MS1 - RENAL

Erthropoietin

Stimulate red blood cell production

True

True or False: Renal disorders are considered systemic disorders, not merely urinary disorders

Kidneys

It produces urine, paired, bean shaped organs

Ureters

This transports urine from the kidneys to the bladder

Bladder

Which part of the urinary system stores urine?

Urethra

It carries urine from the bladder to the outside of the body

Retroperitoneal Space

Where is the kidney located?

False: The right kidney than the left because the liver occupies a large amount of space on the right side

True or false: The left kidney is slightly lower than the right

Renal Hilum

The medial portion of the kidney which contains an opening. Kidney’s major gateway

Renal artery enters the renal hilum, renal vein leaves and ureter leaves.

Does renal artery enters or leaves the renal hilum?

Filtered Blood

What blood eventually leaves through the renal vein?

Blood enters through the renal artery because the kidneys require a tremendous blood supply.

Does blood enter through the renal artery or renal vein?

Renal cortex

Outer portion of the kidney

Renal cortex

It contains many structures of nephrons specifically the glomeruli and portions of renal tubules

Renal Medulla

Inner portion of the kidney which houses the loop of Henle, vasa recta and collecting ducts.

Renal pyramids

It is a structure in the renal medulla where urine is drained toward the renal papillae and then to the calyces

Nephron → collecting duct → renal papilla → minor calyx → major calyx → renal pelvis → ureter → bladder → urethra

What is the pathway of urine from the nephron to the outside of the body?

20-25%

What percentage of cardiac output do the kidneys receive?

Because their primary job is to continously filter plasma

Why do the kidneys need so much blood?

Renal artery

Which carries blood into the kidney?

Through the Efferent arteriole → Exits the glomerulus

After filtration, where does blood leaves?

Afferent arteriole → Arrives at the glomerulus

After the renal artery branches into smaller vessels, what vessel carries blood directly into the glomerulus for filtration?

Acute Kidney Injury (AKI)

Blood loss → ↓ blood volume → ↓ renal perfusion → ↓ Glomerular Filtration → waste accumulation → prerenal AKI, hypovolemia, hemorrhage, severe dehydration

What condition can result from decreased renal blood flow causing the kidneys to be unable to maintain adequate filtration?

Nephron

Functional unit of the kidney

1 Million

How many nephrons are there in EACH kidney?

Nephron

This part of the kidneys work on filtration, reabsorption, secretion and urine formation

Cortical Nephrons

This nephron have shorter loops of Henle

Juxtamedullary Nephrons

These have long loops of Henle and vasa recta. They are important for producing concentrated urine

Juxtaglomerular Apparatus

Renin activates the RAAS (renin–angiotensin–aldosterone system), which increases blood pressure and helps restore adequate blood flow to the kidneys.

Important for regulating blood pressure and renal blood flow because it participates in renin release

Glomerular Filtration

First major step in urine formation

1000-1300 mL/min

How much renal blood flow do the kidneys receive per minute?

180L

How much filtrate is produced each day?

They remain in the blood and do not enter the filtrate

What happens in the blood cell during glomerular filtration?

Damage to the glomerular filtration barrier

What does protenuria indicate?

Renal tubules

Since the kidneys cannot filter everything and the body needs to retain useful substances. After filtration, which part returns substances from the tubular fluid back into the blood?

Tubular Reabsorption

What do you call the process of returning useful substances from the tubular fluid to the blood?

TRUE

TRUE OR FALSE: ~99% of the filtered fluid is eventually reabsorbed

1-2L

After tubular filtration, how many liters of final urine are left under normal circumstances?

Tubular Secretion

What process involves transporting substances from the blood into the renal tubule to be eliminated in the urine?

Metabolic Acidosis

When the kidneys cannot secrete enough hydrogen ions, acid accumulates in the blood, causing increased blood acidity. Tubular secretion is therefore important for maintaining acid-base balance.

What can impaired tubular secretion cause due to decreased acid excretion?

Antidiuretic Hormone/ADH

This regulates water retention

Osmolality

Concentration of dissolved particles in a solution based on the amount of solvent

280-300 mOsm/kg

What are the normal values of serum osmolality?

Blood too concentrated → body conserves water
Blood too diluted → Body eliminates excess water

How do the kidneys regulate serum osmolality when the blood becomes too concentrated or too dilute?

400-500mL

How many mL can a urinay bladder hold?

150-200 mL

How many mL does the sensation of needing to urinate occurs?

Autonomic Nervous System

What nervous system regulates bladder storage and emptying

Symphathetic activity (Fight or Flight)

On the other hand, during voiding, parasympathetic activity (rest and digest) causes the detrusor muscle to contract while the appropriate sphincter mechanisms relax.

During storage, what activity supports urine retention?

Micturition

What is the process of urination?

8 times per day

Though actual frequency varies according to fluid intake, medications, age, and other factors.

Normal adults void approximately how many times per day?

During normal voiding:

The detrusor muscle contracts → The appropriate urinary sphincter mechanisms relax → Urine leaves the bladder

During voiding, which muscle contracts and which mechanism relaxes?

Less than 100mL

Small amount of residual urine may remain. In normal adults less than 50mL of residual urine are retained. How many mL of residual urine may remain in older adults?

1 mL/min/year

Renal function changes naturally with aging. After the age of 40, the Glomerular Filtration Rate decreases by approximately how many mL/min/year?

C. Use respectful language when conversing and always maintain privacy.

Patients may be embarrased to state their urinary symptoms and history. When getting renal assessment, it is important to:
A. Use judgmental communication
B. Explain in scientific terms
C. Use respectful language when conversing and always maintain privacy.

Dysuria

Painful or burning urination, common in UTIs

Hesitancy

Difficulty initiating urination

Nocturia

Waking during the night to urinate

Polyuria

Excessive urine production

Oliguria

Markedly reduce urine production

Anuria

Very little or essentially no urine production

Pyuria

White blood cless or pus in the urine

Incontinence

Involuntary loss of urine

Pyelonephritis

CVA is located near the lower posterior ribs and spine

Tenderness in the Costovertebral Angle/CVA which indicates inflammation or infection in the kidney is a classic example of what disease?

A. Pyelonephritis/Severe UTI

Patient is showing high fever, flank pain and CVA tenderness. What disease is this?
A. Pyelonephritis/Severe UTI
B. Cystitis

B. Cystitis (Inflammation of the Bladder)

Patient has lower urinary symptoms such as dysuria, frequency, urgency and suprapubic discomfort. These symptoms indicate what disease?
A. Pyelonephritis/Severe UTI
B. Cystitis

C. Palpate, Percuss, Bladder Scan

During bladder assessment, what is the most appropriate?
A. Percuss, Auscultate, Bladder Scan
B. Percuss, Palpate, Bladder Scan
C. Palpate, Percuss, Bladder Scan

B. A smooth firm mass in the lower midline abdomen

A distended bladder may be palpable as:
A. A hard flowing mass in the lower midline abdomen
B. A smooth firm mass in the lower midline abdomen

B. Fluid-filled, distended bladder

A patient has difficulty voiding and reports lower abdominal fullness. On percussion, the nurse notes a dull sound over the suprapubic area. Which finding does this most strongly suggest?
A. Gas-filled bowel over the bladder
B. Fluid-filled, distended bladder
C. Empty bladder with increased bowel sounds
D. Pus-filled bladder caused by urinary infection

B. Urinary retention with increased post-void residual volume

A bladder scan noninvasively measures post-void residual urine which is useful in suspected urinary retention. “Voided” does not mean “the bladder emptied”

A postoperative patient reports suprapubic pressure and urgency shortly after voiding. The nurse performs a bladder scan and detects a large volume of urine remaining in the bladder. Which finding best explains the situation?

A. Increased urinary frequency due to excessive urine production
B. Urinary retention with increased post-void residual volume
C. Normal bladder emptying with temporary urinary urgency
D. Decreased urine production caused by inadequate fluid intake

Taking daily weight

What is the useful way to monitor changes in fluid status?

1kg weight gain = 1L fluid retention

1lb weight gain = 500 mL fluid retention

A patient gains 1 kg of body weight. Approximately how many mL of fluid retention does this represent?

Urinalysis

One of the most basic but useful renal tests which evaluates macroscopic, chemical and microscopic charateristics.

Hematuria

Blood in the urine

Proteinuria

Excessive protein in the urine

Albumin Assessment

Microalbuminuria → Small amounts of albumin in the urine can represent an early manifestation of diabetic kidney damage.

Which assessment is important in patients with diabetes?

Urine Specific Gravity

This estimates how concentrated the urine is compared with water

1.005 - 1.025

Normal range of urine specific gravity

B. Isosthenuria

A patient’s urine has a specific gravity consistently near 1.010, regardless of whether the patient is dehydrated or overhydrated. Which condition does this finding most strongly suggest?

A. Glycosuria
B. Isosthenuria
C. Hematuria
D. Proteinuria

Urine Osmolality (200-800 mOsm/kg)
24hr urine osmolality (300-900 mosm/kg)

Which provides a more direct assessment of the kidney’s ability to concentrate or dilute urine?

C. 275-290 mOsm/kg (Serum Osmolality)

Urine Osmolality (200-800 mOsm/kg)
24hr urine osmolality (300-900 mosm/kg)

If the normal urine osmolality is 200-800 mOsm/kg, what is the normal range of serum osmolality?
A. 300-900 mOsm/kg
B. 270-295 mOsm/kg
C. 275-290 mOsm/kg

TRUE

TRUE OR FALSE: Creatinine is eliminated in the urin and is not reabsorbed back into the blood

B. Male: 0.6-1.3 mg/dL
Female: 0.5-1.1 mg/dL

What are the normal values of creatinine
A. Male: 0.5-1.1 mg/dL
Female: 0.6-1.3 mg/dL

B. Male: 0.6-1.3 mg/dL
Female: 0.5-1.1 mg/dL

No, it’s supposed to be low because creatinin is eliminated thru urine

Is it normal that the amount of creatinine is high in the blood?
YES OR NO

FALSE: Increasing creatinine indicates declining renal filtration

TRUE OR FALSE: A decreasing serum creatinin indicates declining renal filtration

Urea

What is the waste product created when the body breaks down proteins?

c. 10-20 mg/dL

Normal values of Urea:
a. 10-21 mg/dL
b. 20-30 mg/dL
c. 10-20 mg/dL

C. Gastrointestinal bleeding

BUN is less specific than creatinine because it can be affected by hydration, protein intake, catabolism, GI bleeding, liver function, and medications. Therefore, BUN should be interpreted together with creatinine and the patient’s clinical condition.

A patient has an elevated BUN level. Which factor can increase BUN without necessarily indicating impaired renal function?

A. Decreased protein intake
B. Increased hydration
C. Gastrointestinal bleeding
D. Decreased protein catabolism

10:1 to 20:1

What is the normal BUN-to-creatinine ratio?

Glomerular Filtration Rate/GFR

This estimates how effectively the kidneys are filtering plasma, making it one of the most important measure of kidney function

Bladder Ultrasound/Bladder scan

What procedure determines whether urine remains in the bladder after voiding?

B. To facilitate renal excretion of the radioactive tracer

After a nuclear scan, why is the patient encouraged to maintain adequate hydration, when not contraindicated?

A. To increase the absorption of the radioactive tracer
B. To facilitate renal excretion of the radioactive tracer
C. To prevent the tracer from being detected by the gamma camera
D. To increase the concentration of the radioactive tracer in the blood

Cystoscopy

This procedure involves inserting a scope through the urethra to visualize the urethra, bladder and ureteral openings

D. Cystoscopy

These can be expected temporarily. However, severe pain, inability to void, significant bleeding, fever, or signs of infection require further evaluation.

The patient may experienced dysuria, urinary frequency, and mild blood-tinged urine after what procedure?
A. CT Scan
B. Nuclear Scan
C. Ultrasound
D. Cystoscopy

C. 24-48hrs

After kidney biopsy, bleeding is a major concern. Therefore, management of the patient includes monitoring for bleeding and urine color. Hematuria is usually resolved within how many hours after a kidney biopsy?
A. 24-36hrs
B. 12-24hrs
C. 24-48hrs

CKD

Refers to kidney damage/decreased GFR that persists for at least three months. It represents persistent kidney abnormality .

Stage 1:

≥90 mL/min/1.73 m²

Kidney damage with normal/high GFR

The patient’s GFR is greater than or equal to 90 mL/min/1.73m2 and shows kidney damage with normal/high GFR. What is the CKD stage of the patient?

Stage 2: 60-89, mild decrease

GFR is 60-89, indicating mild decrease of the GFR. THe patient is in what the stage of CKD

Stage 3: 30-59, moderate decrease

GFR is 30-59, indicating moderate decrease in the GFR. The patient is currently at what stage of CKD?

Stage 4: 15-29, severe decrease

GFR: 15-29 indicating severe decrease. What stage of CKD is this?

<15

Patient is in end stage kidney disease, CKD Stage 5. What is the GFR of the patient?