GU

Question 1

assessment of kidneys and urinary tract

Answer 1

assess previous urinary disease and risk factors, including: 
* increased age
* immobility
* HTM
* DM
* chemical exposure
* chronic disease
* STDs
* drug/alcohol use
determine daily fluid intake
s/s
* flank/abd pain
* hesitancy, urgency, straining w/ voiding
* difficulty emptying bladder
* incontinence
* blood in in urine
* anemia, fever, chills

Question 2

renal biopsy

Answer 2

removes a small segment of cortical tissue to ID extent of kidney disease (ARF, transplant rejection, glomerulopathies, and persistent hematuria or proteinuria

• done percutaneously per needle biopsy or surgically thru a small flank incision
• pre and post urine specimen collection
• severe colicky pain may indicate clot in ureter
• anorexia, vomiting, adb discomfort may suggest bleeding
• to minimize bleeding, maintain BP < 140/90
• maintain fluid intake at 3000 mL/day in absence of renal insufficiency

Question 3

renal ultrasound

Answer 3

non-invasive method of viewing urinary structures

• shows fluid accumulation, movement of blood thru kidneys, masses, malformations, changes in size of kidneys, structures, or other obstructions
• pt should drink 2 8 oz glasses of water ot ensure bladder fullness and not urinate prior to procedure

Question 4

intravenous pyelogram (IVP)

Answer 4

ID structural defects and tumors and to observe urinary structures
Done w/ IV contrast medium

Question 5

radionucleotide renal scan

Answer 5

done w/ dimercaptosuccinic acid (DMSA) requires IV administration of a radioactive element followed by a series of CT scans taken over 20 min to 4 hrs

• used to assess function and perfusion of the kidneys
• can detect lesionsm, atrophy and scars
• can differentiate among different causes for hydronephrosis

Question 6

acute renal failure (ARF)

Answer 6

abrupt and almost complete failure of kidney function w/ decreased GFR that occurs over a period of hours to days

Question 7

causes of ARF

Answer 7

1. pre-renal disorders: hypoperfusion of kidneys resulting from MI, HF, sepsis, anaphylaxis, and hemorrhage
2. Intrarenal disorders: damage to glomeruli or kidney tubules resulting from burns, trauma, infection, transfusion reactions, and nephrotoxic agents
3. Post renal disorders: distal obstruction that increases pressure in tublules ad decreased GFR
   tx
   * discover cause
   * renal diet
   * fluid restriction
   * dialysis

Question 8

chronic renal failure

Answer 8

kidneys are unable to filter and excrete wastes, concentrate urine, and maintain electrolyte balance b/c of hypoxic conditions, kidney disease, or obstruction of urinary tract

• results first in azotemia (increase in nitrogenous waste in the blood) and then in uremia (nitrogenous wastes cause toxic symptoms)
• when > 50% of functional renal capacity is destroyed, the kidneys can no longer carry out necessary functions

Question 9

symptoms and treatment for CKD

Answer 9

s/s
* weight loss, muscle cramping, HA, general malaise
* increased bruising and dry, itchy skin
* increased BUN and creat
* Na and fluid retention w/ edema
* hyperkalemia, metabolic acidosis, uremic syndrome
* Ca and phos depletion, resulting in altered bone metabolism, pain, and retarded growth
* anemia w/ decreased production of RBC.
* increased risk of infection
tx
* supportive/symptomatic therapy
* diet control: low protein, NA, K
* fluid restriction
* Ca and vitamin supplements. Phos binders

Question 10

urine specific gravity

Answer 10

determines kidney’s ability to concentrate urinary solutes

1.005-1.025

Question 11

urine osmolality

Answer 11

shows early changes when kidneys have difficulty concentrating urine
275-295 mOsm/kg

Question 12

uric acid

Answer 12

increases w/ renal failure

3.0-7.5 mg/dL

Question 13

creatinine clearance (24 hr)

Answer 13

evaluates the amount of blood cleared of creatinine in 1 min; approximated GFR
75-125 mL/min

Question 14

serum creatinine

Answer 14

increases w/ decreased renal function, urinary tract obstruction, and nephritis
0.6-1.2 mg/dL

Question 15

BUN (blood urea nitrogen)

Answer 15

increase indicates impaired renal function, as urea is the end product of protein metabolism
7-8 mg/dL

Question 16

urine creatinine

Answer 16

product of muscle breakdown, increase w/ decreased renal function
11-26 mg/kg/24 hr

Question 17

BUN/creatinine ratio

Answer 17

increases w/ hypovolemia. w/ intrinsic kidney disease, the ratio is normal through increased BUN/creat
10:1

Question 18

complications of HD

Answer 18

long term use promotes atherosclerosis and cardiovascular disease
* anemia and fatigue