NPTE -Renal

Ftn of the kidneys

Filter blood (remove waste, excess electrolytes)

Regulate fluid balance and BP (via renin-angiotensin system)

Control acid/base balance (via H+/HCO3-)

Produce erythropoietin (stimulates RBC production)

Activate Vitamin D (important for Ca absorption)

Kidneys main function

Main filtration organs

Nephrons

Functional unit of the kidney

Ureters

Carry urine from kidneys to bladder

Bladder

Stores urine

Urethra

Empties urine from bladder to outside

Blood Urea Nitrogen (BUN)

Normal: 10-20mg/dL

If high = renal dysfunction/dehydration

Creatinine

Normal: .6-1.3mg/dL

If high = impaired kidney ftn

Glomerular filtration rate (GFR)

Normal: >90mL/min

<60 = chronic kidney disease (CKD)

Urinalysis

Should be clear, not protein/glucose

Protein, blood, ketones, bacteria = abnormal

Acute kidney injury (AKI)

Sudden decrease in kidney function

Caused by shock, trauma, sepsis, nephrotoxic drugs

May be reversible with prompt tx

Monitor fluid status, BP, and fatigue level

Chronic Kidney Disease (CKD)

Progressive, irreversible damage over mo-yrs

Commonly caused by diabetes/HTN

CKD stage 1

GFR >90mL/min

often asymptomatic

CKD stage 2

GFR 60-89mL/min

Mild decrease in function

CKD Stage 3

GFR 30-59mL/min

Mod sxs (anemia, fatigue)

CKD Stage 4

GFR: 15-29mL/min

Severe decline

CKD Stage 5

GFR <15mL/min

End-stage renal disease (ESRD)

Dialysis needed

Nephrotic syndrome

Increased glomerular permeability —> proteinuria, hypoalbuminemia, edema

Watch for swelling in LE, especially with prolonged standing

Urinary Tract Infections (UTI)

More common in F

Sxs: urgency, frequency, burning, cloudy urine, LBP

Untreated —> may lead to pyelonephritis (kidney infection)

Renal Calculi (kidney stones)

Sharp flank pain, hematuria, nausea

PT is not typically involved acutely, but may help post-obstruction with mobility and hydration

Dialysis (HD/PD)

Watch for fatigue, hypotension post-tx

Fluid overload

Monitor weight, edema, dyspnea

Anemia

Common

Expect low endurance, modify intensity

Bone demineralization

Due to decreased vitamin D activation

Caution with resistance

AV fistula precautions

No BP, IVs, or heavy lifting on that arm

Electrolyte imbalance

Mm cramping/cardiac changes possible

Na

High: confusion, edema, HTN

Low: confusion, fatigue, hypotension

K

High: arrhythmias, mm cramps, weakness

Low: fatigue, arrhythmias, mm weakness

Ca

High: stones, bone p!, arrhythmias

Low: mm cramps, osteoporosis

Phosphorus

High: weak bones, renal failure

Low: fatigue, confusion

Stress incontinence

Caused by weak pelvic floor —> leaks with pressure

PT management: pelvic floor strengthening (Kegels)

Urge incontinence

Caused by an overactive bladder

PT management: bladder training, urge suppression

Overflow incontinence

Caused by retention —> constant dribbling

Medical referral (often neuro)

Ftnal incontinence

Caused by physical/cognitive barrier to toileting

PT management: environmental adaptation, mobility training

Boards tips pt 1

P! from kidneys often refers to the flank/lower back (T10-L1)

Elevated BUN + creatinine = key indicator of renal insufficiency

ESRD —> no BP measurement in AV fistula arm; monitor fluid overload and fatigue

Schedule PT before dialysis for better tolerance

Hyperkalemia (K+ >5mEq/L) —> life-threatening arrhythmias —> medical emergency

PT addresses pelvic floor, gait/mobility, and behavior modification

Boards tips pt 2

ESRD = stage 5 CKD —> dialysis/transplant required

Avoid overexertion in renal pts —> fatigue is a limiting factor

Post-dialysis = most fatigued, but best BP readings

No BP on AV fistula arm

Monitor fluid shifts and orthostatic hypotension

UTI in the elderly = confusion + back pain (not always fever)

Pelvic floor PT is essential for many forms of incontinence

Flank pain + hematuria = likely kidney issue (stones, infection)