Renal/Urologic System Flashcards
Nephron Function
- filter blood
- reabsorb fluid
- forms filtrate of protein-free plasma
- maintain body fluid volume
- maintain electrolyte composition
- maintain body pH
Kidney receives _____& of cardiac output
-20%
Pathway
- blood vessel
- bowman’s capsule
- glomerulus
- prox convoluted tubule
- Loop of Henle
- Distal convoluted tubule
- collecting duct
- urethra
____ of plasma is filtered into the renal tubules
20%
urinary output=____L/day
1.5L/day
most fluid reabsorbed back from tubules
GFR
- glomerular filtration rate
- rate of plasma filtration by glomerulus
Clearance
-volume from which all test substance is removed
______ is often used to measure GFR
-creatinine clearance
Creatine
- Mm metabolism byproduct
- has fairly constant plasma level
_________level alone is often used to monitor GFR
-plasma creatinine
Substantial GFR changes may be reflected in _______
-relatively small plasma creatinine changes
Normal Creatinine Levels
Male=0.7-1.3
Female=0.6-1.1
Tests of Renal System
- GFR
- Plasma Creatinine Concentration
- BUN
- Urinalysis
Urinalysis
- best test for infectious agents or foreign materials (toxins, drugs)
- color, turbidity, protein, pH, specific gravity, sediment)
Diuretics
- inhibit Na+ uptake
- ->more water remains in tubule and urine
Diuretic Effects on Body
-decrease BP, edema, body fluid, CHF symptoms
Pathologies of Renal System
- Infection
- Cancer
- Renal Cystic Disease
- Renal Calculi
- Chronic Renal Failure
- Glomerulonephritis
- Neurogenic disorders
- urinary incontinence
UTI
- Urethritis
- Cystitis (bladder infection)
Urethritis Sx
- Inflamm/pain at urethral opening
- painful urination
Cystitis Sx
- bladder infection
- Painful urinatino
- frequent urination
- urgent need to urinate
- urine cloudy/red
- fever sometimes
- suprapubic/low back pain
- flank pain
Pyelonephritis Symptoms
- (Kidney infection)
- symptoms suggesting bladder infection
- abrupt onset
- high fever/chills
- back pain around kidney
- nausea/vomiting
Kidney/UTI Evaluation
- Urinalysis
- tender to percussion at costovertebral angle (pyelonephritis)
Prevention of Kidney/UTI
- post-void residual assessment to assess urinary retention
- sufficient fluid intake
- urogenital hygiene
Kidney/UTI Treatment
- antibiotics
- increase fluids
- consider lactobacillius acidophilus to prevent yeast growth when on antibiotics
- contact doc if not better in 48-72 hours
Renal Cell Carcinoma
- malignant tumor
- 80-90% of all renal neoplasms
Renal Cell Carcinoma Incidence
-male (over 60) 2x > female
S/Sx Renal Cell Carcinoma
- bloody urine
- abdominal/flank pain
- palpable mass
- HTN
- hyperparathyroidism
Metastases of Renal Cell Carcinoma
- lungs
- bone (lumbar vert)
Eval/Treatment of Renal Cell Carcinoma
- radiographic imaging
- surgical removal of tumor
Risk Factors of Renal Cell Carcinoma
- tobacco use
- obesity
- HTN
- decreased fruits/veggies
- increased red meat
- occupational toxins
Bladder Cancer Incidence
- 4th leading cause of cancer in men
- 7th leading cause of cancer death in US
S/Sx Bladder Cancer
- hematuria
- frequency
- urgency
- dysuria (painful)
Metastases of Bladder Cancer
- bone
- pariaortic lymphnodes may cause low back pain
Prevention of Bladder Cancer
-tobacco cessation
_________& ______ may reduce recurrence of bladder cancer by 40%
-vitamin/zinc supplement & immunotherapy
Treatment of Bladder Cancer
- resection of pelvic lymph nodes/prostate/seminal vesicles/uterus
- radiation/chemo
- salvage cystectomy &/or transplantation
Bladder Cancer Screening
-screening of men at risk over 50 significantly lowers incidence & mortality
Nephrolithiasis
-kidney stones
Renal Calculi
-masses of crystals and proteins
Nephrolithiasis Cause
-unknown
S/Sx Nephrolithiasis
- pain along flank
- N/V
- hematuria
Eval/Treatment of Nephrolithiasis
- increase urine flow
- modify dietary intake of possible irritant substances
Renal Failure
- acute renal failure (ARF) (reversible)
- Chronic renal failure (irreversible)
causes of ARF
- many causes
- impaired renal blood flow (reversible)
Chronic Renal Failure Results in:
-loss of normal kidney function
Indicators of Chronic Renal Failure
- GFR falls
- Uremia
Uremia
-accumulation of toxins in blood
S/Sx of Chronic Renal Failure
- anorexia
- N/V
- fatigue
- HTN
- pruritis
- decreased urin output
- edema
- neurological changes
Eval/Treatment of Chronic Renal Failure
- regulate food/fluid intake
- Na+ & K+ restriction
- Dialysis
- Transplantation
Stages of Chronic Renal Failure
- Diminished Renal Reserve
- Renal Insufficiency
- Renal Failure
- End-Stage Renal Disease (ESRD)
Diminished Renal Reserve
- GFR: 50% normal rate
- no overt Sx due to kidney adaptation
Renal Insufficiency
- GFR: 20-35% normal rate
- possible azotemia, anemia, HTN
Renal Failure
stage
- GFR <20-25% normal rate
- edema, metabolic acidosis, hypocalcemia
ESRD
- GFR: <5% normal rate
- 90% kidney function lost
- all body systems involved
Systemic Manifestations of Kidney Failure
- decreased urine w/ abnormal constituents
- CAD, HTN, CHF, pulm edema, pericarditis
- GI bleeding, nausea, - HA, irritability irritability impaired judgment & concentration, seizures, coma
- PNS tremors, cramps weakness
- pruritis, hyperpigmentation, pallor, bruising
- anemia, platelet dysfunction
- joint pain, osteodystrophy
- fertility impairment, hyperparathyroidism
Leading cause of kidney failure in US
-diabetic neuropathy
Prevention of Kidney Failure
-edu of risk factors
Risk Factors of Kidney Failure
- DM (#1 cause)
- HTN (#2 cause)
- CAD
- Decreased activity
- tobacco
- NSAIDs/analgesic combos
Dialysis
-hemodialysis or peritoneal dialysis
Hemodialysis
-3x/week for 3-4 hours
Peritoneal dialysis
-3x daily
Risk of Dialysis
-infection of immunocompromised pts
Dialysis Considerations
- HTN before dialysis but hypotensive after
- loss lean Mm mass masked by fluid retention & weight gain
dialysis will improve _____ & ______ peripheral neuropathy
-sensory & motor
PT Considerations in CRF
- co-morbidities (in CV system)
- immunosuppression
- fatigue
- impaired O2 transport
- ex’s help ctrl BP
- VO2 max is 1/3 to 1/2 normal
- S/Sx of anemia, fatigue, Mm wasting, reduced work capacity, reduced cardiac performance
Neurogenic Bladder
- spastic bladder dysfunction
- hypotonic bladder dysfunction
Spastic Bladder Dysfunction
-functional urinary tract obstruction 2* to neurologic injury
Hypotonic Bladder Dysfunctino
- flaccid
- can be seen in spina bifida, cauda equina, similar disorders
Pathophysiology of Neurogenic Bladder
- interrupted innervation results in loss of control
- may result in partial/complete urinary retention, incontinence, urgency/frequency
S/Sx Neurogenic Bladder
- burning sensation (not pain)
- infection common in spastic bladder
Cause of Death in Kidney Failure
-heart failure
Eval/Treat of Neurogenic Bladder
- catheterization
- bladder training
- pharmacologic interventions
Urinary Incontinence
- Functional Incontinence
- Overflow Incontinence
- Stress Incontinence
- Urge Incontinence
Functional Incontinence
- normal control but difficulty getting to toilet
- insufficient mobility
Overflow Incontinence
- dribbling with constantly full bladder
- when urinary outlet obstructed
Stress Incontinence
- uncontrollable voiding when intravesicle pressure > extravesile pressure
- “giggle incontinence”
- insufficient/weak pelvic floor Mm
Urge Incontinence
- sudden/uncontrollable need to void
- suggests neurologic condition (spastic bladder)
- hyper tonicity of bladder/pelvic floor Mm
Suggested Ex’s for ESRF
- 4-6x/week at low capacity
- 30 min
- resistance, aerobic
pts experiencing urge incontinence >/= 1 episode/week are ________
34% more likely to sustain a fracture due to falls at night
