MedSurg Untested Content

glomerulus

part of the kidney nephron that performs filtration

proximal convoluted tubule (PCT)

part of the kidney nephron that absorbs ions, H2O, nutrients 

• Removes toxins & stabilizes pH 

Loop of Henle

part of the kidney nephron that

• Ascending = reabsorbs Na & Cl 

• Descending = reabsorbs H2O 

distal convoluted tubule (DCT)

part of the kidney nephron that reabsorbs Na & Cl

collecting duct

part of the kidney nephron that reabsorbs Na/Cl/H2O & secretes ammonia/hydrogen/K+

anuria

decreased urine output of less than 50mL in 24hrs 

oliguria

urine output less than 400mL in 24hrs

nocturia

awakening at night to urinate

GFR

amount of plasma filtered through the glomeruli per unit of time  

• >60mL/min 

BUN

end product of protein metabolism 

• 6-24mg/dL 

creatinine (CRE)

waste product of skeletal muscle 

• 0.7-1.3mg/dL 

glycosuria

excretion of glucose in the urine

hematuria

RBCs in urine

bacteriuria

bacteria in urine

proteinuria

protein in urine

azotemia

abnormal concentration of nitrogenous waste products in blood

urinary casts

protein secreted by damaged kidney tubules

large; dilute

high fluid intake = ______ amount of _______ urine

small; concentrated

low fluid intake = ______ amount of _________ urine.

renal clearance

ability of kidneys to clear solutes from plasma 

• 24hr collection = primary test 

vasoactive

prostaglandins released by the kidneys have ________ effects.

decrease

as we age, the number of nephrons in our kidneys ________.

glomerulonephritis

Antigen-antibody complexes in blood are trapped in glomerulus --> inflammation/damage to glomeruli 

• proteinuria, hematuria, cola-colored urine

• edema/HTN

• hypoalbuminemia, BUN/CRE changes, anemia

chronic glomerulonephritis

Kidneys shrink to 1/5 size (fibrous tissue) --> scar tissue --> severe glomerular damage 

• Caused by repeated episodes of acute glomerulonephritis 

• Can lead to stage 5 CKD 

• hypoalbuminuria, hyperkalemia, hypophosphatemia, hypocalcemia, anemia

nephrotic syndrome

Increased glomerular permeability --> massive proteinuria 

• hypoalbuminemia, hyperlipidemia, diffuse edema

polycystic kidney disease (PKD)

• Genetic disorder

  • Autosomal dominant (90%) 

  • Autosomal recessive (10%) 

• Numerous fluid-filled cysts --> destroy nephrons 

• Enlarged kidneys --> kidney failure 

• hematuria, proteinuria, HTN

acute kidney injury (AKI)

Rapid loss of renal function due to damage to the kidneys 

• 50% or greater in CRE above baseline 

• Potentially reversible 

• Prognosis determined by early identification of symptoms/cause and treating before irreversible damage occurs 

• prerenal, intrarenal, and postrenal causes

prerenal

category of AKI causes that account for 60-70% of AKIs

• Hypoperfusion 

  • CO 

  • Hypovolemia 

  • Hypotension 

• Anaphylaxis, sepsis, arrythmias, hemorrhage, GI issues, etc. 

intrarenal

category of AKI causes that are from damage to glomeruli or tubules; acute tubular necrosis (ATN) common 

• Nephrotoxic agents, hemoglobinuria, acute pyelonephritis/glomerulonephritis, etc. 

postrenal

category of AKI causes that are due to an obstruction

• BPH 

• Renal calculi 

• Bladder tumor 

• Blood clots, strictures, etc.  

chroni kidney disease (CKD)

End products of protein metabolism accumulate in blood --> uremia/buildup of waste products 

• GFR for 3+ months 

• Associated w/ 

  • Decreased QOL 

  • Increased healthcare costs 

  • Premature death 

• Untreated or prolonged --> ESRD or ESKD 

diabetes

the number one cause of CKD is _________.

stage 1

stage of CKD characterized by:

• Normal function 

• GFR = 90% or more 

• No specific symptoms but kidney function can slowly decline 

stage 2

stage of CKD characterized by:

• Mild loss of function 

• GFR = 60-89% 

• No specific symptoms but kidney function can slowly decline 

stage 3

stage of CKD characterized by:

• Moderate loss of function 

• GFR = 30-59% 

• No specific symptoms but kidney function can slowly decline 

stage 4

stage of CKD characterized by:

• Severe loss of function 

• GFR = 15-29% 

• Kidney function is very low & treatment may be needed soon 

stage 5

stage of CKD characterized by:

• ESRD 

• Kidney failure 

• GFR = <15% 

• Kidneys can no longer keep up and they are failing 

end stage kidney disease (ESKD)

5^th and final stage of CKD; need dialysis and/or kidney transplant; aka end-stage renal disease (ESRD) 

renal replaceent therapy (RRT)

Initiated when kidneys can no longer remove wastes, maintain electrolyte balance, and regulate fluid balance 

• Acute or chronic 

• Types: 

  • Continuous renal replacement therapy (CRRT) 

  • Hemodialysis 

  • Peritoneal dialysis 

    • Continuous ambulatory peritoneal dialysis (CAPD) 

    • Continuous cyclic peritoneal dialysis (CCPD) 

dialyzer

“artificial kidney”; Synthetic permeable membrane that filters blood and uremic toxins/fluid is removed 

dialysate

solution that circulates through the dialyzer to remove fluid, balance lytes, and correct acidosis

hemodialysis

• Uses 

  • Acutely/urgently 

  • Short-term 

  • Long term/chronic/maintenance (3x/week for 3-5hrs each time)

• Does not cure kidney disease 

• Goals: 

  • Remove toxic nitrogenous substances from blood 

  • Remove excess fluid & correct electrolytes 

• No BP/IV/blood draws on arm w/ fistula or graft 

• catheter, AV fistula, or AV graft

hemodialysis catheter

type of hemodialysis access characterized by immediate access IR 

• Uncuffed (non-tunneled, short-term) 

• Cuffed (tunneled, longer term) 

• Infection risk 

arteriovenous (AV) fistula

type of hemodialysis access that is created surgically, usually in forearm, by joining an artery to a vein 

• Needs 3 months to mature 

• 2 large bore needles used to access w/ each dialysis treatment 

• Always check for bruit and thrill 

• Best option 

arteriovenous (AV) graft

type of hemodialysis access characterized by a synthetic graft used to connect artery and vein 

• Used for pts w/ compromised vasculature  

peritoneal dialysis

• Uses 

  • Pts unwilling/unable to go to HD or kidney transplant 

  • Pts unable to tolerate HD (DM, CVD)

  • Pts at risk w/ heparin (older adults) 

• Procedure: 

  • Peritoneal catheter placed (IR) 

  • Peritoneal membrane serves as a semipermeable membrane 

  • Sterile procedure 

  • Dialysate fluid fills peritoneal cavity 

  • Diffusion & osmosis 

  • Dialysate fluid is drained (should be clear color) 

  • Fill, dwell, drain (8-12hrs overnight) 

• Goals 

  • Remove toxic substances and metabolic wastes 

  • Reestablish normal fluid & electrolyte balance 

• CAPD & CCPD

continuous ambulatory peritoneal dialysis (CAPD)

type of peritoneal dialysis characterized by:

• More freedom and control of daily activities 

• Less lab fluctuations 

• Serious commitment to be successful (4-5x/day 24/7) 

• Infuse dialysate (40 min), dwell (4-5hrs), drain 

• Prevent infection

  • Hand hygiene 

  • Mask 

  • Meticulous care of catheter site 

  • Avoidance contamination of catheter, fluid, tubing 

continuous cyclic peritoneal dialysis (CCPD)

type of peritoneal dialysis characterized by:

• Machine (cycler) provides specific number of fluid exchanges 

• Pt connects (HS) & disconnects (AM) 

• Pt connected while sleeping 

• Extra-long tubing 

• Greater risk for infection than CAPD 

• One extended dwell time during day 

  • Free from daytime exchanges 

peritonitis

acute complication of dialysis in which a serious infection occurs

• 1^st sign = cloudy dialysate solution 

• Abdominal pain, hypotension, shock (later stage) 

• Reaction with abx in solution (intraperitoneal) 

• Malnutrition r/t protein loss 

leakage

acute dialysis complication in which dialysate leaks out through catheter site 

bleeding

acute dialysis complication which occurs in pts w/ new catheter insertion and/or menstruating women