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3rd Quarter : 5

GU

QuestionAnswer
What is a normal GFR? >60
What type of organs are the kidneys? Retroperitoneal organs.
What is on the outside of the kidneys? Several layers of fat & connective tissue.
What is the renal capsule? The outside of the kidney.
How much urine is produced per day? 1 - 1.5 L
What is the bare minimum urine output? 30 mL/hour
What are the kidneys dependent upon? Adequate cardiac output.
Where do the kidneys lay? The costovertebral angle.
What is normal cardiac output? 5 - 6 L
How much blood do the kidneys receive each hour? 1.2 L
What hormonal activities do the kidneys play a role in? Ertythropoietin, aldosterone, renin.
What is creatinine a normal waste product of? Muscle metabolism.
What is reabsorbed in acidosis? HCO3-
What is reabsorbed in alkalosis? H+
Where does the final activation of Vitamin D occur? In the kidneys.
Why is Vitamin D important? It is necessary for Ca++ absorption.
Name some things that the kidneys regulate. Fluid balance. Electrolyte balance. Acid-base balance.
What is the functional unit of the kidney called? The nephron.
Name two types of nephrons. Cortical. Juxtamedullary.
How many nephrons are in each kidney. 1.2 million
Where do the Cortical nephrons originate? Superficial part of cortex.
Where do the Juxtamedullary nephrons originate? Deeper in cortex.
How far do the loops of Henle penetrate the medulla in Cortical nephrons? 85%
Describe the loop of Henle in a cortical nephron. Short and thick.
How far do the loops of Henle penetrate the medulla in a Juxtamedullary nephron? The entire length of the medulla.
Describe the loop of Henle in a juxtamedullary nephron. Long and thin.
Which of the two types of nephrons is largely concerned with urine concentration? The Juxtamedullary.
Which nephron is most active at night? The Juxtamedullary.
Which type of nephron is more common? The cortical nephron, making up 80 - 85% of nephrons.
What are the two major components of the nephron? The vascular system and the tubular system.
How does blood enter the kidneys? Via the renal artery.
Where does blood flow to from the Afferent arteriole? Into the glomerulus.
Where does blood exit the glomerulus? The Efferent arteriole.
What are the kidney's regulatory mechanisms? Glomerular filtration. Tubular Reabsorption. Tubular Secretion.
How are the kidney's regulatory mechanisms accomplished? Via diffusion, active transport, osmosis, and filtration.
Diffusion Passive. From high concentration to low concentration.
Active transport requires what? Energy
Active transport Carrier molecule. From low concentration to high concentration.
Osmosis Across semi-permeable membrane. Water moves to area of high solutes.
Filtration From high to low.
Pressure in the glomerulus is... 2 - 3 x higher than any other capillary system.
What is the initial process in the formation of urine? Glomerular filtration.
Where do water, electrolytes, and solutes go once they are filtered across the glomerular membrane? Into the Bowman's capsule.
How many capillaries are in a glomerulus? 4 - 8
What are the 3 layers of the the glomerulus? Endothelium (inner), basement membrane (middle), and epitheleal layer (outer).
Which layer of the glomerulus is associated with Albumin? The basement membrane.
What type of charge does Albumin carry? A negative charge.
What 3 pressure systems are involved with glomerular filtration? Hydrostatic pressure, colloid osmotic pressure, and hydrostatic fluid pressure.
What causes the hydrostatic pressure? Blood flowing through the glomerulus.
What causes the hydrostatic fluid pressure? The presence of fluid in the Bowman's capsule.
What two forces oppose glomerular filtration? Plasma oncotic/colloidal pressure of the glomerulus & the pressure of filtrate in the Bowman's capsule.
What pressure must exceed the sum of 2 opposing pressures in order for filtrate to be formed? Hydrostatic pressure.
How is glomerular filtrate formed? Filtration of water and small solutes thru the filtration membrane.
During periods of severe blood loss, which nervous system overrides renal autoregulatory mechanisms to shunt blood to other critical areas? The Sympathetic system.
What is needed to push water and solutes through all three layers, to form filtrate? Positive hydrostatic pressure.
What are some common components of glomerular filtrate? Glucose, amino acids, nitrogenous waste, urea, uric acid, creatinine, ions, sodium, potassium, chloride, water.
The concentration of substances in filtrate is similar to its concentration where? Plasma
How much filtrate is reabsorbed? 99%
Where are the majority of water and solutes reabsorbed? Proximal convoluted tubule.
What part of the loop of henle is highly permeable to water? The thin descending loop.
What part of the loop of henle is almost impermeable to water? The thin ascending loop.
What part of the loop of henle is relatively impermeable to water? The thick ascending loop.
What is the distal convoluted tubule's affinity for water? It is relatively impermeable to water.
What hormones does the distal convoluted tubule react to? ADH & Aldosterone.
Where is filtrate concentrated? Descending loop of Henle.
Where is filtrate diluted? Ascending loop of Henle.
The method in which substances move from the plasma into the tubular filtrate is called what? Tubular secretion.
What 2 principle effects does tubular secretion have? Helps control pH & rids body of certain substances.
What substances are secreted? K+, H+, ammonium ions, creatinine, urea, some hormones, some drugs (penicillin).
How are K+ levels regulated? Not much is reabsorbed, it is secreted.
What happens to excess H+? Secreted by kidneys.
What process contributes to regeneration of HCO3-? Tubular secretion.
What is counter transport? The movement of a substance in one direction allows the movement of another substance in the opposite direction.
Late filtrate processing includes? Reabsorption & secretion.
Aldosterone and ADH directly control the processing of what? Na+, K+, H20 & urea.
What two hormones effect the composition of urine? Aldosterone & ADH.
What action does ADH take on the DCT? Increases it's permeability to water, enhancing reabsorption.
Where is ADH formed? In the hypothalamus.
Where is ADH stored? In the posterior pituitary.
Where is Aldosterone formed? In the adrenal cortex.
Where is Aldosterone secreted? The adrenal glands.
What action does Aldosterone take on membrane permeability? It increases the permeability.
If Na+ is reabsorbed in the DCT what happens to water? It follows the Na+.
What do prostaglandins facilitate in the GU system? The regulation of glomerular filtration, vascular resistance, and renin production.
What do the prostaglandins act on? The DCT and collecting tubule.
What do prostaglandins do in the DCT and collecting tubule? Inhibit ADH, decrease permeability, promote sodium and water excretion.
Where is renin formed and released? The kidney
What causes the release of renin from the kidneys? Decrease in blood flow, decrease in blood volume, decrease in blood pressure, decrease in Na+.
What does the release of renin stimulate? RAAS
What system auto regulates BP within the nephron as well as systemically? RAAS
What connects the renal pelvis to the urinary bladder? Ureter
Where is the urinary bladder located? Behind the pubis symphysis.
What functions does the bladder have? Store urine and enable voiding.
Micturition Voiding
Voiding is under control of the ______ nervous system. Parasympathetic
Secretions of the bladder lining resist what? Bacteria
The bladder senses that is getting full when it holds how much urine? 250 - 400 mL.
Continence is controlled by the ______ nervous system. Sympathetic
How long is the urethra in a man? 6 - 8 inches
How long is the urethra in a woman? 1 - 1.5 inches
The passage of urine through the urethra promotes what? The removal of bacteria.
What happens to kidneys as we age? They shrink and function declines.
What causes damage to the glomerulus as we age? HTN and collagen deposits.
When is the ideal time to collect urine for urinalysis? First thing in the morning.
Why is first morning urine best for urinalysis? It is most concentrated.
pH of urine 5.5 - 6 normally
Urinalysis components Creatinine, urea, sediment, casts, bacteria, WBCs, glucose, protein, blood, color/clarity, odor, volume, specific gravity.
Casts (urinalysis) None - occasional.
Bacteria (urinalysis) None
WBCs (urinalysis) None - Very few
Glucose (urinalysis) None - <15 mg/dL
Ketones (urinalysis) None
Protein (urinalysis) None - no> 2 - 8 mg/dL
Hgb in urine is usually r/t conditions where? Outside the urinary tract.
Hematuria Intact RBCs in urine.
Specific Gravity of urine. 1.010 - 1.025
BUN 10.0 - 20.0 mg/dL
Blood urea nitrogen is excreted entirely by? The kidneys
Increased BUN d/t Dehydration, GIB, increased protein intake.
Creatinine 0.5 - 1.2
Creatinine excreted entirely by? The kidneys
Formation & release of creatinine into the blood is directly proportional to what? Muscle mass
Which test is more specific to kidneys? Creatinine. Increased level = decrease function.
What do BUN and creatinine measure? The ability of the kidneys to eliminate metabolic waste products.
Sodium 136 - 145
Chloride 98 - 106
Potassium 3.5 - 5
Carbon Dioxide 23 - 30
Calcium 9.0 - 10.5
Where is calcium excreted? Mostly in stool, small quantities in urine.
Uric acid is formed from the breakdown of? Nucleic Acids such as purine.
How much uric acid is excreted in the urine? 75%
pH 7.35 - 7.45
Kidneys regulate reabsorption of HCO3- and rid the body of excess what? H+
GFR/min 125 mL
What test is performed if UA shows bacteria present? C & S (culture and sensitivity)
24 hour urine collection is used to calculate what? The clearance of a particular substance, such as creatinine or protein.
GFR indicates what? The amount of blood filtered by the glomerulus.
What is used to gauge overall renal function? GFR
Cytoscopy, ureteroscopy, ureteroenocopy, nephroscopy. Direct visualization of urethra, bladder, ureters & renal pelvis.
Which diagnostic test is easiest to tolerate? US
Extracorporeal ultrasonic sound wave lithotripsy (ESWL), Percutaneous US lithotripsy. Application of sound waves per cytoscopy or nephrostomy
Renal angiogram/arteriogram Used to assess renal blood flow to the kidneys.
Intravenous pyelography/pyelogram (IVP) or Excretory urography IV dye used to visualize and show outline of kidneys, renal pelvis, ureters & bladder.
Nephrolithotomy Incision into renal calyx
Pyelolithotomy Incision into renal pelvis.
Cystitis Lower Urinary Tract infection (bladder).
Pyelonephritis Upper urinary tract infection (renal pelvis).
What is the second most common type of bacterial infection? UTI
What maintains the sterility of the bladder/urine? Physical barrier of the urethra. Urine flow. Mucin lining the bladder.
Where do bacteria that cause UTI come from? Vagina, urethra, perineal area.
Urethrovesical reflux Urine moves up from the urethra to the bladder.
Activities that increase intra-abdominal pressure cause this type of reflux. Urethrovesical
Vesicoureteral reflux Urine moves up from the bladder into the ureters.
Vesicoureteral reflux see in: Children with UTIs. Congenital defects. Adults with obstruction to bladder outflow.
Narcotics and general anesthesia cause what to urine outflow? Retention
Contributing UTI factors Advancing age, catheter, female, pregnancy, hormones, sexual activity, urethritis.
What effect does progesterone have on GU system? Decreased peristalsis of ureters.
Prevention of UTI Long urethra, good hygiene, washout, peristalsis of ureters.
Cystitis manifestations Frequency & urgency, lower abdominal discomfort, burning & pain on urination, F and malaise.
Cystitis causes E. Coli, Klebsiella, enterobacter, proteus. Herpes simplex. Candidasis. Trichomonas vaginalis.
Cystitis prevention VOID AS SOON AS FEEL URGE. Increase fluid intake (2 - 4L)/chronic 4 - 5L.
Cystitis treatment Nitrofurantoin (Macrodantin), Trimethoprim-Sulfamethoxazole (TMP), Bactrim, Septra, Augmentin (Amoxicillin + Clavulanate), Ceftin, Keflex, Flagyl PO, Phenazopyridine (Pyridium).
Nitrofurantoin (Macrodantin) Urinary tract antiseptic. Prophylaxis. Give with food. Can change color of urine.
Trimethoprim-Sulfamethoxazole(TMP) Bactrim or Septra Broad spectrum antimicrobial. Inhibit folate production. Excreted entirely by kidneys, need adequate hydration.
Augmentin (Amoxicillin + Clavulanate) Broad spectrum antibiotics. Weakens cell wall. Prevent amoxicillin destruction.
Ceftin & Keflex (Cephalasporins) Used if allergic/sensitive to PCN or sulfa
Flagyl PO Treats trichomoniasis
Phenazopyridine (Pyridium) Treats symptoms of UTI. Relaxes bladder. Analgesic. Orange urine.
What color may urine be if taking Nitrofurantoin (Macrodantin)? Orange/brown.
Pyelonephritis Infection within kidney and renal pelvis.
Acute pyelonephritis infections occur how? Via bloodstream or ascending from bladder.
What is the main cause of acute pyelonephritis? Vesicoureteral reflux
Symptoms of acute pyelonephritis Chills, F, back pain/flank pain, dysuria, frequency, urgency. Pyuria.
Tests for acute pyelonephritis Immunofluorescence test, KUB, Urine C&S
Chronic pyelonephritis is the result of what? Infection in addition to obstruction.
Symptoms of chronic pyelonephritis All the same as acute plus polyuria & nocturia. Proteinuria.
Oliguria <400 mL/day
Tests for chronic pyelonephritis: Urine C & S, KUB, Intravenous pyelography (IVP) or excretory urography.
Hydroureter Dilated ureter
Hydronephrosis Renal pelvis swells.
Treatment for acute pyelonephritis Increase fluids. Trimethoprim & Sulfa-methoxazole (Bactrim/Septra). Ciproflaxin/Cipro (quinolone/fluoroquinolone). Pyridium, MS, dilaudid.
You should avoid MOM, amphogel, sucralfate & milk when taking what? Ciprolaxin/Cipro (quinolone/fluoroquinolone)
Treatment for chronic pyelonephritis Treat HTN. Supportive treatment.
Which type of pyelonephritis tends to be more painful? Acute
Systemic manifestations of UTI F, n/v, confusion
Contributing factors for renal calculi. High concentrations of certain substances, pH of urine, urinary stasis, urine concentration.
What substances contribute to renal calculi? Calcium, oxalate, uric acid, and (rarely) cystine.
Magnesium & citrate do what? Help to inhibit stone formation.
80 - 90% of stones are composed of? Calcium
Excess Ca++ from: Vitamin D, Calcium supplements, inactivity, hyperparathyroidism, breast, lung & prostate cancer.
What is the most common metastatic site? Bone
Types of stones: Calcium, Uric acid, struvite, cystine.
Uric acid stones form more readily in: acidic urine, high protein diet.
Purines breakdown to: Form uric acid
Stones from struvite are almost always present with what? Infection
What causes struvite stones? Bacteria splitting apart urea to form ammonia, which then combines with Magnesium and Phosphate.
Struvite stones form more readily in: Alkaline urine.
What stones are characteristically large with a stag-horn shape? Struvite stones.
Gout causes an increase in what? Uric acid.
What causes cystine crystals? Genetic abnormality. Kidneys excrete excess amounts of cystine.
Stone manifestations Intense colicky flank pain. Increased BP & HR, anxiety, pallor, hematuria. May see: N/V, urgency, frequency, anuria. Hydroureter, hydronephrosis.
Hydroureter & hydronephrosis are manifestations of what? Stones
Most common diagnostic tool for stones. Cytoscopy, ureteroscopy, ureterorenoscopy, nephroscopy.
Pain management of stones IV narcotics, NSAID, then PO if tolerated.
Fluids in treatment of stones 3 - 5 L/day
Probanthine or Ditropan Antispasmodics that relax smooth muscles in urinary tract by inhibiting acetylcholine.
Treatment for uric acid stones Allopurinol to reduce urid acid level. Potassium salts to increase urine pH.
Potassium or sodium citrate are used to treat? Stones (drink lemonade)
Treatment of calcium stones Thiazide diuretic to promote Ca++ reabsorption.
If pain is controlled and there is no infection, how long should you wait to see if a stone will pass on it's own? 48 hours
Cytoscopy or ureteroscopy are used for? Mid-low ureteral, bladder, or urethral stones.
Nephrolithotomy or pyelolithotomy are used for? Stones in kidney or upper ureter, larger staghorn stones.
Stone prevention Increase fluids.
Calcium oxalate stone prevention: Avoid dark leafy green veggies, pecans, chocolate.
Calcium phosphate stone prevention: Decrease dietary calcium
Uric acid stone prevention: Reduce purine foods: organ meats, boned fish, fried fatty foods, red wine.
Struvite stone prevention: Limit dairy products, red meats (foods high in phospate)
Cystine stone prevention: Avoid citrus fruits, milk products
Medication to prevent Ca++ stones: Thiazide diuretic to promote Ca++ reabsorption
Medication to prevent uric acid stones: Allopurinol & potassium salts.
Allopurinol Reduces uric acid levels.
Potassium salts Make urine more alkaline.
Medications for struvite stones: Antibiotics, long term, small dose.
Bladder cancer is highest among? White men > 50
Environmental risk factors for bladder cancer. Cigarette smoking, previous chemotherapy, chronic UTI.
What is the #1 risk factor for bladder cancer? Cigarette smoking
Initial presentation of bladder cancer? Painless hematuria
What procedure will need to be drained several times a day? Kock pouch
80 - 90% of kidney cancer is this type. Adenocarcinoma
Where does the adenocarcinoma type of kidney cancer begin? The renal cortex.
The remainder of kidney cancers are this type: Squamous or transitional of the renal pelvis.
Kidney cancer accounts for ____ % of all cancers. 2%
Possible causes of kidney cancer. Chronic irritation d/t stones & smoking. Exposure to lead & cadmium. Obesity. Genetics.
Kidney cancer initially presents with: Painless, renal enlargement.
Excess secretion of renin & erythropoeitin are common with? Kidney cancer
Kidney cancer metastasizes to: lungs, mediastinum, lymphatics & bone.
Metastasis is often present at the time of diagnosis of this type of cancer: Kidney
Symptoms of kidney cancer Hematuria, flank pain, palpable mass.
Glomerulonephritis Immunological response. Antigen-antibody complexes form, circulate, and get deposited in glomeruli structures.
Acute glomerulonephritis is frequently preceded by? Strep throat
Symptoms of acute glomerulonephritis Oliguria, COLA urine, edema (hands & face), HTN, proteinuria & hematuria.
Diuril (hydrochlorothiazide) treat acute glomerulonephritis
If a patient does not have resolution of acute glomerulonephritis within 2 years, what will happen? The patient will never have resolution.
Rapidly progressive glomerulonephritis is characterized by: Severe glomerular injury.
A 50% decrease in GFR can be seen when in rapidly progressve glomerulonephritis? Within 3 months
Rapidly progressive glomerulonephritis may result from: Diabetes, systemic lupus, Goodpasture's syndrome.
The inflammatory process does what to bowman's capsule in rapidly progressive glomerulonephritis? Obliterates it.
Scarring, sclerosis, & tubular atrophy of the glomerulus are seen in: Rapidly progressive glomerulonephritis.
What symptom is unique to Rapidly progressive glomerulonephritis? WBC casts
What treatments are used for Rapidly progressive glomerulonephritis? Diuretics, anti-hypertensives, immunosuppressants, plasmapheresis.
Chronic glomerulonephritis leads to renal deterioration over: 20 - 30 years
Chronic glomerulonephritis is often seen in patients who survive? Rapidly progressive glomerulonephritis
Sclerosed glomeruli, atrophied kidney tissue, eventual failure characterize this: Chronic glomerulonephritis
Initial symptom of chronic glomerulonephritis Very dilute urine
Oliguria progresses to anuria in: Chronic glomerulonephritis
Treatment of chronic glomerulonephritis Restrict protein, K+ & fluid
What type of disorder is more common in nephrotic syndrome? Secondary
Nephrotic syndrome (secondary) Autoimmune disease. Often from RPGN or CGN.
Nephrotic syndrome characterizations Massive Proteinuria. Hypoalbuminia. Edema, hyperlipidema, increased coagulation, infection.
Symptoms of nephrotic syndrome HTN, CHF, DVT, PE, Anasarca
Treatment of nephrotic syndrome Prevent thrombosis. Increase protein intake. Volume expanders: albumin & dextran. Diuretics to treat edema.
Diuretics for nephrotic syndrome Lasix or Furosemide, Spironolactone or Aldactone, Mannitol or Osmitrol
Lasix or Furosemide Loop diuretic. PO & IV, works fast. Ototoxicity, hyperglycemia, hyperuricemia.
Spironolcatone or Aldactone Aldosterone antagonist, K+ sparing. PO.
Mannitol or Osmitrol Increase osmotic P. Poorly metabolized sugar. Promotes rapid diureses in 30-60 min. IV
Do not eat what with diuretics? Black licorice
Black licorice causes: Salt retention & excess K+ loss
Most diuretics promote the excretion of: Na+
The excretion of Na+ can result in the loss of: K+
What is the prostate gland? A gland of the male reproductive system.
Where is the prostate located? Base of the bladder & above external urethral sphincter.
What is the prostatic urethra? Portion of the urethra surrounded by the prostate.
What is the prostate made of? 30% muscle tissue and the rest glandular tissue.
What is the main function of the prostate? To produce prostatic fluid for semen.
BPH symptoms Urgency & frequency, difficutly initiating urination, urinary retention, recurrent UTI.
Early detection is key to: BPH
BPH drugs Flomax, Hytrin, Cardura, Proscar.
Flomax, Hytrin, Cardura Alpha adrenegic receptor antagonists
Common after TURP Bleeding
What is the most common cancer among american men? Prostate cancer
Prostate cancer is _____ growing. Slow
Risk factors for prostate cancer: Family Hx, African-American men, high fat diet, environmental exposure to carcinogens (cadmium), low serum Vit D
Does metastasis of prostate cancer occur in a fairly predictable pattern? Yes
What is the most common presenting symptom of prostate cancer? Gross painless hematuria
Men should have rectal exams when? Annually after 40
PSA test for: Men >50
Estrogen may be given to men to counter the testosterone in this form of cancer: Prostate cancer
Polyuria can be described as: Voiding excess amounts of urine.
Dilution or concentration of urine is largely determined by: ADH
A patient being discharged after urolithiasis should drink how much water a day? 3 - 5 L
Do you include a first morning urine to start a 24 hour urine collection? No
Coffee colored urine, fatigue, n/v, anorexia may indicate: Acute glomerulonephritis
A client with nephrotic syndrome is being admitted to the unit. The nurse includes which of the following in planning the care for this client? Interventions for client with generalized edema.
Bladder cancer etiologies: Smoking, insulation installation.
The bacterial infiltration to the renal pelvis that causes inflammatory changes, F, flank pain and foul urine is: Pyelonephritis
24 hour creatinine clearance measures what? GFR
Why would you have a rectal exam and your PSA done on different days? Rectal exam causes elevation of PSA levels. 24 hours must pass after a rectal exam prior to drawing blood for PSA
BUN levels are increased with: Dehydration
What position should you place a patient who has recieved dyes and is flushing in? Trendelenburg
If a patient is allergic to iodinated dyes, what precautions need to be taken when giving them? Give a diphenhydramine-prednisone preparation.
Bactericidal Kills bacteria
Bacteriostatic Inhibits growth/reproduction of bacteria
What type of ring do penicillin antibiotics have? Beta lactam ring
Penicillins act to? Weaken the cell wall.
Where are metabolites of Penicillin excreted? The kidneys
Where is penicillin metabolized? The liver.
Which medication is a major culprit of C-Diff? Cephalasporins
What do sulfonamides prevent bacteria from doing? Producing folate needed to produce & replicate their DNA & RNA.
What are sulfonamides primarily used for? Treating UTI
When taking sulfonamides a patient needs to be: Well hydrated
What do quinolones do? Prevent gyrase from working.
Are quinolones bactericidal or bacteriostatic? Bactericidal
Which medications are especially useful in treating upper UTI and recurrent UTI? Quinolones
When taking this medication patients should avoid aluminum or magnesium containing antacids? Quinolones
Why should you avoid aluminum or magnesium antacids when taking quinolones? Interferes with absorption.
What can quinolones do to coumadin? Increase it's effect.
When taking macrodantan your urine may turn this color: dark orange or brownish
Macrodantan should be administerd on a(n) _____ stomach. A full stomach
Which medication may damage the myelin sheath of nerve cells? Macrodantan
Diuretics work by: Promoting excretion of Na+ and Cl- by preventing their reabsorption.
Ototoxicity should be monitored when administering? High ceiling loop diuretics (Lasix)
Which type of diuretic may decreatse the excretion of Lithium? High ceiling loop diuretics
What portion of the tubule is effected by Potassium sparing diuretics? The distal convoluted tubule.
Created by: NataschAnn
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