rrd 9 Flashcards
gu and renal disorders
male-specific genitourinary disorders
- BPH (benign prostatic hyperplasia)
- prostate cancer
- testicular cancer
- infections (urethritis + prostatitis)
benign prostatic hyperplasia (BPH)
- enlarged prostate
- proliferation of prostate glandular tissue that is a common age-related change
- begins @ 40-45 and continues until death
- age 60: 60% of men have enlarged prostate
BPH: as the gland ____, it can _____ the urethra where it passes thru the ____, resulting in?
- enlarges
- compress
- prostate
- varying degrees of obstruction to urinary flow
S/S BPH
- urgency
- delay in starting urine flow
- decrease in urine flow
- urine retention
diagnosis of BPH
- history of S/S
- enlarged prostate felt on digital rectal exam (should be done yearly beginning age 50)
- sometimes PSA elevated
tx BPH
- certain meds geared towards decreasing size
- surgery to decrease size - TURP (transurethral resection of prostate)
TURP - transurethral resection of prostate
a certain amt of hyperplastic tissue is resected (surgically removed)
prostate cancer
- malignant neoplastic condition of the prostate gland
- most common cancer in American males
risk factors for prostate cancer
- age over 54
- fam hist
- diet high in saturated fat
- high testosterone levels (promotes tumor growth)
- african american
S/S prostate cancer
- similar to BPH
- may not be present until disease advanced
dx of prostate cancer often by?
PSA - prostate specific antigen
PSA is a _____ marker that is specific to the _______ and will be elevated when there is an ______ or ______ process of the _____.
- tumor
- prostate gland
- inflammatory or malignant
- prostate
sometimes PSA is elevated in ___, but more commonly, a high PSA is related to?
- BPH
- cancerous injury of prostate cells
routine screening of the prostate, performed every _____ between the ages of _____ should include a measurement of the ____ and a ______.
- 2 years
- 55-69
- PSA
- digital rectal exam (DRE)
testicular cancer
- malignant neoplastic condition of the testicle
- occurs most commonly in 15-35
- higher incidence in males w/ unresolved cryptorchidism (undescended testes) bc testis in abdomen cannot be checked regularly for cancer signs
S/S testicular cancer
- painless testicular mass is usual
- may have testicular heaviness or dull ache in the lower abdomen
detection/tx testicular cancer
- cure rate of 95% when caught early
- testicular self-exam monthly for early detection
- surgery, radiation or chemotherapy
urethritis
- infection
- inflammation, discomfort in penis, sometimes dysuria, occasionally discharge
prostatitis
inflammation/infection of prostate
urethritis and prostatitis often caused by ______ such as ____ and _____.
- sexually transmitted infections (STIs)
- chlamydia and gonorrhea
treatment for infections
antibiotics
female-specific genitourinary disorders
- uterine-related
- ovarian cancer
- infections
uterine-related problems
- general flow disturbances (dysmenorrhea + amenorrhea)
- endometriosis
dysmenorrhea
- gen term for menstruation that is more painful, frequent, and/or larger in bleeding volume than is normal
- more often cause by hormonal disturbances but variety of other causes
amenorrhea
absence of menses due to variety of causes (anorexia, over-exercising); in later life can mean onset of menopause
endometriosis
presence of functioning endometrium outside the uterus
endometriosis affects ____ of women of ____ age and can cause _______.
- 15%
- reproductive
- infertility
endometriosis is caused by ____ ______; in addition to being sloughed off w/ menstrual blood via _____ and ____ (normal), endometrial tissue can _________ into pelvic cavity via _____.
- retrograde menstruation
- cervix and vagina
- abnormally escape
- fallopian tubes
the ____ endometrium responds to the menstrual hormones by _____ and ____ wherever it implants itself, just as if it is still in the uterus.
- ectopic (out of place)
- proliferating
- bleeding
S/S endometriosis
- dyspareunia (pain during intercourse)
- dysmenorrhea
- pelvic pain
tx endometriosis
- hormonal therapy
- surgury
the ____ bleeding with endometriosis irritates the area and eventually causes _____: scarring that can wrap around organs and cause obstructions and other problems.
chronic, adhesions
ovarian cancer
malignant neoplastic condition of the ovaries with unknown etiology
ovarian cancer causes the _______ related to the female reproductive system - by the time someone is diagnosed with the cancer, is often?
- most cancer deaths
- advanced and treatment is difficult
early S/S of ovarian cancer
- vague
- bloating
- mild abdominal discomfort
- constipation
if ovarian cancer not found early during ___ pelvic exams, often _____ before diagnosed
yearly, metastasizes
a PAP smear is a test for?
cervical cancer, NOT ovarian cancer
classic patient for ovarian cancer
“I feel bloated and pants have gotten tight around the waist, despite diminished appetite and losing overall weight”
ovarian cancer metastasizes ______, causing symptoms such as?
- intra-abdominally
- pain
- ascites (esp from liver involvement)
- dyspepsia
- vomiting
- alterations in bowel movement
female-specific infections
- reproductive tract - PID
- urologic
pelvic inflammatory disease (PID)
- infection in woman’s reproductive tract
- starts w/ STIs like chlamydia (cause cervicitis) or gonorrhea and spreads into uterus, fallopian tubes, ovaries
infection names for uterus, fallopian tubes, ovaries, and fallopian tubes + ovaries
- endometritis/myometritis
- salpingitis
- oophoritis
- salpingo-oopheritis
S/S PID
- varies according to severity and spread
- abnormal vag discharge
- pelvic/abdominal pain w/ pattern of being worse w/ movement (tendency to be still)
sequela of PID and tx
- cause infertility
- antibx, pain killers
urologic infections can involve just ____ and/or _____ or the _____.
- bladder (cystitis)
- kidneys (pyelonephritis)
- entire tract (UTI - urinary tract infection)
pathogen that cause urologic infections can be? most common organism of infection is?
- bacterial, fungal, viral, or parasitic
- E. coli (usually part of norm intestinal flora)
highest risk grp for urologic infections and why
- women
- proximity of anus and vaginal is to the urethral meatus
- much shorter urethra = shorter distance from outside to urinary tract
____ very rarely get UTIs unless have?
- men
- structural defect, chronic disease, indwelling catheter
S/S urologic infections
- dysuria
- frequency + urgency of urination
- hematuria
- pyuria
- abdominal & sometimes back pain @ costovertebral angle where kidneys located
- sometimes fever
dysuria
pain on urination
frequency + urgency of urination as S/S of urologic infections is due to?
irritation on pressure-sensors of bladder; usually small amt of urine voided at a time
hematuria from?
from irritation/inflammation of bladder and other linings of urinary tract
pyuria
pus in urine; makes urine cloudy, foul-smelling
dx’d of urologic infections
- by S/S
- UA (urinalysis)
- sometimes urine C&S (culture and sensitivity)
non-gender-specific GU problems
- STIs/STD
- obstructive disorders
most common STIs/STDs
- chlamydia
- gonorrhea
- syphilis
- herpes
chlamydia
bacterial infection caused by Chlamydia trachomatis
S/S chlamydia
- urethritis in men: inflammation, discomfort in penis, sometimes dysuria, occasionally discharge
- most common cause of PID in women
gonorrhea
bacterial infection of the genital tracts of men + women caused by Neisseria gonorrhea
gonorrhea: women may be _____, or may have _____ or _____ and/or go on to have full ____.
- asymptomatic
- vaginal discharge
- bleeding
- PID
gonorrhea: men tend to have?
- purulent discharge from the penis
- dysuria
syphilis
STI caused by spirochete Treponema pallidum
if syphilis is treated during the first stage, it can be easily treated with _____, but can become ____ and evolve into _____ if not treated early.
- antibx
- systemic
- other stages
1st stage of syphilis
- primary syphilis
- lesions (chancres) of the skin develop anywhere that the microbe touches mucous membranes or skin (lips, labia, penis)
genital herpes
caused by herpes simplex virus (HSV), subtype 2 (HSV2)
HSV1 invades ___ and surrounding area - sometimes known as “_______” - can be passed via ____, but otherwise not known as _____.
- lips
- cold sores
- kissing
- STI
HSV2 is an _____ - invades ______ and can spread to _____ and ____.
- STI
- genital area
- perineum
- anus
HSV2 infection appears on skin as?
painful, red, and often crusty-looking crops of lesions
HSV2 _____ occur ____ and often depend on _____.
- break-out episodes
- sporadically
- stress level
HSV2 sometimes have ____ S/S such as?
- systemic
- fever + malaise during break-out episodes
patho of HSV2
- initial infection resolved
- HSV penetrates local nerve fibers
- HSV travels up spinal ganglion and lies dormant
- travels back down to genital area or circumoral area periodically (times of stress)
- breaks out on skin again
tx genital herpes
- HSV for life
- antivirals help S/S but no cure
anything that interferes with _____ from ________ can be classified as obstructive disorder of urological system
- flow of urine
- kidneys to urethral meatus
most potentially harmful sequela (if urological obstruction not removed/treated quickly) is?
hydronephrosis
hydronephrosis
- water on the kidneys
- enlargement of + pressure in renal pelvis & calyces due to pathologic accumulation of fluid
hydronephrosis is caused by?
- retrograde urinary flow that can’t get past obstruction in ureters, bladder, and/or urethra
w/in short time, the _____ of urine associated with hydronephrosis can lead to _______ and eventual _____ w/in the ___ and significant decline in ______.
- accumulation
- infection
- fibrosis (scarring + stiffening)
- kidney
- function of nephrons
specific obstructions of urological system
- tumors
- scarring
- pelvic organ prolapse (F)
- BPH (M)
- neurogenic problems
- kidney stones
scarring (aka _____) from previous problems such as _____ can cause _____ (ie, _____) of ureter and/or urethra
- adhesions
- STDs, endometriosis, various surgeries
- strictures
- pinching, narrowing
pelvic organ PROLAPSE in females
falling-down or intrusion of an organ due to deterioration of muscle tone holding it in place or other factors
best example of pelvic organ prolapse is?
uterine prolapse
uterine prolapse
uterus drops from its norm mooring and puts pressure on bladder, urethra, or other structures - acts as obstruction to urine
BPH in males as obstructive disorder
urine can’t get thru urethra narrowed by large prostate (obstruction)n
neurogenic problems include and is related to obstructive disorders of urological system how?
- paraplegia, quadriplegia
- neurogenic bladder dysfxn (bladder loses tone - acts as obstruction to urine flowing forward)
other terms for kidney stones
calculus (calculi plural) or lith
applications/examples of kidney stones according to area found
- kidney stones = renal calculi/lithiasis = nephrolithiasis
- ureteral calculus/lithiasis = kidney stone in ureter
- urethral calculus/lithiasis = kidney stone in urethra
kidney stones are a fairly _____ acute ______ problem; exact cause _______, but there are certain factors that increase risk of getting stone.
- common
- obstructive
- unknown
factors that increase risk of getting stone
- male gender (4x more likely to get kidney stones)
- gout (uric acid accumulation/overproduction)
- dehydration (not enuf drink H20, sweating)
- dietary factors
- diseases like multiple myeloma (hypercalcemia)
patho kidney stones
- urine formed in renal tubules and supersaturated w/ calcium, uric acid, or other ions
- urine and other substances bond and form crystal
- attract each other + form stones in kidney pelvis
if stones forming in the kidney are greater than ~ ___, as they flow into the _____ with urine, they can get stuck in the _____ -> ______ -> _____ backs up AKA _____ -> can cause ______ and possible renal ____ if obstruction remains.
- 2 mm
- ureter
- ureter
- obstruction
- urine
- retrograde urine flow
- hydronephrosis
- failure
S/S kidney stones
- excruciating flank and/or groin pain that comes/goes in spasms (colicky pain)
- presence of hematuria from stone raking ureteral lining
colic or colicky pain is pain that ______, a ____ type of pain. typical when there is a ____ of a tube or other container in the body. gen rule: ppl w/ colicky pain are _____ and tend to ______ or often ____ as opposed to wanting to _____.
- comes and goes
- spasmodic
- spasm
- restless
- toss and turn
- pace
- hold very still
dx of kidney stones based on?
- clinical presentation
- hematuria
- diagnostic tools such as CAT scan
tx kidney stones
- pt sent home on pain meds and push fluid instructions to try get stone to pass on its own
- too large to pass: lithotripsy done or surgery (if other measures not successful)
lithotripsy
sound waves bombard and dissolve the stone
categories of kidney normal fxns
- maintenance of fluid + solute balance
- maintenance of certain metabolic fxns
part of kidneys’ purpose is to decide appropriate gen _____ and _____ of urine. normally, urine is?
- make-up, concentration
- 95% H2O
- 5% urea (urea nitrogen), creatinine, certain amt of Na, K, PO4, and other solutes (hormones, etc.)
concentration decisions are made in each ____ by two structures: ____ and ___.
- nephron
- glomerulus + tubule
as blood enters glomerulus from ______, it circulates in the _____, which have ______ that serve as a screening, or ______, tool - this is called the ______.
- afferent arteriole
- glomerular capillaries
- basement membranes
- filtration
- glomerular membrane
first decision point of the kidneys is?
glomeruli decide what and how much to include as the beginning part of urine
GFR
- glomerular filtration rate
- volume of plasma filtered by all functioning nephrons
- glomeruli filter approx 180 L plasma per day
- norm GFR = 125 mL/min
when a problem or disorder ____ the GFR, know that the appropriate amt of water + solutes are not being sent into the _____, thus _____ risk of accumulation of ______ in the body.
- decreases
- urine
- increasing
- wastes + water
clinically, decreases in GFR often can be seen as?
decreased urine output
if kidneys ______, person would have low GFR and thus, ____ urine output (____)
- aren’t working properly
- low
- oliguria
the tubule of a nephron begins as the _______, becomes the ______, _______, ______, and the _____.
- Bowman’s capsule
- PCT (proximal convoluted tubule)
- loop of Henle
- DCT (distal convoluted tubule)
- collecting tubule
as urine flows through tubule, various decisions are made in form of?
reabsorption vs excretion
tubular reabsorption
movement of fluids + solutes from the tubular lumen -> cells lining the tubular lumen -> peritubular capillaries to join vascular circulation
tubular reabsorption is what the body is?
holding onto in the blood
tubular secretion
movement of fluids + solutes from peritubular capillaries (vascular circulation) -> cells lining tubular lumen -> into tubular lumen
an example of important solutes that should be excreted appropriately into the urine are?
wastes such as creatinine and urea nitrogen - norm these are in small amts in the blood + norm amts in urine
if kidneys are not working properly, person would have?
- high serum creatinine + urea nitrogen
- low urine creatinine and urea nitrogen
decisions made by the glomeruli + tubules are assisted by?
substances created elsewhere in the body, but greatly affect kidney like angiotensin II, aldosterone, ADH, natriuretic peptides
kidney presented with fluid deficit
- low fluid senses by kidneys
- renin secreted by JGA
- stimulates creation of angiotensin II
4.1. peripheral vasoconstriction to keep fluid in central circulation
4.2. secretion of aldosterone by adrenals -> aldo to DCT -> retention of Na+ into blood , followed by H2O (kidneys excrete K+) - ADH secretion from pituitary help retain H2O
- when void: only small amts of conc urine (kidneys held onto H2O to help dehydrated state)
kidneys presented with fluid overload
- BNP + ANP secreted by heart and go to renal tubules
- tubules stimulated to excrete more water into the urine
- void large amts of more dilute urine (kidney get rid of water to help overload state)
the kidneys greatly affect acid/base balance by:
- making and regulating HCO3
- deciding how much H+ (acid) to excrete or hold onto
the kidneys help promote stable nutrition by?
minimizing non-appropriate substances such as proteins from entering urine
the kidneys regulate calcium absorption by?
activating vitamin D
the kidneys regulate BP by?
- increasing or decreasing renin as needed
- renin begins RAAS response -> regulates fluid vol + arterial vasoconstriction -> regulate pressure in arteries
the kidneys help promote stable hematological status by?
- making hormones such as erythropoietin (helps w/ RBC birth)
- making sure no RBCs spill from blood to urine
renal diseases/disorders (for class) focus on the kidney’s ability to maintain
- normal, effective GFR
- ability to appropriately secrete waste products into the urine
when a person’s GFR and/or waste product secretion ______, we consider that person to be at some point on a spectrum from ______ to ______: spectrum of ________.
- decreases
- AKI: acute kidney injury
- CKD: chronic renal failure
- renal compromise
examples of acute kidney injury (AKI)
- glomerulonephritis
- infection
- sepsis
- trauma
AKI outcomes
- gets completely resolved; norm renal fxn restored
- evolved to being CKD -> renal insufficiency -> goes from mild to end-stages
examples of slow,insidious problems
congenital or inherited disorders, diabetes, HTN, atherosclerosis
- no acute event necessary; just slow negative effect on renal fxn
slow, insidious problems can evolve to being?
- CKD
- pt has renal insufficiency (aka chronic renal insufficiency or CRF-chronic renal failure)
- mild to end stage; decline may/may not stop anywhere
stage 1 kidney dz
kidney damage w/ norm or increased GFR (temp increase compensatory response)
stage 2 kidney dz
mild reduction in GFR
stage 3 kidney dz
moderate reduction in GFR (25% of norm GFR, usually < 30 mL of urine output/hr)
stage 4 kidney dz
severe reduction in GFR
stage 5
- full kidney failure
- minimal or no GFR
- aka end-stage renal disease (ESRD)
- only about 10% renal fxn left
AKI definition
- abrupt (occurs over < 48 hrs) decrease in urine output (ie, GFR)
AND/OR - increase in serum creatinine
- typical pt: acute oliguria and/or acute jump in serum creatinine
T/F: w/ AKI, the patient cannot fully recover.
FALSE, they can fully recover or just have some degree of kidney problems depending on how quick problem caught + fixed
subcategories of AKI
- prerenal
- intrarenal
- postrenal
prerenal AKI
- something wrong with arterial flow B4 kidneys
- S/S: oliguria, elevated serum creatinine (sCr)
- not fixed: go into intrarenal AKI -> CKD
intrarenal AKI
- something wrong IN any part of kidney tissue (glomerulus/tubule)
- lead to glomerulonephritis and/or ATN (acute tubular necrosis)
- S/S: oliguria, elevated sCr + blood/protein/casts in urine
- not fixed -> CKD
postrenal AKI
- something wrong w/ urine flow AFTER kidneys
- S/S: oliguria + S/S of obstruction
- not fixed: hydronephrosis -> intrarenal AKI -> CKD
prerenal
most common subtype of AKI
prerenal causative factors of ________ to the kidneys are due to?
- acutely decreased arterial flow
- acute vasoconstriction, trauma to aorta and/or renal arteries
- hypotension/hypovolemia bc hemorrhage, dehydration, HF, hypotension from infection (sepsis)
S/S prerenal AKI
- oliguria
- increased sCr
prerenal prognosis/treatment
- tx: IV fluids/blood, fix basic problem
- blood flow to kidney not quickly restored -> intrarenal AKI from ATN -> CKD maybe
postrenal AKI
acute obstruction that occurs somewhere btw kidneys + urethral meatus
ex of causative factors for postrenal AKI
- urethral obstruction (BPH/uterine prolapse_
- ureteral obstruction (calculi)
S/S postrenal AKI
- elevated sCr
- acute oliguria
- S/S casual problem (pain from kidney stone, probs w/ urine flow, etc.)
prognosis of postrenal AKI if fixed/addressed quickly
return to norm renal fxn
prognosis of postrenal AKI if not fixed/addressed quickly
- obstruction in urinary apparatus -> risk of retrograde flow of urine up into kidneys
- urine back flow -> hydronephrosis
- retrograde pressure/backflow urine -> ATN
intrarenal AKI happens when?
kidneys have acutely diminished fxn from direct kidney tissue injury -> damage any part of nephron (glomerulus and/or kidney tubules)
glomerular damage can be caused by? example?
- autoimmune situations
- post-streptococcal glomerulonephritis (GN)
GN most often happens in conjunction w/ ______. antibody that attacked strep then attacks tissues such as ______.
- recovery from strep throat
- glomeruli of kidneys
patho of glomerular injury/damage
- autoantibody attaches to glomerular membranes
- irritates them, begins inflammatory process
- neutrophils, macrophages infiltrate area
- inflammatory mediators released
- glomerular capillaries pathologically vasodilate + leak protein and blood into urine
kidney tubular damage
acute tubular necrosis (ATN) is the result of tubular cell injury/death
S/S glomerular damage (intrarenal AKI)
- proteinuria
- hematuria
tubular cell injury/death from?
direct tubular injury from toxic substances:
- drugs (antibx)
- recreational drugs (PCP, spray paint)
- environmental agents
- snake venom
kidney tubular damage can come from tubular ischemia from _____ or _____ AKI that are _____ quickly.
- prerenal
- postrenal
- not fixed
patho of acute tubular necrosis ATN
- reduced blood flow (ischemia) or direct injury of tubular cells
- necrosis of tubular cells
- tubular cells die, slough off into lumen of tubule
- cast formation (abnormal clumps)
- tubular blockage and sluggish urine flow
- pressure on Bowman’s capsule + glomerular capillaries
- reduced GFR
- oliguria + decreased ability to excrete creatinine
casts
abnormal clumps of proteins + cells that flow w/ the urine or adhere to the luminal wall
- tubular obstruction if enuf accumulate
S/S intrarenal AKI
- increased sCr
- oliguria
- hematuria + proteinuria (glomerular injury) AND/OR casts in urine (tubular injury w/ ATN)
damage to either the kidney glomerulus or kidney tubule will result in?
decreased ability of nephron to filter waste + water -> reduce GFR -> S/S intrarenal AKI
a pt in the hospital following a drug overdose drops urine output from 35 mL/hr to 15 mL/hr w/in 48 hrs of admission. sCr elevated.
nurse suspects AKI bc?
- acute oliguria
- lab work shows elevated sCR
a pt in the hospital following a drug overdose drops urine output from 35 mL/hr to 15 mL/hr w/in 48 hrs of admission. sCr elevated.
nurse suspects intrarenal AKI bc?
patient’s initial dx of drug overdose
a pt in the hospital following a drug overdose drops urine output from 35 mL/hr to 15 mL/hr w/in 48 hrs of admission. sCr elevated.
nurse suspects ATN bc?
urinalysis (UA) shows casts
causes/indicators of chronic kidney disease (CKD)
- congenital/inherited renal problems (PKD)
- acquired diseases
PKD
- polycystic kidney disease
- autosomal dominant inherited disease
- cysts through out the kidneys interfere w/ norm renal fxn
acquired diseases that negatively affect ability of nephrons to fxn
- AKI that is not fixed quickly
- atherosclerosis: renal arterial vessels stiff + narrowed
- HTN: high press -> damage 2 renal arteries
- diabetes mellitus: hyperglycemia -> toxic change to all renal vasculature
no matter what the initiating problem, the patho and picture of a patient with CKD are ________, varying mostly according to ______, and can be divided into 2 categories: ______ and _______.
- generally consistent
- severity
- impairment to water and solute balance
- impairment to metabolic fxns
the ____ the renal impairment in CKD, the ____ the decision-making capabilities of the renal equipment will be.
worse
CKD: it is _____ for the glomeruli + peritubular capillaries to determine how to excrete the __________ to make urine, which results in _________.
- harder
- right combo of fluids + solutes
- pathologic accumulation of water (fluid overload) and solute (high electrolyte + waste levels)
when nephrons are sick, RAAS becomes ______. RAAS is ______ with sick nephron and sometimes, renin secretion ____, so fluid retention is _____.
- faulty
- not suppressed
- increased
- worsened
initiating prob of CKD makes nephron sick. how does this affect fluid balance?
- GFR sluggish
- oliguria or anuria
2.1. fluid retention
3.1. pathologically increased preload (fluid overload)
4.1. hypertension due to increased circulatory vol cause increased hydrostatic pressure
4.2. decreased serum osmolality
5.1. fluid shifts into tissue
6.1 edema (peripheral and/or pulmonary)
initiating prob of CKD makes nephron sick. how does this affect solute balance?
wastes and other solutes (electrolytes) accumulate in blood
high serum electrolyte levels include
- hyperphosphatemia
- hyperkalemia
- hypernatremia
hyperphosphatemia
increased phosphate due to its excretion
hyperkalemia + hypernatremia patho
- from distal convoluted tubule not responding properly to aldosterone
1. decrease response of DCT to aldosterone
2. solutes pathologically retained
3. serum K+ and Na+ increase
what serum waste levels are raised due to initial prob of CKD?
creatinine and urea nitrogen
as part of norm daily processes, the liver breaks down protein to?
ammonia and then to urea nitrogen
most ____ is excreted from blood to urine, but there is always a certain norm level of it in blood - called _______ (____).
- urea
- blood urea nitrogen
- BUN
____ can increase in renal problems - is ________ in diagnosing kidney problems as ______.
-BUN
- not as definitive
- creatinine
as part of norm daily processes, the liver breaks down CK (_______) to ______.
- creatine kinase
- creatinine
diminished fxn of kidneys = _____ to excrete norm amount of creatinine into urine -> builds up in _____ -> ________.
- unable
- blood
- high sCr
a high _____ is almost always associated with renal dysfunction and is most often used serum lab indicator of renal probs.
creatinine
azotemia
having high levels of waste in your blood
uremia
having azotemia plus other S/S
other S/S pt can have w/ uremia besides azotemia
- fatigue
- anorexia
- N&V
and/or - pruritis
and/or - uremic encephalopathy
pruritis
itching from deposition of urea on skin
uremic encephalopathy
neurological changes (from toxic levels of blood urea)
- confusion
- decreased level of consciousness
- perhaps seizures
norm serum creatinine
0.6 - 1.2 mg/dL
norm BUN
7 - 25 mg/dL
sCr if there is renal problem
> 1.2 mg/dL
BUN if there is renal problem
> 25 mg/dL
patients w/ CKD will have changes in blood levels of wastes and changes in?
urine
urinalysis (UA)
- most common test ordered on the urine
- general, broad measurement of state of urine
what type of questions does a urinalysis answer?
- are there substances (protein, blood, bacteria) that shouldn’t be there?
- are the kidneys generally concentrating the urine appropriately? (creating urine that has norm balance of wastes + water?)
in CKD, UA will show?
- lower than normal concentration
- low specific gravity on the UA
norm urine gravity
1.002 - 1.028
renal problem if oliguria + specific gravity of?
< 1.002
if urine has blood, protein, and/or bacteria, what disease process would you think of?
- glomerulonephritis
- UTI
creatinine clearance urine test
- measures 24hrs worth of creatinine excreted in urine + compares to sCr
- norm range = kidneys good @ filtering waste into the urine
though a simple sCr is most often renal fxn parameter that is tested, _____ is the most accurate bc?
- creatinine clearance
- truly reflects GFR
if the _____ creatinine clearance is lower than normal, the _____ creatine will probably be high.
- urine
- serum
can tell if kidneys are concentrating urine appropriately by measuring ______.
specific gravity
when a person is dehydrated (fluid vol deficit or low preload) and has norm kidney fxn, a urine sample will show ____ concentration because the kidneys have _______ water in the body (_______) while still getting rid of _____ amount of waste (______). this means his specific gravity of urine is approx ______.
- hgih
- held on to water in the body
- absorption
- usual
- excretion
- high
impaired metabolic fxn from CKD includes:
- hypocalcemia
- anemia
- acid-base imbalance
- uremic encephalopathy
- pruritis
hypocalcemia etiology
sick kidneys = less vit. D activation = inability to effectively absorb ingested calcium in GI tract
S/S hypocalcemia
- hyperexcitability of cells -> muscle spasm, peripheral paresthesia (abnorm sensation), (+) Chvostek’s sign
- osteoporosis -> pathologic fractures from lack of Ca2+ in body
anemia etiology
sick kidneys = less RBC-stimulating hormone (erythropoietin)
S/S anemia
- fatigue
- SOB
- weakness
acid-base imbalance (usually ______) due to?
- metabolic acidosis
- inability to regulate/synthesize HCO3
uremic encephalopathy
decreased mentation and/or level of consciousness due to increased levels of urea nitrogen affecting brain
ckd: oliguria and fluid vol overload patho + S/S
- kidney not working (GFR decreased)
- overactivation of RAAS + inappropriate response to RAAS
- kidney not working + unable to remove H2O
- volume overload
- hypoosmolar state
- B-to-T fluid movement
- edema
ckd: oliguria and fluid vol overload tx
diuretics to encourage kidney to remove H2O
ckd: azotemia + uremia patho + S/S
- kidney not working + unable to remove waste in urine
- accumulation of waste (BUN/sCr) in blood (azotemia)
- pt has N, V, pruritis, confusion (encephalopathy) -> uremia
- BUN formed from protein breakdown
ckd: azotemia + uremia tx
low protein diet -> dialysis initiated if dangerous levels
ckd: hyperkalemia patho + S/S
- kidney not working
- unable to remove wastes
- K not removed in urine -> increases in blood
- hyperkalemia
- hypopolarization
- faster HR
ckd: hyperkalemia tx
specific diuretics help remove K -> dialysis initiated if danger levels
ckd: hyperphosphatemia patho + S/S
- kidney not working
- unable to remove wastes
- P not removed in urine -> increase in blood
- problems
ckd: hyperphosphatemia tx
oral antacids (Tums) - bind phosphate in food + prevent absorption -> phosphate goes out in stool instead
ckd: HTN patho + S/S
- kidney not working
- over activate RAAS
- overproduce renin to angiotensin II
- vasoconstriction
- kidney can’t remove water
- volume overload
- HTN
ckd: HTN tx
diuretics + anti-hypertensive meds
ckd: anemia patho + S/S
- kidney not working
- not performing metabolic fxn
- no prod of erythropoietin
- less prod of RBCs over time
- anemia
ckd: anemia tx
administer erythropoietin hormone by injection
ckd: hypocalcemia + osteoporosis patho + S/S
- kidney not working
- not perform metabolic fxn
- no prod of substance that activates vit. D
- inability to absorb Ca2+ from foods
- hypocalcemia
- hypopolarization + osteoporosis
ckd: hypocalcemia + osteoporosis tx
administer vit. D + calcium supplements
ckd: metabolic acidosis
- kidney not working
- not performing metabolic fxn
- no prod of HCO3
- lack/less HCO3 tip into state of met. acidosis
ckd: metabolic acidosis tx
administer HCO3 -> antacids
ckd: extreme waste + water accumulation patho + S/S
- kidney not working
- unable to remove wastes + water
- accumulation leads to S/S of uremia
- uremia cause harm to other organ systems (heart, lungs, brain)
ckd: extreme waste + water accumulation tx
dialysis and/or kidney transplant
