and toxins with renal failure?

1. direct tubular injury 2. tubular obstruction/ damage 3. immunological - inflammatory

What drug plays a part in the immunological inflammatory cause of renal failure?

penicillin

Chronic Kidney Disease is defined as:

a condition characterized by a gradual loss of kidney function over time.

CKD is present when what is consistently found in the urine?

protein (proteinuria)

What are causes of CKD?

DM HTN Glomerulonephritis repeated UTI's autoimmune disorders

Is stage 1 of chronic kidney disease reversible?

possibly

Stage 1 of CKD is characterized by:

microalbuminuria elevated BUN and creatinine

Stage 2 of CKD is characterized by:

more albumin in the urine azotemia (accumulation of nitrogen-containing waste products in the blood)

Stage 5 of CKD is described aka:

End Stage Renal Disease

What are characteristics of stage 5 CKD?

Loss of kidney function Uremia (an excess of amino acid, protein, urea, and creatinine in the blood) kidneys cannot excrete toxins, maintain pH, fluid or electrolyte balance

Pts in Stage 5 CKD need:

transplant or dialysis

What are the clinical manifestations of CKD?

Anemia (loss of erythropoitin, GI bleeds) CVD (HTN, CAD, CHF) GI (N and V, anorexia, gastritis) MS (increased bone reabsorption myopathy)

Neurological clinical manifestations of CKD =

memory loss inability to concentrate perceptual errors decreased alertness

At what GFR will these neurological manifestations occur?

below 10 ml

What is Hemodialysis?

removes blood from the body & sends it across a semipermeable membrane and dialysate. The pressure gradient will remove the harmful substances.

What is required to perform hemodialysis?

vascular access

What do therapists need to stay away from if a pt is receiving hemodialysis?

the fistula

What measures dialysis adequacy?

the urea reduction ratio

Each dialysis trx should reduce:

urea levels (aka BUN) by 65%

What is peritoneal Dialysis?

continuous ambulatory peritoneal dialysis

do you need vascular access for peritoneal dialysis?

What are 5 things we need to remember about peritoneal dialysis?

1. It is less efficient than hemodialysis 2. refill abdominal cavity 4 - 5x daily 3. performed at home 4. fewer adverse effects than hemodialysis 5. access favors infection

What do I need to know about the diet of those receiving dialysis?

fluid intake is limited electrolyte intake is limited low protein diet then progress to high protein diet

What do I need to know about the diet of those receiving dialysis?

fluid intake is limited electrolyte intake is limited low protein diet then progress to high protein diet

what are the adverse effects of CKD?

fluid shifts depression increased risk of infection malnutrition progressively increasing osmotic concentration as time since dialysis lengthens

For a kidney transplant, how do you match the donor and recipient?

1. Tissue type and blood type but primarily blood type

What is the most common cause of CKD?

Diabetic nephropathy

What specific condition leads to glomerular hyperfiltration which will damage the arterioles and capillaries in the glomeruli?

hyperglycemia

What will hyperfiltration of the glomerulus cause?

thickening of the glomerular basement membrane

thickening of the glomerular basement membrane leads to:

intraglomerular hypertension and destruction of the glomeruli.

Why does diabetes cause CKD?

the nephrons will begin to fail if there are chronic high concentrations of glucose

What is a representation of glomerulofiltration rates?

Hemoglobin A1C levels

Why does hypertension cause CKD?

ischemia will cause damage to the kidneys and will not allow regulation of whole body BP

What are the 3 things PTs must-do for pts who have CKD and diabetes?

Monitor BP! How HbA1C levels EDUCATION!!!!!!!