Renal Flashcards

Condition caused by Renal calculi (kidney stones) that form in the urinary tract; they are made of substances that the kidney can normally excrete

20-40

• Supersaturation of urine with stone-forming substances
• Dehydration: concentrated blood is prone to developing stones
• Immobility: when immobile, more prone to dehydration
• Meds: antacids, vitamin D, laxatives, high doses of aspirin
• Hyperparathyroidism and multiple myeloma
• High purine diet or poor metabolism of purine (as in gout)

• Severe colicky flank pain; pain resolves as soon as the stone has passed
• Urinary urgency and frequency with blood urine
• N/V/diarrhea, abdominal discomfort
• Fever and chills

• Physical exam: flank tenderness
• Urinalysis: hematuria and pus
• Ultrasound and x-rays of kidney and upper bladder (KUB): detects some types of stones
• IV urography: uses radiopaque dye: detects stone location and size and if there is any obstruction
• CT: used to detect stone in ureter

• Small stones can be treated with fluids and pain relief; those with severe pain, vomiting, fever should be hospitalized
• Hydrations: oral or IV: dilutes urine and facilitates stone passage
• Pain meds: NSAIDs or opioids
• Lithotripsy: ultrasound waves break up the stone

An infection of the urinary bladder; also known as a lower urinary tract infection (UTI); caused usually by E. coli

An infection of the urethra

• Microorganisms: usually E. coli
• Pregnancy: can cause incomplete emptying of the bladder; hormonal influence and changes in pH can alter normal flora
• Obstruction anywhere in urinary tract
• Impairment of the immune system
• Stasis of urine related to reflux
• Diabetes

• Pain and burning on urination: due to urethra and bladder inflammation Frequency, urgency, nocturia, incontinence: ureter and bladder spasm
• Suprapublic or pelvic pain: inflammation due to infection
• Fever: infection
• Bladder spasms: inflammation of the bladder

• Urinalysis: shows pus (WBCs), bacteria with or without blood
• Urine dipstick: +nitrates indicates infection
• Urine C/S: determine causative organism to guide treatment
• CT: detects source of any obstruction
• Bladder cystoscopy: provides more information when cystitis does not improve with treatment

• ABT: type and dosage depend on causative organisms: common ones are Cipro, Macrodantin, sulfa such as Bactrim or Septra
• Urinary analgesics: relieve burning, urgency, frequency: Pyridium
• Fluids: dilute the urine: increasing water decreases the concentration of bacteria in the urine
• cranberry juice: acidifies the urine

Bacterial infection of one or both kidneys

• Infection of the bladder; UTI
• Repeated catheterizations
• Structural abnormalities: causes an obstruction to the flow of urine
• Reflux of urine from the bladder into the ureters
• Trauma: if system is damaged, urine is not excreted, causing stasis of urine and growth of bacteria
• Pregnancy: enlarged uterus puts pressure on the ureters

• Chills, fever: sign of infection
• N/V/ anorexia
• Dysuria, frequency, urgency
• Pyuria: bacterial growth causes formation of pus
• CVA tenderness: infection of the kidneys causes tenderness (flank pain)

• CBC: shows elevated WBC count
• Urinalysis: pus (leukocytes) in urine, bacteria, and blood
• Urine culture: identifies causative microorganism
• Ultrasound: for complicated pyelonephritis that does not respond to treatment after 72 hours as the most likely cause is obstruction

• ABT
• Antipyretics
• Urinary analgesics
• Surgery: for structural abnormality
• Increase fluids

• An acute inflammation of the glomerulus that can lead to chronic disease
• The glomeruli capillaries become inflamed and impair the kidney’s ability to filter urine

• Streptococcal infection (post-streptococcal glomerulonephritis): this usually occurs 7-12 days after the initial infection
• Viruses and parasites: antigen-antibody mediated

• Asymptomatic: latent symptoms
• Hematuria, proteinuria (proteinuria may continue for months)
• Edema in the hands and face: when the glomerulus is damaged and inflamed, the GFR decreases so sodium and water are retained
• Elevated BP and weight gain
• Dark urine that contains blood (described as smoky, or coffee-colored)

• Serum protein and albumin: decreased Urinalysis: positive for blood, protein, white blood cells
• 24 hour urine for creatinine clearance and total protein
• GFR: decreased due to inflammation
• Antistreptolysin-O titer: elevated in presence of glomerular damage due to strep

• Dietary protein should be limited
• Low-sodium diet
• Monitor fluid intake: due to edema and fluid retention
• Treat strep with ABT
• Bed rest
• Chronic glomerulonephritis: dialysis or kidney transplant

Produces inflammation of the glomerulus just as in glomerulonephritis but the damage is more severe with severe loss of protein, which causes hypoalbuminemia

• Diabetes, mostly diabetic nephropathy: Microalbuminuria occurs in the early stages of kidney disease with progression to end-stage renal disease
• Viral infections
• Drugs: some drugs are toxic to the kidneys: NSAIDs, aminoglycosides, amphotericin B, lithium, IV contrast dye
• Immune mediated response (allergic reaction) to insect bites such as pollens, poison ivy and poison oak

• Edema, periorbital edema, ascites, weight gain: fluid from the vascular space leaks into the tissue as there is no protein or albumin to hold on to the fluid
• Muscle atrophy and/or wasting
• Ascites
• Dyspnea: pulmonary edema
• Oliguria, anuria: severe decline in renal function leads to inability to excrete urine
• Anemia: when kidneys are not well, erythropoietin production is compromised

• Creatinine clearance: decreased
• Blood tests: low level of serum albumin, decreased total protein, decreased Hgb & HCT
• Increased lipid levels include high triglycerides and LDL
• Renal ultrasound

• Proteinuria
• Hypoalbuminemia
• Hyperlipidemia

• ACE inhibitors: decrease proteinuria and lipid levels; can increase serum potassium in those who have renal disease
• Low-sodium diet
• Diuretics: help decrease fluid accumulation, but may increase risk for blood clots (cause hemoconcentration of blood)

Occurs over days to weeks and decreases the kidneys’ ability to filter metabolic waste products from the blood.

A decrease in the kidneys’ ability to filter waste products from the blood that occurs over months to years.

• Prerenal
• Intrarenal
• Postrenal

Results from decreased blood flow to the kidney; hypovolemia due to hemorrhage, dehydration, excessive fluid loss due to burns, heart failure, anaphylactic shock

Damage to the inside of the kidney; acute tubular necrosis (ATN) due to prolonged renal ischemia, nephrotoxic drugs, pyelonephritis, acute glomerulonephritis

Urine is not able to leave the kidney; bilateral uretral obstruction; bladder outlet obstruction

• Develops when filtration rate is less than 20% to 25% of normal
• Caused by anything causing hypotension, decreased heart rate, MI, shock, sepsis
• Infection
• Dehydration
• Meds: ABT, ACE inhibitors, NSAIDs
• Rhabdomyolysis
• Obstruction

• Diabetes
• hypertension
• infections
• medications
• toxic agents
• SLE
• environmental agents such as lead, cadmium, mercury
• May also be idiopathic

• Edema of feet, ankles, hands, face and cola-colored urine
• Fatigue, irritability, pruritis, unpleasant taste in the mouth
• SOB
• hypertension
• weight gain: fluid volume build-up
• BUN: increased
• Hgb/Hct are decreased: erythropoietin production is decreased
• Creatinine clearance is decreased: Poor GFR

• Mental status changes, confusion, encephalopathy, seizures: increased waste products in the blood cause changes in the brain
• Bruising/bleeding: toxins damage blood vessels
• Neuropathy, muscle twitching, cramps
• Yellow-brown skin, uremic crystals on the skin, pruritis: wastes are excreted through the skin since they aren’t excreted in the urine
• Uremic fetor: fishy odor of the breath