Chapters 22 & 23: Renal System
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| what do the kidneys do for the body? | basic powerhouse washer of blood/ cleaner of blood for body
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| Processes of the kidney | acid-base balance, BP regulation, RBC formation/ drug metabolism (stimulates bone marrow to make RBCs), hormone metabolism/ vitamin D synthesis, glucose homeostasis (needed for metabolism)
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| what are the functional units of the kidney? | nephrons
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| What is a normal GFR rate? | 90-120 mL/min
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| What does the GFR tell us about the kidney? | renal perfusion
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| At what age would you expect to see kidney function drop naturally? | GFR peaks at 30, so 31
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| If ______ ________ drops (think heart) then GFR drops | Blood pressure
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| What are the three functions of the nephron? | filter, reabsorb, secrete
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| _______ _______ occurs in the glomerulus | Glomerular filitration
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| What regulates glomerular filtration | Blood pressure
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| Glomerular filtration is the beginning of | urine formation
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| What is urine formation? | The process the kidneys use to filter excess fluids, waste products, and solutes out of the blood and into the urine collecting tubules to be excreted from the body in urine.
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| Products at the end of glomerular filtration | Glomerular particles (?)
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| What occurs after glomerular filtration | Tubular reabsorption
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| Where does tubular reabsorption occur? | proximal convoluted tubule
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| What happens in tubular reabsorption? | The filtrate is reabsorbed back into the capillaries that surround the tubules to be returned to the body for use. It's reabsorbed because the first time absorption occurs is in the small intestines.
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| The kidneys access what needs in the blood? | The needs for solute and water
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| What happens to products not reabsorbed in tubular reabsorption? | they continue to the final process
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| Where does tubular secretion occur | distal convoluted tubule
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| What happens in tubular secretion? | filtrate that is not reabsorbed into the blood is delivered to the collecting ducts where it mixes with urea and is taken to the bladder where it will be eliminated from the body as urine
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| Structures of nephron | Proximal tubule, Loop of Henle, Distal Tubule, Collecting Duct
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| Role of proximal tubule | reabsorbs majority of filtrate
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| role of loop of henle | begin to concentrate filtered fluid
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| role of distal tubule | absorbs water and sodium
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| role of collecting duct | additional water reabsorbed
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| What are the waste products that are eliminated from the kidneys? Where do they come from in the body? | blood urea nitrogen and electrolytes; come from the blood
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| What are the hormones that the kidneys regulate? What are their actions? | Vitamin D: calcium absorption and immune system
Insulin: absorb glucose
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| How do the kidneys regulate insulin? | Glucose is reabsorbed by the kidneys in order to prevent glucose molecules from going through filtration
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| What is a glucose threshold? | How much glucose the kidney can reabsorb before glucose gets into urine
> 180
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| Is it normal to have glucose in the urine? | No
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| If you have glucose in the urine, what condition do we suspect? | Diabetes Mellitus or kidney failure
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| Kidneys are susceptible to _____ injury | ischemic
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| What can cause ischemic injury? | atherosclerosis, leads to high BP, causes kidney to overwork
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| Overtime, a decreased GFR leads to | tubular destruction
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| What does tubular destruction mean | kidney cannot filter blood
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| What does kidneys being unable to filter blood lead to (eventually) | urosepsis
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| Clinical manifestations of kidney issues | swelling or edema
dehydration
low BP or low blood volume
CVA tenderness
hematuria
abdominal pain
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| What does a urinalysis look for (UA)? | bilirubin, urobilinogen, crystals, casts, pH, specific gravity, glucose, ketones, WBCs, protein
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| normal UA values | ph: 4.6-8.0
specific gravity: 1.005-1.030
none of the other stuff
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| If you see abnormal values on a UA, what does that mean? | kidney is not able to filter everything
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| A urine culture looks for ______ and must be done clean catch or steriley | bacteria
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| 4 things that cause BUN to elevate | decreased GFR, dehydration, extremely muscular persons, high protein diet
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| BUN | blood urea nitrogen
this number gives reflection of how well the kidneys are filtering
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| What does serum creatinine measure? | kidney filtration
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| what are the 2 ways to collect serum creatinine? | blood sample and 24-hour urine collection
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| which is the better method to measure kidney function BUN or serum creatinine? | serum creatinine
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| urosepsis | bacteremia; serious complication of UTI
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| uropathy | obstruction of urine flow
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| costovertebral angle tenderness | inflammation/ pain where the kidney is regionally
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| hematuria | blood in the urine
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| proteinuria | protein in the urine
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| urea (BUN) | nitrogenous waste product
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| azotemia | increased BUN in the blood
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| uremia | really high levels of urea and other nitrogenous wastes
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| creatinine | product of muscle breakdown (excreted completely)
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| BUN/ creatinine ratio | 10:1, 20:1 ideal (indicates enough blood flow to kidneys)
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| intravenous pyelography | used to diagnose urinary incontinence; check GFR because dye is injected
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| oliguria | low urine output
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| diuresis | urination
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| vesicoureteral reflex | pee moves backward from bladder to kidneys
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| neurogenic bladder | damage to nerves innervating the bladder
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| hydronephrosis | water in the kidney
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| hydroureter | water in the ureter
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| Causes of acute kidney injury | heart failure, dehydration, enlarged prostate (males), infection, glomerulonephritis
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| Injury that occurs from a decrease in perfusion of the kidney, before the kidney or outside of it | Prerenal dysfunction
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| cause of prerenal injury | hemorrhage or ischemia
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| Injury occurs from damage to the nephron | intrarenal dysfunction
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| What can lead to damage of a nephron | pyelonephritis, autoimmune conditions
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| Injury occurs from blockage of flow of urine out of the kidney (collecting ducts to urethra) | postrenal dysfunction
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| causes of postrenal dysfunction | obstructive uropathy, hydronephrosis, kidney stone
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| Phases of acute kidney injury in order | insult, oliguria, diuresis, recovery
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| acute tubular necrosis | ischemia + hypoxic damage to nephron, lumen is blocked and prevents fluid flow + urination formation
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| Nephrotic syndrome | damage to glomerulus
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| nephritic syndrome | immunological inflammation
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| Acute glomerulonephritis is the same as | post streptococcal glomerulonephritis
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| primary cause of AGN | untreated bacteria
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| Which bacteria are we most concerned with AGN | streptococcal
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| Where does streptococcal often originate from | infection
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| What other organ does AGN impact | liver?
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| How do we diagnose AGN? | throat culture and urine test
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| Damage to the glomeruli that causes a massive leakage of protein in the urine is | nephrotic syndrome
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| what protein is lost in the urine in nephrotic syndrome | albumin
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| What symptoms make it known that the diagnosis is nephrotic syndrome | edema and elevated albumin
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| what are renal calculi | kidney stones
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| most common cause of kidney stones | dehydration
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| Gout is a leading cause of kidney stones. what does gout come from? | foods high in purines
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| symptoms of renal calculi | pain, hypercalcemia, UTI
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| How is renal calculi diagnosed? | urinalysis
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| Infection of the kidney | Urolithasis
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| Bladder infection | Pyelonephritis
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| Difference between urolithasis and pyelonephritis | Urolithasis: lots of abdominal pain, hematuria
Pyelonephritis: dysuria
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| Who is at increased risk for pyelonephritis and why? | Female; shorter urethra, easier for bacteria to travel up
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| Polycystic kidney disease | Genetic; kidneys giving out, 90-95% nephrons impacted
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| Chronic kidney disease | gradual loss of kidney function, 5 stages of progression
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| causes of chronic kidney disease | diabetes mellitus, HTN, glomerulonephritis, PKD
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| What are treatment options for end stage renal disease? | fluid and electrolyte management, BP management, dialysis, transplant
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| the bladder usually holds how much urine? | 300-400mL
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| What are common causes of urological disorders? | urinary system issues
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| What are common causes of hydronephrosis | obstructive neuropathy
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| What is the most common organism that causes a UTI? | urethra + rectum
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| Why do men become more at risk for UTIs? | dehydration, catheters, and diabetes
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| what causes a hospital acquired uti? | leaving in/ neglecting catheter care
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| What are the symptoms of UTI? | high frequency, dysuria, urgency, hematuria
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| What will a urinalysis show for a lower UTI? | RBCs, WBC indicators, nitrates
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| What is urosepsis and who is at greater risk? | Urosepsis- bacteremia, serious complication of UTI
elderly and catheterized at highest risk
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| How can a UTI turn into septic shock? | UTI untreated and spreads
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| Stress Incontinence | loss of muscle support
pee a little while laughing after having a baby
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| Overactive bladder | detrusor muscle overactivity
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| Neurogenic bladder | no control over bladder after paralysis
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