TLO 2.5 Urinary Flashcards
MAJOR FUNCTIONS OF KIDNEYS
Fluid & electrolyte balance
Acid-base balance
Waste excretion
Blood pressure regulation (Renin)
Red blood cell production
(Erythropoietin)
Regulation of Ca/Phos metabolism
(activates vitamin D, enhances Calcium absorption)
Gluconeogenesis & Insulin degradation
Diagnostic Tests
Intravenous pyelogram retrograde pyelogram (IVP) MRI Bladder Scan Renal arteriogram or angiogram Renal biopsy Renal scan Renal Ultrasound UA Post-void residual BUN (hydration status) Creatinine (diagnose kidney disfunction) Creatinine clearance (24 hour test) Cystatin C (filtered by kidneys) CT scan Cystometrogram (CMG) Cystoscopy/cystography GFR
CHRONIC PYELONEPHRITIS: THINK INFECTION!!!
Bacteria –> renal pelvis –> inflammatory response –> edema, tissue swelling –> fibrosis –> scars.
With repeated inflammation, scarring, renal tissue permanently damaged.
Most frequent s/s HTN
Level of renal function determined by whether one or both kidneys affected, magnitude of scarring, presence of co-existing infection
Diagnostic Findings
Radiologic imaging and histological tests
Small, contracted kidney and a small collecting system or hydronephrotic
Acute pyelonephritis looks like an infection
Chronic looks like kidney failure
Chronic GLOMERULONEPHRITIS: THINK IMMUNE REACTION!!!
ANTIGEN-ANTIBODY REACTION with glomerular tissue–> swelling & death to capillary cells, –> enzymes released & attack glomular basement membrane.
Gradual destruction of glomeruli –>kidneys atrophy -> ESRD in 10-30 yrs
Intermittent bouts of Proteinuria & hematuria for years–> decreased filtration–>oliguria, Na & water retention, > Increased Cr & Bun–>HTN, Edema
Many triggers: Lupus, Strep infections, DM, DIC, Vascular injury from HTN
Manifested by anemia secondary to erythropoiesis
Diagnostic findings
Urinalysis Hematuria Proteinuria Ultrasound CT scan
Glomerulonephritis health history
Health History
Complaints of anorexia, nausea, weight gain, edema
Recent exposure to nephrotoxin
Previous transfusion reaction
Chronic diseases such as diabetes, heart failure, kidney disease
Assessment
Physical Exam Vital signs, weight Urine output Skin color Peripheral pulses Lung Sounds Heart Sounds Bowel Sounds Edema -Peripheral, periorbital
Chronic Renal Failure Lemone 934
-Progressive irreversible loss of kidney function
-Presence of kidney damage or GFR<60 ml/min for 3 months or longer
-Significantly higher ages 65 and older
Cultural variances
-Diabetes is leading cause, followed by HTN, glomerulonephritis, and cystic kidney disease
-ESRD the GFR is <10% of normal
Stages of Renal Failure Lemone 935
Stage 1. Normal Function
Stage 2. Reduced Renal Reserve
Stage 3. Renal Insufficiency: >Damage, scarring; Mild Azotemia; Urine concentration impairment. GFR 30-60.
Stage 4. Renal Failure: Severe Azotemia & Anemia, Acidosis, Urine dilution impaired, Electrolyte imbalances. Start Dialysis. GFR 15-30
Stage 5. End Stage Renal Disease
GFR is <10% of normal or < 15 ml/min
Multi-system Problems
Table 28-9 Lemone p. 809
Predisposing factors
- Hypertension, heart failure
- Diabetes
- UTI, pyelonephritis, glomerulonephritis
- Ethnic groups: Native Americans and African Americans
Nephrotoxic Medications
Antibiotics
-Aminoglycosides, Cephalosporins, mycins such as Gent, Tobramycin, Vancomycin and Amphotericin
Diuretics: Lasix (overuse)
Analgesics: Tylenol, NSAIDs, Motrin
Chemotherapy
Heavy metals: Lithium, Gold therapy
RADIOLOGIC CONTRAST DYES
PREVENTION OF CHRONIC RENAL FAILURE
Limit catheter use
Reduce UTI and/or treat progressively
Sterile technique with caths
Aggressively treat DM, HTN, Acute Glomerulonephritis, UTI’s
Watch for low UO & BP; report promptly (Prevent ACUTE RENAL FAILURE)
Monitor Nephrotoxic meds carefully
Assessment findings for ESRD
Multisystem illness – therefore assessment findings indicating ESRD are multisystem
Fluid overload, electrolyte imbalances and toxins in system cause many of assessment findings
Leading cause of ESRD is diabetes!
Pt will have/be: Anemic Low Hgb and Hct Low RBC High K Low Ca High phosphorus
Multisystem effects
Fluid and electrolytes: protein in urine, hematuria, sodium/water retention, hyperkalemia, EKG changes, Hypermagnesium
Cardiovascular: athroloscrosis, glucose intolerance, systemic hypertension
Hematologic: anemia, platelet function impaired (bleeding), declined WBC
Immune system: uremia, dry skin
Gastrointestinal: anorexia, N/V, hiccups, gastroenteritis, urine like breath odor
Neurologic: dif concentrating, fatigue, insomnia, coma, psychotic,
Musculoskeletal: increased Ca reabsorption, renal rickets, softening of bones, bone pain,
Endocrine/Metabolic: uric acid increase, glucose intolerance
Dermatologic: pale, yellow color skin, dry skin turgor, bruise easily
Sexuality Concerns: impotence, lowered test
Psycho-social
Discomfort: bone pain, muscle pain
