Renal System and Disorders- Notes from Slideshow (quiz 3) PART 1 Flashcards
1
Q
Recommended to review slide on fluid and electrolytes acid base. Important and book does not cover them.
A
Recommended to review slide on fluid and electrolytes acid base. Important and book does not cover them.
2
Q
The main function of the nephron
A
To maintain balance/homeostasis of
blood volume
blood pressure
plasma osmolarity
3
Q
What mechanisms are used by the nephron to maintain balance?
A
- Filtration
- Reabsorption
- Secretion
4
Q
Glomeruli generate ultrafiltrate of the plasma
A
Nephron function: Filtration
5
Q
Tubules selectively reabsorb substances from the ultrafiltrate
A
Nephron function: Reabsorption
6
Q
Tubules secrete substances into the urine
A
Nephron function: Secretion
7
Q
Components of the Nephron
Know how to find on diagram
A
- Afferent arteriole
- Efferent arteriole
- Bowman’s capsule
- glomerulus
- Renal Vein
- Loop of Henle with capillary network
- Tubule
- Collecting duct
(Know how to find on diagram)
8
Q
- Afferent arteriole
- Efferent arteriole
- Bowman’s capsule
- glomerulus
- Renal Vein
- Loop of Henle with capillary network
- Tubule
- Collecting duct
(Know how to find on diagram)
A
Parts of the Nephron
Know how to find on diagram
9
Q
Components of the Urinary System
Know how to find on diagram
A
- Main vein to the heart
- Main artery from the heart
- Kidneys (R/L)
- Ureters (R/L)
- Bladder
- Bladder Nerves (open/close)
- Bladder Muscle
- Urethra
(Know how to find on diagram)
10
Q
- Main vein to the heart
- Main artery from the heart
- Kidneys (R/L)
- Ureters (R/L)
- Bladder
- Bladder Nerves (open/close)
- Bladder Muscle
- Urethra
(Know how to find on diagram)
A
Components of the Urinary System
Know how to find on diagram
11
Q
Urinary System: Function of the Main vein to the heart
A
Carries cleaned blood to the heart
12
Q
Urinary System: Function of the Main artery from the heart
A
Bring blood with with wastes from the heart
13
Q
Urinary System: Function of the Ureters
A
Carry urine
14
Q
Urinary System: Function of the Bladder
A
Collects urine
15
Q
Urinary System: Function of the Bladder Nerves
A
- one nerve tells the brain the bladder is full
2. second nerve tells the bladder to open
16
Q
Urinary System: Function of the bladder muscle
A
To keep bladder closed
17
Q
How do kidneys work?
A
- Blood enters kidney through renal artery to nephrons
- Inside each nephron is a vessel (glomerulus)
- Glomerulus strains out extra fluid/wastes and lets blood cells/other substances in
- Wastes produce urine which travels to the ureter then bladder
18
Q
- Blood enters kidney through renal artery to nephrons
- Inside each nephron is a vessel (glomerulus)
- Glomerulus strains out extra fluid/wastes and lets blood cells/other substances in
- Wastes produce urine which travels to the ureter then bladder
A
How do kidneys work?
19
Q
A hormone system within the body that is essential for the regulation of blood pressure and fluid balance
A
RAAS
20
Q
What 3 hormones comprise RAAS?
A
- renin
- angiotensin II
- aldosterone
21
Q
What system regulates RAAS?
A
Renal blood flow
22
Q
What simulates RAAS?
A
Hypotension
23
Q
What senses hypotension to stimulate RAAS?
A
Kidneys
24
Q
What is stimulated in order to activate RAAS?
A
Kidneys and blood vessels
25
What supplies the kidneys with blood? How much blood?
1. The renal arteries
| 2. 20-25% of cardiac output
26
What is included in the kidney anatomy that is important to RAAS?
1. Afferent arterioles
2. glomerulus
3. juxtaglomular cells
4. Efferent arterioles
27
What do to juxtaglomular cells do in RAAS?
They produce prorenin
28
What does prorenin do in RAAS?
When BP is low prorenin is converted to renin
29
What does renin do in RAAS?
It converts Angiotensinogen to angiotensin 1
30
Where is Angiotensinogen made?
In the liver
31
What is ACE and where is it found?
1. Angiotensin converting enzyme
| 2. found in lungs
32
What does ACE do for RAAS?
It converts angiotensin 1 to angiotensin 2
33
What is angiotensin 2?
1. a vasoconstrictor
| 2. RAAS mediator
34
What does angiotensin 2 effect in RAAS?
1. blood vessels
2. Kidneys directly
3. Kidneys indirectly
4. Pituitary gland
35
How does angiotensin 2 effect the blood vessels in RAAS?
It constricts the arteries AND veins
36
What does the constriction of arteries AND veins by RAAS do?
Higher BP
37
How fast does the constriction of arteries AND veins by RAAS occur?
within mins
38
How does angiotensin 2 effect the Kidneys directly in RAAS?
constricts afferent vessels to glomeruli
39
How does the constriction of afferent vessels to glomeruli effect RAAS?
It decreases blood flow to kidneys
40
How does decreased blood flow to kidneys effect RAAS?
lowers GFR
41
What is the effect of a lower GFR?
Lowers urine output
42
How does angiotensin 2 effect the kidneys indirectly in RAAS?
acts on adrenal gland to release aldosterone
43
What does aldosterone do in RAAS?
increases sodium and water reabsorption
44
In RAAS what does decreased urine output, increased water reabsorption and increased sodium reabsorption lead to?
1. Increased Extracellular fluid (EFC)
2. Increased capillary pressure
3. Long term increase in arterial pressure
45
What tests are evaluated to determine renal function?
1. Renal concentration test (specific gravity and osmolarity of urine)
2. Creatinine clearance
3. Serum creatinine
4. Serum urea nitrogen (blood urea nitrogen BUN)
5. Protein
6. Microalbumin/creatinine ratio
7. Urine casts
46
The ratio of the mass of a solution compared to the mass of an equal volume of water
specific gravity
47
What is specific gravity of urine testing?
The density of urine
48
What is normal specific gravity of urine?
1.005 to 1.030
49
If specific gravity of urine is increased what does it indicate?
dehydration
50
If specific gravity of urine is decreased what does it indicate?
overhydrated
51
How else can you tell if urine is concentrated?
Just by looking- yellow is concentrated and clear is not concentrated
52
What is creatinine?
waste product filtered from the blood by the kidneys into the urine
53
What does creatinine clearance measure
The amount of blood cleaned of creatinine by your kidneys
54
What is normal creatinine clearance for women?
95 mL/min
55
What is normal creatinine clearance for men?
120 mL/min
56
What does high/low creatinine clearance indicate?
kidneys are not filtering as they should
57
What does serum creatinine measure?
level of creatinine in your blood
58
What is normal serum creatinine for women?
0.6 to 1.1 mg/dL
59
What is normal serum creatinine for men?
0.9 to 1.3 mg/dL
60
What is another name for serum urea nitrogen
Blood urea nitrogen
61
What does BUN measure?
the amount of nitrogen in your blood
62
What is does nitrogen levels in a BUN test indicate?
Urea is a waste product that produces nitrogen
63
What is a normal BUN level?
6 to 20 mg/dL
64
What does high BUN indicate?
The kidneys aren't filtering properly
65
Proteins test
Done to see if there is protein in urine
66
What does it mean if there is protein in urine?
It means the kidneys are filtering out important blood components. The body needs and uses proteins
67
What does a microalbumin creatinine ratio measure?
compares the amount of albumin to the amount of creatinine in your urine
68
What is a normal microalbumin creatinine ratio?
less than 30
69
Why do we compare albumin and creatinine in urine?
Albumin in urine can carry throughout the day but creatinine is released at a steady rate.
70
What is albumin?
A protein found in blood
71
What does high albumin indicate?
The kidneys aren't working properly and are filtering products (like albumin) needed by the body.
72
Urinary casts
Particles found when urine is examined under the microscope during a urinalysis.
73
What is a normal cast range?
There should be NO casts in urine
74
What are the different types of abnormal casts?
1. Fatty
2. Granular
3. Waxy
4. RBC
5. WBC
6. Renal tubular epithelial cell
75
What does a test with fatty casts indicate?
1. lipids in urine
| 2. nephrotic syndrome
76
What does a test with Granular casts indicate?
many types of kidney diseases
77
What does a test with RBC casts indicate?
microscopic amount of bleeding from the kidney
78
What does a test with Renal tubular epithelial cell casts indicate?
damage to tubule cells in the kidney
79
What does a test with Waxy casts indicate?
- advanced kidney disease
| - long-term (chronic) kidney failure.
80
What does a test with WBC casts indicate?
acute kidney infections and interstitial nephritis
81
Hgb and Hct test
test for levels of RBC
82
How does a hgb and hct indicate kidney malfunction?
Pts with kidney disease are anemic
83
Why are kidney disease pts anemic?
they are not producing erythropoietin EPO (made in kidney)
84
Why test for potassium in kidney disease pts?
Potassium would be high because they retain urine and therefore potassium
85
Clinical urine test for examination of urine for certain physical properties, solutes, cells, casts, crystals, organisms, or particulate matter, and mainly serves for medical diagnosis.
Urinalysis
86
Urine culture vs Urinalysis
Culture takes days and analysis is faster
87
Urinalysis with a positive result may indicate what?: Leukocytes
UTI
88
Urinalysis with a positive result may indicate what?: Nitrate
UTI
89
Urinalysis with a positive result may indicate what?: Urobilinogen
Liver disease (hepatitis of cirrhosis)
90
Urinalysis with a positive result may indicate what?: Protein
infection or kidney damage
91
Urinalysis with a positive result may indicate what?: pH
high- UTI or kidney damage
low- kidney stones
92
Urinalysis with a positive result may indicate what?: Blood
kidney damage, liver disease
93
Urinalysis with a positive result may indicate what?: Specific Gravity
UTI or kidney dysfunction
94
Urinalysis with a positive result may indicate what?: Ketone
diabetic or ketogenic diet
95
Urinalysis with a positive result may indicate what?: Bilirubin
liver damage
96
Urinalysis with a positive result may indicate what?: Glucose
diabetes
97
Normal Urinalysis: Glucose
negative
98
Normal Urinalysis: Bilirubin
negative
99
Normal Urinalysis : ketones
negative
100
Normal Urinalysis: proteins
negative
101
Normal Urinalysis Levels: blood
negative
102
Normal Urinalysis Levels: nitrate
negative
103
Normal Urinalysis Levels: specific gravity
1.015-1.025
104
Normal Urinalysis Levels: urobilinogen
0-2
105
Normal Urinalysis Levels: leukocyte esterase
negative
106
Normal Urinalysis Levels: RBCs
0-2
107
Normal Urinalysis Levels: WBCs
0-5
108
If urinalysis indicates infection what should an APRN do?
Order antibiotics for the pt prophylactical
109
Etiology for hematuria
1. Nephritic syndrome
2. Pyelonephritis
3. UTI
4. Kidney stones
5. Enlarged prostate
6. Medication their taking
7. Someone who strenuously exercises such as a long distance runner
8. Family- inherited disorders
110
Narrowing of one or more arteries that carry blood to your kidneys
Atherosclerotic renal artery stenosis (RAS)
111
Symptoms of RAS
1. HTN before 30yrs
2. Sig. HTN after 55
3. Abdominal bruit
4. Accelerated HTN
5. HTN that was easy to control but now resistant
6. Recurrent flash pulmonary edema
7. Multivessel CAD
8. PAD
9. Unexplained CHF
10. Refectory angina
11. Renal failure of certain etiology
12. Renal failure involving RAAS treatment
112
Teachers example of RAS
When the teacher worked in cardiology she knew a pt that was a thin young man with HTN and he was on two HTN medications. His mother was a nurse. Meds could not control his HTN. Mom talked to cardiology friends and got referred to a specialist. He had RAS
113
What main symptom should prompt the APRN to send their pt to a specialist?
Pt with HTN who is refractory to medication management
114
Why is it important to identify pt that may have RAS?
If pt is not treated they could have a stroke
115
What is a treatment for RAS?
Stenting
