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
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.
3
Q
What is the role of the kidney?
A
Taking blood and filtering particles out of it and to excrete the “leftovers”.
4
Q
- What makes up the Upper Urinary Tract?
- What makes up the Lower Urinary Tract?
A
- Kidneys and Ureters
- Urinary Bladder and Urethra
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
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
7
Q
What are kidney chokepoints?
A
Pathologies that create “obstructions” in the normal kidney pathway.
8
Q
What is glomerular filtration?
A
The removal of waste and excess fluid from the blood.
9
Q
What are the 3 components of the Glomerular Filtration Barrier?
A
- ) Endothelial cells
- ) Glomerular basement membrane
- ) Slit processes of the podocytes
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)
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.
12
Q
What is glomerulofiltrate (ultrafiltrate)?
A
Fluid that makes it through the glomerular capsule.
13
Q
Parts of the kidney tubule system?
A
- ) Proximal convoluted tubule
- ) Descending limb of Loop of Henle
- ) Ascending limb of the Loop of Henle
- ) Distal convoluted tubule
- ) Collective duct into minor calyx of kidney
14
Q
Passage of urine through the urinary tract and possible choke points at each.
A
Kidney→renal pelvis → ureter → urinary bladder→ urethra
15
Q
URINARY TRACT INFECTION (UTIs)
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URINARY TRACT INFECTION (UTIs)
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
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
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
19
Q
Only the lower / of the urinary tracy has microorganisms.
A
1/3, proximal to that is sterile
20
Q
What are the bacteria most often responsible for UTIs?
A
Fecal-associated gram-negative organisms
- E. coli - 80%
- Staphylococcus saprophyticus - 5-15%
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
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)
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
24
Q
What is Pyelonephritis?
A
Infection of the kidney.
25
- 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?
- UTI traveling "upstream", chronic inflammatory disease
- upper urinary system
- scarring in the calices of the bladder
26
- Urethra infection --> bladder infection = ________.
- Bladder infection --> kidney infection = ___________.
- If acute kidney infection persists --> chronic kidney infection = ______________.
- serious
- very serious
- very very serious
27
What are the Pyelonephritis risk factors?
- frequent sexual activity
- recent UTI
- recent spermicide use
- DM
- recent incontinence
- immune compromised individuals
- urine reflux
- ureter/bladder obstruction
28
What are the causes of Pyelonephritis (Chronic)?
- Chronic infection
- Urine reflux
- Urine/bladder obstruction
- Atonic bladder
29
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.
- calices
| - 25%
30
Symptoms of Pyelonephritis?
- Back pain or flank pain
- Fever or chills
- Feeling sick
- Nausea and vomiting
- Confusion (esp in elderly)
31
Urine changes of Pyelonephritis?
- Blood in the urine (hematuria)
- Cloudy or foul-smelling urine
- Painful urination
- Increased frequency or urgency of urination
32
- UTIs rank second only to ____ __________ _____ infections in incidence of bacterial infections as possible comorbidities.
- What is the PTs role in UTIs?
- Upper respiratory tract infections
| - Recognize the risk factors and presentation of UTIs
33
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
- N/V, temp >102, change in mental status
- sepsis or infection elsewhere
- hygeine
- incontinence
34
Problems that occur secondary to kidney disease.
- Cognitive problems
- Anemia
- Electyolyte imbalance
- Impaired drug metabolism
- Impaired muscle function
- Osteoporosis
35
ASSESSING GLOMERULAR FILTRATION RATE
ASSESSING GLOMERULAR FILTRATION RATE
36
What is GFR?
- 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
What is a normal GFR?
>90ml/min/1.73m²
38
GFR can be directly measured by assessing the clearance of _________ filtration markers. How is this done?
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
GFR can be estimated from the results of a blood __________ test, the patient's age, body size, gender and race.
creatine
40
Serum creatine and urea levels ________ in the presence of kidney dysfunction.
increase
41
What are some other tests that may be done to help detect kidney damage and/or evaluate kidney function.
- Urine albumin (microalbuminuria or proteinuria) and albumin/creatine ratio (ACR)
- Urinalysis
- Renal Panel
42
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.
- rise
- rise
- increasing
43
ACUTE RENAL FAILURE
ACUTE RENAL FAILURE
44
Acute Renal Failure is an abrupt decrease in renal function sufficient enough to result in retention of nitrogenous waste and disrupt _____ and ____________ homeostasis.
fluid and electrolyte
45
What are some things that the kidney does?
- water balance
- electrolyte balance
- EPO production
- blood pH maintenance
46
How is Acute Renal Failure diagnosed?
- Serum Creatine Levels (increased)
- Decreased urine output
- Lab results and clinical findings
47
Drugs and toxins associated with renal failure can decrease renal _________ (NSAIDs), direct _________ injury, intratubular ____________, and immunological-___________ (Penicillin).
- perfusion
- tubular
- obstruction
- inflammatory
48
CHRONIC KIDNEY DISEASE
CHRONIC KIDNEY DISEASE
49
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
- function
- 26 million
- proteinuria
50
What are the 2 main causes of Chronic Kidney Disease?
- poorly managed DM
| - poorly managed HTN
51
What are some other causes of Chronic Kidney Disease?
- Glomerulonephritis
- Inherited diseases
- Anatomic anomalies
- Autoimmune disorders (lupus)
- Obstructions
- Repeated UTIs
52
List the GFR stages and values.
```
G1= >/=90
G2= 60-90
G3a= 45-59
G3b= 30-44
G4= 15-29
G5= <15
```
53
GFR stage G1=_________, G5=_____________.
- normal
| - kidney failure
54
Kidney Failure Stage 1:
- Gradual onset of symptoms
- Possibly __________
- Micro________
- Elevated ______ and __________
- reversible
- microalbuminia
- BUN and creatinine
55
Kidney Failure Stage 2-4:
- Progressive kidney damage
- Progressive increase in urine _________ levels
- _________: Accumulation of nitrogen containing waste products (urea, creatinine) in the blood.
- albumin
| - Azotemia
56
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.
- 15
- End Stage Renal Disease
- Uremia
- toxins, maintain pH, fluid or electrolyte balance
57
What are the clinical manifestations of Stage 5 (ESRD)?
- Anemia
- CV
- GI
- MS
- Neurologic Involvement
- Hyperkalemia, hyperphosphatemia, hypocalcemia, metabolic acidosis
58
What is hemodialysis?
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
Hemodialysis requires ________ _________ and involves __ treatment sessions/week.
- vascular access
| - 3 sessions for 3-4 hours each
60
- The _____ _______ _____ (____) measures dialysis adequacy.
| - Each treatment should reduce your urea level (BUN) by at least ___%.
- Urea Reduction Ratio (URR)
| - 65%
61
What is peritoneal dialysis?
- 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
Peritoneal Dialysis:
- _____ efficient
- Refilling abdominal cavity repeated _-_ times daily
- Can be performed at home
- ______ AE than hemodialysis
- Access favors __________
- less
- 4-5x daily
- fewer
- infection
63
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 ________.
- diet
- limited
- electrolytes
- low, high
- 32oz, hyponatremia and increased preload
64
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
- Fluid
- Depression
- infection
- Malnutrition
65
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).
- tissue and blood
- 82%
- 91%
66
Chronic Kidney Disease (CKD) is often the result of poorly managed ________.
diabetes mellitus
67
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
- nephropathy
- 44%
- glomeruliae
- hypertension
68
Chronic exposure of the nephrons to high concentrations of glucose → glomeruli/nephron failure → kidney failure
This says what 2 things?
- Slowly progressive disease
| - Demands long term glycemic control (A1C <7%)
69
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
- reduced
| - ischemic
70
In CKD, PTs MUST:
- Monitor BP in patients with DM
- Know the HbA1C levels of their patients with DM
- EDUCATE
