Renal Flashcards
(108 cards)
1
Q
Why do renal dz pts have low hct
A
Bc their kidneys can’t stimulate RBC production with erythropoeitin
2
Q
KUB/Flat plate of abdomen
A
Scan of urinary system K-kidneys U-ureters B-bladder U-urethra
3
Q
3 main areas of kidneys
A
Pelvis, Medulla, Cortex
4
Q
Where do kidney stones occur
A
In the pelvis, urine backs up in that area first (hydronephrosis)
5
Q
Where are pyramids located
A
In the medulla
6
Q
The cortex houses what
A
Glomeruli and nephrons
7
Q
Functioning unit of kidney
A
Nephron
8
Q
3 major functions of nephron
A
- Filter water soluble substances from blood
- Reabsorb filtered nutrients, water, and electrolytes (reabsorb about 90%)
- Secrete waste products
9
Q
Site where fluid filtration form blood to nephron (osmosis) takes place
A
Glomerulus
10
Q
Characteristics of glomerulus
A
- More permeable than other capillaries
- Prevents transport of blood cells and proteins
11
Q
GFR
A
R/t bp and blood flow
-Normal is 125 mL/min
12
Q
What is GFR determined by
A
Filtration pressure within glomeruli
13
Q
How does each glomeruli regulate its own GFR
A
High/Low bp, NaCl, glucose (thats why pts w/ high BG pee a lot)
14
Q
What is the most important factor with GFR
A
Blood volume
15
Q
Formed and released when theres decreased blood flow, volume, or pressure
A
Renin
16
Q
What stimulates the production of angiotensin II
A
Renin
17
Q
Causes vasoconstriction and the release of aldosterone
A
Angiotensin II
18
Q
Increases reabsorption of Na
A
Aldosterone
19
Q
What is the result of renin-angiotensin system vasoconstricting?
A
Tank will be smaller so pressure is higher. CVP and SVR will increase.
20
Q
Produced in the kidney and regulate GFR, renal vascular resistance, and renin production
A
Prostaglandins
21
Q
Angiotensin II stimulates the release of what?
A
Bradykinin
22
Q
Dilates renal vasculature to maintain renal blood flow
A
Bradykinin
23
Q
Triggers RBC formation in marrow
A
Erythropoietin
24
Q
Converted to active form in the kidney
A
Vitamin D
25
Most direct measure of overall hydration as a reflection of GFR and why
Creatinine, no other pathologic condition increases Creat than renal dz
26
Indirect measure of overall hydration
BUN
27
BUN can also elevate with what besides renal dz?
Diet, GI bleed, tissue breakdown
28
RCC stats
- In men 2x more than women
- 20% more in AA
- 5 year survival is
29
S/S of RCC
- Often asymptomatic till late dz
- Costovertebral angle tenderness
- Hematuria as a late sign
- Palpable abd mass
30
Late signs from metastatic dz of RCC
Bone pain, SOB, chest pain
31
Metastasis of RCC
Tumors spread quickly and grow up superior vena cava into right atrium
32
Sx removal of RCC
Nephrectomy, you only need one kidney
33
Chemo w/ RCC
Limited effectiveness, metastasis is usually unresponsive to chemo
34
Problem w/ urinary stasis
Bacterial growth, predisposes to UTIs
35
Renal obstruction can lead to what?
Post-renal acute renal failure and acute tubular necrosis
36
Congenital link to renal obstruction
Anatomical malformations, seen more in children
37
Changes secondary to renal obstruction
Depend on location and size, the higher up the worse
38
What increases proximal to the renal obstruction
Hydrostatic pressure
39
Why does GFR reduce with obstructions?
Dilation
40
Hydroureter
Complete obstruction of ureter
41
Hydronephrosis
Enlarged kidney due to dilation
42
Stent placement for treatment of obstruction
To retrieve stone. Done in the OR
43
Nephrostomy for obstruction
Like a foley cath but instead of going into the bladder the drainage tube goes into the kidney
44
ileal conduit
Ureters lead out of the skin like a colostomy bag
45
Micturation
Unidirectional flow
46
What host defenses in women prevent infections
Urethral secretions
47
What host defenses in men prevent infections
Prostatic secretions
48
How does the urine prevent infection
Acidic pH and urea, epithelial cells provide additional protective barrier
49
Major risk factor for acute pyelonephritis
Pregnancy due to alterations in urinary tract
50
Urinary reflux w/ kidney infection
Due to catheter bag not being below pt
51
Acute pyelonephritis is usually caused by what?
E. coli
52
Acute pyelonephritis is usually what type of infection?
Ascending, unilateral. Can rarely be blood borne
53
Patho of acute p
Bacteria binds to epithelial cells inside the kidneys, hard to get rid of
54
S/s of acute p
Differentiates from regular infection w/ high fever and CVA tenderness.
- dysuria, freq, urge, burn, nocturia
- sudden onset
- back, flank, loin pain
- abd discomfort, n/v, fatigue
55
Tx of acute p
ABX for 7-10 days, broad first, assume e coli
| -Hospitalized for severe cases, usually preg. When admitted: urine culture, IV abx, fluids bc n/v
56
Chronic p is characterized by what?
Small atrophied kidneys w/ diffuse scarring
57
Risks for chronic p
Urinary obstruction, reflux, neurogenic bladder
58
Patho of chronic p
Chronic infections, interstitial inflammation, reduced number of functional nephrons
59
S/s of chronic p
- Minimal symptoms
- Flank pain less intense than in acute
- HTN
- UTI
- ^ creatinine
- Frequency bc inability to conserve Na
- Decreased ability to concentrate urine (nocturia)
- Hyperkalemia and acidosis
60
Tx of chronic p
* Correct underlying problem
- Prolonged abx (6-8 wks)
- Support existing renal function
61
Renal TB
TB invades kidneys through bloodstream, inflammatory response forms scar tissue that replaces normal kidney tissue, difficulty w/ elimination
62
Primary glomerulopathies
Only the kidney is involved
- Acute glomerulonephritis
- Chronic g
- Nephrotic syndrome
63
Secondary glomerulopathies
Injury due to drug exposure, infection, systemic or vascular pathology
- Lupus
- Goodpasture's syndrome
- amyloidosis
- diabetic glomerulopathy
- hepatitis b and c
- cirrhosis
- sickle cell
- mult. myeloma
64
Assessment w/ acute glom
Ask if they've had a sore throat, BP, changes in urinary pattern, breathing patterns
65
Patho of acute glom
- Infection occurs
- S/s don't appear for 10 days
- Seen a lot in men after an acute strep infection
66
Acute glom s/s
- Dark, tea colored urine
- Proteinuria
- Hematuria
- Edema
- HTN
- Oliguria
- Increased BUN/creat
67
Tx for acute glom
ABX, prevent complications, supportive care, temporary dialysis
68
Chronic glom progresses into what? Why?
Chronic end stage renal dz, bc nephrons atrophy, become scarred and non-functioning
69
S/s of chronic glom
Circulatory overload: edema, weight gain, JVD, crackles, uremia
70
Uremia assessment findings
Slurred speech, tremors, asterixis, *skin changes (uremic deposits=dry, flaky skin that itches) Don't let them itch cause they'll break their skin
71
Tx of chronic glom
Focuses on slowing the progression of dz (diet changes, maintaining sufficient fluids, drugs for s/s)
72
Nephrotic syndrome
Increased permeability of glomeruli allows bigger molecules to pass through. Leads to massive loss of protein in urine, Na follows protein, water follows Na
73
Main feature of nephrotic syndrome
Severe proteinuria (3.5 g protein/24 hr)
74
S/s of nephrotic syndrome
```
Hypoalbuminemia
Hyperlipidemia
Edema
Hypercoagulability
Renal insufficiency
```
75
Tx of nephrotic syndrome
```
Treat underlying process, renal biopsy
Immunosuppressive therapy
ACE inhibitors decrease proteinuria, watch for nephrotoxicity
Cholesterol lowering drugs
Mild diuretics
Na restriction, diet changes
```
76
What is the leading cause of ESRD in the US?
Diabetes, diabetic nephropathy (microvascular damage)
77
What is the first manifestation of diabetic nephropathy?
Albuminuria
78
What would a UA reveal for acute p?
Positive leukocyte esterase and nitrite dipstick test, presence of white blood cells (WBCs) and bacteria; urine culture and sensitivity (C&S); blood cultures; C-reactive protein; erythrocyte sedimentation rate.
79
What is the primary care plan for a pt with acute p?
Acute pain
80
Tx of acute p
Nitrofurantoin (macrodantin) 50mg with meals and at bedtime is a urinary antiseptic drug that also helps w/ comfort. Fluid intake should be 2-3 L per day
81
Which imaging test is ordered for acute p?
IV urography or KUB x-ray
82
Difference in acute and chronic renal failure
Acute is potentially reversible
83
Acute renal failure is characterized by what?
Abrupt deterioration of renal function, happens overnight, so BUN and creatinine will be ordered every day in the hospital
84
Oliguria
85
Anuria
86
Pre-renal acute renal failure
- Diminished perfusion to kidney
| - Decrease in blood volume
87
If pre-renal is uncorrected
Hypoperfusion will lead to ischemia of renal parenchyma and acute tubular necrosis
88
Infra-renal acute renal failure
- Acute glomerulonephritis
- Drug induced nephrotoxins (contrast media, ace inhibitors, bacterium, renal artery stenosis)
- Acute tubular necrosis (renal cellular hypoxia)
89
Post-renal acute renal failure
-Obstruction of normal urine outflow from kidney
90
Most common causes of post renal failure
BPH, kinked catheters, tumors, strictures, calculi
91
Which renal failure is the easiest to identify and fix?
Post-renal
92
Stages of acute renal failure
1. Oliguric phase
2. Diuretic phase
3. Recovery phase
93
Oliguric phase
May require temp. dialysis to survive 1-2 times in a few days. Volume overload, hyperkalemia, uremia, metabolic acidosis
94
Diuretic phase
UOP normalizes over a few days, at risk for dehydration, not actively trying to die but thinking about it
-Hypovolemia, hypokalemia, uremia
95
Recovery phase
1 week to 1 year, normal creatinine is marker for full recovery
96
Hallmark of acute renal failure
Elevated creatinine
97
Signs of fluid overload
Edema, JVD, crackles, SOB
98
Tx of acute renal failure
* Treat underlying cause
| - Optimize BP, manage fluids, support other body systems-hard to do, ventilation, vasoactive meds
99
Chronic kidney dz
Progressive and irrevocable loss of functioning nephrons
| -75% lost before s/s
100
Risk factors for ESRD
Diabetes and HTN
101
Stages of CKD
Decreased reserve 90%
102
Renal osteodystrophy with CKD
High phosphorus and low calcium
103
Tx of CKD
ACEII/ARB to reduce proteinuria, BG control, BP control, evaluation for CV risk factors
104
vascath
Ventral line in IJ or subclavian, shouldn't stay for longer than 7 days, curved or straight cath
105
Difference in native and gortex fistulas
Native can't be used until 3-4 weeks, vortex clots more but can be used right away
106
Normal adult bladder capacity
400-500 mL
107
Usual urge to void
At about 150-300 mL
108
Post void residual normal volume
About 50 mL
