GU Flashcards
(33 cards)
Age-Related Changes
Nephrons lost with aging
- Reduces kidney mass and GFR
Less urine concentration
- Risk for dehydration when combined with diminished thirst
Potassium excretion decreased at times
- Potential fluid and electrolyte imbalance
Diagnostic Tests
Urine Studies - C&S Renal Clearance - BUN, creatinine and creatinine clearance, protein Imaging studies - Abd. X-ray - KUB - IVP, Retrograde Pyelography - CT - Renal scan - US - Cystoscopy
Incontinence
Incontinence - Loss of voluntary control of the bladder Stress Overflow incontinence Functional
UTIs
Affect up to 20% of women
Incidence increases with aging - both sexes
Nosocomial infections (common)
Affect any portion of the urinary tract - classified according to region and primary site affected
- Lower Urinary Tract (Urethritis, prostatitis, cystitis)
- Upper Urinary Tract (Pyelonephritis: kidney, renal pelvis)
UTIs: Risk Factors
Incontinence with incomplete emptying of the bladder
Retention of urine in the bladder
Obstruction to urine flow (scar tissue, renal calculi)
Decreased host resistance
Direct contamination from decal incontinence
Introduction of bacteria by use of instruments or catheters
Risk Factors
Male - Enlarged prostate gland Female - Short, straight urethra - Proximity meatus to vagina - Tissue trauma/ contamination sexual intercourse - Diaphragm - Personal hygiene - Voluntary urinary retention
Cystitis
Most common UTI, inflammation of the bladder
Bladder mucosa inflamed and congested with blood
Bladder wall is irritable and bladder capacity is usually reduced
S&S
- discomfort in the lower abdomen
- dysuria
- frequency, urgency, nocturia
- hematuria
- pyuria (cloudy with an odour)
- systemic signs of infection (fever, malaise, nausea, leukocytosis)
Cystitis
Generally uncomplicated and resolves spontaneously
Can ascent to the kidneys
Older adults or those with impaired immunity bacteria, sepsis and shock are possible complications
Pyelonephritis
Inflammatory disorder of renal pelvis and parenchyma
Risk factors include: pregnancy, obstruction (renal calculi) and congenital malformation, vesicoureteral reflex (common in children)
Acute
- caused by bacterial infection in E. coli
Chronic
- Associated with other disorders
Pyelonephritis S&S
Acute - Rapid onset - Chills, fever - Malaise, vomitting - Flank pain (dull and aching), costovertebral tenderness - Cystitis (dysuria) Chronic - Leads to fibrosis, scarring, renal failure as tubules are gradually destroyed
UTIs: Diagnostic Tests
Urinalysis Urine C&S CBC with differential IVP (intravenous pyelography) Voiding cystourethrography Cystoscopy
Urolithiasis: Calculi or Kidney Stones
Calculi can develop anywhere in the urinary tract
Stones can be small or large
Formed from materials normally excreted in urine: 75% made from calcium salts with the remainder consisting mainly of uric acid, urates, struvite (Mg, phosphate) or cystine
Form when poorly soluble salt crystallizes
Urinary Calculi: Risk Factors
Family Hx Dehydration Excess calcium, oxalate, protein intake Uric acid stones gout Hyperparathyroidism and immobility (hypercalcemia) Urinary stasis Alkaline pH of urine (calcium stones)
Urinary Calculi: S&S
General Symptoms:
- UTI symptoms
- Chills and fever
- Frequency, urgency, and dysuria
Urinary Calculi: S&S
Kidney/ Pelvis - May be asymptomatic - Dull, aching flank pain Ureter - Acute serve flank pain may radiate (renal colic) - N/V - Pallor, cool moist skin - Hematuria Bladder - May be asymptomatic - Dull suprapubic pain - Hematuria
Urinary Calculi: Diagnostic Tests
Urinalysis KUB X-ray IVP Renal ultrasound CT scan or MRI Cystoscopy
Renal Failure
Condition where the kidneys are unable to remove waste products from blood
Acute or chronic
Characterized by azotemia, fluid, electrolyte, acid-base imbalances
Acute Renal Failure
Rapid decline in function with an abrupt onset
Often reversible with prompt treatment
Dialysis may be used to replace kidney function until primary problem dealt with
Failure of the kidney function r/t:
- blood flow into the kidney
- inflammation and necrosis of the tubules (leading to obstruction, back pressure and greatly reduced GFR and reduced or no urine output)
Etiology and Pathophysiology
3 sites of disruption:
- Renal perfusion (prerenal)
- Circumstances within the kidney blood vessels, tubules, glomeruli, or interstitium (intrarenal)
- Urine flow distal to the kidney (post renal)
Distinction between the sites of disruption helps determine appropriate therapy
Acute Renal Failure
Prerenal failure: decreased blood flow to glomeruli (kidney)
Intrarenal failure: nephrotoxic agents, kidney infections, occlusion of infrarenal arteries, hypertension, DM, or direct trauma to the kidney
Postrenal failure: obstructions beyond the kidneys that cause urine to back up
Acute Renal Failure
Initiation phase:
- Kidney injury is evolving
- Prevention of injury is possible
Maintenance phase:
- Established kidney injury and dysfunction
- Urine output is lowest during this phase and serum creatinine and blood urea nitrogen both increase
Recovery phase:
- Injury repaired and normal renal function re-established
- Diuresis common
- Decline in serum creatinine and urea
- Increase in creatinine clearance
Renal Failure: Diagnostic Tests
Serum creatinine, BUN Creatinine clearance Serum electrolytes, ABGs, CBC Urinalysis Kidney biopsy
Chronic Renal Failure
Involves progressive, irreversible destruction of the nephrons in both kidneys
End result is a systemic disease involving every organ
Up to 80% of the GFR may be lost with few changes in the functioning of the body
Remaining nephrons hypertrophy to compensate
Stages defined based on level of kidney function
Chronic Renal Failure
Leading causes of End Stage Renal Disease:
- DM
- Hypertension
