Alterations in Renal and Urologic Function, Week 10 Notes

what 4 products should not leave the blood and enter the urine?

plasma, proteins, RBCs and WBCs

what is the functions of the kidneys?

they filter electrolytes, glucose, water, and hormones out of the blood and some filtered products are also reabsorbed back to the blood based on the body’s needs; they regulated fluid balance, blood pressure control (RAAS), RBC and vitamin D production as well as acid base balance

what 3 things can cause urinary obstructions?

kidney stones (nephrolithiasis), enlarged prostate gland, and uterine or bladder prolapse

what are symptoms of urinary obstruction?

urinating less than 2 hrs, noctura (more than 1-2x/night), weak and intermittent urine stream, urgency, hesitancy, and incomplete emptying

what is BPH/ benign prostatic hyperplasia?

prostate cancer, it affects 50% of men over 50 and is a common cause of urinary retention

what is the diagnosis for BPH?

digital rectal exam (DRE) and elevated prostate specific antigen (PSA)

what is the treatment for BPH?

alpha 1 blockers (sympathetic so promote urination), tamsulosin and doxazosin are commonly used medications

what is doxazosin?

general alpha-1 blocker; relaxes smooth muscle; treats high BP and relaxes muscle in bladder to encourage urine flow

what are side effects of doxazosin?

dizziness and hypotension

what is tamsulosin?

selective alpha-1 blocker, does not impact BP and only impacts bladder to relax smooth muscle and allow urine flow

what are side effects of tamsulosin?

dizziness and ejaculatory dysfunction

what do sympathetic drugs do (stress)

they stimulate the body's "fight or flight" response by increasing heart rate, blood pressure, pupil dilation and bronchodilation and blood flow to muscles; they bind to alpha 1 and beta 1 and 2; decreases GI peristalsis; relaxes bladder so do not pee (DRY)

what do parasympathetic drugs do?

they activate the body's "rest and digest" response by decreasing heart rate, increasing gastrointestinal activity, promoting urinary excretion, and constricting pupils and blood vessels; they bind to muscarinic receptors, enhancing secretions and smooth muscle contraction as well as increase GI peristalsis

true or false: cholinergic promote urination (parasympathetics)

true

what does finasteride do?

treats BPH, inhibits the enzyme 5-alpha-reducatse, preventing conversion of testosterone into the more potent androgen, DHT, by reducing DHT levels, finasteride causes enlarged prostate to shrink and can take up to 6 months and lower doses are used for paternal baldness

what are the sexual side effects of finasteride?

females who touch the medication, especially during pregnancy, may experience hormonal changes and potential birth defects in a male fetus; additionally, men may experience decreased libido, erectile dysfunction, and ejaculation disorders

what are risk factors of pelvic organ prolapse?

vaginal birth, aging and menopause, obesity, increased abdominal pressure due to heavy lifting, cough, or constipation are key risk factors for pelvic organ prolapse, as these factors can weaken the pelvic support structures and increase likelihood of organ displacement

what is the first option for treating pelvic organ prolapse?

vaginal pessary ring is typically the first option for treating pelvic organ prolapse

what is nephrolithiasis?

formation of crystalline (kidney stone) aggregates in the urinary tract, caused by supersaturation of urine with solutes (calcium, oxalate, uric acid)

what is the most common stone of nephrolithiasis?

calcium oxalate stone formation in urine due to high calcium levels, urinary tract conditions, or metabolic disorders

what are risk factors for nephrolithiasis?

dehydration, high protein diet, foods high in sugar/salt, diuretics, antacids, gout, 1st incident <50 yrs old

what are symptoms for nephrolithiasis?

pain, fever, urinary retention, hematuria, n/v, 80% of stones pass on their own

what is used to treat nephrolithiasis?

analgesics: NSAIDs, opioids for severe pain, alpha blockers (tamsulosin) to facilitate stone passage, hydration and diet modifications, monitor urine output, strain urine for stones, patient education and shockwave lithotripsy for big stones, ureteroscopy and nephrolithotomy to remove stones surgically

define stress incontinence

due to increased abdominal pressure and pain under stress (weak pelvic floor muscles)

define urge incontinence

due to involuntary contraction of the bladder muscles

define overflow incontinence

due to blockage of the urethra or inability to fully empty the bladder, leading to urine leakageor overdistension of the bladder

define neurogenic incontinence

due to disturbed function of the nervous system resulting in loss of bladder control and impaired communication between the bladder and brain

what are neurogenic bladders?

bladder dysfunction due to neurological damage; can be flaccid (underactive) or spastic (overactive); caused by spinal cord injury, MS or diabetes mellitus and results in urinary retention or incontinence

what is used to treat neurogenic bladder?

anticholinergics for overactive type and cholinergic medication for flaccid type; intermittent catheterization to prevent retention; monitor for infection, bladder training and programs and safety training

what is an overactive bladder?

urgency with or without urge incontinence, frequency and nocturia; due to involuntary detrusor muscle contractions; common in aging, post menopausal women and sedentary lifestyle is a huge modifiable risk factor

what do you treat overactive bladders with?

antimuscarinics (oxybutynin, tolterodine) which cause blurred vision, dry eyes, and urinary retention, constipation, B3 adrenergic agonists (mirabegron) to relax detrusor muscles, and bladder training and avoid caffeine and diuretics

how do we prevent CAUTIs?

determine initial placement, aseptic technique, closed system, secured position, catheter reminders and never bring bag above bladder due to backflow

what is the most common health-associated infections (HAIs)?

catheter-associated urinary tract infections (CAUTIs) are the most common type of health-associated infections, resulting from the use of indwelling catheters that introduce bacteria into the urinary tract; accounts for 30-40% of all infections, risk increases each day

what are risk factors for CAUTI’s?

prolonged catheterization, female sex, elderly or immunocompromised, poor aseptic technique, breaks in the closed drainage system, and improper perineal hygiene

what do adrenergic/sympathomimetics drugs do?

mimic effects of sympathetic stimulation (DRY) and act on alpha and beta receptors; used in shock, asthma, cardiac arrest; they cause vasoconstriction, increased heart rate, and bronchodilation.

what do adrenergic antagonists/sympatholytic drugs do?

blocks sympathetic effects (WET), include alpha and beta blockers that reduce blood pressure, heart rate, and decrease vasoconstriction. They are used to manage hypertension, anxiety, and various cardiac conditions.

what do cholinergic/parasympathomimetic drugs do?

mimic parasympathetic activity (WET); act on muscarinic and nicotinic receptors; used for glaucoma, myasthenia, gravis, and urinary retention by promoting secretion and smooth muscle contraction in various organ systems

what do cholinergic antagonists/parasympatholytic drugs do?

block parasympathetic activity (DRY); increases HR, cause mydriasis, decreases secretions; used in pre-anesthesia, bradycardia, and monitor sicknessto reduce smooth muscle spasms, control secretions, and manage certain types of poisoning

what is the most common renal tumor?

renal cell carcinoma (RCC); originates from proximal tubular epithelium and is associated with smoking, obesity, HTN, and genetic factors; often asymptomatic so classic triad of hematuria, flank pain, and mass

what are bladder tumors?

most are transitional cell carcinomas and are linked to smoking, chronic cystitis, and chemical exposure; can cause hematuria, frequency, and urgency of urination

what is the most common symptom of bladder tumors?

painless hematuria

what is cystitis?

inflammation of the bladder and usually due to bacteria like E. Coli; more common in women due to shorter urethra

what are symptoms of cystitis?

dysuria, frequency, urgency and suprapubic pain may also include foul-smelling urine and cloudiness

how do you diagnose cystitis?

urinalysis and urine culture and sensitivity to identify causative pathogens

what is bacteria in urine without symptoms called?

asymptomatic bacteriuria which increases with age and 50% of women are in long-term care facilities, prevalence in men drastically increases in those older than 60; treatment is not required due to colonization unless pregnancy, TURP, women with bacteriuria symptoms, or invasive procedures

how do we treat cystitis?

antibiotics; nitrofurantoin, trimethoprim-sulfamethoxazole and phenazopyridine for urinary analgesia which treats bladder spasms and side effects include red/orange urine color

what is pyelonephritis?

infection of renal pelvis and parenchyma which usually ascends from lower UTIs

what are symptoms of pyelonephritis?

flank pain, costovertebral tenderness

how do we treat pyelonephritis?

antibiotics; fluoroquinolones, cephalosporins (IV for severe); hydration, rest, and monitor for sepsis and renal impairment

what is glomerulonephritis?

inflammation of glomeruli causing decreased filtration; often immune-mediated (post-strep or lupus)

what are symptoms of glomerulonephritis?

hematuria, proteinuria, HTN and edema

true or false: glomerulonephritis can lead to nephrotic or nephritic syndrome

true

what is nephritic syndrome?

hematuria, mild proteinuria, HTN, and oliguria

what is nephrotic syndrome?

massive proteinuria with edema, hypoalbuminemia, and hyperlipidemia; MOST SERIOUS

true or false; both nephritic and nephrotic syndrome involve glomerular injury but differ in permeability and inflammation

true

how do we treat glomerulonephritis?

corticosteroids, immunosuppressants (cyclophosphamide), manage BP (ACE inhibitors, diuretics) and monito fluid balance, daily weights, and limit Na/protein

what is AKI?

acute kidney injury; sudden decline in kidney function over hours to days

prerenal; intrarenal vasoconstriction, systemic vasodilation and volume depletion

intrinsic; glomerular, interstitial, tubular, and vascular

postrenal; uterus/bladder, pelvic, and intrarenal obstruction

how do we diagnose AKI?

RIFLE; risk, injury, failure, loss and end-stage kidney disease; classified by criteria based on changes in serum creatinine and urine output

what are the 3 stages of RIFLE?

1) risk; SCr increased 1.5-2 times baseline or GFR decreased to <25%

2) Injury; SCr increased to 2-3 times baseline or GFR decreased to <50%

3) failure; SCr increased by >3 times baseline of GFR decreased to <75%

what are triggers for ATN/ acute tubular necrosis?

nephrotoxins (NSAIDs, contrast dye, medications), circulatory shock, sepsis, hemorrhage, severe burns, rhabdomyolysis, and major surgery

what are risk factors of ATN?

include pre-existing kidney disease, diabetes, HF, and older age

what are symptoms of ATN?

reduced urine output, anuria, fluid retention, edema, fatigue, lethargy, n/v, confusion and SOB

how do we treat AKI?

avoid nephrotoxins (NSAIDs, contrast) and diuretics for fluid overload, dialysis if needed and monitor electrolytes, strict I and O, daily weights

what is chronic kidney disease/CKD?

progressive, irreversible nephron loss (>3 months) which leads to uremia, anemia, and bone mineral disorders; 1 in 9 adults have CKD

what are common causes of CKD?

HTN, diabetes, and glomerulonephritis

what is azotonia?

a sign of CKD; it is when nitrogenous waste accumulates in the blood due to decreased kidney function; symptoms may include fatigue, nausea, and confusion

what is stage 1-4 of CKD and GFR?

stage 1: GFR >90 mL/min, kidney damage with normal or increased GFR
stage 2: GFR 60-89 mL/min, mild reduction in kidney function
stage 3: GFR 30-59 mL/min, moderate reduction in kidney function
stage 4: GFR 15-29 mL/min, severe reduction in kidney function; prepare for dialysis

approaching failure: <15

what medications do we use to help treat CKD?

ACE inhibitors/ARBS to slow progression, diuretics, epogen, phosphate binders, vitamin D analogs and dialysis preparation

what diet should people with CKD be on?

low protein, sodium, potassium and phosphorus

what 2 medications are used to treat hyperkalemia in CKD?

1) IVP calcium gluconate- protects heart from K+ causing dangerous arrythmias, onset is 1-3 minutes and duration is 30-60 minutes, administer over 5-10 minutes slowly to prevent extravasation

2) IVP insulin and glucose- insulin lowers blood sugar and pushes potassium back into cells

what is the serum creatinine normal range and how does it serve as a major kidney function test?

0.6-1.2; it is the waste for muscle metabolism so if it is high that means impaired filtration

what is the BUN normal range and how does it serve as a major kidney function test?

7-20; it reflects protein metabolism and if its high that meals renal dysfunction or dehydration

what is the BUN/Cr normal ration and how does it serve as a major kidney function test?

10;1 or 20;1: >20 suggests prerenal causes and <10 suggests intrinsic renal damage

how does the creatinine clearance test serve as a major kidney function test?

24 hr urine test; decreased in renal impairment

how does the urinalysis serve as a major kidney function test?

detects protein, blood WBCs, and bacterial; abnormal= infection or glomerular disease

how does the urine protein/albumin test serve as a major kidney function test?

<30 mg/day suggests early renal diabetes especially in diabetes and HTN

what is the normal specific gravity range and how does it serve as a major kidney function test?

1.005-1.030; low= dilute and renal failure, and high= concentrated and dehydrated

what does a urinalysis test do?

evaluates color, clarity, PH, specific gravity, protein, glucose, blood and nitrites

what does a urine culture and sensitivity test do?

identifies pathogens and antibiotic sensitivity

what does a 24 hr urine collection test do?

measures creatinine clearance, protein, calcium, and uric acid

what does a urine cytology test do?

detects abnormal or malignant cells

what does an ultrasound detect?

a noninvasive procedure that detects obstruction, cysts, stones or masses

what does a CT scan detect?

detects tumors, calculi, abscesses and need to check contrast allergy and renal function before doing

what does an MRI detect?

evaluates soft tissue and vessels; avoid in patients with metal implants or pacemakers

what does a KUB-X-ray detect?

simple radiograph for stones and structural abnormalities

what does an IV pyelogram (IVP) visualize?

visualizes urinary tract with contrast dye; assess allergy and renal function pre/post

what does a voiding cystourethrogram evaluate?

evaluates reflux or obstruction during voiding by using contrast

what does a renal arteriogram outline?

outlines renal blood vessels; post-care includes pulse checks and site monitoring

what does a cystoscopy visualize?

direct bladder visualization; post-procedure burning and pink urine common

what is a renal biopsy?

needle sample for diagnosis; monitor for bleeding, flank pain, hematuria post-test

what is a nuclear renal scan?

uses radioisotopes to assess renal perfusion and function

what are nursing considerations for diagnostics?

assess for iodine/shellfish allergy before contrast procedure, check renal function (BUN, creatinine) before and after contrast imaging, encourage hydration post-procedure to flush contrast dye, monitor for bleeding, infection, and urine changes and provide patient teaching