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NURS 319 Exam 1
Renal & Urologic Disorders Questions Pt. 1 (slides 1-19)
| Question | Answer |
|---|---|
| What is the cleaner of the body? | the kidneys |
| Name 7 roles that the kidney partakes in | Acid/Base balance, BP regulation, RBC formation, Drug metabolism, Hormone metabolism, Vitamin D synthesis, Glucose homeostasis |
| The nephron determines if the _____________ from a drug are needed, and if not, then they are __________. | metabolites, excreted |
| What hormone is excreted into the blood by the kidneys to stimulate bone marrow production of RBC? | erythropoietin |
| Through what system does the kidney regulate blood pressure? | RAAS |
| What part of the nephron can sense the change in blood pressure? | the glomerulus |
| What begins RAAS? | the production of renin by the glomerulus |
| How can autoimmune conditions play a role in increased kidney disease occurrence in the US? | through hapten formation, which clogs the filters in the glomerulus |
| What disease indicates that the kidney can no longer filter toxins out? | end-stage renal disease (ESRD) |
| Synthesis of which hormone boosts the immune system? | Vitamin D |
| What does the glomerulus stimulate the release of when water pressure is too high? | Natriuretic peptides |
| How do natriuretic peptides help lower water pressure? | Natriuretic peptides stops the release of ADH and Aldosterone so that the kidney can release some water. |
| How much of the total cardiac output do the kidneys receive? | 1/5 of cardiac output |
| What does GFR tell you? | it tells you if the nephron is working properly |
| What brings blood into the glomerulus? | Afferent arteriole brings blood into the glomerulus |
| What brings blood out of the glomerulus? | Efferent arteriole pushes blood back out |
| Why is the glomerulus under high hydrostatic pressure? | Since the afferent arterial is feeding the glomerulus with blood directly from the heart, it carries a lot of pressure. |
| What is the normal rate for GFR? | 90 to 120 mL/min |
| A decrease in renal perfusion = a decrease in _____ | GFR |
| When is GFR at its peak? | At age 30 |
| What are the three main processes used to form urine? | 1) Glomerular Filtration 2) Tubular Reabsorption 3) Tubular Secretion |
| What is the glomerulus surrounded by? | Bowman's capsule |
| In which process are needed particles reabsorbed into the blood? | Tubular Reabsorption |
| Where does waste mix with urea to make urine? | in the renal pelvis |
| What occurs during Tubular Secretion? | anything that is not needed in the blood is excreted into the collecting duct |
| The renal corpuscle is made up of which two parts? | The glomerulus and Bowman's capsule |
| What part of the glomerulus contains filtration slits? | the endothelium |
| What physical component encourages filtration of blood in the glomerular capillaries? | High hydrostatic pressure |
| In what scenario would an individual "spill" protein or glucose? | When their BP is too high so unwanted particles are getting through the filter |
| What are the four parts of the nephron following Bowman's capsule? | Proximal Tubule, Loop of Henle, Distal Tubule, Collecting Ducts |
| Where does urea enter the nephron? | In the Loop of Henle |
| The distal tubule is under the influence of which hormone? | Aldosterone |
| What does aldosterone do to the kidney? | It encourages the absorption of water and sodium into the kidney |
| The collecting ducts are under the influence of which hormone and what does that hormone trigger to happen? | Anti-diuretic hormone (ADH), absorbs additional water into the blood |
| The __________ ___________ wraps around the proximal tubule to allow for reabsorption of filtrates. | efferent arteriole |
| What part of the nephron begins to concentrate filtered fluid? | The Loop of Henle |
| The increase of creatinine in the blood is a sign of what? | That GFR is decreasing (not working as well) |
| Which two hormones are a part of the secretory function of the kidney? | Erythropoietin and Renin |
| Explain the RAAS | Renin becomes angiotensin 1 which then becomes angiotensin 2 with the help of angiotensin converting enzyme (ACE) which then finally stimulates the nephrons to release Aldosterone |
| How does the RAAS raise BP? | When aldosterone is released, sodium and water are absorbed into the water which increases blood volume and constricts blood vessels. |
| Vitamin D is important in the absorption of what? | Calcium |
| Normal glucose levels in blood | 90 to 120 mg/dL |
| What is the renal threshold to reabsorb glucose? | blood glucose of 180 mg/dL |
| What happens if blood glucose levels exceed 180 mg/dL? | Glucose is excreted into the urine, known as "spilling of glucose" |
| Why is gluconeogenesis beneficial to glucose homestasis? | Gluconeogenesis provides the kidney with non-carbohydrate sources of glucose (i.e. protein, lipids) when there aren't carbohydrate sources. |
| What is occurring when there is insufficient filtration in the kidneys leading to a negative impact on blood? | buildup of waste products |
| Buildup of toxins in the blood leads to destruction of ____ and _________________ symptoms. | RBCs, neurological |
| What are three neurological signs of kidney dysfunction? | Confusion, stupor, encephalopathy |
| Is erythropoietin secretion increased or decreased during kidney dysfunction? | Decreased; when the kidneys are damaged they can't secrete the normal amount of erythropoietin |
| Is renin secretion increased or decreased during kidney dysfunction? | It is increased because the kidneys have undergone damage and can't properly regulate what enters and exits the nephron. This can lead to the kidneys thinking RAAS needs to be activated to raise BP when it doesn't need to be. |
| Why would pH be affected from kidney dysfunction? | the kidneys can not properly maintain acid-base balance when damaged |
| Why can renal osteodystrophy occur with kidney dysfunction? | Vitamin D and calcium levels drop due to improper reabsorption/secretion, resulting in bone disease. |
| Excess of potassium is not secreted during kidney dysfunction, eventually leading to the development of _______________. | Hyperkalemia |
| Explain the difference between concentrated and unconcentrated urine. | Urine that is concentrated contains several components, urea, water, and other waste products. Unconcentrated urine does not have waste or urea present, so the urine is clear and mainly water. |
| The kidneys are susceptible to what type of injury? | Ischemic |
| If BP isn't high enough to profuse the glomerulus, what happens to the nephrons? | The nephrons become hypoxic because not enough oxygen is being forced through the glomerulus through high BP. This can then lead to ischemia and then necrosis. |
| Why can uropathy result in fluid backup? | Uropathy is when there is an obstruction of urine flow, so urine can't pass out of the ureters/kidney, resulting in fluid backup in the renal pelvis. |
| What color does hematuria turn the urine? | Pink or red |
| Hematuria can be a sign of _________ _________ or ____________. | Renal calculi; infection |
| What is an obvious indication of proteinuria? | foamy or frothy urine |
| Tea-colored urine is an indication of what? | Bilirubin in the urine |
| What type of pain indicates a kidney problem? | Costovertebral angle tenderness (CVA) |
| What eleven things are tested in a urinalysis? | pH, specific gravity, glucose, ketones, leukocyte esterase (WBC's), nitrite, protein, bilirubin, urobilinogen, crystals, casts |
| What is the normal pH range of urine? | 4.6 - 8.0 |
| What is the normal specific gravity range in urine? | 1.005 - 1.030 |
| What is not normally present in the urine unless there is an infection (UTI)? | Leukocyte Esterase (WBC's) or Nitrites |
| What does it mean if specific gravity is too low or too high? | If the specific gravity is too low then the urine is too dilute (too much water) and if the specific gravity is too high then the urine is too concentrated. |
| What does it mean if crystals are present in urine? | increased risk for kidney stone development |
| Name a few situations where casts are present in urine. | Nephrotic syndrome, dehydration, diuretics, tubular necrosis, autoimmune disorders, pyelonephritis, vigorous exercise, etc. |
| Is bilirubin supposed to be in the urine? | No, the liver breaks down bilirubin entirely, so if it is present in urine, that indicates a liver disorder |
| Is urobilinogen supposed to be in urine? | Small amounts yes, but large amounts can indicate liver disease |
| What is not normally in urine and can indicate high BP or a glomerular injury? | protein |
| How many CFU/mL indicate infection of one type of bacteria for a clean-catch sample? | greater than 100,000 CFU (colony-forming-units)/mL |
| Why should the CFU/mL be significantly lower than clean-catch samples in the cases of catheter use? | Catheters should have minimal to no contamination. Therefore, bacteria should not be present. CFU/mL of 1.000 to 100,000 would be especially concerning. |
| What is the purpose of Blood Urea Nitrogen? | a test that measures the amount of urea/nitrogen in the blood |
| Not excreting enough urea out of the kidneys results in what? | Azotemia |
| What is a sign of azotemia? | an increase of BUN in the blood |
| What are the four reasons for an increase in BUN? | 1) Decreased GFR 2) Dehydration 3) Extremely muscular people 4) High protein diet |
| Why would BUN levels be higher in someone that is extremely muscular? | The byproduct of protein metabolism is urea, so people eating mass amounts of protein will have a higher BUN. |
| Why should BUN measurement alone not be used for kidney function indication? | BUN measurement results point to four possible reasons for increased BUN instead of a specific cause |
| What is uremia and why is it bad? | Uremia is when someone has extremely high levels of BUN. This typically indicates end-stage renal disease (ESRD or ESKD) |
| Creatinine is the byproduct of _________ breakdown. | muscle |
| What is a great measure of kidney filtration and why? | Creatinine, because it is normally excreted completely. |
| What would normal creatinine clearance be? | Higher creatinine in the urine, low in the blood |
| What is creatinine clearance do and what is it used for? | it is a test conducted to assess GFR by collecting blood samples and a 24-hour urine sample to assess excretion of creatinine |
| Decreased creatinine clearance = decreased ________ and impaired __________ ___________. | GFR; renal function |
| Which two tests/lab values are best for determining the ability of kidney function? | GFR and creatinine |
| Why must someone have good kidney function to get an IVP? | The radiopaque dye can cause renal failure if contrast cannot be thoroughly excreted. |
Created by:
veerkabi
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