Chapter_36

Regulate blood volume composition and pressure by the exfretion or conservation of water, regulate electrolytes, regulate acid-base balance, produce erythropoietin, and activation of vitamin D

The renal cortex

Parts of the nephrons (renal corpuscles and convoluted tubules)

The renal medulla

The loop of Henle and the collecting tubules, renal pyramids, and the renal pelvis, extensions of the renal pelvis called calyces enclose the papillae of the renal pyramids.

The nephron (1 million per kidney)

The renal corpuscle and renal tubule.

A glomerulus surrounded by a Bowmans or glomeurular capsule.

Afferent/Efferent

Glomerular filtration in the renal corpuscles, tubular reabsorption and tubular secretions.

Process by which bp forces plasma and disolved materials and small proteins out of the glomeruli abd into Bowmans capsule.

55

20

100-125 mL/min

Less/decreases.

99

1,000-2,000 mL / 24hours

ATP

Glucose, vitamins, amino acids and ions.

Promoted reabsoption of sodium from the filtrate to the blood abd excretion of potassihm ions into the filtrate. Water is reabsorbed following the reabsorption of sodium.

Promotes reabsorption of water from the filtrate to the blood.

Decreases reabsorption of sodium ions which remain in the filtrate. More sodium and water are eliminated in the urine.

Promotes reabsorption of calcium ions from the filtrate to blood and excretion of phosphate ions into filtrate.

Pinocytosis

Hydrogen and bicarbonate.

Hydrogren and bicarbonate.

Secretion of renin, activation of vitamin D, production of erythropoietin.

Renin

Calcitrol

Ureters

Urinary bladder

Urethra

Spinal cord reflex

Detrusor muscle

1,000-2,000mL's

Straw (dilute) to amber (concebtrated)

1.002-1.035. (distilled water is 1.000)

4.6-8.0

95% water; urea; creatinine; and uric acid.

By liver cells when excess amino acids are metabolized to be used for energy production.

Comes from the metabolism of creatinine phosphate an energy source in muscles.

Metabolism of nucleic acids- breakdown of DNA and RNA.

Decrease in number of nephrons, decrease in GFR, arteriosclerosis and decreased renal blood flow (the reason for decreased GFR) bladder decreases in size, decrease in detrusor muscle tone, risidual in bladder after void.

When the waste products are not filtered by the kidneys or with treatment, they can come out through the skin and look like a coating of frost.

Awakening from sleep at night to urinate.

Age gender ethnicity occupation health habits medical history family disorders r/t gu current meds (including otc and herbs) renal/urinary problems new onset of symptoms diet and fluid intake

Vitals neuro skin hair and nail assessment eyes ENT CV Resp Heme GI GU musculoskeletal and endo

• Color-pale yellow-amber
• Odor- aromatic
• pH-4.6-8.0
• Specific Gravity-1.002-1.035
• Protein-0-18mg/dL or 0-150mg/24 hours
• Glucose-none
• Ketones-none
• Bilirubin-none
• Nitrate- negative
• Leukocyte esterase- nagative
• RBC's- 0-4/hpf
• WBC's-0-5/hpf
• Casts-none to occasional

Metformin aka Glucophage

GFR or creatinine clearance

Mucomyst or acetykcysteine

Bladder cancer marker

8-30mg/dL

0.6-1.5 mg/dL

2-7mg/dL

135-145 mEq/L

3.5-5.5 mEq/L

9-11mg/dL

2.8-4.5 mEq/L

22-28

1.3-2.1 mEq/L

3.5-5.0 g/dL

High frequency sound waves image the kidneys ureters and bladder or map the kidneys before a biopsy is done. Can show disorders of the kidney abcesses hydronephrosis kidney stones or tumors kidney enlargement structural changes with chronic infection.

Portable US computes bladder volume from 12 cross sectional readings. Used for residual urine volume bladder wall thickness bladder calculi tumors and diverticula.

Shows size shape and position of the kidneys ureters and bladder. Can show renal calculi kidney size and masses in the kidney

Computer constructs images of the area scanned from a series of tomograms or cross-sectional slices. Contrast media may be given. Evaluates the kidneys ureters bladder abdominal and pelvis organs for kidney size tumors cysts abcesses malignant masses matasteces lymph node enlargement nonfunctioning kidneys renal stones obstructions and infections. (NPO 4 hours before procedure check allergies BUN and creat before contrast. Withold metformin)

Computer generated films produced by interaction of radio waves and magbetic fields of kidneys bladder prostate testes and retroperitoneum. Used to stage cancers of the kidney bladder and prostate. (contraindicated in patients with implanted metal devices, can use open MRI if pt is claustrophobic, may use contrast)

X-ray exam of renal tissues calyces pelvises ureters abd bladder after IV injection of contrast media or dye. Radiographs taken at frequent intervals to see dye filling the renal pelvis and going to the ureters into the bladder. Can show abnormal size or shape of kidneys absebt kidneys polycystic kidney disease tumors hydronephrosis renovascular hypertension. (prep- NPO 8 hours before, enemas to empty colon, check allergies, BUN creat, explain warm flush of dye. Post care- encourage fluids to flush out dye, monitor urine output)

Visualizes renal blood vessels. Femoral artery is pierced with a needle, and a cath is threadded upward through the femoral and iliac arteries into the aorta and then the renal artery. Contrast agent is injected to make renal arterial supply visable on x-ray exam. Can show hypervascular tumors renal cysts renal artery stenosis, renak artery aneurysms, pyelonephritis, obstructions, renak infarction, renal trauma evaluation. (pre- NPO 4-8 hours prior check allergies BUN creat enemas may be given, post- bedrest up to 12 hours, check distal pulses every 30 minutes, do not bend leg, do not raise HOB more than 45*, monitor v/s and dsg frequently)

Series of x-rays using IV contrast taken from different angles to create a 3-D picture. Used for renal cysts, tumors, areas of nonperfusion, renal fractures or lacerations following renal trauma. (monitor I&O same prep as IVP)

Nuclear scan in which radioactive substance injected into the bloodstream is detected by a special camera similar to an x-ray machine. Isotope injected IV. Used for renovascular HTN, kidney function, renal blood flow, GFR, tubular function, excretion of urine, kidney size and shape, abcesses, cysts, tumors, dissecting aneurysm, and other disorders affecting bloodflow to the kidneys.

Lab analysis of renal tissue. Percutaneous: local anesthetic needle though skin. Open: surgical incision. Ct scan done first to locate kidney. Microscopic exam of kidney tissue for diagnosis or treatment of a renal disorder.

Minor surgical procedure with lighted fiber optic cytoscope. Used to inspect thr inside of thr bladder, collect urine specimen from either kidney, take x-ray or biopsy growths. Therapeutic: to remove small bladder tumors, stones from bladder/ureters, dilation of ureters. Used to find calculi, infection, vesicoureteral reflux, enlarged prostate, bladder tumors, urethral strictures, polyps and congenital abnormalities. (surgical prep; measure urine to detect retention from swelling or urinary meatus; encourage fluids; expect dysuria and blood tinged urine for 24 hours post.

X-ray of thr bladder and lower urinary tract with contrast media or radioisotope instilled into bladder via catheter or cytoscope to evakuate bladder filling and emptying. Used for incomplete bladder emptying, distention, reflux, obstruction to urine outflow. No prep urine may be pink for 1-2 days Bright red urine fever or persistant discomfort should be reported to MD

Burning, pain on urination

Involuntary loss of 50mL of urine associated with increased abdominal pressure during coughing, sneezing, laughing or other physical activities.

Involuntary loss of urine associated with an abrupt and strong desire to void. "unable to make it to the bathroom"

Involuntary leakage of urine and is very common.

Inability to reach the toilet because of ebvironmental barriers, physical limitations, loss of memory, or disorientation.

Involuntary loss if urine associated with overdistention of the bladder Occurs with acute or chronic urinary distension with dribbling of urine. (Can be caused by a spinal cord injury or enlarged prostate)

Continous and unpredictable loss of urine. (usually a result from surgery, trauma, or malformation of the ureter) bladder training had be tried and ineffective. Usualoy these patients are neurologically impaired.

Strengthen the pubococcygeal muscle. Can help prevent uterus prolapse, enhanse sensation during sex, and hasten postpartum healing. May also be used by the older male patient to control dribbling.

Acute retention is a medical emergency and can lead to bladder rupture or acute renal failure. Chronic may be related to an enlarged prostate, diabetes, pregnancy, a medication effect, strictures, or other causes of obstruction of the urinary tract. Bladder scan will determine risidual volumr after void. <50mL is normal 150-200mL needs treatment for urine retention.

Reasons: shock, heart failure, or urinary obstruction.

For the pt who is unable to void. May teach a patient how to self cath. (at home can use clean technique and use same cath multiple times if cleaned in between)

Inserted through the skin, needs a clean dry dressing and keep cath taped to prevent tension.

Can indicate kidney disease; shock; severe heart failure; dehydration; high protein diet; GI bleeding or steroid use.

Higher level= higher impairment in kidney function.

Usually 10:1. Elevated ratio occurs in hypovolemia. Normal ratio with elevated BUN and creatinine occurs in intrinsic renal disease.

Can be caused by kidney disease, gout, malnutrition, leukemia, use of thiazide diuretics (because of impaired uric acid clearance by the kidneys)

• Remains within normal range until the late stage of renal disease.
• Decreases with fluid retention.

• One of the first electrolyes to become abnormal with renal disease.
• Level greater than 6mEq/L can lead to muscle weakness and arrythmias.

• Inversely related to calcium balance.
• Elevated in renal disease.

Most patients with renal disease have metabolic acidosis and low serum HCO3 levels.

• Elevated in chronic renal disease.
• Symptoms of elevated mag levels include lethargy, N/V, and slurred speech.

Low level occurs in neohrotix syndrome and renal disease and leads to edema.