1. regulate elytes and fluids 2. excrete water soluble waste products of metabolism (cr, urea, uric acid) 3. hormone production (erythropoietin, renin, bradykinin, prostaglandins, calcitriol, vit d3) 4. process meds, ATBs

renal urology Flashcards by Nicole Bajusz

main role of kidney

regulate fluids and elytes

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kidney fx

regulate elytes and fluids
excrete water soluble waste products of metabolism (cr, urea, uric acid)
hormone production (erythropoietin, renin, bradykinin, prostaglandins, calcitriol, vit d3)
process meds, ATBs

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erythropoietin

RBC production

bone marrow stimulates erythropoietin when circulating blood volume is low to make more RBCs

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renin and bradykinin

hormones rt bp

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prostaglandins

hormones r/t renal perfusion

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calcitriol/vitamin d3

hormones r/t bone production

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ureters

smooth muscle tubes that carry urine that is created by kidney

propel urine from kidney to bladder

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bladder

hollow muscular organ that collects and stores urine

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serum cr lab values

male 0.7 - 1.3

female 0.6 - 1.1

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what is creatinine

end product of protein metabolism, predominately looking at muscle

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what affects creatinine

muscle mass, gender, race

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how does aging affect creatinine

falsely decreased serum creatinine d/t decreased muscle mass

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things that cause serum creatinine to rise

renal fx decline
renal damage
nephrotoxic drugs
dehydration
CHF (likely prerenal failure)
excessive blood loss, ie shock
gout
excessive exercise or muscle injury
DKA- falsely elevated
cephalosporin use
high protein diet

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creatinine clearance range

75-112

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24 hr urine cr clearance

reflects renal fx in 24 hr period

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creatinine clearance measures what

how much creatinine is being cleared from kidney

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creatinine clearance 24 hr urine is used in presence of what

proteinuria, albuminuria, microalbuminuria

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bence jones protein screens of what

multiple myelmoa

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what can you measure protein in the urine with- first line

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what happens to creatinine clearance when renal fx decreases

decreases

bc amount of creatinine cleared from kidney will be less as when the kidneys aren’t functioning creatinine will be able to clear less

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which is more sensitive, creatinine clearance or serum creatinine, and why

creatinine clearance

bc it is not affected by fluid status, diet, or exercise

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what is a estimation of gfr

creatinine clearance

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what is the best predictor for staging CKD

GFR

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what does GFR represent

amount of fluid filtered by glomerulus within a certain unit of time

hence the name glomerular filtration rate

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bun measures what

kidneys capacity to excrete urea

what is urea

waste product of protein metabolism

BUN can be used for what

to evaluate hydration status and assess renal function also to assess blood in GI tract

what causes BUN to elevate

1. AKI 2. high protein diet 3. hemolysis- breakdown of RBC 4. CHF 5. drugs- ie diuretics 6. dehydration

sensitivity of BUN in comparison to GFR or serum creatinine

not as sensitive

what to check in regards to renal function if BUN elevated

check GFR, if normal, kidneys are most likely ok

bun - cr ratio range

10:1 - 20:1

what causes an increased bun to cr ratio

condition that causes a decrease in flow of blood to kidneys, such as CHF or dehydration or excessive blood loss

urinalysis uses

1. check for protein 2. check for blood 3. check for UTI

what is happening to body in proteinuria

kidney damage normally protein and albumin should not be allowed in glomuerular filtrate and what little does get through should be reabsorbed

microalbuminuria

small amount of protein

macroalbuminuric

large amount of protein in urine

what amount of blood is normal in the urine

<5 RBC

causes of hematuria

renal calculi, pyelonephritis, cystitis, bladder cancer

pyelonephritis clinical presentation

bright red blood in urine, back pain, renal stones, FH of renal stones, fevers. chills, sweats, lower back pain

leukocytes esterase lab range

normal is <10

what is pyuria

presence of WBC in urine

do uncomplicated UTIs need diagnostic testing for treatment

no can treat based on clinical symptoms

leukocytes esterase indicate what

pyuria

nitraites in UA indicate what

UTI with e coli

what is normal in casts in UA

hyaline

WBC cast indicates what

UTI or pyelonephritis

RBC cast indicates what

glomerulonephritis

why would you check WBC cast after treating UTI with ATB

to make sure casts have gone away

urine specific gravity lab value

1.005 - 1.03

urine specific gravity decreased with what

1. renal disease 2. too much fluid intake 3. DI

urine specific gravity elevated with what

1. dehydration 2. excessive fluid loss- v/d/f 3. excessive radiographic contrast 4. DM 5. SIADH

microalbuminuria lab value

30 - 150 mg/day

mild albuminuria lab value

150 - 500 mg/day

moderate albuminuria lab value

500 - 1000 mg/day

heavy albuminuria lab value

1000 - 3000 mg/day

nephrotic albuminuria lab value

>3000 mg/day

false positive for albuminuria

1. hyperinfiltration (newly dx dm) 2. exercise. ppl who exercise a lot spill a lot of protein and albumin into urine 3. marked HTN 4. CHF 5. UTI 6. acute febrile illness

urine culture and sensitivity is used for what

1. UTIs- recurrent, complicated, males 2. pregnancy- risk for preterm birth 3. pyelonephritis

what happens if urine culture and sensitivity is positive

transfer to medium with discs applied to determine sensitivity to ATBs may send automatic reflex culture depending on WBC and nitrates

> 10,000 CFU/ml of organism indicates what

UTI | treat pt

WBC casts with proteinuria indicate what

pyelonephritis

large amounts of epithelial cells or multiple organisms indicate what

contaminated urine

what labs are preferred for renal fx assessment

serum creatinine and GFR not BUN

Na, Cl, K are important for what

fx of nerves and muscles

what happens to sodium with over hydration

decreases

what happens to sodium with dehydration

increases

what caues K to increase

renal failure

what caues K to decrease

diuretics, excessive vomiting, g tubes

cl generally follows what

what is KUB xray

plain firm of lower abdomen and pelvis quick assessment of kidneys and ureters for calcium containing kidney stones and bowels for obstruction

what to do if pt symptoms and PE suspicious of kidney stones

refer to urologist regardless of KUB findings

best test to confirm or r/o possibility of calcium containing kidney stone

helical or spiral CT calcium will light up on KUB bc its bone and will be white

what kind of stones do not show up on KUB

uric acid stones

what kind of testing is needed for uric acid stones

ultrasound

renal urology Flashcards

(74 cards)