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Pathophysiology > Renal- T2 > Flashcards

Renal- T2 Flashcards

1
Q

acute kidney injury

A
  • has potential to be reversed
  • 48 hours
  • has stages: prerenal, intrarenal, and postrenal
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2
Q

if kidney injury symptoms persists…

A

chronic kidney disease

  • progressive and can take years (N stage: terminal)
  • has VALUES
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3
Q

if not urinating, could lead to..

A

edema

-so fluids goes into interstitual tissues or lungs (causes infection and affects breathing, SOB)

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4
Q

most common cause of kidney disease

A
  • diabetes

- hypertension

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5
Q

other conditions that can harm kidney

A
  • glomerulonephrotis
  • inherited diseases
  • lupus and other autoimmune diseases (“body turning against yourself”)
  • obstructions
  • urinary tract infection
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6
Q

those most at risk for kidney disease

A
  • 60 yrs old
  • african american, asian, hispanics, pacific islander, american islander
  • prolonged use of medications that damage the kidney
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7
Q

protective mechanisms against UTI- male

A
  • urine acts as antiseptic (urine helps push any bacteria thats near meatus away)
  • urethra enclosed in penis
  • protective prostate
    • prostate secretes liquid thats acidic in nature
    • acid helps kill bacteria
  • immune defense
  • longer urethra
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8
Q

protective mechanisms against UTI- females

A
  • urine acts as antiseptic
  • lactobacilli in vagina
    - acidic and helps keep bacteria away
  • acidic vaginal environment
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9
Q

risk factor for AKI- The Aged Individual

A
  • reduced GFR (glomerular filtration rate)
  • dehydration
  • cardiovascular
  • high blood pressure
  • diabetes
  • diuretics
  • immobility
  • obstructive disorders
  • > 65 likely to recover from AKI
  • infections can be slow to heal if they have diabetes
  • polypharmacy
  • aged kidney less likely to compensate for changes: fluid, solute, cardiac output
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10
Q

organism of UTI

A
  • Escherichia coli (main)
  • Staphylococcus aureus
  • Enterobacter
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11
Q

E. coli

A
  • main causative of UTI

- from intestine

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12
Q

Staphylococcus aureus

A

can be found on your hand, skin, mouth, nose

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13
Q

Enterobacter

A

common in hospital

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14
Q

how many mL do you want to produce per hour for urine?

A

-you want to produce 3- mL of urine per hour

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15
Q

why are kidney so important?

A
  • filtration of nitrogenous wastes (urea, creatine)
  • excretion of wastes and toxins
  • regulate ECF
  • regulate osmolarity
  • regulate pH (more H = more acidotic)
  • regulate key ions
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16
Q

what does kidney produce?

A
  • renin: use to help regulate bp
  • erythropoietin: hormones that use in production of RBC
  • vitamin D
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17
Q

renin

A
  • kidney maintains homeostasis

- regulate blood pressure

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18
Q

where is renin produced?

A

glomerulus

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19
Q

what is in liver that renin comes in contact with?

A

angiotensinogen and liver

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20
Q

what does angiotensinogen create or metabolizes?

A

angiotensin 1

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21
Q

where and what does angiotensin 1 produces?

A

Angiotensin 1 in the LUNGS → creates angiotensin 2 by angiotensin converting enzymes (ACE)

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22
Q

whats the end result of renin?

A

peripheral vasoconstriction

  • increasing pressure in vessels and then stimulates adrenal cortex –> produces aldosterone (aldosterone conserves water or produces water and sodium)
  • more volume = high BP
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23
Q

vitamin D

A
  • obtained via diet or supplements
  • synthesized by UV radiation on cholesterol in skin
  • metabolically activated in the kidney
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24
Q

whats needed for strong bone?

A
  • vitamin D
  • calcium
  • phosphorus
  • parathyroid hormone
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25
Q

renal disease

A

phosphorus tries to find calcium and sends signal to parathyroid

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26
Q

What results when you have high phosphorus and parathyroid?

A
  • phosphorus and parathyroid steals from bone –> result in low calcium
  • so bone is getting brittle –> creates OSTEODYSTROPHY
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27
Q

osteodystrophy

A

silent crippler (brittle and soft bone, which deforms it)

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28
Q

what is inversely related in renal disease?

A

calcium and phosphorous

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29
Q

what happens to blood vessels when calcium is pulled out from bone?

A

blood vessles harden

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30
Q

why is heart disease common?

A

because calcium and phosphorus are deposited elsewhere and usually in the heart

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31
Q

Other than removing fluid and wastes from the body, name 3 additional functions of the kidney

A
  1. erythropoietin
  2. osteodystrophy, vitamin D, calcium
  3. blood pressure
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32
Q

What is renal osteodystrophy?

A

bone loss and pain, pathological factors: brittle bone

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33
Q

specific gravity of urine

A

varies with its concentration of solutes

- 1.010-1.025 with a normal fluid intake

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34
Q

in renal pt…

A

makes urine but are not good quality

  • toxins still in blood but kidney letting water thru but not filtering toxin out (water coming out, toxin in blood –> poor quality)
  • normal: amber and yellow color
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35
Q

protein in urine

A

negative trace

- if positive, proteinuria; may be dysfunction of glomerulus: nephrotic syndrome

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36
Q

urine culture

A

clean catch midstream specimen

- urine analysis tells you whats INSIDE but will not tell you an organism that’s causing it

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37
Q

What is Benign Prostatic Hypertrophy (BPH)

A

enlargement of the prostate gland increases with age (around 35 yrs old)
-as it enlarged, it adds pressure and makes it difficult to urinate

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38
Q

Characteristics ofBPH

A
  • hesitancy (dribbling, weak urinary stream)
  • frequency
  • urgency
  • dysuria
  • nocturia
  • hematuria
  • urinary retention (causes infection)
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39
Q

how much urine does the bladder hold?

A

600 mL of urine

-about 200-300 is the urge to go

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40
Q

urinary obstruction with retention or stasis of urine

A
  • congenital (born with it)

- acquired (BPH/enlarged prostate, calculi, tumors, scar tissue, spinal cord injury, pregnancy)

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41
Q

UTI consideration

A
  • women (sexually active, pregnant)
  • age-related
  • elderly
  • men
  • fluids (water and avoid bladder irritating fluids)
  • elimination
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42
Q

uremia

A
  • kidney clear toxin out of body

- can affect their thinking, their breath is terrible if theyre uremic

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43
Q

What happens when toxin builds up very high?

A

causes it to build up on skin, which creates uremic frost

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44
Q

What is glomerular filtration rate and the gold standard?

A
  • diagnostic kidney function test

- measured using serum creatinine or 24 hr urine clearance (GOLD STANDARD)

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45
Q

what is serum creatinine?

A

determines filtration rates and measures creatine (waste product of muscle metabolism)

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46
Q

what is urea?

A

the byproduct of protein

47
Q

What is the Nitrogen BUN (meat)?

A

the byproduct of protein urine metabolism

48
Q

function of glomerurlar filtration rate?

A

estimates amount of blood flowing through the glomeruli per minutes

  • overall best way to measure kidney function
  • affected by age, sex, body size, and ethnicity
49
Q

what is the normal range for glomerular filtration rate?

A

120-130 mL/min/1.73m2

50
Q

acute kidney injury

A
  • impaired kidney function
  • inability to efficiently/effectively remove waste from the blood
  • develops rapidly over a few hours or days
  • potentially reversible
  • high mortality rate
51
Q

oliguria

A

decrased amount of urine

-less than 400 mL

52
Q

auria

A

no urine

-less than n100 mL a day

53
Q

azotemia

A

accumulation of nitrogenous waste

  • increased serum creatinine and urea
  • fluiud and electrolyte disorders (might affect K, heart)
54
Q

azotemia can lead to what?

A

acute tubular necrosis is most common

55
Q

pre-renal

A

-sudden reduction in blood flow, loss of blood, hemorrhage are enemy to the kidney (pertains to purfusion and blood volume)

56
Q

ischemia of nephron

A

nephron not getting adequate perfusion of blood

  • decreased GFR
  • sharp decrease in urine output
57
Q

disorders of pre-renal

A
  • cardiogenic shock: result of MI
  • heart failure
  • MI
  • burns: losses a lot of fluids
  • trauma: hemorrhaging
  • renal artery obstruction
58
Q

intra-renal failure

A

direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply
-renal parenchymal injury

59
Q

3 categories of renal parenchymal injury

A
  • acute tubular necrosis (ATN)
  • interstitial nephritis
  • glomerulonephritis
60
Q

acute tubular necrosis (in intra-renal failure)

A
  • nephrotoxic medications
  • sepsis
  • ischemia
61
Q

interstitial nephritis (in renal failure)

A
  • medications
  • infections
  • autoimmune disease
62
Q

post renal

A

obstruction in ureter ot stricker from renal stone or scaring, urine is going to back up bc it cant fo into bladder
-related to prostate, tumor

63
Q

what happens to someone that is paralyzed and they cant feel anything?

A

called neurogenic bladder

- urine stays in the bladder so they need to be cauterized

64
Q

post- streptococcal Glomerulonephritis

A
  • acute onset
  • in most cases, the stimulus is group A Beta-hemolytic strptococci (causative organism)
  • may develop 1-2 weeks after a throat infection or skin infection (impetigo)
65
Q

chronic glomerulonephritis

A
  • encompasses several glmerular diseases
  • progressive, leading to chronic kidney failure
  • primary cause may be difficult to establish
66
Q

what is the secondary cause of chronic glomerulonephritis?

A
  • diabetes melitus

- lupus erythematosus

67
Q

stages of renal disease

A
  1. renal insufficiency
  2. nephrotic syndrome
  3. accelerated progression
  4. ESRD
68
Q

pyelonephritis

A

-often in female that are pregnant
-inflammation of the nephron in the pelvic
has high fever

69
Q

acute pyelonephritis

A
  • upper urinary tract

- responds well to 2 weeks of organism-specific antibiotic therapy

70
Q

what does acute pyelonephritis inflamed and affect?

A
  • inflammation of kidney medulla
  • parencyhma
  • renal pelvis
  • affecting tubules
71
Q

chronic pyelonephritis

A
  • persistent or recurrent infection of the kidney by the same organism assicuated with resulting inflammation and scarring of the kidney
  • structural abnormalities. Impairs the function of the kidneys and can lead to chronic kidney disease
72
Q

symptoms of post renal failure

A
  • abdominal distention w/ complete obstruction
  • suprapubic tenderness w/ palpation (down low, b pubic bone)
  • symptoms related to the level of the obstruction
73
Q

renal and ureteral calculi

A

stone formation

-more likely in the summer bc people are sweating and not staying hydrated

74
Q

who does renal and ureteral calculi affect the most?

A
  • southeastern U/S = highest incidence
  • usually btw 20-55
  • most frequent in whites
  • males more likely to be affected
  • more likely if + family history
75
Q

how are renal and ureteral classified and named?

A
  • named based on their diet and medications

- classified based on mineral composition

76
Q

what is the most common renal and ureteral calculi?

A

calcium oxylate

77
Q

symptoms of renal and ureteral calculi

A
  • severe pain: depends on location
  • diaphoresis: sweating
  • N/V
  • fever
  • chill
  • hematuria, WBCs in urine
  • **RENAL CALCULI CAN FORM IN ANY PART OF THE URINARY TRACT
78
Q

G1

A
  • > 90 mL/min/1.73m2
  • normal or high
  • asymptomatic
79
Q

G2

A
  • 60-89
  • mildly decreased
  • asymptomatic
80
Q

G3a

A
  • 45-59
  • mildly to moderately decreased
  • when symptoms start to show (swelling, loss of appetite)
81
Q

G3b

A
  • 30-44

- moderately to severely decreased

82
Q

G4

A
  • 15-29
  • severely decreased
  • starting to get concerning, clearance well but theyre declining
83
Q

G5

A

<15

  • kidney failure
  • in stage needs support to sustain life
  • can go on dialysis (hemodialysis or peritoneal dialysis, transplant, or nothing at all)
84
Q

chronic Kidney disease- kidney function

A

progressive, irreversible loss

85
Q

CKI- mortality rate

A

-high, btw 19-24% for those on dialysis

86
Q

major causes of CKI

A
  • diabetes (#1)

- hypertension (#2)

87
Q

CKD is when…

A

GFR <60 mL/min/1.73 mz > 3 months

88
Q

stage 1 CKD

A
  • higher than normal levels of creatinine or urea in the blood
  • blood or protein in the urine
  • evidence of kidney damage in MRI, CT scan, ultrasound or contrast X-ray
  • a family history of polycystic kidney disease
89
Q

Stage 2 CKD

A
  • higher than normal levels of creatinine or urea in the blood
  • blood or protein in the urine
  • evidence of kidney damage in an MRI, CT scan, ultrasound or contrast X-ray
  • a family history of polycystic kidney disease
90
Q

Stage 3 CKD

A
  • fatigue
  • fluid retention, swelling of extremities and SOB
  • urination changes (foamy; dark orange, brown, tea-colored or red if it contains blood; and urinating more or less than normal
  • kidney pain felt in their back
  • sleep problems due to muscle cramps or restless legs
91
Q

Stage 4 CKD

A
  • fatigue
  • fluid retention, swelling, SOB
  • urination changes (foamy: dark orange, brown, tea colored or red if contains blood)
  • kidney pain felt in their back
  • sleep problems due to muscle cramps or restless legs
  • N/V
  • taste changes such as metallic taste in the mouth
  • bad breath due to urea buildup in the blood
  • loss of appetite
  • numbling or tingling in the toes or fingers
92
Q

Stage 5 CKD

A
  • loss of appetite
  • N/V
  • headaches
  • being tired
  • being unable to concentrate
  • itching
  • making little, or no urine
  • swelling, especially around the eyes and ankles
  • muscle cramps
  • tingling in the hands or feet
  • changes in skin color
  • increased skin pigmentation
93
Q

elimination of nitrogenous wastes (CKD assessment)

A
  • azotemia: increased creatinine (can be used as an indirect method for assessing the GFR and the extent of renal damage & BUN levels rise to 800mg/dl
  • uremia: “urine in the blood”; weakness, lethargy, confusion, pruritus
94
Q

acid-base balance (CKD assessment)

A

-impaired ability to excrete acid inability to excrete hydrogen ions (result in Metabolic acidosis), sodium and bicarbonate re-absorption, and production of ammonia

95
Q

potassium balance (CKD assessment)

A

-decreased K+ excretion leads to hyperkalemia when kidney function is severe

96
Q

erythropoietin production (CKD assessment)

A
  • impaired ability o produce erythropoietin hormone

- reduction in RBC production (anemia, increased bleeding tendency r/t defective function)

97
Q

sodium & water balance (CKD assessment)

A

-reduction in regulating of Na+ excretion

98
Q

hypocalcemia

A
  • results due to inability of GI tracts to absorb calcium in absence of active vitamin D
  • if serum calcium level is low, parathyroid tells the bones to release calcium, which causes weakended bones
99
Q

hypercalcemia

A

may occur w/ calcium and Vitamin D supplementation (hold vit. D and replaces binders w/ non-calcium binders)

100
Q

hyperparathyroidism

A
  • may require parathyroidectomy
  • located behind thyroid
  • usually are taken out, slithered, and monitor calcium
101
Q

calciphylaxis

A

when phosphorus levels are high

  • it’s a bad infection, open wound
  • takes months to heal, require strong meds
102
Q

What is parathyroidectomy

A

prOteinuria >3.5 g/day (losing)

103
Q

cause of may require parathyroidectomy

A

systemic disease (diabetes, lupus)

104
Q

Nephrotic syndrome may require parathyroidectomy-damage

A
  • damage to glomeruli

- 3.5+ grams of proteins in 24 hours leaks into urine

105
Q

Nephrotic syndrome - signs and symptoms

A
  • weight gain
  • edema
  • fatigue
  • foamy urine
  • loss of a
106
Q

Nephrotic syndrome - symptoms

A
  • proteinuria
  • hyperlipidemia
  • hypoalbuminemia
107
Q

Nephrotic syndrome - complication

A
  • blood clots
  • loss of immuniglobulins
  • CAD
  • hypertension
  • hypothyroidism
  • anemia
  • AKI: usually due to glomerulonephritis
108
Q

Nephrotic syndrome - diagnosis

A
  • 24 hr urine or urine dipstick
109
Q

pyelonephritis

A

upper urinary tract

110
Q

acute pyelonephritis

A
  • upper urinary tract
  • inflammation of kidney medulla, parenchyma, and renal pelvis
  • responds well to 2 weeks of organism-specific antibiotic therapy
111
Q

chronic pyelonephritis

A

-perisistent or recurring infection of the kidney by the same organism associated with resulting inflammation and scarring of the kidney: reflux

112
Q

structural abnormalities of chronic pyelonephritis

A
  • structural abnormalities

- impairs the function of the kidneys and can lead to Chronic Kidney Disease

113
Q

urinalysis

A

general examination of urine to establish a tentative diagnosis and determine whether further studies are to be ordered
-normal urine is clear, amber-colored fluids (no proteins)

114
Q

renal creatinine

A
  • renal creatinine clearnace nad GFR
  • ability of the kidney to filter and reabsorb and/or secrete substance in the blood
  • “how clean is the blood”

Pathophysiology (4 decks)

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