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
REVIEW OF URINARY TRACT ANATOMY AND PHYSIOLOGY
In stage 4 HF, blood flow to the ______ becomes compromised, why?
- Kidney
- The heart lacks contractility to drive blood to the kidney.
What is the role of the kidney?
Taking blood and filtering particles out of it and to excrete the “leftovers”.
- What makes up the Upper Urinary Tract?
- What makes up the Lower Urinary Tract?
- Kidneys and Ureters
- Urinary Bladder and Urethra
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.
- osmotic
- extracellular
- acid-base
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.
- 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
What are kidney chokepoints?
Pathologies that create “obstructions” in the normal kidney pathway.
What is glomerular filtration?
The removal of waste and excess fluid from the blood.
What are the 3 components of the Glomerular Filtration Barrier?
- ) Endothelial cells
- ) Glomerular basement membrane
- ) Slit processes of the podocytes
What do the parts of the Glomerular Filtration Barrier prevent?
Movement of large molecules into the Bowman’s Capsule (tubule system of kidney)
Statins can cause skeletal muscle degredation and pieces of muscle to get into the vasculature, what can this do?
- Occlude slits between endothelial cells and podocytes.
- Kidneys become obstructed.
What is glomerulofiltrate (ultrafiltrate)?
Fluid that makes it through the glomerular capsule.
Parts of the kidney tubule system?
- ) 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
Passage of urine through the urinary tract and possible choke points at each.
Kidney→renal pelvis → ureter → urinary bladder→ urethra
URINARY TRACT INFECTION (UTIs)
URINARY TRACT INFECTION (UTIs)
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.
- increased
- shorter
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.
- Women and older adults
- 5% of all females
- 5-30% of older adults
What are the risk factors for UTIs?
- 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
Only the lower / of the urinary tracy has microorganisms.
1/3, proximal to that is sterile
What are the bacteria most often responsible for UTIs?
Fecal-associated gram-negative organisms
- E. coli - 80%
- Staphylococcus saprophyticus - 5-15%
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 __________.
- kidney
- urine stream
What are the S/Sx of Urinary Tract Pathologies?
- 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)
What are the 3 infection sites of UTIs?
- Cystitis-infection of bladder
- Urethritis-infection of the urethra
- Pyelonephritis-infection of the kidney
What is Pyelonephritis?
Infection of the kidney.
- 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
- Urethra infection –> bladder infection = ________.
- Bladder infection –> kidney infection = ___________.
- If acute kidney infection persists –> chronic kidney infection = ______________.
- serious
- very serious
- very very serious
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
What are the causes of Pyelonephritis (Chronic)?
- Chronic infection
- Urine reflux
- Urine/bladder obstruction
- Atonic bladder
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%
Symptoms of Pyelonephritis?
- Back pain or flank pain
- Fever or chills
- Feeling sick
- Nausea and vomiting
- Confusion (esp in elderly)
Urine changes of Pyelonephritis?
- Blood in the urine (hematuria)
- Cloudy or foul-smelling urine
- Painful urination
- Increased frequency or urgency of urination
- 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
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
Problems that occur secondary to kidney disease.
- Cognitive problems
- Anemia
- Electyolyte imbalance
- Impaired drug metabolism
- Impaired muscle function
- Osteoporosis
ASSESSING GLOMERULAR FILTRATION RATE
ASSESSING GLOMERULAR FILTRATION RATE
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.
What is a normal GFR?
> 90ml/min/1.73m²
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.
GFR can be estimated from the results of a blood __________ test, the patient’s age, body size, gender and race.
creatine
Serum creatine and urea levels ________ in the presence of kidney dysfunction.
increase
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
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
ACUTE RENAL FAILURE
ACUTE RENAL FAILURE
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
What are some things that the kidney does?
- water balance
- electrolyte balance
- EPO production
- blood pH maintenance
How is Acute Renal Failure diagnosed?
- Serum Creatine Levels (increased)
- Decreased urine output
- Lab results and clinical findings
Drugs and toxins associated with renal failure can decrease renal _________ (NSAIDs), direct _________ injury, intratubular ____________, and immunological-___________ (Penicillin).
- perfusion
- tubular
- obstruction
- inflammatory
CHRONIC KIDNEY DISEASE
CHRONIC KIDNEY DISEASE
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
What are the 2 main causes of Chronic Kidney Disease?
- poorly managed DM
- poorly managed HTN
What are some other causes of Chronic Kidney Disease?
- Glomerulonephritis
- Inherited diseases
- Anatomic anomalies
- Autoimmune disorders (lupus)
- Obstructions
- Repeated UTIs
List the GFR stages and values.
G1= >/=90 G2= 60-90 G3a= 45-59 G3b= 30-44 G4= 15-29 G5= <15
GFR stage G1=_________, G5=_____________.
- normal
- kidney failure
Kidney Failure Stage 1:
- Gradual onset of symptoms
- Possibly __________
- Micro________
- Elevated ______ and __________
- reversible
- microalbuminia
- BUN and creatinine
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
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
What are the clinical manifestations of Stage 5 (ESRD)?
- Anemia
- CV
- GI
- MS
- Neurologic Involvement
- Hyperkalemia, hyperphosphatemia, hypocalcemia, metabolic acidosis
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.
Hemodialysis requires ________ _________ and involves __ treatment sessions/week.
- vascular access
- 3 sessions for 3-4 hours each
- The _____ _______ _____ (____) measures dialysis adequacy.
- Each treatment should reduce your urea level (BUN) by at least ___%.
- Urea Reduction Ratio (URR)
- 65%
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.
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
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
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
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%
Chronic Kidney Disease (CKD) is often the result of poorly managed ________.
diabetes mellitus
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
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%)
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
In CKD, PTs MUST:
- Monitor BP in patients with DM
- Know the HbA1C levels of their patients with DM
- EDUCATE
