T4 renal, urinary, CKD

major function of kidneys

control blood pressure

how do kidneys manage water balance

anti - diuretic hormone & aldosterone

nephrotic syndrome

urinary leakage of protein out of kidneys

tea / caffeine

a pt with a hx of kidney stones should avoid

chronic kidney disease

GFR < 60% for at least 3 months

hemodialysis complications

muscle cramps

hypoTN

blood loss

hepatitis b & c

kidney function tests

sodium

potassium

bicarbonate

calcium, total

phosphorus

creatinine

blood urea nitrogen (BUN)

nephrotoxic drugs

antibacterial

• aminoglycosides (‘mycin’)

• sulfonamides (sulfamethoxazole / trimethoprim)

• vancomycin, ciprofloxacin, cephalosporins

antifungals

• amphotericin B

antivirals

• ‘vir’

illegal drugs

• cocaine, heroin

pyelonephritis (kidney infection)

CVA tenderness is a sign of

female midstream clean catch teaching

spread labia & wipe periurethral area front to back using moistened clean gauze sponge

keep labia spread for collection

male midstream clean catch teaching

wipe the glans penis around the urethra

midstream clean catch teaching

NO ANTISEPTICS → false negative results

1. void in toilet for 1-2 sec

2. stop stream

3. collect urine in sterile specimen cup

4. finish voiding in toilet

refrigerate urine immediately on collection

post void residual

catheterize pt immediately after voiding or use bladder scan (ultra sound)

24 hr urine collection

discard 1st void to start test

save urine for 24 hrs

have pt void @ end of collection to complete test

refrigerate or keep on ice

post op cytoscopy

expect pink-tinged urine, burning, urination freqeuncy

call HCP for bright rest bleeding, fever, severe pain

cytoscopy

used to insert ureteral catheters, remove stone, obtain biopsies, treat bleeding

visualizes interior of bladder

outpatient procedure, requires local anesthesia or conscious sedation, lithotomy position

UTI s/sx

lower UTI

• cloudy urine, hematuria, frequency, urgency, suprapubic pressure

upper UTI

• flank pain, chills, fever

older adults

• cognitive impairment → confusion, agitation

UTI prevention

avoid irritants

• bubble baths, douches, sprays, caffeine, alcohol, curies, hot peppers, chocolate

drink cranberry juice or cranberry essence tablets

drink adequate amounts of liquid (2000 mL)

UTI pain

phenazopyridine (AZO) treats what

yuh

im taking AZO for my UTI pain and now my piss is red-orange, is that normal

pyelonephritis s/sx

flank pain

CVA tenderness

LUTS

systemic

• malaise

• chills

• fever

• N/V

pyelonephritis

inflammation of renal parenchyma & collecting system, including renal pelvis

usually ascends from a lower UTI

glomerulonephritis

inflam of the glomeruli

affects both kidneys equally

3rd leading cause of ESRD in the US

glomerulonephritis s/sx

tubular & interstitial changes

vascular scarring & hardening (glomerulosclerosis)

acute

• sudden sympt → temporary or reversible

chronic

• slow progressive → irreversible renal failure

glomerulonephritis risks

diabetic neuropathy

HTN

immunoglobulin A (IgA) neuropathy

scleroderma

SLE

infective endocarditis

viral infections

illegal drug use

nephrotic syndrome

glomerulus permeable to plasma protein causing proteinuria leading to low plasma albumin & tissue edema

nephrotic syndrome s/sx

peripheral edema

massive proteinuria

HTN

hyperlipidemia

hypoalbuminemia

weight gain

ascites

foamy urine

puffy face

kidney stones

what is nephrolithiasis

nephrolithiasis prevention

high intake of water → 3 L / day

• limit sodas, coffee & tea

low sodium diet

dietary restrictions

• purine, calcium, oxalate

nephrolithiasis s/sx

sudden severe pain (renal colic)

ureter stretches, dilates & spasms

N/V, ‘kidney stone dance’, dysuria, fever, chills

moist cool skin

flank pain

cath in NOW

urinary retention emergency

normal post void residual

50 - 75 mL

abnormal post void residual

> 100 - 200 mL

urinary retention s/sx

agitation

confusion

bladder distension

urinary retention prevention

drink small amts throughout the day

be warm when trying to void

avoid excess alcohol

pt teaching if unable to void

drink caffeinated coffee or tea to increase urgency

warm bath / shower

seek medical care

chronic urinary retention teaching

scheduled toileting → q 3 - 4 hrs

catheterization

surgery

drugs

BPH

what condition can cause urinary retention

urinary incontinence → stress

involuntary loss of urine following sudden increase in intra-abdominal pressure

• coughing, sneezing, laughing, lifting, exercise

usually in women

urinary incontinence → urge

associated w/ overactive bladder

involuntary urine loss after a sudden urge to void

urinary incontinence → overflow

involuntary loss of urine when bladder pressure in a chronically full bladder rises to a lvl higher than urethral resistancy

usually in men

urinary incontinence → functional

results from physical, mental, psychological or environmental factors interfering w/ the ability to make it to the toilet on time

urinary incontinence stress mgt

pelvic floor muscle rehab → kegel exercise

surgery to reposition urethra or support the bladder

urinary incontinence urge mgt

bladder training, meds

alpha - adrenergic blockers (doxazosin, terazosin, tamsulosin)

anticholinergics (oxybutynin, tolterodine)

CKD causes

diabetes

HTN

glomerulonephritis

cystic diseases

urologic diseases

CKD clinical manifestations

uremia → GFR ≤ 15 mL/min

fluid retention

waste product accumulation

N/V

lethargy

fatigue

increased BP, BUN, & serum creatine

hyperkalemia → dysrhythmias and other cardiac sympt

hypermagnesemia, HTN

pruritus

BP control

what is one of the most important goals for CKD

CKD assessment findings

uremic frost → white skin ‘crystals’ form d/t high blood urea lvls

• BUN > 200 mg/dl

pale mucous membranes

edema

CKD → hyperkalemia interventions

restrict high potassium foods

sodium polystyrene sulfonate (kayexalate)

• cation - exchange resin

  • bowel changes Na+ for K+ ions

• osmotic laxative action (diarrhea)

patiromer (Veltessa)

• binds K+ in GI tract

• may bind other oral meds

  • take 6 hrs b4 or after → bc it may cause delayed onset

dialysis most effective

CKD → anemia interventions

folic acid supplements

• needed for RBC formation

• removed by dialysis

avoid blood transfusions

• ↑ the development of antibodies

• may lead to iron overload

erythropoietin (EPO)

• given IV or subq

• ↑ hemoglobin & hematocrit in 2 - 3 wks

• SE: thromboembolism, HTN

• use lowest possible dose → contraindicated in uncontrolled HTN

CKD nutrition

protein intake

• norm for stages & HD pt

• ↑ for HD pt

fluid restriction for HD

• I depends on daily urine O

sodium restriction

• vary from 2 - 4 g/day

• avoid salt substitutes → contain potassium chloride

• avoid high sodium foods

peritoneal dialysis risk → exit site formation

redness, tenderness, drainage

tx w/ antibiotics

peritoneal dialysis risk → peritonitis / exit site or tunnel infection

abd pain, rebound tenderness, or cloud effluent w/ ↑ WBCs or bacteria, may have fever

GI

• D/V, distension

tx w/ antibiotics

repeated infections may cause adhesions

hemodialysis vascular access assessments

feel thrill, hear bruit → d/t high velocity of blood flow