Week 4 - AKI and Urinary Tract Seminar Flashcards
what is AKI characterized by
- abrupt decline in kidney function
- elevated serum creatinine and/or reduction in urine output
is AKI reversible?
- often it is
describe the mortality for AKI
- high
what are the 3 main categories of AKI
- pre renal
- intrarenal
- post renal
what is pre renal AKI
- decreased profusion to the kidney (marked decrease in renal blood flow)
- decreased glomerular filtration rate
what is an intrarenal AKI
- direct damage to the renal tissue
what is a postrenal AKI
- mechanical obstruction of urinary outflow
what are the 5 major roles of the kidneys
- filter & excrete metabolic wastes
- regulate blood vol & pressure
- produce erythropoietin
- regulate electrolytes
- regulate pH
what should we ask about for health history for AKI
- history of current symptoms
- PMHx
- PSHx
- family Hx
- meds
- social Hx (smoking, drugs)
- occupation Hx
- dietary/fluid intake
how long does it take for pre and post renal injuries to resolve if they have not caused intrarenal damage?
- usually promptly with correction of cause
list 6 meds/drug that may be harmful to the kidney (6)
- NSAIDs
- aminoglycosides
- ACE inhibitors at high doses
- cocaine
- heroin
- chemo –> methotrexate
what is ATN?
- acute tubular necrosis
- the most common intrarenal cause of AKI
what are the 3 phases of ATN? what is the timeline for each?
- initiation (24 hrs to a week)
- maintenance (10-14 days to months)
- recovery (up to a year)
what is the initiation phase of ATN characterized by
- increase in serum creatinine
- drop in urine output
what is the most common manifestation of the maintenance phase of ATN
- ologuria (<400 mL/24h)
what other symptoms are seen during the maintenance phase of ATN (9)
- urinary changes (oliguria)
- fluid retentions: HTN, edema
- metabolic acidosis
- sodium normal or low
- hyperkalemia
- anemia, platelet defects, WBC altered
- calcium deficit, phosphate excess
- azotemia (increased BUN and creatinine)
- neurological disorders
(very similar to CKD)
even tho sodium is normal or below-normal, why should excessive intake of sodium be avoided during ATN
- can lead to volume expansion, HTN, and CHF
what are characteristics of the recovery phase of ATN (6)
- return of BUN, creatinine, and GFR towards normal
- may experience diuretic phase & increased urine output
- hypovolemia & hypotension
- dehydration
- hyponatremia
- hypokalemia
why do people experience a diuretic phase during the recovery phase of ATN
- bc the kidney’s have recovered their ability to excrete wastes but not concentrate the urine
describe physical assessment for ATN in the initiation phase (3)
- vital signs (BP, HR) for signs of fluid retention
- ins and outs (sign of drop in u/o)
- lab work: BUN and creatinine
describe physical assessment for ATN during the recovery phase
monitor:
- ins and outs
- signs of hypokalemia
- signs of hyponatremia
- signs of hypovolemia/dehydration
what are signs of hyponatremia
Stupor
Abdominal cramping
Lethargy
Trouble concentrating (confused)
Loss of urine & appetite
Orthostatic hypotension, overactive bowel sounds
Shallow respirations
Seziures, spasm of muscles
what are signs of hypokalemia
Lethargy Low, shallow resp Lethal cardiac dysrhythmias Lots of urine Leg cramps Limp muscles Low BP and HR
what are some signs of dehydration/hypovolemia (5)
- tenting
- dry mucus membranes
- low BP
- sunken eyes
- dry, cool skin
what is glomerulonephritis
- immune related inflammation of the glomeruli
what is glomerulonephritis characterized by (4)
- proteinuria
- hematuria
- decreased urine production
- edema (periorbital common)
what is important for assessment of glomerulonephritis
- history! especially:
1. recent viral or bacterial infections
2. autoimmune conditions
3. immunization history
what is glomerulonephritis often associated with
- recent (1-3 weeks ago) history of strept A infection
= post-strep glomerulonephritis
list symptoms of post-strep glomerulonephritis
- some are symptomactic (urinalysis)
- hematuria
- HTN
- oliguria
- periorbital/peripheral edema
- abdominal or flank pain
what is a sign of hematuria in post-strep glomerulonephritis
- coke/tea colored or smoky urine
describe the recovery for post-strep glomerulonephritis
- 95% have complete recovery
- treatment is generally supportive in nature
what would you see in urinalysis of post-strep glomerulonephritis
- RBCs (hematuria)
- erythrocyte casts
- proteinuria
what would you see in blood work for someone w post-strep glomerulonephritis
- elevated creatinine/BUN
describe the history interview for someon w urinary complaints
- OPQRSTU r/t current complaint
- PMHx
- PSHx
- FHx
- nutritonal Hx
- elimination Hx
- meds
- allergies
- occupational Hx
- social Hx
- sexual H
what do you specificaly want to ask about regarding someone’s current complain for urinary complaints
- changes in bladder emptying (freq, urgency)
- characteristics of urine
- ask what their normal elimination is
what do you want to specifically ask about regarding PMHx for someone with a urinary complaint
- Hx of UT problems
- recent illness
- diabetes? (glucosuria = higher risk of infection)
what do you want to specifically ask about regarding meds for someone w a urinary complaint
- any that treat UT problems?
- cause UT problems (diuretics = increased u/o, opiods = retention)
why do you want to ask about sexual history for someone w urinary compliant
- possible STI exposure? –> can mimic UTI symptoms & can cause scarring = obstruction & stasis = risk of infection
what do you want to ask about regarding social history for someone w a urinary complaint
- smoking? (Bladder ca risk)
- drug use? (kidney injury risk)
what do you want to monitor in all patients for assessment r/t bladder drainage (5)
- ins and outs
- urine output
- patient comfort
- signs of infection
- integ changes (tissue integ from moisture)
what do you want to monitor for patients regarding drainage changes
any:
- kinks
- obstructions
- leakage
- position –> needs to be below the bladder
what do you want to monitor for patients regarding drainage changes
any:
- kinks
- obstructions
- leakage
- position –> needs to be below the bladder
if you see sediment/shredded material in urine sample, what could it be (5)
- mucous
- protein strands
- blood cells
- casts
- lymph
what is cystitis?
- lower UTI
- bladder infection
what happens is cystitis is untreated?
- can ascend up the urinary tract to cause pyelonephritis
what is pyelonephritis
- upper UTI/kidney infection
what is the most common cause of UTIs
- e.coli
what are some signs of cystitis (4) what is this set of symptoms called?
- dysuria
- frequency & urgency
- suprapubic discomfort
- cloudy urine
= LUTS (lower urinary tract symptoms)
what are 2 age related considerations for cystitis symptioms
- older adults: delirium
- young kids: may have vague sx like headache, stomachache, bedwetting
what are some signs of pyelonephritis (6)
- LUTS +
- fever
- chills
- malaise
- vomitting
- lower back & flank pain
what should physical assessment of UTI look like (both upper and lower)
- vitals (increased temp w pyelo)
- suprapubic discomfort on palpation of abdomen
- check CVA tenderness (only w upper)
what is the difference between a complicated and uncomplicated UTI
- uncomplicated = occurs in an otherwise normal urinary tract
- complicated = occur with the presence of obstruction, stones, catheters, diabetes, neuro disease, infection = risk of renal damage
what is CVA tenderness
- percussing the costevertebral angle (where the kidneys are) to assess for pain, which would indicate pyelonephritis
list diagnostic tests for UTIs
- urine dipstick/urinalysis
- urine C&S
- CBC
- KUB
- renal US
what will we see in urinalysis for both lower and upper UTI
- cloudy urine
- pyuria
- hematuria
- nitrites (due to bacteria)
when is a urine C&S required?
- always for pyelonephritis
- may not be for uncomplicated UTI
what will we see in CBC for UTIs?
- increased WBC with left shift (pyelonephritis only)
when do we require a KUB or renal US
- for repeated cystitis in childrren
- pyelonephritis
list the types of treatment for UTIs
- antibiotics
- possibly hospitalization
how long does a pt need to be on antibiotics for an uncomplicated cystitis? complicated?
- uncomplicated = 3-5 days
- complicated = 7-14 days
what type of antibiotics are required for pyelonephritis? how long?
- IV/oral Tx
- 14+ days
when might someone with a UTI need to be hospitalized?
- if severe infection
- or for N/V r/t dehydration
- high urea or creatining
what is renal calculi
- kidney stones
who are renal calculi more common in?
- men than women
what age has high prevalence of renal calculi
- 20-55
what causes the pain r/t kidney stones
- obstruction of urinary flow
describe the health hisotry part of assessment for renal calculi
- OPQRSTU of current symptoms
- personal history of kidney stones
- family history of kidney stones
- social history
- dietary history
what are common symptoms of kidney stones
- abdominal and/or flank pain
- radiation of pain to groin
- hematuria
- NV
- dysuria
- urgency
what should you specifically ask about regarding social hisotry for assessment of kidney stones
- sedentary lifestyle/immobility
what should you specifically ask about regarding dietary history for assessment of kidney stones
- fluid intake
- high protein?
- high oxalate?
describe the general physical exam for someone w kidney stones
- VS (BP, HR, temp)
- observe behavior (bent over in pain?)
- abdominal exam (tenderness?)
- CVA tenderness
what is lithotripsy
- treatment using ultrasound shock waves to break the kidney stone down into smaller pieces so it can be passed out by the body
describe the physical assessment after lithotripsy removal of kidney stones
- vital signs (BP, temp)
- expect hematuria
- assess & treat pain
- signs of infection
describe the assessment after surgical removal of kidney stones
- same as lithotripsy
what are diagnostic tests commonly used for renal calculi
- blood work
- urinalysis
- urine C&S
- abdominal xray
- US
- CT scan
why would we use an abdominal xray, ultrasounds, and CT scan as a diagnostic for renal calculi?
- to identify stones & their location
