n351: renal disorders

kidneys attached to

abdominal wall at last thoracic & first 3 lumbar vertebrae

kidneys enclosed in

renal capsule

cortex surrounds

medulla

cortex

outer layer of renal capsule

nephron makes up

FUNCTIONAL UNIT of kidney

CVA tenderness

costovertebral angle

• where kidneys sit

function of kidneys

maintain homeostasis

get rid of products of body metabolism

control fluid & electrolyte balance & bp

function of parathyroid horomes & vitamin D

kidneys - excrete

bacterial toxins, water-soluble drugs, metabolites

kidneys - secrete

renin & erythropoietin within body

nephrons composed of

glomerulus & tubules

hoop of henle

filter & concentrate urine

glomerulus

encased in bowman’s capsule

glomerulus filters

fluid out of blood

renal tubules: 3

proximal, distal, henle’s loop

tubules: fluid converted to

urine which then moves to renal pelvis

• flows through ureter, empties in bladder

as fluid flows through proximal tubules

water and solutes are reabsorbed

proximal tubule: fluid not reabsorbed

become urine

• selective reabsorption determine urine concentration

prostate gland surround

male urethra

prostate gland

secretes alkaline portion of seminal fluid

prostate gland: enlarged

men will have trouble urinating

• as you get older, pressure increases on urethra

risk factors associated with renal disorders

frequent UTI

high sodium diet

contact sports, (trauma, injury)

hypertension, family history

med use, associated med conditions

Lasix

diuretic for pts w heart failure, but too much can lead to renal failure

normal renal function tests

BUN

serum creatinine

creatinine clearance

uric acid serum

uric acid urine

BUN stands for

blood urea nitrogen

• 5-20 mg/dL (given tho)

10 to 1

normal BUN and creatinine

urinalysis - description

evaluating renal system, determining renal disease

urinalysis - implementation

wash perineal area, use clean container

obtain 10-15 mL of first morning sample

urinalysis - don’t send urine with

stool, mucus, blood (if menstruating, note on labs)

urinalysis - wipe from

front to back

• must be CLEAN sample

urinalysis - midstream

wipe/clean, void, stop, void into cup

components of urinalysis

physical exam, chemical exam

urinalysis - physical exam

color, clarity, specific gravity (hydrated)

urinalysis - chemical exam

urine pH, protein (NO), glucose (NO), ketones, blood, bilirubin, urobilinogen, WBCs, nitrites, leukocyte esterase

specific gravity - description

measures specific gravity of urine

• evaluates concentrating and excretory ability of kidneys

• hydration status

people with chronic renal disease: specific gravity

LOW value

specific gravity - high indicates

concentrated urine (dehydration)

specific gravity - low value

dilute urine (overhydration)

urine culture & sensitivity - description

looking for microorganisms & determines specific antibiotics that will treat it

urine culture & sensitivity - implementation

urine sample, midstream sample

• can collect with urinalysis

urine culture & sensitivity - clean perineal area & urinary meatus with

bacteriostatic solution

urine culture - forced fluids

may result in hyperdiluted, washed out bacteria

creatinine clearance test - description

blood & timed urine specimen that evaluate kidney function

• drawn at start of test & morning of day that 24 hr urine specimen collection is complete

• all the urine voided in 24 hrs

creatinine clearance test - implementation

encourage adequate fluids, avoid caffeine & certain meds

put it on ice, keep it preserved

creatinine clearance test - meds

check with physician if pt can take ACTH, cortisone, thyroxine

creatinine clearance - purpose

how well blood filtered in glomerulus is clearing or moving creatinine

vs how much concentrated in afferent arteriole

vma (vanillylmandelic acid) test - description

24 hr urine collection to diagnose pheochromocytoma, a tumor of adrenal gland

• identifies assay of urinary catecholamines

vma - implementation

things that can affect adrenal gland ability to produce nepi and epi

• caffeine, cocoa, vanilla, cheese, gelatin, licorice, fruits for at least two days prior and during

• avoid meds for 2-3 as prescribed

• avoid stress, keep them relaxed

uric acid test - description

24 hr urine collection to look at gout & kidney disease

uric acid test - implementation

encourage fluids & regular diet

place specimen on ice or refrigerate

• check w lab ab needing preservative

renal biopsy

take a piece of tissue to check for renal cancer or carcinoma

• invasive, use biospy needle into kidney itself

• CONSENT, bleeding, coagulation studies, risk of infecition

kub (kidneys, ureter, bladder) - description

x-ray film that view urinary system & adjacent structures

used to detect urinary calculi (aka kidney stones)

no specific implementation

intravenous pyelogram (IVP) - description

injection of radiopaque dye that outlines renal system

identifies abnormalities

intravenous pyelogram (IVP) - education

informed consent, assess for allergies to iodine, seafood & radiopaque

inform about possible throat irritation, flushing of face, warmth, or salty taste

renal angiography - description

injection of radiopaque dye through cath for examination of renal arterial supply

• impaired

angiography

looking at vessels with dye

renal angiography - implementation

allergies to iodine, seafood, radiopaque dyes

burning feeling or heat along vessel after injection

assess and mark peripheral pulses

computed tomography: kidney tumor

CT scan

• make sure renal function, GFR is good enough to handle dye

renal scan - description

Iv injection of a radioisotope for visual imaging of renal blood flow

renal scan - implementation

assess allergies

instruct clients that they will be required to remain motionless

instruct clients that imaging may be repeated at various intervals before test is complete

radioactive material will clear in 24 hrs

voiding cystourethrogram

place indwelling urinary cath to sit on bladder

contrast media injected in cath to obtain image of bladder

• issues with detrusor musscle

cystitis urinary tract infections (UTI) - description

inflammation of bladder from infection of obstruction of urethra

cystiti UTI - causitive organisms

E. coli, Enterobacter, Pseudomonas, serratia

UTIs more common in

women due to shorter urethra, close to rectum

• sexually active & pregnant women most vulnerable

causes of cystitis

anything present there/causes moisture buildup

hormonal changes influencing alterations in vaginal flora (menopause)

loss of bactericidal properties of prostatic secretions in men

sexual intercourse

ill fitting diaphragms

use of spermicides

synthetic underwear, pantyhose, wet bathing suits

allergens or irritants

invasive procedure, cath

bladder distention

urinary stasis

prevention of cystitis

good perineal care & wipe from front to back

avoid bubble bath, tub baths, vaginal deodorants

void every 2 to 3 hrs, void and drink water after intercourse

wear cotton pants, avoid pantyhouse, tight clothes

water-soluble lubricants for coitus, especially after menopause

prevention of cystitis - pregnant women

void every 2 hrs

prevention of cystitis - menopausal women

estrogen vaginal cream to restore pH

urosepsis - description

gram - bacteria originating in urinary tract

urosepsis - most common organism

E. coli

urosepsis - most common cause

indwelling cath or untreated UTI in client who is medically comprimised

urosepsis - major issue

ability of bacteria to develop resistant strains

• can lead to septic shock if not treated aggressively

urosepsis - manifestation

fever

urosepsis - management

urine C&S, IV antibiotics until client is afebrile for 3-5 days, then oral antibiotics

urethritis - description

inflammation of urethra commonly associated with STD

may be seen with cystitis

urethritis - men

caused by gonorrhea & chlamydial infection

urethritis - women

feminine hygiene sprays, perfumed toilet paper, sanitary napkins, spermicidal jellies, UTI, changes in vaginal mucosa lining

urethritis - signs and symptoms in men

burning on urination

frequency, urgency, nocturia

difficulty voiding

discharge from penis

urethritis - signs and symptoms in women

frequency, urgency, nocturia, painful urination, difficulty voiding

lower abdominal discomfort

ureteritis

inflammation of ureter that is commonly associated with pylonephritis

chronic pyelonephritis

causes ureter to become fibrotic & narrowed by structure

pyelonephritis

inflammation of renal pelvis & parenchyma, commonly caused by bacterial invasion

• e. coli most common causative agent

acute pyelonephritis often occurs

after bacterial contamination of urethra or following an invasive procedure of the urinary tract

chronic pyelonephritis often occurs after

chronic obstruction with reflux or chronic disorders

acute pyelonephritis - description

short course that recurs as a relaspe of a previous or new infection

can progress to bacteremia or chronic pyelonephritis

acute pyelonephritis - signs and symptoms

fever & chills, nausea, flank pain on affected side

costovertebral (CVA) tenderness, headache, muscular pain, dysuria, frequency & urgency

cloudly, bloody or foul-smelling urine

increased WBC in urine

chronic pyelonephritis - description

slow progressive disease with recurrent acute attacks

causes contraction of kidneys & dysfunction of nephrons, which are replaced by scar tissue

can lead to renal failure

chronic pyelonephritis - signs and symptoms

diagnosed incidentally when client is being evaluated for hypertension

poor urine-concentrating ability, pyuria, azotemia, proteinuria, anemia, acidosis

azotemia

nitrogenous waste buildup

nephrolithiasis

kidney stones (hurt when they move and descend down ureter)

urolithiasis & nephrolithiasis - description

calculi or stones can form anywhere in urinary tract, but most frequent site is kidneys

causes pain, obstruction, tissue trauma with secondary hemorrhage & infection

determining kidney stone location

KUB film, IVP, CT scan, renal ultrasonography

stone analysis done after passage of kidney stone

determines type of stone, assist in treatment

urolithiasis refers to

formation of urinary stones

• urinary calculi formed in ureter

nephrolithiasis refers to

formation of kidney stones

• kidney stones formed in renal parenchyma

hydroureter

calculus occludes the ureter & blocks flow of urine, ureter dilates

if obstruction not removed

urinary stasis results in infection, impairment of renal function on side of blockage, resultant hydronephrosis & irreversible kidney damage

urolithiasis & nephrolithiasis - causes

family history

diet high in calcium vitamin d,m milk, protein, oxalate, purines, alkali

purine-rich food

obstruction & urinary stasis

dehydration

use of diuretics

UTIs, prolonged urinary cath

immobilization

hypercalcemia & hyperparathyroidism

elevated uric acid levls, as in gout

urolithiasis & nephrolithiasis - signs & symptoms

renal colic symptoms

ureteral colic

sharp, severe pain of sudden onsent

dull, aching kidneys

nausea & vomiting, pallor, diaphoresis

urinary frequency w alternating retention

signs of UTI

low-grade fever

RBCs, WBCs, bacteria in urinalysis

hematuria

urolithiasis & nephrolithiasis - renal colic

originates in lumbar region

radiates around

• men: side & down towards testicle

• women: bladder

urolithiasis & nephrolithiasis - urethral colic

radiates around genitalia & thigh