Renal Assessment

Question 1

The upper urinary system consists of…

Answer 1

2 kidneys and 2 ureters

Question 2

The lower urinary system consists of…

Answer 2

A urinary bladder and a urethra

Question 3

Flow of urine

Answer 3

Urine is formed in kidneys, drains through ureters, stored in bladder, passes from body through the urethra

Question 4

The kidneys are the principal organs of the urinary system. The primary functions of the kidneys include…

Answer 4

Regulate volume and composition of ECF
Excrete waste products from body
Control BP, produce erythropoietin, activate Vit D, regulate acid-base balance

Question 5

Kidneys mactrostructure

Answer 5

Bean-shaped organs
Adrenal gland lies on top of each kidney
Hilus on medial side
-Arteries and nerves enter
-Veins and ureters exit

Question 6

Kidneys mictrostructure

Answer 6

Nephron is functional unit

Question 7

Tubular system includes

Answer 7

Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
Collecting tubules

Question 8

Nephron is composed of

Answer 8

Glomerulus
Bowman’s capsule
Tubular system

Question 9

What is located in the cortex of the kidney?

Answer 9

Glomerulus
Bowman’s capsule
Proximal tubule
Distal tubule

Question 10

What is located in the medulla?

Answer 10

Loop of Henle

Collecting tubules

Question 11

Kidneys blood supply

Answer 11

Renal artery arises from aorta

• divides into smaller branches
• each forms an afferent arteriole
• afferent arteriole divides into capillary network (glomerulus)

Question 12

Glomerular function: physiology of urine formation

Answer 12

Blood is filtered by hydrostatic pressure
Passes through Bowman’s capsule
Glomerular filtrate passes down tubule (GFR)

Question 13

GFR

Answer 13

Glomerular filtration rate
Amount of blood filtered each minute by glomeruli
Normal is 125mL/min

Question 14

Tubular function: physiology of urine formation

Answer 14

Reabsorption
-both active and passive transport mechanisms
Secretion

Question 15

Proximal convoluted tubules

Answer 15

Reabsorbs 80% of electrolytes

Question 16

Loop of Henle

Answer 16

Reabsorbs water

Question 17

Descending loop

Answer 17

Reabsorbs water, some sodium, urea, other solutes

Question 18

Ascending loop

Answer 18

Reabsobs chloride, sodium

Question 19

BP regulation with kidneys

Answer 19

Renin is secreted from kidneys in response to decreased renal perfusion, decreased arterial BP, decreased ECF, decreased serum Na+ concentration, and increased urinary Na+ concentration
Renin activates angiotensinogen (from liver) to angiotensin I
Angiotensin I is converted to angiotensin II by ACE
Angiotensin II stimulates the release of aldosterone from adrenal cortex

Question 20

RBC production with kidneys

Answer 20

Erythropoeitin hormone produced in kidneys and secreted in response to hypoxia and decreased renal blood flow

Question 21

More about angiotensin II

Answer 21

After aldosterone is released from adrenal cortex, it causes Na+ and water retention, leading to an increased ECF volume.
Also causes increased peripheral vasoconstriction
Release of renin is inhibited by elevated BP

Question 22

Ureters

Answer 22

Carry urine from renal pelvis to bladder
Join the renal pelvis at the ureteropelvic junction (UPJ)
Join the bladder at the ureterovesical junction (UVL)

Question 23

Bladder

Answer 23

Serves as reservoir for urine (600-1000 mL)
Trigone
Detrusor
Urination, micturition, voidiong, etc

Question 24

Detrusor

Answer 24

Bladder muscle

Controls ability to pass urine and contract bladder

Question 25

Urethra

Answer 25

``` Extends from bladder neck to external meatus Conduit for urine during voiding Length: -Female: 1-2 in -Male: 8-10 in ```

Question 26

Urethrovesical unit

Answer 26

Formed by bladder, urethra, pelvic floor muscles Voluntary control of this unit is defined as continence -distention of bladder stimulates stretch receptors -impulses sent to brain

Question 27

Size and weight of kidneys decrease 20% - 30% when?

Answer 27

Between ages 30 and 90

Question 28

When does loss for glomerular function (30%-50%) occur?

Answer 28

By seventh decade

Question 29

What can accelerate the decrease of renal size with age?

Answer 29

Atherosclerosis

Question 30

Physiologic changes (gerontologic considerations)

Answer 30

Decreased renal blood flow (results in decreased GFR) Altered hormonal levels Loss of elasticity and muscle support Prostate enlargement

Question 31

Altered hormonal levels results in

Answer 31

Decreased ability to concentrate urine | Altered excretion of water, sodium, potassium, and acid

Question 32

Palpation during physical exam

Answer 32

Nonpalpable organs (left kidney rarely palpable)

Question 33

Urinalysis (urine study)

Answer 33

First morning void Examine urine within 1 hour First void of the day more likely to be concentrated and contain abnormal constituents if present

Question 34

Creatinine Clearance (urine study)

Answer 34

Collect 24-hour urine specimen | Closely approximates GFR

Question 35

Urodynamics

Answer 35

Measures urinary tract function | Study of the storage of urine within bladder and flow of urine through urinary tract

Question 36

Creatinine and BUN levels

Answer 36

Primarily used for kidney function | Checked before contrast dye studies done to make sure kidneys are healthy enough for study

Question 37

Anasacara

Answer 37

Generalized, overall edema due to kidneys

Question 38

Protein in urine...

Answer 38

small protein ok, lots of urine is BAD

Question 39

Midstream catch

Answer 39

Clean perineal area (labia minora and labia majora for females; around the meatus of the penis in males) Begin voiding Mid void, place clean specimen container in line of urine stream DO NOT TOUCH THE OPENING TO CONTAINER WITH ANYTHING ELSE