MS1 - Renal Dysfunction Overview

Renal dysfunction has a major impact on the body’s homeostasis this includes

pH + cardiac function

Primary intervention of renal dysfunction include all of the following EXCEPT:

pulmonary restriction

What should be screened for medical referral?

UTI

Upper urinary tract =

Kidneys / Ureters

Lower urinary tract

Bladder / Urethra

The chief fxns of the kidneys are

control mineral / water balance

filter waste / remove excess fluid from blood

The renal ENDOcrine produces

erythropoietin, calcitrol, and renin

End-stage renal failure can result in

anemia

What is activated from the production of erythropoietin, calcitrol, and renin?

vit D3

Renal ENDOcrine system functions as part of the

RAAS

RAAS

renin - angiotension - alderstone sys

The renin - angiotension - alderstone sys regulates

minerals / BP

Renal EXOcrine secretes

urine

to regulate homeostasis / body fluid vol

NORMAL KIDNEY FUNCTION

involves the regulation of electrolytes, acid-base balance, fluid volume, and waste excretion, maintaining overall homeostasis in the body.

VOLUME ~200 quarts of _________ and ~2 quarts _________

fluid filtered daily; exiting the body

What is the name of the specific kidney function lab?

BUN - Blood Urea Nitrogen

(N = 6-25 mg/dL)

Blood Urea Nitrogen rise with

decreased renal function, principally by decreased renal blood flow

Abnormal levels of BUN may be associated with

mental status changes

No real exercise implications except

those associated with root causes

What is the CRITICAL VALUE for BUN?

>100 mg/dL

What does BUN > 100 mg/dL indicates?

serious impairment in renal function

Creatinine is a normal waste product of

creatine phosphokinase which is used in skeletal muscle contraction

Normal = Male _________ ; Female __________

0.6 – 1.2 mg/dL; 0.5 – 1.1 mg/dL

Rise in creatinine indicates a decline in

kidney function or dehydration

SERUM CREATININE declines associated with

age, pregnancy, liver disease

No real exercise implications except for significant muscle injury – use

musculoskeletal guidelines

What is the CRITICAL value for serum creatinine?

> 4 mg/dL

kidney function affects _____ balance

acid-base

Which populations are UTIs commonly found in?

women and older adults

Anatomical structures makes women more susceptible to UTIs than men. All fhe following increase risk of UTI except:

Female urethra longer

All of the following are general risk factors for______

 Age  Female  Immobility/inactivity  Urinary tests and/or catheterization  Frequently catheterized neurogenic bladder  Atonic bladder  Spermicide use with diaphragm or condom  Uncircumcised penis (1st year)  Hx obstruction  Constipation  Kidney transplantation  Diabetes mellitus  Hx STDs

UTI

For persons with DIABETES MELLITUS INC risk of UTI include all of the following EXCEPT:

impaired renal function

What pathogenesis is associated with renal dysfunction?

 Fecal-associated bacteria  Hospital-associated bacteria

What is the most common route of entry for the pathogenesis?

urethra

The patogenesis may also be

bloodborne or lymphatic origin

UTI s/s include all of the following EXCEPT

No changes in color or odor

REFERRED KIDNEY PAIN from irritated diaphragm can involve

Ipsilateral shoulder / Lumbar back pain

REFERRED KIDNEY PAIN from older adults can involve

 Malaise  Anorexia  Mental status changes

PREVENTION of renal disease include

hydration (8oz/d), urinate after sex, good hygeiene

__________ and _________ is inconclusive for prevention

hormone therapy; dietary manage

Acute pyelonephritis =

kidneys, ASC UTIs, women>men

Chronic pyelonephritis =

Scarring of kidney parenchyma and renal pelvis

 Several diseases may cause/contribute to this renal insufficiency

~25% chronic pyelonephritis =

End Stage Renal Disease (ESRD)

The following are s/s of________

 Abrupt onset

 Fever

 Chills

Malaise

 Headache

 Flank Pain

Murphy’s sign (tenderness over costovertebral angle)

 Bladder irritation (dysuria, frequency, urgency)

acute pyelonephritis

The following are s/s of _______
 Vary depending upon cause

 May not have any symptoms

 Must test kidney function

chronic pyelonephritis

What are the 3 most common causes of chronic kidney disease?

 Diabetes  Hypertension  Glomerulonephritis

CHRONIC KIDNEY DISEASE can be secondary to

Cystic kidney disease, excessive aspirin or acetaminophen use

END STAGE RENAL DISEASE (ESRD) is the final stage of

chronic kidney disease

What should be expected with exercise for ESRD?

compromised autonomic function

Compromised autonomic function is associated with

cardiac mortality

esp, diabetics (monitor glucose levels)

Perceived exertion rating scale (RPE) is preferred for

prescribing exercise intensity

Exercise is associated with improved

autonomic cardiac function

For ESRD, Exercise testing is

not generally recommended

What guidelines for exercise is typically used for patients with ESRD?

 Exercise 4-6x/week  Slowly build to 30 minutes  Low intensity, especially on dialysis days  RPE scale monitoring intensity  Do not exercise BP > 200 systolic; 110 diastolic mmHg

ESRD LABORATORY VALUES may have low normal ______ and high normal ______ with abnormal ________.

Hgb & HCT; creatinine & BUN; electrolytes

Critical Low Hemoglobin

< 5 g/dL

Critical High Hemoglobin

>20 g/dL

Critical Low Hematocrit

< 15%

Critical High Hematocrit

> 60%

ELECTROLYTE PANEL

 Sodium (Na)  Potassium (K)  Calcium (Ca)  Chloride (Cl)  Phosphate (PO4 )  Magnesium (Mg)

Na, K, Ca changes can alter

excitability of neurons and cardiac and skeletal muscles

Na, K, Ca changes can alter the excitability of neurons and cardiac and skeletal muscles can result in

 Arrhythmias  Weakness  Spasms  Tremors

POTASSIUM (K) critical values =

< 2.5 mEq/L

> 6.5 mEq/L