renal urology Flashcards
main role of kidney
regulate fluids and elytes
kidney fx
- regulate elytes and fluids
- excrete water soluble waste products of metabolism (cr, urea, uric acid)
- hormone production (erythropoietin, renin, bradykinin, prostaglandins, calcitriol, vit d3)
- process meds, ATBs
erythropoietin
RBC production
bone marrow stimulates erythropoietin when circulating blood volume is low to make more RBCs
renin and bradykinin
hormones rt bp
prostaglandins
hormones r/t renal perfusion
calcitriol/vitamin d3
hormones r/t bone production
ureters
smooth muscle tubes that carry urine that is created by kidney
propel urine from kidney to bladder
bladder
hollow muscular organ that collects and stores urine
serum cr lab values
male 0.7 - 1.3
female 0.6 - 1.1
what is creatinine
end product of protein metabolism, predominately looking at muscle
what affects creatinine
muscle mass, gender, race
how does aging affect creatinine
falsely decreased serum creatinine d/t decreased muscle mass
things that cause serum creatinine to rise
- renal fx decline
- renal damage
- nephrotoxic drugs
- dehydration
- CHF (likely prerenal failure)
- excessive blood loss, ie shock
- gout
- excessive exercise or muscle injury
- DKA- falsely elevated
- cephalosporin use
- high protein diet
creatinine clearance range
75-112
24 hr urine cr clearance
reflects renal fx in 24 hr period
creatinine clearance measures what
how much creatinine is being cleared from kidney
creatinine clearance 24 hr urine is used in presence of what
proteinuria, albuminuria, microalbuminuria
bence jones protein screens of what
multiple myelmoa
what can you measure protein in the urine with- first line
UA
what happens to creatinine clearance when renal fx decreases
decreases
bc amount of creatinine cleared from kidney will be less as when the kidneys aren’t functioning creatinine will be able to clear less
which is more sensitive, creatinine clearance or serum creatinine, and why
creatinine clearance
bc it is not affected by fluid status, diet, or exercise
what is a estimation of gfr
creatinine clearance
what is the best predictor for staging CKD
GFR
what does GFR represent
amount of fluid filtered by glomerulus within a certain unit of time
hence the name glomerular filtration rate
bun measures what
kidneys capacity to excrete urea
what is urea
waste product of protein metabolism
BUN can be used for what
to evaluate hydration status and assess renal function
also to assess blood in GI tract
what causes BUN to elevate
- AKI
- high protein diet
- hemolysis- breakdown of RBC
- CHF
- drugs- ie diuretics
- dehydration
sensitivity of BUN in comparison to GFR or serum creatinine
not as sensitive
what to check in regards to renal function if BUN elevated
check GFR, if normal, kidneys are most likely ok
bun - cr ratio range
10:1 - 20:1
what causes an increased bun to cr ratio
condition that causes a decrease in flow of blood to kidneys, such as CHF or dehydration or excessive blood loss
urinalysis uses
- check for protein
- check for blood
- check for UTI
what is happening to body in proteinuria
kidney damage
normally protein and albumin should not be allowed in glomuerular filtrate and what little does get through should be reabsorbed
microalbuminuria
small amount of protein
macroalbuminuric
large amount of protein in urine
what amount of blood is normal in the urine
<5 RBC
causes of hematuria
renal calculi, pyelonephritis, cystitis, bladder cancer
pyelonephritis clinical presentation
bright red blood in urine, back pain, renal stones, FH of renal stones, fevers. chills, sweats, lower back pain
leukocytes esterase lab range
normal is <10
what is pyuria
presence of WBC in urine
do uncomplicated UTIs need diagnostic testing for treatment
no can treat based on clinical symptoms
leukocytes esterase indicate what
pyuria
nitraites in UA indicate what
UTI with e coli
what is normal in casts in UA
hyaline
WBC cast indicates what
UTI or pyelonephritis
RBC cast indicates what
glomerulonephritis
why would you check WBC cast after treating UTI with ATB
to make sure casts have gone away
urine specific gravity lab value
1.005 - 1.03
urine specific gravity decreased with what
- renal disease
- too much fluid intake
- DI
urine specific gravity elevated with what
- dehydration
- excessive fluid loss- v/d/f
- excessive radiographic contrast
- DM
- SIADH
microalbuminuria lab value
30 - 150 mg/day
mild albuminuria lab value
150 - 500 mg/day
moderate albuminuria lab value
500 - 1000 mg/day
heavy albuminuria lab value
1000 - 3000 mg/day
nephrotic albuminuria lab value
> 3000 mg/day
false positive for albuminuria
- hyperinfiltration (newly dx dm)
- exercise. ppl who exercise a lot spill a lot of protein and albumin into urine
- marked HTN
- CHF
- UTI
- acute febrile illness
urine culture and sensitivity is used for what
- UTIs- recurrent, complicated, males
- pregnancy- risk for preterm birth
- pyelonephritis
what happens if urine culture and sensitivity is positive
transfer to medium with discs applied to determine sensitivity to ATBs
may send automatic reflex culture depending on WBC and nitrates
> 10,000 CFU/ml of organism indicates what
UTI
treat pt
WBC casts with proteinuria indicate what
pyelonephritis
large amounts of epithelial cells or multiple organisms indicate what
contaminated urine
what labs are preferred for renal fx assessment
serum creatinine and GFR
not BUN
Na, Cl, K are important for what
fx of nerves and muscles
what happens to sodium with over hydration
decreases
what happens to sodium with dehydration
increases
what caues K to increase
renal failure
what caues K to decrease
diuretics, excessive vomiting, g tubes
cl generally follows what
Na
what is KUB xray
plain firm of lower abdomen and pelvis
quick assessment of kidneys and ureters for calcium containing kidney stones and bowels for obstruction
what to do if pt symptoms and PE suspicious of kidney stones
refer to urologist regardless of KUB findings
best test to confirm or r/o possibility of calcium containing kidney stone
helical or spiral CT
calcium will light up on KUB bc its bone and will be white
what kind of stones do not show up on KUB
uric acid stones
what kind of testing is needed for uric acid stones
ultrasound
