Elimination and Renal Disorders

Edema

Excess fluid in the interstitial space

1. Na and H20 retention

2. venous obstruction

3. CHF

4. Renal failure

5. decreased albumin

6. allergic reaction

Causes of edema: [6]

Lymphedema

Edema caused by an accumulation of fluid that is usually drained through the body’s lymphatic system

Pleural effusion

Edema in the pleural space of the lungs

Ascites

Edema in the peritoneal cavity

Pericardial effusion

edema in the pericardial space

Blood urea nitrogen (BUN) test

Renal function test that measures the nitrogen portion of urea

Azotemia

increased BUN

Tissue necrosis and decreased glomurular function and fluid volume deficit

Increased BUN (Azotemia) is indicative of what?

2.1-7.1 mmol/L

Normal BUN

1. glomurulonephritis

2. pyelonephritis

3. urinary tract obstruction

4. shock

5. MI

6. excessive protein intake

7. anabolic steroid use

Increased BUn may occur with: [7]

Creatinine

Renal test that measure the byproduct of muscle . Can give an approximate of the estimated GFR (eGFR)

Reduces the excretion of creatinine

Decreased kidney function effect on creatinine

80-115 μmol/L

Normal creatinine levels

glomerular filtration rate

This test estimates how much blood passes
through the glomeruli each minute

Golmeruli

the tiny filters in the kidneys that
filter waste from the blood.

1. age

2. sex

3. height

4. weight

Blood creatinine levels are combined with WHAT to estimate GFR? [4]

>90 mL/min

Normal GFR:

Kidney stones (renal calculi)

Obstructive uropathy, supersaturation of one or more salts in the urine leading to crystallization. Can occur in the bladder, ureters, or kideys

Calcium oxalate or phosphate (80-90%)

Most kidney stones are caused by what?

1. renal colic

2. pain in flank to groin

3. urgency

4. frequency

5. hematuria

Clinical manifestations of kidney stones:

24 hours urinalysis

How are kidney stones diagnosed?

Alkaline urine (pH<7) increases risk for calcium phosphate stone formation

Acidic urine (pH>7) increases risk for uric acid stone formation

How are kidney stones formed?

1. dehydration

2. diuretic

3. hyperparathyroidism

4. Gasto-intestinal or genito-urinary surgery

Risk factors for kidney stones

1. manage acut pain

2. promote stone passafe

3. reduce stone size

4. prevent new stone formation

5. Remove stones as needed

Treatment for kidney stones:

e. coli

Most common cause of UTI

Anywhere along the urinary tract

Where do UTIs occur:

Cystitis

pyelonephritis

two types of UTIs:

1. female

2. diabetes

3. kidney stones

4. urine reflux

5. pregnancy

6. neurogenic bladder

7. prostate enlargement

Risk factors for UTIs [7]

Cystitis

bladder inflammation

1. infectious bacteria

2. other reasons (e.g., interstitial cystitis)

Causes of cystitis

1. redness

2. hemorrhage

3. pus

4. edema

   in the bladder wall

Cystitis can lead to: [4]

1. urgency

2. frequency

3. dysuria

4. suprapubic/back pain

5. hematuria

6. cloudy urine

7. bacteriuria

Clinical manifestations of cystitis:

Urine culture

How is cystitis diagnosed?

1. antimicrobial therappy

2. increased fluid intake

3. avoid bladder irritants

4. analgesics

treatment for cystitis:

Painful bladder syndrome/ interstitial cystitis

Nonbacterial cystitis caued by virus, chlamydia, fungi. Can be caused by radiation, autoimune disease

Negative urine cultures

Urine culture results for painful bladder syndrome

1. frequency

2. urgency

3. dysuria

4. nocturia

Clinical manifestations of painful bladder syndrome [4]

Pyelonephritis

Inflammation of one or both upper urinary tracts due to infection

1. kidney stones

2. urine reflux

3. pregnancy

4. neurogenic bladder

5. catheterization

6. female

Risk factors for pyelonephritis [6]

1. acute onset of fever,

2. chills

3. flanl/groin pain

4. frequency

5. dysuria

Clinical manifestations of pyelonephritis [5]

May develop into chronic pyelonephritis leading to kidney scarring.

Pyelonephritis can lead to what?

Glomerulonephritis

inflammation of the glomerulus

1. ischemia

2. drugs

3. toxins

4. infection

5. diabetes

6. htn

7. vasculitis

8. lupus

9. CHF

10. HIV

11. immune hypersensitivity

Risk factors for glomerulonephritis [11]

1. proteinuria

2. microalbuminuria

3. Ag/ Ab complex deposition in tissue

4. increased plasma BUN and creatinine

5. reduced creatinine clearance

Clinical manifestations of glomerulonephritis: [5]

kidney failure

Glomerulonephritis can lead to what?

Nephrotic syndrome

Excretion of 3.5g or more of protein in urine per day caused by glomerular injury

1. hypoproteinemia

2. proteinuria

3. edema

4. dyslipidemia

5. vitamin D deficiency

6. hypothyroidism

CLinical manifestations of nephrotic syndrome: [6]

Acute kidney injury

Sudden decline in kidney function

1. decreased GFR

2. decreaesd urine output

3. iNcreased plasma BUN and creatinine

Clinical manifestations of acute kidney injury

1. hypovolemia

2. ischemia

3. hypoperfusion of kidneys

4. shock

5. tumour growth

6. stones

7. neorugenic bladder

8. nephrotoxic drugs (contrast dye)

9. allergy

Risk factors for acute kidney injury [9]

temporary hemodialysis

Acute kidney injury may require waht?

Chronic kidney disease

AKI may progress to what?

1. initiation phase (kidney injury evolving, prevention is possible)

2. maintenance (oliguric) phase: established injury and dysfnction, urine output is the lowest. Serum creatinine and BUN increase

3. Recovery (polyuric) phase: Injury repaired and normal renal function established.

3 stages of AKI

Chronic kidney disease

Progressive kidney disease

1. diabetes

2. htn

3. lupus

4. kidney injury

5. vascular disorders

Chronic kidney disease risk factors: [5]

1. decreased GFR

2. HTN

3. increased plasma BUN and creatinine

4. hyperkalemia

5. hypernatremia and water retention

6. hyperphosphatemia

7. anemia

8. pruritis

9. edema

10. sallow skin

11. weakness/lethargy

12. hypocalcemia

13. metabolic acidosis

Chronic kidney disease clinical manifestations: [13]

– Normal (GFR > 90 mL/min)
– Mild (GFR 60 to 89 mL/min)
– Moderate (GFR 30 to 59 mL/min)
– Severe (GFR 15 to 29 mL/min)
– End stage (GFR < 15 mL/min)

Stages of chronic kidney disease based on progressive decrease in GFR