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S3 - Pathophysiology > Review of Urinary Tract Anatomy and Physiology, UTI, Glomerular Filtration Rate and ITS Assessment, Acute Renal Failure, Chronic Kidney Disease (CKD) > Flashcards

Review of Urinary Tract Anatomy and Physiology, UTI, Glomerular Filtration Rate and ITS Assessment, Acute Renal Failure, Chronic Kidney Disease (CKD) Flashcards

1
Q

REVIEW OF URINARY TRACT ANATOMY AND PHYSIOLOGY

A

REVIEW OF URINARY TRACT ANATOMY AND PHYSIOLOGY

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2
Q

In stage 4 HF, blood flow to the ______ becomes compromised, why?

A
  • Kidney

- The heart lacks contractility to drive blood to the kidney.

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3
Q

What is the role of the kidney?

A

Taking blood and filtering particles out of it and to excrete the “leftovers”.

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4
Q
  • What makes up the Upper Urinary Tract?

- What makes up the Lower Urinary Tract?

A
  • Kidneys and Ureters

- Urinary Bladder and Urethra

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5
Q

The Kidney:

  • Maintains ________ pressure of the body’s fluids by regulating the blood concentrations of numerous ions including Na+, K+, Ca2+, MG2+, Cl-, HCO3-, phosphate and sulfate.
  • Regulates the volume of the _____________ fluid by controlling Na+ and water excretion.
  • Helps regulate ____-____ balance by excreting H+ when there is excess acid, or HCO3- when there is an excess of base.
A
  • osmotic
  • extracellular
  • acid-base
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6
Q

The Kidney:

  • Helps regulate _____ ________, how?
  • Has _________ function.
  • _____ excretion.
  • Mechanisms of action include ________,_________, and __________ which takes place in the _________.
  • Filters ____ qts a day, eliminates ___ qts a day.
A
  • BP (blood pressure) by regulating fluid volume/RAS system
  • Endocrine (produces erythropoietin and renin)
  • Drug
  • filtration, reabsorption, and secretion which take place in the nephron.
  • 200, 2
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7
Q

What are kidney chokepoints?

A

Pathologies that create “obstructions” in the normal kidney pathway.

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8
Q

What is glomerular filtration?

A

The removal of waste and excess fluid from the blood.

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9
Q

What are the 3 components of the Glomerular Filtration Barrier?

A
  1. ) Endothelial cells
  2. ) Glomerular basement membrane
  3. ) Slit processes of the podocytes
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10
Q

What do the parts of the Glomerular Filtration Barrier prevent?

A

Movement of large molecules into the Bowman’s Capsule (tubule system of kidney)

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11
Q

Statins can cause skeletal muscle degredation and pieces of muscle to get into the vasculature, what can this do?

A
  • Occlude slits between endothelial cells and podocytes.

- Kidneys become obstructed.

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12
Q

What is glomerulofiltrate (ultrafiltrate)?

A

Fluid that makes it through the glomerular capsule.

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13
Q

Parts of the kidney tubule system?

A
  1. ) Proximal convoluted tubule
  2. ) Descending limb of Loop of Henle
  3. ) Ascending limb of the Loop of Henle
  4. ) Distal convoluted tubule
  5. ) Collective duct into minor calyx of kidney
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14
Q

Passage of urine through the urinary tract and possible choke points at each.

A

Kidney→renal pelvis → ureter → urinary bladder→ urethra

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15
Q

URINARY TRACT INFECTION (UTIs)

A

URINARY TRACT INFECTION (UTIs)

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16
Q

The urethra of females lies close to the vaginal and rectal openings, allowing for relative ease of bacterial transport and _________ risk of UTIs. The _______ urethra in females also contributes to the increased incidence of UTIs.

A
  • increased

- shorter

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17
Q

Incidence of UTIs:

  • _______ and ______ _______ comprise the majority of cases.
  • UTIs affect over 11.3 million women per year, or up to _% of all females.
  • __-__% of the older adult population is also affected
  • For those living in long term health care facilities the numbers are even greater and include males.
A
  • Women and older adults
  • 5% of all females
  • 5-30% of older adults
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18
Q

What are the risk factors for UTIs?

A
  • Age
  • Immobility/inactivity
  • Instrumentation and urinary catheterization
  • Frequently catheterized neurogenic bladder
  • Atonic bladder (without tone, flaccid)
  • Urinary Tract Obstructions
  • Renal calculi (kidney stones)
  • Prostatic hyperplasia
  • Female
  • Pregnancy
  • DM
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19
Q

Only the lower / of the urinary tracy has microorganisms.

A

1/3, proximal to that is sterile

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20
Q

What are the bacteria most often responsible for UTIs?

A

Fecal-associated gram-negative organisms

  • E. coli - 80%
  • Staphylococcus saprophyticus - 5-15%
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21
Q

The common urinary pathogens are able to adhere to the urinary tract mucose, colonize, and cause infection. They migrate upwards through the urinary tract to the _______. This migration is opposed by a __________.

A
  • kidney

- urine stream

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22
Q

What are the S/Sx of Urinary Tract Pathologies?

A
  • Urinary frequency
  • Urinary urgency
  • Nocturia (night time urination)
  • Pain (shoulder, back, flank, suprapubic, pelvis, lower abdomen)
  • Costovertebral tenderness
  • Fever and chills
  • Dysuria (painful urination)
  • Hematuria (bloody urine)
  • Pyuria (urine containing pus)
  • Dyspareunia (painful sexual intercourse)
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23
Q

What are the 3 infection sites of UTIs?

A
  • Cystitis-infection of bladder
  • Urethritis-infection of the urethra
  • Pyelonephritis-infection of the kidney
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24
Q

What is Pyelonephritis?

A

Infection of the kidney.

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25
Q
  • Pyelonephritis (kidney infection) is often secondary to a _____ traveling “________” or a _______ __________ disease involving the kidney parenchyma or renal pelvis.
  • Pyelonephritis occurs when a UTI progresses to involve the _____ urinary system (the bladder, urethra, and ultimately kidneys).
  • Chronic Pyelonephritis is defined by what?
A
  • UTI traveling “upstream”, chronic inflammatory disease
  • upper urinary system
  • scarring in the calices of the bladder
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26
Q
  • Urethra infection –> bladder infection = ________.
  • Bladder infection –> kidney infection = ___________.
  • If acute kidney infection persists –> chronic kidney infection = ______________.
A
  • serious
  • very serious
  • very very serious
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27
Q

What are the Pyelonephritis risk factors?

A
  • frequent sexual activity
  • recent UTI
  • recent spermicide use
  • DM
  • recent incontinence
  • immune compromised individuals
  • urine reflux
  • ureter/bladder obstruction
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28
Q

What are the causes of Pyelonephritis (Chronic)?

A
  • Chronic infection
  • Urine reflux
  • Urine/bladder obstruction
  • Atonic bladder
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29
Q

Pyelonephritis (Chronic) Pathogenesis:

  • Scarring results in deformity of the ________ (abnormal movement of urine)
  • Responsible for upwards of __% of cases of end stage renal disease –> dialysis and transplantation.
A
  • calices

- 25%

30
Q

Symptoms of Pyelonephritis?

A
  • Back pain or flank pain
  • Fever or chills
  • Feeling sick
  • Nausea and vomiting
  • Confusion (esp in elderly)
31
Q

Urine changes of Pyelonephritis?

A
  • Blood in the urine (hematuria)
  • Cloudy or foul-smelling urine
  • Painful urination
  • Increased frequency or urgency of urination
32
Q
  • UTIs rank second only to ____ __________ _____ infections in incidence of bacterial infections as possible comorbidities.
  • What is the PTs role in UTIs?
A
  • Upper respiratory tract infections

- Recognize the risk factors and presentation of UTIs

33
Q

Therapist Role Helping Manage UTIs:

  • May limit participation in rehabilitation
  • Be aware of __/__, temp > ___, change in ______ status, unexplained or insidious onset of back or shoulder pain
  • A UTI increases the risk of developing ______ or _________ elsewhere
  • Personal _________ of patient
  • Management of urinary _________ (pelvic floor PTs)
  • Reconditioning patients who are on dialysis and/or post kidney transplant
  • ________ control in the context of urinary catheters
A
  • N/V, temp >102, change in mental status
  • sepsis or infection elsewhere
  • hygeine
  • incontinence
34
Q

Problems that occur secondary to kidney disease.

A
  • Cognitive problems
  • Anemia
  • Electyolyte imbalance
  • Impaired drug metabolism
  • Impaired muscle function
  • Osteoporosis
35
Q

ASSESSING GLOMERULAR FILTRATION RATE

A

ASSESSING GLOMERULAR FILTRATION RATE

36
Q

What is GFR?

A
  • A direct measure or an estimation of the rate (volume/unit) at which materials in the blood are filtered out by the kidneys.
  • An assessment of the functionality of the kidneys.
37
Q

What is a normal GFR?

A

> 90ml/min/1.73m²

38
Q

GFR can be directly measured by assessing the clearance of _________ filtration markers. How is this done?

A

exogenous

  • Inject the compound into the blood and monitor its disappearance from the blood and appearance in the urine.
  • This is a complex procedure and generally not routinely performed.
39
Q

GFR can be estimated from the results of a blood __________ test, the patient’s age, body size, gender and race.

A

creatine

40
Q

Serum creatine and urea levels ________ in the presence of kidney dysfunction.

A

increase

41
Q

What are some other tests that may be done to help detect kidney damage and/or evaluate kidney function.

A
  • Urine albumin (microalbuminuria or proteinuria) and albumin/creatine ratio (ACR)
  • Urinalysis
  • Renal Panel
42
Q

Laboratory Tests for Assessing Kidney Function:

  • Serum Creatinine: levels ______ as kidney disease worsens.
  • Blood Urea Nitrogen (BUN): levels ______ as kidney function worsens.
  • Urine Albumin: ________ amounts of albumin in the urine can be a sign of kidney disease.
A
  • rise
  • rise
  • increasing
43
Q

ACUTE RENAL FAILURE

A

ACUTE RENAL FAILURE

44
Q

Acute Renal Failure is an abrupt decrease in renal function sufficient enough to result in retention of nitrogenous waste and disrupt _____ and ____________ homeostasis.

A

fluid and electrolyte

45
Q

What are some things that the kidney does?

A
  • water balance
  • electrolyte balance
  • EPO production
  • blood pH maintenance
46
Q

How is Acute Renal Failure diagnosed?

A
  • Serum Creatine Levels (increased)
  • Decreased urine output
  • Lab results and clinical findings
47
Q

Drugs and toxins associated with renal failure can decrease renal _________ (NSAIDs), direct _________ injury, intratubular ____________, and immunological-___________ (Penicillin).

A
  • perfusion
  • tubular
  • obstruction
  • inflammatory
48
Q

CHRONIC KIDNEY DISEASE

A

CHRONIC KIDNEY DISEASE

49
Q

Chronic Kidney Disease:

  • A condition characterized by a gradual loss of kidney ________ over time.
  • __ million American adults have CKD and millions of others are at increased risk.
  • Persistent _____________(protein in the urine) means CKD is present
  • Early detection can slow disease progression
  • African Americans, Hispanics, Pacific Islanders, American Indians and seniors are at greatest risk
A
  • function
  • 26 million
  • proteinuria
50
Q

What are the 2 main causes of Chronic Kidney Disease?

A
  • poorly managed DM

- poorly managed HTN

51
Q

What are some other causes of Chronic Kidney Disease?

A
  • Glomerulonephritis
  • Inherited diseases
  • Anatomic anomalies
  • Autoimmune disorders (lupus)
  • Obstructions
  • Repeated UTIs
52
Q

List the GFR stages and values.

A 
G1= >/=90
G2= 60-90
G3a= 45-59
G3b= 30-44
G4= 15-29
G5= <15
53
Q

GFR stage G1=_________, G5=_____________.

A
  • normal

- kidney failure

54
Q

Kidney Failure Stage 1:

  • Gradual onset of symptoms
  • Possibly __________
  • Micro________
  • Elevated ______ and __________
A
  • reversible
  • microalbuminia
  • BUN and creatinine
55
Q

Kidney Failure Stage 2-4:

  • Progressive kidney damage
  • Progressive increase in urine _________ levels
  • _________: Accumulation of nitrogen containing waste products (urea, creatinine) in the blood.
A
  • albumin

- Azotemia

56
Q

Kidney Failure Stage 5:

  • < ___mg/min/1.73mm
  • Clinical Manifestations: __________
  • loss or nearly complete loss of kidney function
  • _______: Excess amino acid and protein metabolism end products (urea and creatinine) in the blood.
  • Kidneys unable to excrete _______, maintain ___,_______, or ___________ balance.
A
  • 15
  • End Stage Renal Disease
  • Uremia
  • toxins, maintain pH, fluid or electrolyte balance
57
Q

What are the clinical manifestations of Stage 5 (ESRD)?

A
  • Anemia
  • CV
  • GI
  • MS
  • Neurologic Involvement
  • Hyperkalemia, hyperphosphatemia, hypocalcemia, metabolic acidosis
58
Q

What is hemodialysis?

A

Removes blood from the body and sends it across a semipermeable membrane and dialyzate. The pressure gradient filter favors the removal of harmful substances. Blood is then returned to the body.

59
Q

Hemodialysis requires ________ _________ and involves __ treatment sessions/week.

A
  • vascular access

- 3 sessions for 3-4 hours each

60
Q
  • The _____ _______ _____ (____) measures dialysis adequacy.

- Each treatment should reduce your urea level (BUN) by at least ___%.

A
  • Urea Reduction Ratio (URR)

- 65%

61
Q

What is peritoneal dialysis?

A
  • A sterile solution is run through a tube into the peritoneal cavity.
  • Exchange occurs between this dialyzing solution and the vasculature of the peritoneal cavity.
62
Q

Peritoneal Dialysis:

  • _____ efficient
  • Refilling abdominal cavity repeated - times daily
  • Can be performed at home
  • ______ AE than hemodialysis
  • Access favors __________
A
  • less
  • 4-5x daily
  • fewer
  • infection
63
Q

Patients on dialysis are on a regulated ______ to keep the levels of electrolytes, minerals, and fluid in your body balanced.

  • Patient fluid intake is ___________.
  • Patient intake of salt, potassium, phosphorous, and other __________ is limited.
  • Getting enough calories is difficult for these patients.
  • Initially they eat a __-protein diet progressing to ___-protein diet.
  • Limiting fluids (__oz) between dialysis treatments is important. This creates _________ and increased ________.
A
  • diet
  • limited
  • electrolytes
  • low, high
  • 32oz, hyponatremia and increased preload
64
Q

CKD Dialysis AE:
-______ shifts
-_________/oscillating mood status
-Increased risk of ________ (Immune suppressed and
openings in the skin)
-_________, anorexia, loss of lean body mass
-Progressively increasing osmotic concentrations as time since dialysis lengthens

A
  • Fluid
  • Depression
  • infection
  • Malnutrition
65
Q

CKD Kidney Transplant:

  • Match by _____ and ______ type
  • Diseased tissue not always removed
  • The national 3 year kidney transplant survival rate was ___% in 2006 (cadeavor).
  • The national 3 year kidney transplant survival rate was ___% in 2006 (living donor).
A
  • tissue and blood
  • 82%
  • 91%
66
Q

Chronic Kidney Disease (CKD) is often the result of poorly managed ________.

A

diabetes mellitus

67
Q

CKD and DM:

  • Diabetic ___________
  • Most common cause of CKD (__%)
  • 24 million diabetics; 200,000 with diabetes
  • Hyperglycemia leads to glomerular hyperfiltration damaging the arterioles and capillaries in the ____________
  • Hyper filtration also causes thickening of the glomerular basement membrane
  • Leads to intraglomerular __________ and further destruction of glomeruli
A
  • nephropathy
  • 44%
  • glomeruliae
  • hypertension
68
Q

Chronic exposure of the nephrons to high concentrations of glucose → glomeruli/nephron failure → kidney failure

This says what 2 things?

A
  • Slowly progressive disease

- Demands long term glycemic control (A1C <7%)

69
Q

CKD and HTN:
HTN → damage to renal/glomerular blood vessels
As a result:
-Blood flow to the kidney is ________ and kidney function becomes compromised
O2 and nutrient delivery to the nephrons are limited, causing an _________ situation for kidney cells which are metabolically very active
Damaged kidney loses ability to regulate whole body blood pressure. Creates a vicious circle

A
  • reduced

- ischemic

70
Q

In CKD, PTs MUST:

A
  • Monitor BP in patients with DM
  • Know the HbA1C levels of their patients with DM
  • EDUCATE

S3 - Pathophysiology (14 decks)

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