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Medical Conditions II > Renal/Urologic System > Flashcards

Renal/Urologic System Flashcards

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USMLE® Step 1 flashcards
1
Q

Nephron Function

A
  • filter blood
  • reabsorb fluid
  • forms filtrate of protein-free plasma
  • maintain body fluid volume
  • maintain electrolyte composition
  • maintain body pH
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2
Q

Kidney receives _____& of cardiac output

A

-20%

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3
Q

Pathway

A
  • blood vessel
  • bowman’s capsule
  • glomerulus
  • prox convoluted tubule
  • Loop of Henle
  • Distal convoluted tubule
  • collecting duct
  • urethra
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4
Q

____ of plasma is filtered into the renal tubules

A

20%

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5
Q

urinary output=____L/day

A

1.5L/day

most fluid reabsorbed back from tubules

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6
Q

GFR

A
  • glomerular filtration rate

- rate of plasma filtration by glomerulus

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7
Q

Clearance

A

-volume from which all test substance is removed

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8
Q

______ is often used to measure GFR

A

-creatinine clearance

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9
Q

Creatine

A
  • Mm metabolism byproduct

- has fairly constant plasma level

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10
Q

_________level alone is often used to monitor GFR

A

-plasma creatinine

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11
Q

Substantial GFR changes may be reflected in _______

A

-relatively small plasma creatinine changes

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12
Q

Normal Creatinine Levels

A

Male=0.7-1.3

Female=0.6-1.1

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13
Q

Tests of Renal System

A
  • GFR
  • Plasma Creatinine Concentration
  • BUN
  • Urinalysis
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14
Q

Urinalysis

A
  • best test for infectious agents or foreign materials (toxins, drugs)
  • color, turbidity, protein, pH, specific gravity, sediment)
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15
Q

Diuretics

A
  • inhibit Na+ uptake

- ->more water remains in tubule and urine

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16
Q

Diuretic Effects on Body

A

-decrease BP, edema, body fluid, CHF symptoms

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17
Q

Pathologies of Renal System

A
  • Infection
  • Cancer
  • Renal Cystic Disease
  • Renal Calculi
  • Chronic Renal Failure
  • Glomerulonephritis
  • Neurogenic disorders
  • urinary incontinence
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18
Q

UTI

A
  • Urethritis

- Cystitis (bladder infection)

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19
Q

Urethritis Sx

A
  • Inflamm/pain at urethral opening

- painful urination

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20
Q

Cystitis Sx

A
  • bladder infection
  • Painful urinatino
  • frequent urination
  • urgent need to urinate
  • urine cloudy/red
  • fever sometimes
  • suprapubic/low back pain
  • flank pain
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21
Q

Pyelonephritis Symptoms

A
  • (Kidney infection)
  • symptoms suggesting bladder infection
  • abrupt onset
  • high fever/chills
  • back pain around kidney
  • nausea/vomiting
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22
Q

Kidney/UTI Evaluation

A
  • Urinalysis

- tender to percussion at costovertebral angle (pyelonephritis)

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23
Q

Prevention of Kidney/UTI

A
  • post-void residual assessment to assess urinary retention
  • sufficient fluid intake
  • urogenital hygiene
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24
Q

Kidney/UTI Treatment

A
  • antibiotics
  • increase fluids
  • consider lactobacillius acidophilus to prevent yeast growth when on antibiotics
  • contact doc if not better in 48-72 hours
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25
Q

Renal Cell Carcinoma

A
  • malignant tumor

- 80-90% of all renal neoplasms

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26
Q

Renal Cell Carcinoma Incidence

A

-male (over 60) 2x > female

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27
Q

S/Sx Renal Cell Carcinoma

A
  • bloody urine
  • abdominal/flank pain
  • palpable mass
  • HTN
  • hyperparathyroidism
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28
Q

Metastases of Renal Cell Carcinoma

A
  • lungs

- bone (lumbar vert)

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29
Q

Eval/Treatment of Renal Cell Carcinoma

A
  • radiographic imaging

- surgical removal of tumor

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30
Q

Risk Factors of Renal Cell Carcinoma

A
  • tobacco use
  • obesity
  • HTN
  • decreased fruits/veggies
  • increased red meat
  • occupational toxins
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31
Q

Bladder Cancer Incidence

A
  • 4th leading cause of cancer in men

- 7th leading cause of cancer death in US

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32
Q

S/Sx Bladder Cancer

A
  • hematuria
  • frequency
  • urgency
  • dysuria (painful)
33
Q

Metastases of Bladder Cancer

A
  • bone

- pariaortic lymphnodes may cause low back pain

34
Q

Prevention of Bladder Cancer

A

-tobacco cessation

35
Q

_________& ______ may reduce recurrence of bladder cancer by 40%

A

-vitamin/zinc supplement & immunotherapy

36
Q

Treatment of Bladder Cancer

A
  • resection of pelvic lymph nodes/prostate/seminal vesicles/uterus
  • radiation/chemo
  • salvage cystectomy &/or transplantation
37
Q

Bladder Cancer Screening

A

-screening of men at risk over 50 significantly lowers incidence & mortality

38
Q

Nephrolithiasis

A

-kidney stones

39
Q

Renal Calculi

A

-masses of crystals and proteins

40
Q

Nephrolithiasis Cause

A

-unknown

41
Q

S/Sx Nephrolithiasis

A
  • pain along flank
  • N/V
  • hematuria
42
Q

Eval/Treatment of Nephrolithiasis

A
  • increase urine flow

- modify dietary intake of possible irritant substances

43
Q

Renal Failure

A
  • acute renal failure (ARF) (reversible)

- Chronic renal failure (irreversible)

44
Q

causes of ARF

A
  • many causes

- impaired renal blood flow (reversible)

45
Q

Chronic Renal Failure Results in:

A

-loss of normal kidney function

46
Q

Indicators of Chronic Renal Failure

A
  • GFR falls

- Uremia

47
Q

Uremia

A

-accumulation of toxins in blood

48
Q

S/Sx of Chronic Renal Failure

A
  • anorexia
  • N/V
  • fatigue
  • HTN
  • pruritis
  • decreased urin output
  • edema
  • neurological changes
49
Q

Eval/Treatment of Chronic Renal Failure

A
  • regulate food/fluid intake
  • Na+ & K+ restriction
  • Dialysis
  • Transplantation
50
Q

Stages of Chronic Renal Failure

A
  • Diminished Renal Reserve
  • Renal Insufficiency
  • Renal Failure
  • End-Stage Renal Disease (ESRD)
51
Q

Diminished Renal Reserve

A
  • GFR: 50% normal rate

- no overt Sx due to kidney adaptation

52
Q

Renal Insufficiency

A
  • GFR: 20-35% normal rate

- possible azotemia, anemia, HTN

53
Q

Renal Failure

stage

A
  • GFR <20-25% normal rate

- edema, metabolic acidosis, hypocalcemia

54
Q

ESRD

A
  • GFR: <5% normal rate
  • 90% kidney function lost
  • all body systems involved
55
Q

Systemic Manifestations of Kidney Failure

A
  • 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
56
Q

Leading cause of kidney failure in US

A

-diabetic neuropathy

57
Q

Prevention of Kidney Failure

A

-edu of risk factors

58
Q

Risk Factors of Kidney Failure

A
  • DM (#1 cause)
  • HTN (#2 cause)
  • CAD
  • Decreased activity
  • tobacco
  • NSAIDs/analgesic combos
59
Q

Dialysis

A

-hemodialysis or peritoneal dialysis

60
Q

Hemodialysis

A

-3x/week for 3-4 hours

61
Q

Peritoneal dialysis

A

-3x daily

62
Q

Risk of Dialysis

A

-infection of immunocompromised pts

63
Q

Dialysis Considerations

A
  • HTN before dialysis but hypotensive after

- loss lean Mm mass masked by fluid retention & weight gain

64
Q

dialysis will improve _____ & ______ peripheral neuropathy

A

-sensory & motor

65
Q

PT Considerations in CRF

A
  • 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
66
Q

Neurogenic Bladder

A
  • spastic bladder dysfunction

- hypotonic bladder dysfunction

67
Q

Spastic Bladder Dysfunction

A

-functional urinary tract obstruction 2* to neurologic injury

68
Q

Hypotonic Bladder Dysfunctino

A
  • flaccid

- can be seen in spina bifida, cauda equina, similar disorders

69
Q

Pathophysiology of Neurogenic Bladder

A
  • interrupted innervation results in loss of control

- may result in partial/complete urinary retention, incontinence, urgency/frequency

70
Q

S/Sx Neurogenic Bladder

A
  • burning sensation (not pain)

- infection common in spastic bladder

71
Q

Cause of Death in Kidney Failure

A

-heart failure

72
Q

Eval/Treat of Neurogenic Bladder

A
  • catheterization
  • bladder training
  • pharmacologic interventions
73
Q

Urinary Incontinence

A
  • Functional Incontinence
  • Overflow Incontinence
  • Stress Incontinence
  • Urge Incontinence
74
Q

Functional Incontinence

A
  • normal control but difficulty getting to toilet

- insufficient mobility

75
Q

Overflow Incontinence

A
  • dribbling with constantly full bladder

- when urinary outlet obstructed

76
Q

Stress Incontinence

A
  • uncontrollable voiding when intravesicle pressure > extravesile pressure
  • “giggle incontinence”
  • insufficient/weak pelvic floor Mm
77
Q

Urge Incontinence

A
  • sudden/uncontrollable need to void
  • suggests neurologic condition (spastic bladder)
  • hyper tonicity of bladder/pelvic floor Mm
78
Q

Suggested Ex’s for ESRF

A
  • 4-6x/week at low capacity
  • 30 min
  • resistance, aerobic
79
Q

pts experiencing urge incontinence >/= 1 episode/week are ________

A

34% more likely to sustain a fracture due to falls at night

Medical Conditions II (34 decks)

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