Renal disorders Flashcards
(51 cards)
Atomy of the Kidney
Renal artery blood supply
renal vein: venous return to the heart
Further you go down into the medulla the more urine production that gets eliminated by the ureter
Kidneys anatomy
Attached to the abdominal wall at the level of the last thoracic & first three
lumbar vertebrae
CV angle tenderness:
(because of where the kidney is positioned you asses for infection via cv angle tenderness )
Enclosed in the renal capsule
The cortex is the outer layer of the renal capsule
The medulla is surrounded by cortex
(functional unit of the kidney): The nephron makes up the functional unit of the kidney
Function of the kindey
Maintain homeostasis of the blood
Excrete end-products of body metabolism
Control fluid & electrolyte balance
Excrete bacterial toxins, water-soluble drugs, & drug metabolites
Secrete renin & erythropoietin
Play a role in the function of the parathyroid hormones & vitamin D
(excrete: elimination from the body i.e pee and poop)
(secrete: released in the body)
Nephron: functional unit
composed of the glomerulus and renal tubules
proximal and distal convoluted tubule and the loop of Henley
Tubules
Include proximal, distal, & Henley’s loop
Fluid is converted to urine in tubules & urine then moves to pelvis of kidney
The urine flows from pelvis of kidney through ureter & empties into the bladder
afferent arteriole, Glomerulus, and efferent arteriole
Is encased in Bowman’s capsule
Filters the fluid out of blood
The glomerulus is a ball of capillaries located inside Bowman’s capsule.
Blood enters the nephron through the afferent arteriole, a small branch of the renal artery.
This arteriole brings oxygenated, high-pressure blood to the glomerulus, facilitating filtration.
The high pressure in these capillaries forces water and small solutes (like glucose, amino acids, urea, and ions) out of the blood into the capsule, forming the filtrate.
Large proteins and blood cells remain in the blood because they’re too large to pass through the capillary walls.
The efferent arteriole:
carries the filtered blood (minus plasma components) away from the glomerulus.
It is narrower than the afferent arteriole, helping maintain high pressure in the glomerulus.
It eventually branches into the peritubular capillaries, which surround the rest of the nephron.
efferent arteriole to proximal convoluted tubules and loop of henley
The filtrate enters the PCT from Bowman’s capsule.
This is where most reabsorption happens:
Glucose, amino acids, sodium, chloride, and water are reabsorbed back into the blood via the peritubular capillaries.
Some waste products like drugs and toxins may be secreted into the PCT.
Filtrate flows from the PCT into the loop of Henle, which dips into the medulla.
This loop has two limbs:
Descending limb: permeable to water, which is reabsorbed.
Ascending limb: impermeable to water, but actively transports Na⁺ and Cl⁻ out.
This section helps concentrate the urine and create a salt gradient in the medulla.
Distal convoluted tubule and collecting duct
Filtrate then moves to the DCT from loop of henley
Additional reabsorption of ions (e.g., Na⁺, Ca²⁺) occurs here, under hormonal control (e.g., aldosterone).
Secretion of waste products like hydrogen ions and potassium may also occur here to help maintain pH and electrolyte balance.
Filtrate enters the collecting duct, where final water reabsorption is regulated by antidiuretic hormone (ADH).
The collecting duct passes through the salt-rich medulla, so water can be reabsorbed osmotically.
What remains becomes urine. which is drained into the bladder. the process of selective reabsorption determines the amount of water and solutes to be secreted
Prostate gland
Surrounds male urethra
Contains a duct that opens into the prostatic portion of the urethra & secretes the alkaline portion of the seminal fluid
prostate gland if enlarged can prevent urination
Risk Factors Associated with Renal Disorders
Frequent urinary tract infections
High-sodium diet
Contact sports
Trauma & injury
History of hypertension
Family history of renal disease
Medication use: too much can lead to renal failure
(lasix: diuretic for cognitive heart failure. to remove excess fluid volume by promoting dieresis to help patients breath better to relive pulmonary congestion and vascular edema.)
so does NSAID’s
Associated medical conditions
Normal Renal Function Tests
BUN (blood urea nitrogen) 5-20 mg/dL
Serum creatinine 0.6-1.3 mg/dL
10:1–> BUN should be about 10 and creatinine should be about 1
Creatinine clearance 100-120
mL/minute
Uric acid serum 2.5-8.0 mg/dL
Uric acid urine 250-750 mg/24 hours
Urinalysis test
Description:
A urine test for evaluation of the renal system & for determining renal disease
a very good tester for health, depending on what is found in the urine
Implementation:
Wash perineal area
Use a clean container
Obtain 10-15 mL of the first morning sample
Note that refrigerated samples may alter the specific gravity
If the client is menstruating, indicate this on the laboratory requisition form
(collect the test in the morning first thing, mid stream sample, no contaminants)
Components of Urinalysis
Physical Examination:
Color
Clarity
Specific gravity
Chemical examination:
Urine pH
Protein
Glucose (possible diabetic or on hypoglycemic)
Ketones (lack of hydration)
Blood (menses? bacterial irritation?)
Bilirubin
Urobilinogen
WBCs
Nitrites (bacterial infection)
Leukocyte esterase
Specific Gravity
Description:
A urine test that measures the specific gravity of the urine
This test is used to evaluate:
Concentrating and excretory ability of the kidneys
Hydration status
Results:
High specific gravity indicates concentrated urine (dehydration)
Low specific gravity indicates dilute urine (overhydration)
Application:
Chronic renal diseases are associated with low specific gravity of urine
Knowledge of specific gravity helps in the interpretation of a urinalysis
Urine Culture & Sensitivity
Description:
A urine test that identifies the presence of microorganisms & determines the specific antibiotics that will appropriately treat the existing microorganism
Implementation:
Clean perineal area & urinary meatus with bacteriostatic solution
Collect midstream sample in a sterile container
Send the collected specimen to laboratory immediately
Note that urine from clients who forced fluids may be too dilute to provide a positive culture
Identify any sources of potential contaminants during the collection of the specimen such as the hands, skin, clothing, hair, & vaginal or rectal secretions
Creatinine Clearance Test
Description:
A blood & timed urine specimen that evaluates kidney function
Blood is drawn at the start of the test & the morning of the day that the 24-hour urine specimen collection is complete. completing all the urine that is excreted in 24 hours
Implementation:
Encourage adequate fluids before & during the test
Instruct client as prescribed to avoid tea, coffee, & medications during testing
If the client is taking ACTH, cortisone, or thyroxine, check with the physician regarding administration of these medications during testing
Maintain the urine specimen on ice or refrigerate, & check with the laboratory regarding the addition of a preservative to the specimen during collection
Creatinine Clearance Test what is it testing
Testing how well blood being filtered in the golerulus is actually filtering creatinine.
how much of the testing agent is being cleared ( presence of agent in efferent arteriole (reabsoprtion) vs how much is cleared by glomerulus)
VMA (Vanillylmandelic Acid) Test
Description:
A 24-hour urine collection to diagnose pheochromocytoma, a tumor of the adrenal gland
The test identifies an assay of urinary catecholamines in the urine
Normal range in people 15+ years of age is 2-7 mg/24 hours
Implementation:
what can affect the body’s ability to create epinephrine and norepinephrine?
Avoid foods such as caffeine, cocoa, vanilla, cheese, gelatin, licorice, & fruits for at least 2 days prior to beginning the urine collection & during the collection, & to avoid taking medications for 2-3 days prior to beginning the test as prescribed
Avoid stress & to maintain adequate food & fluids during the test
Uric acid test
Description:
A 24-hour urine collection to diagnose gout & kidney disease
in gout: uric acid form deposits in the lower extremities, crystalizing and creating pain
Implementation
Encourage fluids & a regular diet during testing
Place specimen on ice or refrigerate, & check with the laboratory regarding the addition of a preservative
Renal biopsy
taking a piece of renal tissue and inspecting it
very invasive test
Done if someone is suspected of having kidney cancer
KUB (Kidneys, Ureters, & Bladder)
Description:
An x-ray film that views the urinary system & adjacent structures; used to detect urinary calculi (kidney stones)
Implementation:
There is no specific preparation
Intravenous Pyelogram (IVP)
Description:
The injection of a radiopaque dye (can be iodine) that outlines the renal system
Performed to identify abnormalities in the system
Education:
Obtain informed consent
Assess the client for allergies to iodine, seafood, & radiopaque dyes
Inform the client about possible throat irritation, flushing of the face, warmth, or a salty taste that may be experienced during the test
Renal Angiography
Description:
The injection of a radiopaque dye through a catheter for examination of the renal arterial supply
renal artery stenosis (atery is smaller or hardened)
impaired blood flow to the kidney, meaning higher pressure required to get blood through
Implementation
Need to know about allergies to iodine, seafood, & radiopaque dyes
Dye may cause a burning feeling or a feeling of heat along the vessel after the dye is injected
Need to assess & mark the peripheral pulses
Renal scan
Description:
An IV injection of a radioisotope for visual imaging of renal blood flow
Implementation:
Assess for allergies
Instruct clients that they will be required to remain motionless
Instruct clients that imaging may be repeated at various
intervals before the test is complete
Radioactive material will clear within 24 hours
