The Renal and Urologic System Flashcards by Elizabeth Diaferia

What organs are considered the Upper Urinary Tract?

Kidneys

- Ureters

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What organs are considered the Lower Urinary Tract?

Urinary bladder

- Urethra

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What are the functions of the kidneys?

maintains osmotic pressure
regulates the volume of the extracellular fluid (Na and H2O)
helps regulate acid-base balance

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the kidneys excrete _____ when there is excess acid, and _____ when there is excess base

H+

HCO3-

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Kidneys filter _____ L or bood/day and eliminates a min. of ___ L of urine/day

190 L

2 L

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Kidneys regulate ____________ by regulating fluid volume/RAS system

blood pressure

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Kidneys contribute to ________ function by producing erythropoeitin and renin

endocrine

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Kidneys excrete _____

drugs

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MOA for kidneys include:

Where does this take place?

filtration, reabsorption, and secretion which take place in the nephron

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The ________ is a network of small blood vessels known as a ____, located at the beginning of a nephron in the kidney

Glomerulus

tuft

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Blood enters the Glomerulus through _________ arterioles and exit into _________ arterioles

afferent

efferent

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What surrounds the Glomerulus?

Bowman’s capsule

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______ is filtered across capillary walls of glomerulus through glomerular filtration ______ - yields its filtrate into the Bowman’s capsule - goes into __________

Blood
barrier
proximal tubule

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What is the Glomerular filtration barrier made up of?

endothelial cells
glomerular basement membrane
podocytes

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Endothelial cells can be damaged from what disease?

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Why do podocytes cause a possible “chokepoint” in the kidneys?

they guide material into Bowman’s capsule and can get clogged making it harder for material to pass through

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What are the possible choke points in the kidneys?

hint: basically throughout the whole urinary tract

between kidney–> renal pelvis–> ureter–> urinary bladder–> urethra

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Where is the prostate located and what does it surround?

located just below the bladder and surrounds the top portion of the urethra

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The urinary tract has a _________ & ___________ funcition

transportation & storage

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Prolonged exposure of these organs and tissues to carcinogens can result in _______

cancer

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Why are females at an increased risk of getting UTIs?

-the urethra lies close to the vaginal & rectal openings, allowing for relative ease of bacterial transport

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The shorter ______ in females also contributes to the increased incidence of UTIs

urethra

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What parts of the urethra are/ are not strerile?

Upper 2/3 is sterile

Lower 1/3 is not sterile

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UTIs are common in what age population?

Elderly, especially in long term health care facilities

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Risk factors for UTIs

- age - immobility - catheter - atonic bladder (w/o tone) - UTO - Kidney stones - Prostatic hyperplasia (cannot completely clear bladder) - females - pregnancy - DM

Presence of UTI increases the risk for ________ infections

systemic

Signs and Symptoms of UTI

- increased urinary frq. - greater urinary urgency - nocturia - pain - costovertebral tenderness - fever & chills - sepsis with AMS - painful urination (dysuria) - hematuria - pyruria (pus) - dyspareunia (pain during sex)

Specific infection sites for UTIs

- pyelonephritis (kidney) - cystitis (bladder) - urethritis (urethra)

Pyelonephritis occurs when a UTI progresses to involve the _______ urinary system

upper

Urine flow in the kidney: Urine formed in kidney-->

passes through papilla at apex into major and minor calyx --> through renal pelvis into the ureter

Chronic Pyelonephritis can lead to scarring in the ______ of the kidney

calyces

How does scarring impact the contractions of smooth muscle?

contractions will be reduced--> increased urine overflow--> urine cannot be eliminated--> kidneys become overflowed w/ urine

Risk factors of Pyelonephritis

- revent incontinence | - urine reflux

Causes of chronic Pyelonephritis

- chronic infection - urine reflux - ureter/bladder obstruction - atonic bladder

Pathogenesis of Pyelonephritis

scarring resulting in deformity of the calices (abnormal movement of urine)

Pyelonephritis is responsible for upwards of ____% of cases of end stage renal disease. This leads to??

25% | dialysis and transplantation

Urinary tract infections (UTIs) rank _______ only to upper respiratory tract infections in incidence of bacterial infections as possible comorbidities

second

PT role for patients with UTI

recognize risk factors and presentations

PT implications for UTI

- N & V - > 102 temp - unexplained onset of back or shoulder pain - UTI increases risk of sepsis-systemic issue - personal hygiene - pelvic floor PT

Problems secondary to kidney disease

- cognitive issues - anemia - electrolyte imbalance - impaired drug metabolism - impaired muscle function - OP

What is Glomerular filtration rate (GFR)?

an estimation of the rate at which materials in the blood are filtered by the kidneys

What does GFR tell us?

it gives an assessment of the functionality of the kidneys

Normal GFR=

> 90 ml/min/1.73m^2

GFR can be estimated from the results of a blood _______ test

creatinine

Acute Renal Failure (ARF) is an abrupt disease in renal function sufficient enough to result in _________ of nitrogenous waste and disrupt fluid and electrolyte __________.

retention | homeostasis

ARF can be diagnosed by having increased _______ levels and decreased _________

serum creatinine levels | urine output

Drug and toxins associated with renal failure mechanisms:

- decreased renal perfusion - direct tubular injury - tubular obstruction/direct tubular damage - immunological-inflammatory

Chronic Kidney Disease (CKD) is a condition characterized by a.....

gradual loss of kidney function over time

Persistent ________ means CKD is present

proteinuria

Causes of CKD

poorly managed/controlled DM and HTN!

As the GFR number increases, kidney function ________

decreases

``` G1= ________ G5= _________ ```

normal | kidney failure

How many stages of kidney failure are there?

5 stages

Stage 1 of CKD

- microalbuminia | - elevated BUN & creatinine

Stages 2-4 of CKD

Axotemia: accumulation of nitrogen containing waste products in the blood

Stage 5

end stage renal disease (ESRD), uremia (excess amino acids) | -kidneys unable to excrete toxin, maintain pH, fluid or electrolyte balance

Hemodialysis for CKD- movement is driven by...

cardiac function

How does Hemodialysis work?

blood is removed from the body via vascular access and sends it across a semipermeable membrane and dialysate.

The pressure gradient filter of Hemodialysis favors the removal of ____________

harmful substances.

How many treatment sessions a week for Hemodialysis and how long is each?

3 sessions a week and 3-4 hours each

Dialysis- urea reduction rate (URR) measures ________ adequacy

dialysis

Each dialysis treatment should reduce _____ level

BUN

Peritoneal dialysis-

solution is run through a tube into the peritoneal cavity

Diet for patients on dialysis?

- fluid intake is limited (risk of UTI) - intake of salt, potassium, phosphorous, and other electrolytes is limited - getting enough calories is difficult

Patients on dialysis are hypo or hypernatremic? | Preload?

- hyponatremic | - increased preload

What is the most common cause of CKD and how?

diabetic neuropathy (44%)

Hyperglycemia leads to glomerular ___________, damaging the arterial capillaries in the glomerulus and ________ of BM

hyperfiltration | thickening

CKD demands long term ________ control with a < ___% A1c

glycemic | 7%

PT implications for CKD and DM

Monitor BP and glucose levels, know A1c of pt

HTN causes damage to _____/________ blood vessels

renal/glomerular

How does uncontrolled HTN cause kidney disease?

Damage to blood vessels in glomerulus--> BF to kidney is reduced and compromises kidney function --> limited O2 and nutrient delivery to the nephron --> damaged kidney loses ability to regulate whole body BP

PT implications of CKD

- Monitor BP with DM and HTN - Know A1C levels - Educate!

Primary glomerular disease (PGD) is a group of disorders characterized by _______ alterations in normal glomerular structure and function, independent of systemic disease processes such as ____ and ____

pathologic | DM and HTN

PGD results from damage to the kidney’s ___________ - the site of the initial steps in kidney function!!!

filtering units

Deposition of ______/_______ complexes into some portion of the glomerulus → inflammatory response → _______ damage

antigen/antibody | sclerotic

Damage to glomerular epithelial cells allows larger molecules (proteins) to escape the circulation and enter the ________ tubule resulting in ________

proximal | proteinuria

Damage to capillary wall allows _____ to escape and enter proximal tubule and resulting in _________

RBCs | hematuria

Clinical Signs of PGD

- Edema - Hypoalbuminemia- due to low GFR - Proteinuria - Hematuria - HTN

Treatment for PGD

- fluid restriction - statins - glucocorticoids

Renal calculi aka kidney stones are the ____ most common urinary tract disorder

3rd

Kidney stones cause _______ obstruction and severe _____

urinary | pain

Hydronephrosis is the distension and dilation of the __________ and ______, secondary to urine accumulation

renal pelvis | calyces

Pain for kidney stones is most commonly felt in the flank, which is located...

lower ab and groin

Treatment for kidney stones

- watchful waiting - shock wave US - surgery

Neurogenic bladder disorders occur when...

input to detrusor muscles lining the wall of bladder via parasympathetic neurons is inhibited

Neural stimulation is required for _________

micturition

Internal sphincters have _____ muscle and are innervated by ________ neurons

smooth | sympathetic

External sphincters have _______ muscle and are under ________ control

skeletal | voluntary

Micturition

- Coordinated activity - Remove inhibition of detruser muscle - Remove stimulation of internal sphincter muscle - Reduce tonic activity to the external sphincter

Urinary incontinence is the ________ loss of urine that is sufficient to be a problem and occurs most often when bladder pressure ______ sphincter resistance

involuntary | exceeds

Risk factors for urinary incontinence

- age | - pelvic floor weakness

Functional Incontinence -

normal urine control but who have trouble reaching a toilet in time b/c of muscle or jt dysfunction

Stress Incontinence -

loss of urine during activities that increase intra abdominal pressure (coughing, laughing, valsalva maneuver)

Urge Incontinence -

sudden and unexpected urge to urinate and an inability to prevent the loss of urine

Overflow Incontinence -

constant leaking of urine from bladder that is full but unable to be emptied -drugs, DM, SCI

The Renal and Urologic System Flashcards

(95 cards)