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Unit 7 - Test 3

Kidney Function

What are the 6 function of the kidney? FAM BAM Filter Blood Acid-Base Balance Make Erythropoietin Blood Pressure Activate Vitamin D Make and release Renin
What are 3 protein by products that are excreted by the kidneys? creatinine, urea, ammonia
How do the kidneys help with the acid-base balance of our bodies? Through the absorption and secretion of hydrogen and bicarbonate.
Activated ___________ allows the GI tract to absorb more Calcium. Vitamin D
What is the Normal range for Blood urea nitrogen (BUN) Less than 20
What is the most important catabolic pathway for eliminating excess Nitrogen? Creation of Blood Urea Nitrogen (BUN)
Protein metabolism releases ammonia that is synthesized into ______ in the liver urea
BUN is an indicator of Kidney damage but BUN levels are also effect by _________. As a result it only indicated kidney damage if _________ levels are also elevated. Dehydration, Creatinine
__________ is a waste product of the normal breakdown of muscle tissue. Creatinine
If creatinine levels are high in the blood it means it is not being what? Excreted by the kidneys
elevated creatinine + elevated BUN levels indicate __________ Kidney damage
Normal range for GFR 125mL/min (85-135 mL/min)
______ is a measure of how much blood gets filtered through the kidney every minute. GFR
What is more reliable when it comes to detecting kidney disease? GFR test or Creatinine/BUN test? GFR
GFR is affected by anything that would decrease the amount of blood flowing through the kidneys. What are some condition that could effect the GFR? Heart failure, atherosclerosis, hypotension
A ______ can provide a great deal of information about the kidneys. Urinalysis
What is the specific gravity of urine? 1.010 -1.030
___________ measures how dilute or concentrated the urine is. Specific Gravity
If specific gravity is fixed is this a good or a bad thing. Explain. it is bad - if SG is fixed it means the kidneys are no longer functioning. They can no longer concentrate or dilute urine (kidney death)
Could Indicate what if found in urine: Red blood cells kidney stones, infection, bladder inflammation, kidney damage
Could Indicate what if found in urine: White blood cells infection
Could Indicate what if found in urine: Protein kidney damage
Could Indicate what if found in urine: glucose high blood sugar
Could Indicate what if found in urine: Cast or crystals mineral deposits breaking loose and being shed into the urine
Term for protein in the urine proteinuria
Term for glucose in the urine glucosuria
What do you need for a creatinine test. serum creatinine test and a 24hour urine collection
increased BUN and creatinine (in blood) without systemic s/s Azotemia
increased BUN and creatinine with multiple system organ failure uremia
increase urine output Polyuria
In diabetes does polyuria indicate kidney damage? Nope
decreased urine output Oliguria
No urine output Anuria
Anuria indicates ____ Kidney failure
what are the parts of the RAAS. LOW BP-> kidneys release Renin --> renin combines with angiotensinogen (from liver) to make Angiotensin I ---> Angiotensin I goes to the lungs to combine with ACE ---> making Angiotensin II which simulated the Adrenal Cortex to release Aldosterone
Aldosterone signals the kidneys to reabsorb what? What follows? Na+, Water
What does ACE stand for? Angiotensin Converting Enzyme
What is release from the posterior pituitary gland in response to increase osmolality? Vasopressin or Antidiuretic hormone (ADH)
What two hormones work together to lower BP? ANP and BNP
Atrial (ANP) is released by the heart atria. What does it do? Blocks aldosterone secretion and action and inhibits Renin secretion
What is the hormone that is released by the ventricles and is important in diagnosing hear failure. BNP
______________ hormones cause kidneys to secrete sodium. Water follow sodium so this will decrease the overall fluid volume and blood pressure will go down. Natriutetic
What are the 3 types of renal dysfunctions? 1. Prerenal 2. Intrinsic 3. Postrenal
Type of renal dysfunction: server decrease in blood flow to the kidneys. Prerenal
Type of renal dysfunction: Damage to the structures within the kidney. intrinsic
Type of renal dysfunction: Obstruction of urine leaving the kidney postrenal
Kidney stones (renal calculi) are an example of a urinary tract ______ obstruction
Who is at risk for kidney stones? male gender, age 20 to 40 years, living in a desert or tropical area where dehydration is prone, inadequate fluid intake, heavy activity levels, alcohol
When is stone at risk for being an obstruction? >5mm
Pathophysiology of stone formation High urine concentrations of stone forming substances precipitates into a crystal Alkaline urine increases aggregates of calcium phosphate Acid urine promotes crystallization of uric acid Stone growth in pelvis or calyces
is the presence of blood cells in the urine. hematuria
What are the clinical manifestations of kidney stones? renal colic, hematuria, nausea and vomiting, flank pain or pain that spreads to the lower abdomen/groin
Kidney stone are considered a __________ condition Postrenal
UTI can all be referred to as _________ Cystitis
What is the most common UTI bacterial organism. E. Coli
Who is at high risk for UTIs? Females, toddlers, sexually active females, diabetes mellitus, indwelling urinary catheter, prostatic hypertrophy (obstruction to flow)
What are the clinical manifestations of UTI's may have no symptoms frequent urination urgent need to urinate dysuria suprapubic or low back pain Hematuria, WBCs and bacteria in urine Nitrites in urine Cloudy urine
T or F - Senior UTI's are often misdiagnosed with dementia or Alzheimer's. True
A potentially organ- and/or life-threatening infection that often leads to renal scarring. Bacteria usually reach the kidney by ascending from the lower urinary tract but may also reach the kidney via the bloodstream. Pyelonephritis
What is the cause of pyelonephritis? cystitis (UTI’s), urinary tract obstruction with reflux infection with E. coli, proteus, or pseudomonas
Females are 5 time more likely to develop __________ ____________. Acute pyelonephritis
The most common cause of pyelonephritis is the ________ _______ of infected urine from the bladder to the upper urinary tract. backward flow
Bacterial infections may be carried to one or both of the kidneys through the blood stream or lymph glands from an infection that began in the __________. Bladder
A blockage or abnormality of the urinary system( stones, tumors, congenital deformities) or loss of bladder function from nerve disease, increases a person's risk of_______. pyelonephritis
What is the bacterial most likely to cause pyelonephritis? Escherichia coli - cause about 85% of acute bladder infections
What are the clinical manifestations of pyelonephritis? 1. Flank Pain 2. fever/chills 3. Nausea/ vomiting 4. leukocytosis 5. purulent urine
The primary s/s of kidney damage Edema
inflammation of the glomerular membrane Acute glomerulonephritis (GN)
Primary GN is untreated ______ _ __________ infection while _________ is caused by other diseases/conditions. Group A streptococcal, Secondary GN
In glomerulonephritis when immune complexes form there is type _ __________. Type 3 hypersensitivity
Clinical manifestations for glomerulonephritis. 1. Acute Hematuria 2. proteinuria 3. Edema 4. low serum albumin 5. eventually oliguria
What are some other possible causes of glomerular injury? drugs or toxins, systemic diseases, vascular disorders, viral infections
Glomerulonephritis can result in either _____ or _____. Nephritic or Nephrotic syndrome
acute inflammatory process that occludes the glomerular capillary lumen and damages the capillary wall. NephrITIC Sydrome
In its most dramatic form, _________ is characterized by sudden onset of hematuria , variable degrees of proteinuria, diminished glomerular filtration rate (GFR), oliguria, and signs of impaired renal function, acute nephritic syndrome
In acute nephritic syndrome why does extracellular fluid accumulation, edema, and hypertension develop happen? decrease GFR and enhanced tubular reabsorption of salt and water.
not a specific glomerular disease, but a constellation of clinical findings that result from an increase in glomerular permeability and loss of plasma proteins in the urine. Nephrotic syndrome
Excretion of 3.5 gm or more of urinary protein per day Nephrotic syndrome
nephrOtic sydrome = urinary prOtein
In this condition there is no hematuria present and loss of protein in the urine cause low serum albumin levels. Nephrotic syndrome
What are some cause of Nephrotic syndrome. Glomerulonephritis, Genetic defects in the glomerular membrane,Systemic diseases (Diabetes, Lupus, etc.), Drugs, Infections
What S/S would you expect to see if a person has lost protein through their urine as occurs in Nephrotic Syndrome? Answer: EDEMA. When kidneys are malfunctioning, the body retains water and causes full body edema (the Pillsbury Doughboy!). If severe, even the area around the eyes fills with fluid and gets puffy. This is called PERIORBITAL EDEMA
In nephrotic syndrome loss of plasma proteins results in hypoalbuminemia which leads to? decreased oncotic pressure --> full body EDEMA and fluid overload in the lungs/heart/brain.
In nephrotic syndrome there is a loss of what that increases the risk of infections immunoglobins
In nephrotic syndrome the loss of specific transporter protein for Vitamin D3 leads to what decrease Calcium absorption
In nephrotic syndrome what is the increased hepatic synthesis of lipids combined with decreased albumin levels hyperlipidemia
In nephrotic syndrome there can also be a fat in the urine referred to as lipiduria
Damage to the tubule cells of the kidneys, which can then lead to acute kidney failure. acute tubular necrosis (ATN)
Acute tubular necrosis (ATN) is usually caused by _________ but may also occur if the kidney cells are damaged by a poison or harmful substance. lack of oxygen to the kidney tissues (ischemia of the kidneys).
What is the most common cause of acute kidney injury (failure) is hospitalized patients? Acute tubular necrosis
T or F - Acute tubular necrosis is not reversible for most people. False - it is reversible for most people.
What are the risk factors for acute tubular necrosis? hypotention (longer than 30min), septic shock, dye, medications that are toxic to the kidneys, trauma or injury to muscles, blood transfusion reaction, recent major surgery.
s/s of acute tubular necrosis Change in LOC, Oliguria or Anuria, Full body edema, cardiac problems, fixed specific gravity
In acute tubular necrosis there is a change in LOC, confusion and delirium. Why? Hypernatremia and cerebral edema
In acute tubular necrosis why is there oliguria or anuria sever kidney damage
In acute tubular necrosis why is there full body edema? fluid and sodium retention and protein loss thought tubules
In acute tubular necrosis why are there cardiac problems? potassium imbalance (kidneys control secretion of potassium)
In acute tubular necrosis fixed Specific gravity is a sign of what. end stage kidney failure
refers to temporary or permanent damage to the kidneys that result in loss of normal kidney function. Renal failure
in the kidneys this has an abrupt onset and is potentially reversible Acute kidney injury or acute renal failure
In the kidneys this progresses over at least 3 months resulting in permanent renal failure. Chronic renal failure
S/s of acute renal failure Oliguria or Anuria, Anemia s/s (fatigue/short of breath). Nausea & vomiting, Abdominal pain, Edema, Periorbital edema, Pale skin (due to anemia, ⬇ erythropoietin), History of taking certain medications, History of trauma or recent infection
What are the 4 phase of acute kidney injury and what is their duration? 1. onset - hours to days 2. oliguric (anuric) - 8 to 14 days depending on nature of AKI 3. diuretic - 7 to 14 days 4. recovery- Several months to one year
What are some cause of acute kidney injury? prerenal, intrarenal, postrenal associations
Common problems associated with chronic kidney disease, include alterations in fluid and electrolyte balance; list some associated problems disorders of skeletal (related to Vitamin D not available to process Calcium), hematologic (decrease in erythropoietin --> anemia), cardiovascular, immune, neurologic, and integumentary systems.
What are the most common s/s of chronic renal failure? high urine output (diuresis phase) or no urine output (oliguric phase), full body edema, change in metal status, electrolyte imbalances (Sodium loss and potassium retention ) in oliguric phase.
Acute Kidney Injury or Chronic Renal failure: Decrease blood flow to the kidneys for 20 -30 minutes. This may occur from blood loss, surgery, cardiac arrest or shock. Acute kidney injury
Acute Kidney Injury or Chronic Renal failure: obstruction or blockage along the urinary tract (triggers the inflammatory response of the body) or E. Coli infection of the kidney. Acute kidney injury
Acute Kidney Injury or Chronic Renal failure: Glomerulonephritis -the glomeruli become inflamed due to development of large antigen-antibody immune complex molecules which impairs the kidney's ability to filter urine. Acute kidney injury
Acute Kidney Injury or Chronic Renal failure: Nephrotoxic medications cause damage to the kidney that leads to _______. Acute kidney injury
Acute Kidney Injury or Chronic Renal failure: Diabetes: High High blood sugar damages blood vessels throughout the body, especially in the kidneys, which prevents filtration of waste products from the body. Chronic Renal Failure
Acute Kidney Injury or Chronic Renal failure: hypertention - high blood pressure damages the kidney filters which then increases blood pressure even more. Chronic renal failure
Acute Kidney Injury or Chronic Renal failure: Nephrotic syndrome - a condition that has several different causes. Nephrotic syndrome is characterized by protein in the urine, low protein in the blood, high cholesterol levels, and tissue swelling. Chronic renal failure
Acute Kidney Injury or Chronic Renal failure: ________ obstructions can cause urine backflow (hydronephrosis) and increased pressure in the kidney that lead to ____. chronic, CRF - Chronic renal failure
List some treatments for acute and chronic renal failure other than hospitalization, Administration of intravenous (iv) fluids in large volumes (to replace depleted blood volume) and medications to control blood pressure. • Diuretic therapy or medications (to increase urine output) • Close monitoring of important electrolytes (Na+, K+, Ca++) • Specific diet (low protein because kidney cannot flush protein byproduct –urea) • Dialysis
True or false - Treatment for acute renal failure depends on the underlying cause True
True or False - Treatment for chronic renal failure does not depend on the degree of kidney function that remains. False - it does depend on degree of damage
What are the treatments for chronic renal failure? • Medications (to help with growth, prevent bone density loss, and/or to treat anemia) • Diuretic therapy or medications increase urine output) • diet restrictions (protein is limited due to buildup of urea) • Dialysis • Kidney transplantation
________ and ________ are the leading cause of chronic kidney failure. Hyptension and diabetes
_______ is the most common cause of kidney failure. why? Diabetes - Kidney damage is caused by high blood glucose levels triggering the inflammatory response leading to blood vessel injury in kidneys --> they dont receive enough O2 --> chronic renal failure and the inability of the kidneys to filter blood.
A prominent s/s that diabetes is damaging the kidney is the finding of what in the urine. What is this called Protein - proteinuria or albuminuria
This the 2nd most common cause of Chronic renal failure. It can be the cause of kidney damage or the result of kidney damage. Why? Hypertension - As kidney disease progresses, physical changes in the kidneys lead to increased blood pressure. Rising BP and factors that raise blood pressure occurs. Remember that atherosclerosis of blood vessels causes INFLAMMATION and HYPERTENSION.
Acute cystitis (UTI) or acute Pylelonephritis: Fever, leukocytosis, Nausea, vomiting, acute Pylelonephritis
Acute cystitis (UTI) or acute Pylelonephritis: Flank Pain and tenderness acute Pylelonephritis
Acute cystitis (UTI) or acute Pylelonephritis: Urgancy, Dysuria, frequent urination. Acute cystitis (UTI)
Acute cystitis (UTI) or acute Pylelonephritis: Suprapubic tenderness Acute cystitis (UTI)
Renal Diagnosis: Protein in urine, no WBC, no RBC, full body edema Nephrotic syndrome
Renal Diagnosis: RBC in urine, no WBC or protein Kidneys stone
Renal Diagnosis: WBC and RBC in urine, no fever/chills UTI/Cytitis
Renal Diagnosis: WBC and RBC in urine, temp present pyelonephritis
Renal Diagnosis: Uremia, change in LOC, oliguria, fixed specific gravity Acute Tubular necrosis
Renal Diagnosis: presence of antigen-antibody complexes Glomerulonephitis
Renal Diagnosis: Hematuria, proteinuria, RBC cast, high B/P nephritic syndrome
Created by: sbertelsen
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