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Flashcards in Renal Deck (108):
1

Why do renal dz pts have low hct

Bc their kidneys can't stimulate RBC production with erythropoeitin

2

KUB/Flat plate of abdomen

Scan of urinary system
K-kidneys
U-ureters
B-bladder
U-urethra

3

3 main areas of kidneys

Pelvis, Medulla, Cortex

4

Where do kidney stones occur

In the pelvis, urine backs up in that area first (hydronephrosis)

5

Where are pyramids located

In the medulla

6

The cortex houses what

Glomeruli and nephrons

7

Functioning unit of kidney

Nephron

8

3 major functions of nephron

1. Filter water soluble substances from blood
2. Reabsorb filtered nutrients, water, and electrolytes (reabsorb about 90%)
3. Secrete waste products

9

Site where fluid filtration form blood to nephron (osmosis) takes place

Glomerulus

10

Characteristics of glomerulus

-More permeable than other capillaries
-Prevents transport of blood cells and proteins

11

GFR

R/t bp and blood flow
-Normal is 125 mL/min

12

What is GFR determined by

Filtration pressure within glomeruli

13

How does each glomeruli regulate its own GFR

High/Low bp, NaCl, glucose (thats why pts w/ high BG pee a lot)

14

What is the most important factor with GFR

Blood volume

15

Formed and released when theres decreased blood flow, volume, or pressure

Renin

16

What stimulates the production of angiotensin II

Renin

17

Causes vasoconstriction and the release of aldosterone

Angiotensin II

18

Increases reabsorption of Na

Aldosterone

19

What is the result of renin-angiotensin system vasoconstricting?

Tank will be smaller so pressure is higher. CVP and SVR will increase.

20

Produced in the kidney and regulate GFR, renal vascular resistance, and renin production

Prostaglandins

21

Angiotensin II stimulates the release of what?

Bradykinin

22

Dilates renal vasculature to maintain renal blood flow

Bradykinin

23

Triggers RBC formation in marrow

Erythropoietin

24

Converted to active form in the kidney

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