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Patho > Week 6 Renal System > Flashcards

Week 6 Renal System Flashcards

1
Q

The nurse is caring for a client with suspected dehydration. Which results does the nurse recognize will help confirm this diagnosis?

A. elevated urine specific gravity
B. casts in the urine
C. blood in the urine
D. white blood cells in the urine

A

A. elevated urine specific gravity

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2
Q

When the glomerular transport maximum for blood glucose is exceeded and its renal threshold has been reached, what happens to the excess glucose?

A. reabsorbs quickly
B. spills into the urine
C. swaps for sodium
D. attaches to protein carries

A

B. spills into the urine

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3
Q

Define dysgenesis, agenesis, and hypoplasia

A

dysgenesis = failure of an organ to develop normally

agenesis = the complete failure of an organ to develop

hypoplasia = failure of an organ to reach normal size

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4
Q

Explain the causes and definition of cystic disease of the kidney

A

definition: fluid filled sacs or segments of a dilated nephron
causes: tubular obstructions that increase intratublar pressure

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5
Q

What are the two types of polycystic kidney disease

A
  1. autosomal recessive polycystic kidney disease (supportive care, 10 yr survival rate)
  2. autosomal dominant polycystic kidney disease (seen in adult population)
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6
Q

What are causes of urinary tract obstructions

A
  • developmental defects
  • calculi
  • pregnancy
  • benign prostatic hyperplasia
  • scar tissue resulting from infection and inflammation (narrowing or ureters)
  • tumors
  • neurologic disorders such as spinal cord injury
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7
Q

What are the damaging effects of urinary obstruction

A
  • stasis of urine predisposes to infection and stone formation
  • development of back pressure which interferes with renal blood flow and destroys kidney tissue (creates a compartment syndrome scenario)
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8
Q

What are the consequences of obstructions?

What are the common symptoms?

A
  1. hydronephrosis - expansion of the kidney with urine (can lead to compartment syndrome)
  2. hydroureter: dilation of the ureters caused by accumulation of urine (become distended and hold onto fluid)

Symptoms: pain, signs and symptoms of UTI r/t urinary stasis, manifestations of renal dysfunction, complete bilateral obstruction results in oliguria (<400 ml/day)

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9
Q

What is characterized as lower obstructions and upper obstructions of renal system

A

lower = bladder and below (urethra/bladder)

upper = ureters, kidneys

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10
Q

Define kidney stones. What are the requirements for formation

A

Definition: crystalline structures that form from component of the urine (common cause of upper urinary tract obstruction)

Requirements:

  • A nidus must form (nidus = germ cell)
  • a urinary environment that supports continues crystallization of stone components (hydration status and concentration of ions)
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11
Q

What are the manifestations of kidney stones

A
  • renal colic: intermittent and sharp, stones in ureters, flank or upper outer quadrant of affected side
  • noncolicky pain: dull, achy, flank pain, somewhat persistent, worse with fluids
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12
Q

Explain the 4 types of stones

A
  1. calcium: #1 types; 75% incidence; caused by prolonged immobility, increased GI absorption, impaired renal reabsorption
  2. Magnesium ammonium phosphate called Struvite: common stone in women because they cause UTIs, want more of a basic urine, staghorns in renal pelvis
  3. uric acid: primarily seen with gout, prefers acidic environment
  4. cystine: genetic defect in renal cystine reabsorption
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13
Q

Which of the following conditions does not lead to stone formation

a. acidic pH
b. supersaturated urine
c. urine stasis
d. high Na+ concentration

A

d. high Na+ concentration

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14
Q

Gout and the development of kidney stones are often attributed to high levels of what compound?

a. uric acid
b. urea
c. protein
d. albumin

A

a. uric acid

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15
Q

What are the four types of urinary tract infections

A
  1. asymptomatic bacteriuria (people that straight cath themselves, suprapubic catheters, indwelling catheters)
  2. symptomatic infections
  3. lower UTIs (down in bladder called cystitis
  4. upper UTIs (affecting body of kidney called polynephritis)
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16
Q

What are examples of anatomic and functional obstructions that would cause urinary stasis

A
  1. anatomic: urinary tract stones, prostatic hyperplasia, pregnancy, malformations of the uteterovesical junction, increase pressure resulting in reflux
  2. functional: neurogenic bladder (messengers not telling the body to void), infrequent voiding, detrusor (bladder muscle) muscle instability, constipation
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17
Q

What are the UTI protective mechanisms by the body

A
  • washout phenomenon
  • mucin layer (prevents bacteria from making a home for itself)
  • local immune responses
  • normal flora of the periurethral area in women (losing flora opens up “housing” for other bacteria to move in)
  • prostate secretions in men
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18
Q

Explain urosepsis

A
  • bacteria originates from a UTI
  • 20% - 30% of all septic patients
  • occurs in renal pelvis
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19
Q

Explain the two types of pyelonephritis

A
  1. complicated: when there is some other disease process or obstruction that causes you to have frequent UTIs and they become more difficult to treat
  2. uncomplicated: I wore a bathing suit too long and got a UTI
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20
Q

What is the normal urine pH values

A

5 - 6.5

21
Q

Explain casts, cells, and crystals in urine and why they are bad

A
  1. Cells:
    - come from the bladder
    - epithelial cells = normal
    - RBCs = bleeding
    - WBCs = infection (UTI)
  2. Casts
    - originate in renal tubules
    - red = bleeding into tubules
    - white = inflammation, suggest kidney infection
    - epithelial = damage to tubular walls
  3. crystals
    - made of uric acid, calcium, phosphates, cysteine
22
Q

What is the biggest reason for glomerulonephritis

A

own immune system causing problem; overreacting to a perceived problem and causing damage to glomerulus

23
Q

What are the characteristics of glomerulonephritis

A
  • hematuria with red cell casts
  • diminished glomerular filtration rate
  • azotemia (nitrogenous wastes in the blood)
  • oliguria (<400 ml/day)
  • hypertension (urines is staying in vessels and now you’re fluid filled)
24
Q

Explain acute nephritic syndrome (still part of glomerulonephritis)

A
  • inflammatory process that occludes the glomerular capillary lumen and damages capillary wall
  • you begin to have leaky walls which allow small amounts of protein in the urine and you’ll start to see hematuria with red cell casts because the damage is up in the kidneys
  • a diminished GFR and increased salt and water retention leads to edema, HTN, and oliguria
25
Q

What are the two conditions that are considered acute nephritic syndrome

A
  • Lupus

- acute postinfectious glomerulonephritis caused by strep

26
Q

Explain nephrotic syndrome and the consequences of it

A

You lose a lot of proteins; its not a specific disease, but a specific group of clinical findings

  • albumin is a carrier protein so drugs become toxic
  • albumin carries thyroid hormone
  • clotting factors are proteins and now you’ve lost them which could lead to thrombosis
  • immunoglobulins and complement leads to losing your immune system

Liver will try to compensate by releasing proteins but it will overshoot and you’ll end up with lipiduria and hyperlipidemia

27
Q

What is the most common cause of primary nephrosis in adults

A

membranous glomerulonephritis

28
Q

What are other factors that can lead to glomerulonephritis

A
  1. Lupus: forms immune complexes with glomerular capillary wall
  2. diabetic glomerulosclerosis: widespread thickening of basement membrane
  3. hypertensive glomerular disease: scarring of renal arterioles
  4. drug induced impairment: result of direct toxic injury, hypersensitivity reaction
29
Q

Glomerulonephritis will result from which of the following?

A. basement membrane thickening
B. sclerosis
C. fibrosis
D. all of the above

A

D. all of the above

30
Q

The nurse would be concerned when the glomerular filtrate contains:

A. protein
B. sodium
C. potassium
D. water

A

A. protein

31
Q

Explain the three types of acute kidney injury (prerenal, intrarenal, postrenal)

A
  1. prerenal
    - not getting enough perfusion to the kidneys
    - before making urine
    - caused by hypovolemia, shock, HF and cardiogenic shock
    - low renal perfusion due to sepsis, vasoactive mediators, drugs
  2. intrarenal:
    - this occurs while making urine (tubular system is the problem)
    - caused by acute tubular necrosis
  3. postrenal
    - caused by bilateral ureteral obstruction or bladder outlet obstruction
    - occurs after making urine
32
Q

A client in the intensive care unit is diagnosed with hypovolemic shock based on a blood pressure of 88/53 mmHg, heart rate of 122 bpm, respiratory rate of 26 breaths. given these vital signs, what urine output should the nurse expect

a. maintained between 30 to 50 ml/hour with no sediment in the bag
b. increased to 60+ ml/hr with dilute urine
c. decreased below 30 ml/hour with decrease GFR
d. client’s normal amount with dark, concentrated urine

A

c. decreased below 30 ml/hour with decrease GFR

33
Q

What are the reasons acute tubular necrosis (intrarenal) may occur?

A
  • prolonged renal ischemia
  • exposure to nephrotoxic drugs (meds that are hard on kidneys like vancomycin)
  • intratubular obstruction (backflow of pressure inside the Bowman’s capsule and you can’t filter it out) and causes hemoglobinuria, myoglobinuria, myeloma light chains, uric acid casts
  • acute renal disease
  • rhabdomyolysis
34
Q

Explain the acute kidney injury phases

A
  1. onset = hours to days
  2. oliguric (anuric) = UO is lowest at this point; increase in BUN and creatinine and K; fluids would not help because you’re adding pressure but the body can’t filter through GFR
  3. Diuretic = increased urine output without successfully concentrating urine (getting better but still fragile)
  4. recovery = normalization of electrolytes and fluid balance; making urine to order again
35
Q

explain chronic kidney disease and the consequences of it

A
  1. the outcome of the progressive and irrevocable loss of nephrons

Outcomes:

  • decreased GFR greater than 3 months
  • remaining nephrons must filter more (hypertrophy)
  • azotemia (increased nitrogen waste but no signs and symptoms present) (no widespread organ impact)
  • uremia
36
Q

What are the signs and symptoms of chronic kidney disease

A
  • clinical manifestations of kidney failure due to increase nitrogenous waste products in the blood
  • altered neuromuscular function (fatigue, restless leg syndrome, peripheral neuropathy)
  • GI disturbances such as anorexia and nausea
  • WBC and immune dysfunction
  • amenorrhea and sexual dysfunction
  • dermatologic = pruritus due to uremic crystals
37
Q

Explain the acid base imbalances with chronic kidney disease

A
  1. hyperkalemia: body is not excreting through urine like they should and they get dangerous levels of K in the blood
  2. Kidneys secrete erythropoietin; they don’t make enough RBCs and they become anemic and can affect healing
  3. kidneys secrete Vit D; Vit D converts inactive calcium to active; you’ll be hypocalcemic
  4. Leads to acidosis because the kidneys are no longer excreting H+ ions (kidneys are the only place you can excrete them)
  5. Calcium lives in yin/yang with phosphate. If phosphate is high, you are losing calcium. When the monitoring system notices that calcium levels are low, you will secrete more parathyroid hormone to increase calcium (PTH pulls from the bone). This tears up the bones
38
Q

What are the cardiovascular complications with chronic kidney disease

A
  • anemia: from hemolysis, bone marrow suppression, decreased erythropoietin and iron
  • weakness, fatigue, depression, insomnia, decreased cognitive function
  • decreased blood viscosity which causes increased heart rate, peripheral vasodilation
  • angina pectoris and other ischemia
  • decreased platelets which leads to bleeding
39
Q

Explain the renal diet for individuals with chronic renal disease

A
  • protein: want to reduce because they can’t get rid of nitrogenous waste (BUN); the protein challenges the GFR
  • carbohydrates, fat, calories: increase because this is where their calories have to come from
  • potassium: decrease intake here as well because you’re not secreting it through urine because filtration system is broken
  • sodium and fluid intake: they cannot hold onto salt; most will have fluid restrictions because they can’t get rid of it
40
Q

Explain the two types of dialysis

A
  1. hemodialysis system:
    - pulling blood out then filtering wastes out, fluid exchange, electrolyte imbalances
    - through catheters
    - cleaning the kidneys out like they should be doing
    - they create a fistula
  2. peritoneal dialysis:
    - indwelling catheter in peritoneal cavity
    - solution with osmotic pull and creates an exchange in the space and it pulls out the components that need to be removed
    - risk for infection is huge
    - you can do this at home
41
Q

The client with chronic kidney disease asks the nurse why he must take active vitamin D as a medication. What is the most appropriate response by the nurse?

A. in renal disease, vitamin D is unable to be transformed to its active form
B. the skin is no longer able to activate vitamin D for use
C. vitamin D can no longer be released from the exocrine glands
D. the bones no longer respond to vitamin D and demineralize

A

A. in renal disease, vitamin D is unable to be transformed to its active form

42
Q

What are the signs of outflow obstruction and urine retention

A
  • bladder distention
  • hesitancy
  • straining when initiating urination (seen with prostate frequently)
  • small and weak stream
  • frequency
  • felling of incomplete bladder emptying
  • overflow incontinence (leaking)
43
Q

What are the common causes of neurogenic bladder?

A
  • stroke and advanced age
  • Parkinson’s disease
  • spinal cord injury
  • injury to the sacral cord or spinal roots
  • radical pelvic surgery
  • diabetic neuropathies
  • MS

These are all motor neuron disorders. You are no longer cognitive enough to control sphincters

44
Q

Explain the different neurogenic bladder disorders

A
  1. detrusor hyperreflexia (bladder overactivity): you’ve lost the ability to hold urine
    - the bladder responds to the bare minimum of 300mls and releases urine
    - stroke, traumatic brain injury
  2. detrusor - sphincter dyssynergia: sphincter doesn’t relax and won’t let urine out
    - damage to micturition center or impair communication between there and spinal cord
  3. areflexic bladder dysfunction:
    - failure to contract and empty
    - lower motor neurons are damaged
    - spinal shock, peripheral neuropathies
    - detrusor does not get the message to squeeze which causes bladder to be full
    - these individuals can straight cath themselves
45
Q

Which of the following is not a cause of neurogenic bladder

A. spinal cord injury
B. Alzheimer disease
C. injury to the sacral cord or spinal roots
D. Parkinson’s disease

A

B. Alzheimer disease

46
Q

Name and explain the different types of incontinence

A
  1. stress incontinence: weak urethral sphincter leads to escape of urine
  2. urge incontinence: caused by disorders that result in hyperactive bladder contractions
  3. overflow incontinence: caused by overfilling of the bladder with escape of urine
  4. nonurological conditions (nothing is wrong with the system, they just don’t have awareness)
    - DIAPPERS
    - dementia
    - infection (urinary or vaginal)
    - atrophic vaginitis
    - pharmaceutical agents (drugs that make you pee)
    - psychological causes
    - endocrine (diabetes)
    - restricted mobility
    - stool impaction
47
Q

What are the signs of bladder cancer

A
  • increased frequency
  • urgency
  • dysuria
  • hematuria (painless = ominous)
48
Q

Explain benign prostatic hyperplasia

A
  • common age related, nonmalignant enlargement of the prostate
  • two types:
    1. epithelial tissue increases and causes it to grow.
    2. smooth muscle component grows and constricts the blood flow
  • complications: obstructions leads to UTI, scarring of the bladder wall, hydronephrosis

Patho (10 decks)

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