Test 2 Renal Flashcards
Anatomy of kidneys
Attached to the abdominal wall at the level of the last thoracic and first three lumbar vertebrae
Enclosed in the renal capsule
Cortex
Outer layer of the renal capsule
Medulla
Surrounded by the cortex
Functions of kidneys
Maintain homeostasis of the blood
Excrete end products of metabolism
Control fluid and electrolyte balance
Excrete bacterial toxins, water-soluble drugs and drug metabolites
Secrete renin and eryhropoietin
Play a role in the function of the parathyroid hormones and vitamin D
Nephron
Functional renal unit
Composed of glomerulus and tubules
Glomerulus
Encased in Bowman’s capsule
Filters the fluid out of the blood
Tubules
Fluid is converted to urine in tubules and urine then moves to pelvis of kidneys
Urine flows from the pelvic of kidney through the ureter and empties into the bladder
What the tubules include
Proximal distal and Henle’s loop
Urine production
As fluid flows through the proximal tubules water and solutes are reabsorbed
Water and solutes not reabsorbed become urine
Selective reabsorption
Determines the amount of water and solutes to be secreted
Prostate gland
Surrounds male urethra
Contains a duct that opens into the prostatic portion of the urethra and secretes the alkaline portion of the seminal fluid
Risk factors associated with renal disorders
Frequent UTIs
High sodium diet
Contact sports
Trauma and injury
History of hypertension
Family history of renal disease
Medication use
Associated conditions
Normal BUN (blood urea nitrogen)
5-20 mg/L
Normal Serum creatinine
0.6-1.3 mg/dL
Normal Creatinine clearance
100-120 mL/minute
Normal acid serum
2.5-8.0 mg/dL
Normal Uric Acid Urine
250-750 mg/24 hours
Urinalysis
A urine test for evaluation of the renal system and for determining renal disease
Implementation of Urinalysis
Wash perineal area
Use a clean container
Obtain 10-15 mL of the first morning sample
Lookout for in urinalysis
Refrigerated samples may alter the specific gravity
If client is menstruating, indicate in lab requisition form
Physical exam of urinalysis
Color
Clarity
Specific gravity
Chemical exam of urinalysis
Urine pH
Protein
Glucose
Ketones
Blood
Bilirubin
Urobilinogen
WBCs
Nitrites
Leukocyte esterase
Specific gravity
Urine test that measures the specific gravity of the urine
Evaluates concentrating and excretory ability of the kidneys and hydration status
Results of specific gravity
High indicates concentrated urine - dehydration
Low indicates dilute urine - overhydration
Application of specific gravity test
Chronic renal diseases are associated with low specific gravity
Knowledge of specific gravity helps in the interpretation of a urinalysis
Urine culture and sensitivity
Urine test that identifies the presence of microorganisms and determines the specific antibiotics that will appropriately treat the existing microorganisms
Implementation of urine culture and sensitivity
Clean perineal are and urinary meats with bacteriostatic solution
Collect midstream sample in a sterile container
Send to laboratory immediately
Lookout of urine culture and sensitivity
Urine from clients who forced fluids mat be too dilute to provide a positive culture
Identity any sources of potential contaminants during the collection of the specimen such as the hands, skin, clothing, hair and vaginal or rectal secretions
Creatinine Clearance Test
Blood and timed urine specimen that evaluates kidney function
Blood is drawn at the start of the test and the morning of the day that the 24-hour urine specimen collection is complete
Implementation of Creatinine Clearance Test
Encourage adequate fluids before and during the test
Maintain the urine specimen on ice or refrigerate and check with the laboratory regarding the addition of a preservative to the specimen during collection
Lookouts for Creatinine Clearance Test
Avoid tea, coffee and medications during testing
If taking ACTH, cortisone or thyroxine, check with physician regarding admin during testing
VMA (Vanillylmandelic Acid) Test
24-hour collection to diagnose pheochromocytoma
Test identifies as assay of urinary catecholamines in the urine
Pheochromocytoma
Tumor of the adrenal gland
Implementation and lookouts of VMA test
Avoid foods such as caffeine, cockamamie vanilla, cheeses gelatin, licorice and fruit for at least 2 days prior to beginning the urine collection and during
Avoid taking meds for 2-3 days prior to beginning as prescribed
Avoid stress and maintain adequate food and fluids during the tests
Uric Acid test
24-hour urine collection to diagnose gout and kidney disease
Implementation and lookouts of Uric Acid Test
Encourage fluids and a regular diet during testing
Place specimen on ice or refrigerate and check with lab regarding the addition of a preservative
KUB (kidneys, ureters and bladder)
An x-ray film that views the urinary system and adjacent structures
Used to detect urinary calculi
Intravenous Pyelogram (IVP)
Injection of a radiopaque dye that outlines the renal system
Preformed to identify abnormalities in the system
Education of Intravenous Pyelogram (IVP)
Obtain informed consent
Assess the client for allergies to iodine, seafoods and radiopaque dyes
Inform the client about possible throat irritation, flushing of the face, warmth, or a salty taste that may be experienced during the test
Renal Angiography
The injection of a radiopaque dye through a catheter for examination of the renal arterial supply
Implementation of Renal Angiography
Need to know about allergies to iodine, seafood and radiopaque dyes
Dye may cause a burning feeling or a feeling of heat along the vessel after the dye is injected
Need to assess and mark the peripheral pulses
Renal Scan
IV injection of a radioisotope for visual imaging of a renal blood flow
Implementation of Renal Scan
Assess for allergies
Instruction clients that they will be required to remain motionless
Instruct clients that imaging may be repeated at various intervals before the test is complete
Radioactive material will clear within 24 hours
Voiding Cystourethrogram
The contract medium is injected through the catheter
Cystitis
UTI
Inflammation of the bladder from injection or obstruction of the urethra
More common in women because they have a shorter urethra and is close to the rectum
Sexually active and pregnant women are most vulnerable to cystitis
Most common causative organisms of Cystitis
Escherichia coli
Enterobacter
Pseudomonas
Serratia
Causes of Cystitis
Hormonal changes influencing alterations in vaginal flora
Loss of bactericidal properties of prostatic secretions in men
Sexual intercourse
Poor fitting diaphragms
Use of spermicides
Synthetic underwear and pantyhose
Wet bathing suits
Allergens or irritants
Invasive urinary tract procedures
In dwelling urethral catheters
Bladder distention
Urinary stasis
Calculus
Urosepsis
Gram neg bacteremia originating in the urinary tract
Major problem is the ability for it to develop resistant strains
Can lead to septic shock if not treated aggressively
Most common causes of Urosepsis
Organism: Escherichia coli
Most common cause is the presence of an indwelling catheter or an untreated UTO in a client who is medically compromised
Management of Urosepsis
Includes urine C&S, IV antibiotics until the client has been afebrile for 3 to 5 days and then oral antibiotics
Urethritis
Inflammation of the urethra commonly associated either sexually transmitted diseases (STDs)
Also may be seen with cystitis
Urethritis in Men
It is most often caused by gonorrhea and chlamydial infection
Urethritis in women
Most often caused by feminine hygiene sprays, perfumed toilet paper and sanitary napkins, spermicidal jellies, UTIs and changes in the vaginal mucosal lining
Signs and symptoms of Urethritis in Men
Burning on urination
Frequency
Urgency
Nocturia
Difficulty voiding
Discharging from the penis
Signs and symptoms of urethritis in women
Frequency
Urgency
Nocturia
Painful urination
Difficulty voiding
Lower abdominal discomfort
Ureteritis
Inflammation of the ureter that is commonly associated with pyelonephritis
Chronic pyelonephritis causes the ureter to become fibrotic and narrowed by strictures
Pyelonephritis
Inflammation of the renal pelvis and the parenchyma
Commonly caused by bacterial invasion
Acute pyelonephritis causes
Often occurs after bacterial contamination of the urethra or following as invasive procedure of the urinary tract
Chronic pyelonephritis causes
Most commonly occurs following chronic obstruction with reflux or chronic disorders
Escherichia coli is the most common bacterial causative organism
Acute pyelonephritis description
Usually a short course that recurs as a relapse of the previous infection or as a new infection
Can progress to bacteremia or chronic pyelonephritis
S/s of acute pyelonephritis
Fever and chills
Nausea
Flank pain on the affected side
Costovertebral tenderness
Headache
Muscular pain
Dysuria
Frequency and urgency
Cloudy, bloody or foul smelling urine
Increased WBC in the urine
Chronic pyelonephritis description
A slow progressive disease that is usually associated with recurrent acute attacks
Causes contraction of the kidneys and dysfunction of the nephrons, which are replaced by scare
S/s of chronic pyelonephritis
Frequently diagnosed incidentally when a client is being evaluated for hypertension
Poor urine concentrating ability
Pyuria
Azotemia
Proteinuria
Anemia
Acidosis
Urolithiasis and Nephrolithiasis
Calculi or stones can form anywhere in the urinary tract however, most frequently in the kidneys
The problems that can occur as a result are pain, obstruction and tissue trauma with secondary hemorrhages and infection
Urolithiasis and Nephrolithiasis testing
KUB film, IVP, CT scan and renal ultrasonography will determine location
Stone analysis will be done after to determine the type and treatment
Urolithiasis
Refers to the formation of urinary stones
Urinary calculi are formed in the ureter
Nephrolithiasis
Referees to the formation of kidney stones
Kidney stones are formed in the parenchyma
Hydroureter
When a calculus occludes the ureter and blocks the flow of urine, the ureter dilates
If the obstruction is not removed, urinary stasis results in infection, impairment of renal function on the side of the blockage and resultant hydronephrosis and irreversible kidney damage
Causes of Urolithiasis and Nephrolithiasis
Family history
Diet high in calcium, vitamin D, milk, protein, oxalate, purines or alkali
Obstruction and urinary stasis
Dehydration
Use of diuretics which cause volume depletion
UTIs and prolonged catheterization
Immobilization
Hypercalcemia and hyperparathyroidism
Elevated Uric acid levels (gout)
S/s of Urolithiasis and Nephrolithiasis
Renal colic originates in the lumbar region and radiates around the side and down towards the testicle. In men and to the bladder in women
Ureteral colic radiates towards the genitalia and thigh
Sharp sever pain of sudden onset
Dull, aching kidney(s)
N&V, pallor, diaphoresis during a true pain
Urinary frequency with alternating retention
Signs of UTI
Low grade fever
RBCs, WBCs and bacteria in urinalysis
Hematuria
Calcium Oxalate Stones
Caused by supersaturation of urine with calcium and oxalate
Diet includes acid ash foods, because calcium stones have alkaline chemistry
Dietary prescription for calcium oxalate stones
Decreasing intake of foods high in calcium
Avoiding oxalate doos sources to reduce oxalate content and formation of
Oxalate rich foods
Tea, almonds, cashews, chocolate, cocoa, beans, spinach and rhubarb
Struvite stones
Also called triple phosphate stones
Composed of magnesium and ammonium phosphate
Caused by urea splitting bacteria
Tend to form in alkaline urine
Diet included acid ash foods
Dietary prescription for struvite stones
Limiting high-phosphate foods
High phosphate foods
Dairy product, red and organ meat, whole grains
Uric acid stones
Caused by excess dietary purine or gout
Tend to form in acidic urine
Dietary prescription for Uric acid stones
Alkaline ash foods and decreased intake of purine sources
Allopurinol (zyloprim) may be prescribed to lower Uric acid levels
Purine sources
Organ meats, gravies, red wines, and sardines to reduce urinary purine content
Cystine stones
Caused by cystine crystal formation
Tend to form in acidic urine
Diet includes alkaline ash foods
Dietary prescription for cystine stones
Low intake of methionine, an essential AA that does cystine
Also focus on encouraging fluids up to 3 L a day, unless contraindicated to help dilute the urine and prevent cystine crystals from forming
Alkaline Ash Diet
Increases the pH
Reduces the acidity of the urine
Includes:
Milk
Fruits, except cranberries, plums and prunes
Rhubarb
Most veggies
Small amounts of beef, halibut, veal, trout and salmon allowed
Acid ash diet
Decreases pH, makes urine more acidic
Includes:
Cheese, eggs
Meat, fish, oysters, poultry
Bread, cereal, whole grains
Pastries
Cranberries, prunes, plums, tomatoes
Corn and legumes
Foods to avoid in acid ash diet
Carbonated beverages
Baking soda or powder
All veggies except corn and legumes
Olives, pickles
Nuts other than peanuts
Cystoscopy
May be done for stones located in the bladder or lower ureter
No incision
One or two ureteral catheters are inserted past stone, may mechanically guide stones downward
May be manicured or dislodges by the procedure
Catheters left for 24 hrs to drain urine
Continuous chemical irrigation
Extracorporeal shock wave lithotripsy (ESWL)
Noninvasive no incisions or drains
Breaks up stones that are located in the kidney or upper ureter
Fluoroscopy is utilized to to visualize the stone
Ultrasonic waves are delivered through a bath of warm warm water to the area of the stone
Stones are passed in three urine within a few days
Percutaneous Lithotripsy
Performed for stones in the bladder, ureter or kidneys
An invasive procedure in which a guide is inserted under fluoroscopy near the area of the stone
Ultrasonic wave is aimed at the stone to break it into fragments
May be cystoscopy (no incision) or nephroscopy (small flank)
Possibly indwelling catheter
Nephrostony tube to administer chemical irrigation
Steps after a percutaneous lithotripsy
Encourage client to drink 3000 to 4000 mL of fluid per day following the procedure
Monitor for and instruct client to monitor for complications of infection, hemorrhage and extravasation of fluid into the retoperitoneal cavity
Ureterolithotomy
Open surgical procedure, preformed if lithotripsy is not effective
Performed if the location is in the ureter
Incision into ureter is made through lower abdominal or flank incision to remove the stone
Client may have a Penrose drain, ureteral stent catheter and an indwelling bladder catheter
Pyelolithotomy
A flank incision into the kidney is made to remove stones from the renal pelvis
Large flank incision required
Client will have a Penrose drain and indwelling catheter
Nephrolithotomy
Incision into the kidney is made to remove the stone
Large flank required
Client may have a nephrostomy tube and an indwelling catheter
Partial or total nephrectomy
Performed if there is extensive kidney damage, renal infection or severe obstruction and to prevent stone recurrence
