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Flashcards in Lust 2 Deck (23)
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1

What are the indicators we use for Kidney Function?

Blood

  • Serum Creatinine
    • creatinine= breakdown product of muscle
    • completely excreted
    • measure of kidney filtration
    • High Serum Creatinine=Kidney Dysfunction
  • BUN=Blood Urea Nitrogen
    • High plasma BUN=Azotemia
    • Bad indicator of GFR bc it rises with dehydraiton, high protein diet, or muscle breakdown 
  • Serum Creatinine=better measure of kidney fxn

2

Other Common Signs of Kidney Disorder

  • Physical
    • CVA tenderness
  • Urine:
    • Proteinuria (microalbuminuria)
    • Hematuria
    • positive leukocyte esterase
      • measures the amount of enzyme secreted by WBCs
      • high amount=bladder or kidney infection
  • Caution:
    • IV contrast enhanced imaging studies
      • avoid=radiopaque dye cause renal failure
    • Dehydration
      • increases the risk

3

Guide to renal disease classification:

  • Pre-renal causes
    • Cardiovascular
  • Glomerular Diseases
    • Filtration at glomerular capillaries
    • Reabsorption at peritubular capillaries
  • Tubular/Interstitial Diseases
    • Epithelial Transport
  • Post-renal causes
    • Ureter
    • bladder
    • urethra
    • micturition reflex

4

Acute Kidney Injury

  • Aka Acute Renal Failure
  • decreased glomerular filltration of blood in AKI leads to azotemiaHigh serum creatinine, and fluid retention
  • Abrupt insult to the kidney that causes a rapid decrease in renal filtration funciton (Decrease GFR)
  • Accumulation of nitrogen waste products in body due to decline in function
  • Common cause
    • ischemia of kidney
  • Other causes:
    • prerenal
    • intrarenal (Glomerular or tubular)
    • post renal
  • With Proper interventions, normal renal function can return
    • 2 weeks to 3 months of initial event

5

Postrenal Dysfunction

  • Caused by:
    • obstructive uropathy
      • prevents urine outflow from kidneys
  • Examples:
    • kidney stone
    • prostate gland hyperplasia

6

Nephrolithiasis

  • formation of Calculi/stones in the kidney
  • stones can travel down ureter or bladder

7

Most common Renal Calculi

  • Calcium Stones
  • Struvite uric acid stones
  • Cystine Stones

8

Renal Calculi

  • 75% consist of calcium
  • most composed of calcium oxalate

9

What are the different types of Kidney Stones

  • Agony
  • Pain
  • Misery
  • Calcium Stones
  • Uric Acid Stones
  • Struvite Stones
  • Cystine Stones

10

Uric Acid Stones

  • 10% of kidney stones
  • Seen in patients with:
    • low urine pH
    • low urine volume
  • Associated with:
    • Chronic Diarrhea
    • volume depletion
    • high animal protein diet
    • myeloproliferative disorders

11

Calcium Oxalate Stones

  • 60-80% of kidney stones
  • Most preventable cause:
    • dehydration
    • low urine output
  • Other factors:
    • Diet
      • high sodium intake
      • high oxalate intake
      • high protein oxalate

12

Symptoms of Nephrolithiasis

  • Pain
    • Severe Abdominal Pain
    • Flank pain around to groin
    • Colicky pain caused by ureter spasms
  • Hematuria
  • Crystalluria

13

Nephrolithiasis: Risk Factors

  • Genetic Susceptibility
  • Dehydration
  • Hypercalcemia-excessive calcium intake
  • Hyperparathyroidism
  • GOUT
  • Hyperuricemia
  • Urinary Tract Infection; proteus
  • Immobility
  • Large quantities of soft drinks

14

Nephrolithiasis: Treatment

  • High fluid intake (>3L/day) to flush out stone
  • Lithotripsy
  • Surgery if not relief
  • Strain urine to catch stone
  • Save stones for analysis
  • Dietary changes to keep urine acidic or alkaline
    • depends on stone composition

15

Lithotripsy

  • When stone will not pass by itself
  • ultrasound shock waves
    • breakdown into smaller parts to pass through ureters

16

Nephrolithiasis: Complications

Infection of Hydronephrosis

  • Hydronephrosis
    • stone causes back pressure in renal pelvis
    • occurs when edema and distention of renal pelvis occurs
  • Prolonged hydronephrosis causes:
    • compressin of kidney tissue
    • ischemia
    • irreversible kidney damage

17

recall: Urination after ureter

  • Default mode is to automatically void bladder when stretched
  • Basic reflex is a spinal reflex arc
  • Over-ride on external sphincter is CNS controlled
  • external sphincter
    • skeletal muscle
    • voluntary control
  • Bladder at rest: Sympathetic Input Dominant
    • relaxed
      • Detrusor muscle
    • Contracted:
      • ureteral sphincter and internal sphincter
      • ureter
  • Micturition Reflex: PNS tone
    • actiavted by stretch receptors
    • relaxed:
      • sphincters
    • Contracts:
      • Detrusor

18

Neurogenic Bladder

  • Lack of nerve supply to the bladder

  • Person can't feel when bladder is full

  • Must use catheter to void

  • Brain

    • Cerebral Palsy

    • Dementia

    • Parkinson’s

    • Stroke

  • Spinal Cord

    • AIDS

    • MS

    • Polio

    • Spinal Cord injury

  • Peripheral Nerve/NMJ

    • Diabetic neuropathy

    • Myathenia Gravis

    • Pelvic Plexus injury

19

Types of Incontinence

  • Stress Incontinence
    • increased abdominal pressure under stress
      • weak pelvic floor musclees
  • Urge Incontinence
    • involuntary contraction of bladder muscles
  • Overflow
    • blocked urethra
  • Neurogenic 
    • impaired nervous system

20

Abnormal Prostate

  • Prostatitis
    • acute symptoms of urinary infeciton
    • Obstructive symptoms
    • Perineal or suprapubic pain
  • Benign Prostatic Hyperplasia
    • Most common benign tumor in men
    • Obstructive or irritative voiding symptoms
  • Prostate Cancer
    • PSA unreliable
    • typically asymptomatic

21

Overactive Bladder

Sympathetic nerve damage

22

Atonic Bladder

Aka Paralytic Bladder

Damage to parasympathetic nerve

23

Signs and symptoms of bladder dysfunction

  • Hesitancy
  • Urgency
  • Frequency
  • Incontinence