Renal Disorders PP Flashcards by Jade Ring

Kidney Cortical tissue loss

Small nephron

Decline blood flow to kidney

Low GFR, # of nephrons, low creatinine clearance

Increased BUN

Ureter, bladder, Urethra

Decreased bladder capacity, elastic, tone of detrusor

Weak urinary sphincter

Retain urine

Prostate enlargement males

UTI, Pelvic muscle weakness, Urethral/ Vag weakness/ dryness female

Associated with…

Aging

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3 mechanism maintaining ECF & electrolyte balance…

Glomerular filtration, tubular reabsorption, tubular secretion

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Prostaglandins dilate afferent artery having this affect on GFR….

NSAIDS can block Prostaglandin having this effect on GFR…

Increased GFR (GOOD)

NSAIDS can Lower GFR (BAD)

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NSIADS Affect Afferent Arteriole how…

ACE / ARBS affect Efferent Arteriole how….

NSAID Afferent vasoconstriction = Lower GFR

ACE/ARB Efferent Vasodilation = Lowered GFR

CORRECT

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Hormones

Bradykinins…

Prostaglandins…

Activated vit D….

Increase Bloodflow (vasodilation) and permeability

Regulate intrarenal blood flow by vasodilation/ constricting

Promote calcium absorption

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Name problem….

Bacterial infection starts at bladder and progress towards kidneys

Acute or chronic

Local & systemic inflammation

URINE REFLUX COMMON CULPRIT

Edema, tubular cell necrosis, abcess formation

Pyelonephritis

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Acute pyelonephritis

Flank / back pain
CVA tenderness
NV
Fever chills tachycardia/ penia
Fatigue
Burning urgency frequency
WBC in urine increased

Chronic

Hypertension causes ….
Decreased ability to concentrate urine….(this problem)
Hyponatremia/ Hyperkalemia
Acidosis

Scar tissue/fibroids, strictures

Nocturia

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Immunological damage to the renal corpuscle….

Glomerulonephritis

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Acute glomerulonephritis

Sudden onset about 10 days after…

Strep infection

Caused by excessive immune response in the kidney

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Acute glomerulonephritis

An immune response 10 days after a strep infection.

Associated with these problems…(4)

HTN
Leads to CKD
Edema
Anemia

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Recent travle / infection/ virus

Skin lesions facial piercing

Facial edema

Fluid overload

Hematuria common

Mild / mod HTN

Fatigue

Acute glomerulonephritis

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Acute glomerulonephritis

UA: Color…
Increase…

Serum albumin….

Serum creatinine & BUN….

Hypercholesterolemia

Reddish color

RBC, Protein, albumin

Serum albumin Decreased

GFR Decreased

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Why fluid restriction with acute glomerulonephritis…

If HTN

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When would you give dialysis fir a pt with glomerulonephritis…

Uremia present

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Chronic glomerulonephritis

Always leads to…

End stage renal disease

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Uremic symptoms (4)

Ataxia ( a lack of muscle coordination affecting movements such as walking, speech, and eye movements)

Tremors

Asterixis ( flapping tremor )

Pruritis

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Urine output with chronic glomerulonephritis

Decreased

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Chronic glomerulonephritis

Will dialysis or transplant be needed….

Yes

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Symptoms of chronic glomerulonephritis mimic this problem in the elderly…

CHF

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Patho

Immunological disease

Glomeruli permeability increase due to damage

Massive protein loss

Edema

Nephrotic Syndrome

Minimum change disease most common cause in children

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_____rare condition characterized by the accumulation of abnormal proteins, known as amyloid fibrils, in various tissues and organs.

Found in which problem…

Amyloidosis

Nephrotic Syndrome

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Systemic conditions such as

Lupus
Diabetes
Amyloidosis
HIV

May lead to this problem…

Nephrotic syndrome

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Assessment

Edema
Foamy urine
Anorexia
Weight gain
Fatigue
HTN

RISKS.

Blood clots / Infection

Nephrotic syndrome

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Diagnostic

Severe proteinuria >3.5 / 24 hrs

Low serum albumin
Hyperlipidemia
Edema
HTN
Renal vein thrombosis

This problem…

Nephrotic syndrome

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Kidney biopsy to diagnose cause Steroids & cytotoxics ACE Statins Heprin Increased protein if GFR normal Decreased protein if GFR low

Nephrotic syndrome

Benign nephrosclerosis will have this surface in the kidney...

Fine, leathery, granularity

Patho Degenerative disorder Thickening of nephron blood vessels Decreased kidney blood flow Tissue chronically hypoxia, ischemia/ fibrosis occurs

Nephrosclerosis

Causes: HTN Diabetes Atherosclerosis Genetic: Apolipoprotein L 1 (APOL 1)

Nephrosclerosis

Control HTN & reduce albuminuria ACE Inhibitors / ARBS combined Diuretics

Nephrosclerosis

Narrowing of renal artery lumen Reduced blood flow to kidney Ischemia, atrophy, scarring Impaired Fluid, Electrolyte, Acid-Base balance CAUSES: Renal vein thrombosis Renal artery stenosis Atherosclerosis Aneurysms

Renovascular disease

Renovascular disease Diagnostic...(4)

MRA, Renal US, Renal Arteriography, Renal scan

Renovascular Disease Caused by Renal Artery Stenosis Treatment....

Antihypertensive Endovascular procedure - Stent placement Ballon angioplasty Renal artery bypass 2 months recovery

Vascular complications caused by atherosclerosis, HTN, neuropathy from DM Leading cause if CKD Degree of disease is relat3d to glycemic control

Diabetic nephropathy

Genetic disorder / Dominate (more common) & recessive Overgrowth of fluid filled cysts in the nephron Progressive kidney enlargement Cysts damage glomerular & tubular membranes

Polycystic Kidney Disease

Complications Infection Pain Ab fullness Hematuria Kidney STONES HTN Cysts in liver / blood vessels Correlation with Kidney Stones & cerebral aneurysms

Polycystic Kidney Disease

Why ask about family history of Polycystic Kidney Disease...

Its genetic Autosomal Dominate

Physical assessment Abdominal girth increased Abdominal/ flank pain Nocturia HA Hematuria CONSTIPATION HTN

Polycystic Kidney Disease

Diagnostic US primary tool MRI / CT for confirmation & potential donor UA: Proteinuria, RBC, Bacteria (infection of cyst)

Polycystic Kidney Disease

Priority management in Polycystic Kidney Disease Other interventions...(3)

HTN management Pain (Opiods) Infection Prevent constipation

Obstruction causes fluid backup Hydronephrosis Kidney enlarged as fluid collects in _____ Pressure in kidney causes damage to vessels/tubules Hydroureter Pressure backs up to kidney Dilation & enlargement above Obstruction Causes: Stones (common), tumor, strictures, fibrosis, abcess, cysts, BPH Permanent damage can occur in _____

48 hrs

Hydronephrosis / Hydroureter ____ to diagnose obstruction/ stones

Can ston3s be removed by cystoscopy/ retrograde urogram Used for Hydronephrosis/ Hydroureter

Yes

Hydronephrosis/ ureter Nephrostomy tube placement Pre-Procedure (3)... Post-Procedure (3) report to HCP

NPO, Consent, Clotting Study Blood/ Urine from insertion site Absent or low drainage Back pain

Renal cell carcinoma affects RBC... Ca.... Renin... hCG...

RBC increased or decreased Ca >10.5 Renin Increased HTN hCG Increased (Lower libido)

Risk factors for renal cell carcinoma (6)

Male Black Fat HTN Smoker Exposure to cadmium/ heavy metal, asbestos, benzene

Renal cell carcinoma Physical assessment (3) Late signs (3)

Flank pain, hematuria, palpable kidney mass Muscle wasting, weight loss, weakness

Goal prevent spread & management of complications Microwave ablation/ cryoablation Chemotherapy- limited effectiness Biological response modifiers; increase survival Radiation: Palliative Surgery: Nephrectomy (Tumor highly vascular, increased bleed risk)

Renal cell carcinoma Biological Response Modifiers (BRMs) are substances that modify the body's immune response to various diseases, including cancer, autoimmune disorders, and infections.

Happens over time Thickening of nephron blood vessels - due to deceased blood flow in kidney Causes: HTN, DM, atherosclerosis

Nephrosclerosis

To diagnose nephrosclerosis...

US possible CT

Type of medication most given for nephrosclerosis...

ACE

Never give diuretics for nephrosclerosis...

False it is given sometimes

Sudden onset HTN in a client >50 maybe this problem

Renal vascular disease

Why give an ACE before a renal scan with renovascular disease...

It alows better visualize the artery blood flow and determine the occuled part

Diabetic nephropathy is microscopic damage inside the kidney. 1# cause of CKD T OR F

Mineral corticoid receptor are non steroidal drugs that reduce scaring. Used in this problem....

Diabetic neuropathy

Berry aneurism in the brain are associated with....

Polycystic Kidney Disease

Distended abdomen Flank pain Constipation Nocturia Head aches Are associated with...

Polycystic Kidney Disease Headaches from ruptured aneurysms in brain Berry aneurysms

Diagnostic tool for Polycystic Kidney Disease

US primary tool

Polycystic Kidney Disease Early: Hyperfiltration (Describe) Late: Discuss diet...

Hyperfiltration = Lots of urine 3L daily - Hyponatremia is a risk Late: Low protein (renal diet)

What does it mean if during palpation of bladder that urine dribbles out...

Blockage and possibly back flow of urine into ureter / Kidney. Emergency: can lead to severe damage in 48 hrs

Pyelonephritis CVA / Flank pain NV Fever,chills Tachycardia/ Tachypnea Describe urine output... WBC increased

Urgency/ Frequency

Caused by bacteria entering urethra & making it to the kidney causing infection...

Pyelonephritis

Sudden onset 10 days post strep infection...

Glomerulonephritis

Describe Pathophysiology of glomerulonephritis...

Immune response 10 days post strep infection Causes injury and inflammation of the glomerulus Allows protein & blood into the urine

Facial / Periorbital edema is associated with...

Glomerulonephritis

Diagnostic of glomerulonephritis...

Kidney biopsy

Meds for glomerulonephritis

Antibiotics Diuretics Corticosteroids Cytotoxic drugs Fluid restriction Low sodium, K, protein diet I & O Daily weight

Massive protein loss in urine Immunological disease Glomerulus more permible due to damage Edema Causes Minimum change disease in children Systemic condition Lupus Diabetiñes AmyloidosisHIV

Nephrotic syndrome

Foamy urine is seen with...

Nephrotic syndrome

Diagnostic of nephrotic syndrome is...

Severe proteinuria (>3.5 / 24hrs) Low serum albumin Hyperlipidemia edema HTN Renal vein thrombosis Delayed clotting/ Increased bleeding

_______ is a non-invasive imaging technique used to evaluate renal arteries for stenosis (narrowing) or occlusion in suspected renovascular disease (e.g., renal artery stenosis). Used to diagnose Renovascular Disease

MRA (Magnetic Resonance Angiography)

Vascular complication caused by atherosclerosis, HTN & Neuropathy from DM

Diabetic Nephropathy Leading cause of CKD

Diagnostic UA increased RBC Lowered Hgb & Hct Increased calcium, ESR, (Hormones) hCG, renin, PTH INCREASED BUN & Cr CT & MRI Kindey Biopsy

Renal cell carcinoma

Renal Disorders PP Flashcards

(74 cards)