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Patho Exam 4 > The Renal System > Flashcards

The Renal System Flashcards

1
Q

Urinary System

A 
Regulates:
-Fluid volume
-Blood pressure
-Metabolic waste and drug excretion
-Vitamin D conversion
-Acid-base balance
-Hormone synthesis
Includes: kidneys, ureters, bladder, and urethra
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2
Q

Renal capsule

A

connective tissue surrounding the kidney

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3
Q

Renal cortex

A

area immediately beneath the capsule, which contains the nephrons.

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4
Q

Renal artery

A

supplies each kidney with blood

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5
Q

Renal hilum

A

opening in the kidney the renal artery and nerves enter and the renal vein and ureter exit

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6
Q

Renal sinus

A

cavity form the renal pelvis

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7
Q

Calyces

A

tubes through which urine drains into the renal pelvis

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8
Q

Ureters

A

transports urine from the calyces to the bladder

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9
Q

Bladder

A

muscular structure that serves as a reservoir for urine until it can be excreted

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10
Q

Urethra

A

transports urine from bladder to urinary meatus

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11
Q

Urination

A

Voluntary activity
As urine volume in the bladder increases, the urine exerts pressure on the two bladder sphincters (internal and external) and stretch receptors in the bladder
Normal daily urine output is 1,500 mL

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12
Q

Three Components of Urine Formation

A

Filtration
Reabsorption
Secretion

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13
Q

Bowman’s capsule

A

double membrane that surrounds the glomerulus

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14
Q

Glomerulus

A

cluster of capillaries

where filtration happens

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15
Q

Glomerular filtration rate

A

rate of blood flow through the glomerulus

Best indicator renal function
Normal 125 mL/min

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16
Q

Juxtaglomerular cells

A

measure blood flow in the afferent arteriole and urine flow and composition

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17
Q

Renin

A

comes from the kidneys;

which turns on the Na+/K+ ATPase in the distal tubule

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18
Q

K+

A

is secreted

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19
Q

Na+ and water

A

are reabsorbed

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20
Q

Hormonal Influences

A

Antidiuretic hormone
Aldosterone
Renin-angiotensin-aldosterone

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21
Q

Other Renal Activities

A

Converts vitamin D to its active form

Secretes bicarbonate

Excretes or retains hydrogen

Synthesizes atrial natriuretic peptide, erythropoietin, and renin

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22
Q

A man has severe renal disease
Why does he develop
Anemia?
Weak bones?

A

He’s not making enough red blood cells. Kidney is not responding when the body ask for blood.

weak bones- lack of vitamin D

23
Q

Tests of Renal Function

A

Blood Test
Creatinine
BUN (Blood Urea Nitrogen)
Creatinine Clearance

Urinalysis (UA)

Urine Sediment

Glomerular Filtration Rate

24
Q

We expect a 10:1 ratio between BUN and Creatinine

If both are elevated, it indicates kidney damage

If only BUN is elevated, it indicates dehydration
WHY?

A

Cause the water balances the concentration of the blood

25
Q

Health care providers frequently ask a patient for a clean- catch, midstream urine sample. Why?

A

best sample possible
pee a little cause they want wants in the bladder.
results could be inaccurate with stuff on the skin

26
Q

Changes with Aging

A

Exacerbated by the presence of chronic conditions

Increased risk for waste accumulation and loss of homeostatic regulation

Other renal-related complications include anemia, hypertension, and osteoporosis

Also at increased risk for drug toxicity

27
Q

Polycystic Kidney Disease

A

Inherited disorder characterized by numerous, grape-like clusters of fluid-filled cysts in both kidneys

Cysts enlarge the kidneys while compressing and eventually replacing the functional kidney tissue

28
Q

Polycystic Kidney Disease Manifestations

A

Symptoms that may both children and adults:
Hematuria
Nocturia
Drowsiness

Symptoms in adults include:
Hypertension
Lumbar pain
Increased abdominal girth
Swollen, tender abdomen
Grossly enlarged, palpable kidneys
29
Q

Cystic disease of the kidney

A

Simple and acquired renal cysts
Medullary cystic disease
Autosomal dominant polycystic kidney disease

30
Q

Glomerulonephritis

A

Bilateral inflammatory disorder of the glomeruli that typically follows a streptococcal infection

Diagnosis: history, physical examination, urinalysis, blood chemistry, serum antibody levels, computed tomography, and renal biopsy

Treatment: antibiotic therapy, corticosteroids, blood pressure management, and temporary dialysis

31
Q

Glomerulonephritis Signs and Symptoms:

  1. Hematuria (blood in urine), proteinuria (protein in urine)
  2. Edema
  3. Malaise, headache, N/V
  4. Elevated B/P and fluid volume overload
  5. Dark urine with blood (cola colored)
  6. Anemia
  7. Dyspnea, cardiomegaly, pulmonary edema
  8. Oliguria (scant urine output)
  9. Confusion
A

Why?

  1. Damage to the membrane allowing protein to leak
  2. Proper excretion is not occurring
  3. Retaining toxins
  4. Fluid retention d/t decreased urine output (UOP)
  5. RBCs and protein in the urine
  6. No erythropoietin
  7. Circulatory overload
  8. Unable to Excrete
  9. Sodium imbalances and overload
32
Q

Nephritic syndrome

A

Inflammatory injury to the glomeruli that can occur because of antibodies interacting with normally occurring antigens in the glomeruli- triggers complement system

Causes: diseases that initiate the inflammatory response

Manifestations: gross hematuria, urinary casts and leukocytes, low GFR, azotemia (high BUN and creatinine), oliguria, and high blood pressure

Complications: impaired renal function

33
Q

Pyelonephritis

A

Infection that has reached one or both kidneys

E. coli is the most common culprit

Kidneys become grossly edematous and fill with exudate, compressing the renal artery

Abscesses and necrosis can develop, impairing renal function and causing permanent damage

May be acute or chronic

Complications: renal failure, recurrent UTIs, and sepsis

34
Q

Pyelonephritis manifestations

A

Manifestations: severe UTI symptoms, flank pain, and increased blood pressure

Diagnosis: history, physical examination, urinalysis, urine and blood cultures, complete blood count, cystoscopy, intravenous pyelogram, computed tomography, renal ultrasound, biopsy, and cystourethrogram

Treatment: usual UTI treatments, but long-term antibiotics (4–6 weeks) are usually required

35
Q

Pyelonephritis-
Signs and Symptoms

Chills and fever
Anorexia, N,V
Dysuria, frequency, urgency
Pyuria (pus) in the urine
CVA tenderness
A

Why?

Infection
Kidneys cannot excrete toxins and they build up
Inflammation and infection of the kidneys
Bacterial growth
Infection of the kidneys

36
Q

Consequences of Dilatation of Renal Tubules or Tract

A

Expansion of the kidney with urine (hydronephrosis)
Increased pressure inside the renal capsule
Compartment syndrome compresses blood vessels inside kidney
Renal ischemia

Stasis of urine
Risk of infection
Stones

37
Q

Hydronephrosis

A

Abnormal dilation of the renal pelvis and the calyces of one or both kidneys

Causes: urolithiasis, tumors, benign prostatic hyperplasia, strictures, stenosis, and congenital urologic defects

38
Q

Urolithiasis (Kidney Stones)

A

Presence of renal calculi, hard crystals composed of minerals that the kidneys normally excrete

More common in men and Caucasians

The most frequent type of calculi contains calcium in combination with either oxalate or phosphate

Other types include struvite or infection stones, uric acid stones, and cystine stones

39
Q

Urolithiasis risk factors

A 
pH changes
urinary stasis
family history
obesity
hypertension
diet
40
Q

Urolithiasis Manifestations:

A 
Flank area pain
Groin or leg pain
Bloody, cloudy, or foul- smelling urine
Dysuria
Frequency
Nausea, vomiting
Fever and chills
41
Q

Urinary Tract Obstructions
Signs and Symptoms

  1. Flank pain
  2. Urgency, frequency, hematuriaSigns and Symptoms
  3. N/V, Abd. Pain, diarrhea
  4. Fever and Chills
A

Why?

  1. Stone is obstructing the ureter, pelvis or tubes
  2. Stone passage causes spasms
  3. Severe pain, infection, nerve stimulation causing nausea
  4. Immune response to infection
42
Q

Renal Cell Carcinoma

A

Manifestations: asymptomatic, painless hematuria, abnormal urine color, dull and achy flank pain, urinary retention, palpable mass over affected kidney, unexplained weight loss, anemia, polycythemia, hypertension, paraneoplastic syndromes, and fever

43
Q

Renal Failure

A

Kidneys are unable to function adequately

Classified as either acute or chronic

44
Q

Acute Kidney Injury

A

Sudden loss of renal function
Generally reversible
Most common in critically ill, hospitalized patients
Risk factors: advanced age, autoimmune disorders, and liver disease

There is a hope that the kidney will recover

45
Q

Causes of Acute Kidney Injury

A

Prerenal conditions
Extremely low blood pressure or blood volume
Heart dysfunction

Intrarenal conditions
Reduced blood supply within the kidneys
Hemolytic uremic syndrome
Renal inflammation
Toxic injury

Postrenal conditions
Ureter obstruction
Bladder obstruction and dysfunction

46
Q

Phases of Acute Kidney Injury

A
  1. Asymptomatic phase
  2. Oliguric phase - daily urine output decreases to approximately 400 mL or less, and waste products accumulate
  3. Diuretic phase - daily urine output increases to as much as 5 L
  4. Recovery phase - glomerular function gradually returns to normal
47
Q

Manifestations of Acute Kidney Injury

A

Oliguric phase: decreasing urine output, electrolyte disturbances, fluid volume excess, azotemia, and metabolic acidosis

Diuretic phase: increased urine output, electrolyte disturbances, dehydration, and hypotension

Recovery phase: symptoms begin resolving

48
Q

Acute Kidney Injury Diagnosis

A

Diagnosis: history, physical examination, blood chemistry, arterial blood gases, urinalysis, complete blood count, renal ultrasound, and biopsy

49
Q

Acute Kidney Injury Treatment

A

Correct fluid and electrolyte imbalances
Dialysis
A diet high in calories and restricted in protein, sodium, potassium, and phosphates
Hypertension management
Anemia treatment with synthetic erythropoietin
Infection prevention strategies

there is a hope that

50
Q

Chronic Kidney Disease

A

Gradual loss of renal function that is irreversible
Causes: diabetes mellitus, hypertension, urine obstructions, renal diseases, renal artery stenosis, ongoing exposure to toxins and nephrotoxic medications, sickle cell disease, systemic lupus erythematosus, smoking, advancing age

51
Q

Phases of

Chronic Kidney Disease

A

Manifestations appear slowly

Stage 3-4: waste products begin to accumulate and kidneys don’t concentrate urine, maintain BP, or secrete erythropoietin

Stage 5: unable to maintain homeostasis while waste products, fluid, and electrolytes accumulate

52
Q

Manifestations of Chronic Kidney Disease

A 
Peripheral neuropathy, restless leg syndrome, and seizures
Nausea and vomiting
Anorexia
Malaise
Fatigue and weakness
Headaches that seem unrelated to any other cause
Decreased mental alertness
Flank pain
Jaundice
Persistent pruritus
Recurrent infections
Sleep disturbances
Hypertension
Polyuria with pale urine (early)
Oliguria or anuria with darkly colored urine (late)
Anemia
Bruising and bleeding tendencies
Electrolyte imbalances
Muscle twitches and cramps
Pericarditis, pericardial effusion, pleuritis, and pleural effusion
Congestive heart failure
Respiratory distress and abnormal breath sounds
Sudden weight change
Edema of the feet and ankles
Azotemia
53
Q

Chronic Kidney Disease Diagnosis

A

Diagnosis: history, physical examination, urinalysis, blood chemistry, computed tomography, magnetic resonance imaging, renal ultrasound, biopsy, complete blood count, and arterial blood gases

Treatment:
Manage and prevent complications and alternative medication dosing (BP control, blood glucose control)
Smoking cessation
Dietary management depending on stage of disease (limit high phosphate foods, monitor proteins, potassium-rich foods, possible sodium and water restrictions)
Medications to manage complications
Dialysis or transplant for late stages

Patho Exam 4 (1 decks)

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