Renal System

GFR declines by __%

50%

________ ability to concentrate urine and clear drugs

decreased

decreased ability to _________ urine and clear ____

concentrate; drugs

renal blood flow perfusion decreased by ___%

50%

most important deficit is _________ which is measures via creatinine clearance

GFR

renal _____ decline

mass and weight

renal tubules develop _______ with retention in the distal tubule

diverticuli

renal blood vessels become ______, twisted, and ______

sclerotic; calcified

ability to concentrate urine ________

decreases

number of filtering units (nephrons) __________

decreases

reduced kidney _________ function

reserve

when older adults undergo minor traumas there is a ______ loss of renal function

major

T/F: ureters do not show change with aging

true

bladder capacity declines from ______ to _____ in the elderly

600mL to 250mL

_______ urinary frequency/urgency increases what

increased; risk of incontinence

in women the urethra _______ (lengthens, shortens) and things with decreased strength of the _________

shortens; urinary sphincter

in men the ________ enlarges which impedes urine flow

prostate

_____ and creatinine increases as ___ declines

BUN; GFR

aging causes what changes in glomeruli

decrease in number and size

absorptive capillaries are _________

greatly reduced

___________ deficiency is a function of renin deficiency

aldosterone

aldosterone deficiency is a function of _______ deficiency

renin

impairments in RAAS seriously impact _______ and dehydration which leads to _________, syncope, and falls

volume depletion; orthostatic hypotension

______ is more common in elderly due to difficulty with filtration

drug intoxicatoin

increased progression to acute/chronic _______

renal failure

increased _________ urine, urinary reflux, and both symptomatic and asymptomatic ____

residual; UTI

incontinence due to _______ following pregnancy

weakened pelvic floor muscles

T/F: hormonal changes, infection, tumors, side effects of medications, bladder, or prostate disease are all common in elderly

true

types of incontinence

stress, urge, mixed, overflow, functional

causes of transient incontinence

DIAPPERS (dementia/delirium, infection, atrophic vaginitis, pharmaceuticals, psychological, excess fluid intake, restricted mobility, stool impaction)

blood flow through the kidneys in mL/min at age 80

600 mL/min

kidney size decreases by this % by age 90

20-30%

smaller thicker vessels with decreased blood flow, increased tortuosity, decline in capillary loops are all changes that occur where

kidney vascular changes

kidney vascular change: increased ________

tortuosity

GFR is at __% the capacity of a 40 year olf by the time we reach __ years old

50%; 75

renal tubules decrease in _____ and increase in ______

number; wall thickness

bladder capacity in the elderly

250 mL

number of stages of CKD, dependent on what value

5 stages; dependent on % of normal GFR

altered renal function may be caused by altered ________

altered cognition

increased residual volume and urinary reflux predispose us to _________

bacteriuria

remaining functional nephrons at age 85

50%

rate of urine flow from bladder to urethra

slowed

__________ indicates deterioration in renal function

elevated creatinine or BUN

renal diverticula _____________

increase

The aging renal system exhibits all of the following changes except:

A. Renal blood flow and GFR decrease by 75%

B. Ability to concentrate urine and to clear medications decreases

C. Increased diverticuli and retention exists in renal tubules

D> Kidney size decreases by 30% by age 90

A

Normal age related changes in the ureters/bladder include all but the following:

A. Minimal to no change in ureters

B. Rate of urine flow from bladder through urethra slows

C. Urinary frequency increases with decreased time from "urge to go" to actually "going"

D. Bladder capacity decreases from 600 to 500 ml

D

Vascular renal aging changes include the following:

A. Glomerular permeability and filtration surface area remain unchanged

B. The number of epithelial and mesangial cells remain unchanged

C. Blood flow through the renal system decreases by 50% in the elderly

D. Renal blood vessels retain normal elasticity

C

In the aging renal angiotensin aldosterone system, the following is true:

A. Renin basal level decreases by 90%

B. There is increased development of fluid and electrolyte imbalances

C. Tubular concentration remains within normal limits

D. Aldosterone deficiency is independent of renin deficiency

B

Transient bladder incontinence (DIAPPERS) may be caused by all of the following except:

A. restricted mobility

B. dementia

C. pharmaceuticals

D. insecurity

D

Physical therapy for the aging GU system includes the following:

A. Decreased physical mobility

B. Avoidance of aerobic activity

C. Biofeedback and therapeutic exercise such as Kegels

D. Long term promotion of incontinence supplies

C

The aging of the renal system contributes to development of chronic renal failure which is monitored by regular labwork for which of the following:

A. BUN (blood urea nitrogen) and creatinine

B. CBC - complete blood count

C. HGB and HCT - hemoglobin and hematocrit

D. ESR - elevated sedimentation rate

A

Aged and altered renal function can result in the following:

A. No alteration of potassium, water or sodium levels

B. Drug intoxication due to decreased renal clearance

C. No risk of progression to chronic or acute renal failure

D. Acid/base stability during periods of physiological stress

B

In the arteriole glomerular unit, aging causes all but the following:

A. Decreased kidney function

B. Decreased glomerular filtration

C. Decreased blood flow

D. Unchanged afferent efferent arteriole anatomic continuity

D

Chronic kidney failure in the aging kidney can be caused by all of the following disease processes except:

A. Glomerulonephritis

B. Diabetes mellitus

C. Osteoarthritis

D. Hypertension

C

renal perfusion rate decreases by ___%

50%

kidney size _______

decreases

by age ___ the number of remaining nephrons decreased by 30-40%

85