Kidney Hormones
Renin |
Raises blood pressure as result of angiotensin (local vasoconstriction) and aldosterone |
Prostaglandins |
Regulate intrarenal blood flow by vasodilation or vasoconstriction |
Bradvkinins |
Increase blood flow (vasodilation) and vascular permeability |
Erythropoietin |
Stimulates bone marrow to make red blood cells |
Vit D |
Promotes absorption of calcium in the GI tract |
Pyelonephritis
Top renal disease |
Inflammation of renal parenchyma and upper urinary tract |
S/S |
Fever, chills, flank pain |
Acute |
Bacteria |
Chronic |
immune disorder |
Urosepsis |
bacteria in urine |
s/s |
lower BP, fever, high HR, lower lOC |
lead to |
septic shock, multisystem failure |
Renal Calculi
Causes |
Male, high sodium, calcium, protien, genetics, dehydration, immobility, gout, UTI |
S/S |
depends on size and location - Upper= flank pain Lower = genital/abdominal pain |
Calcium stone |
60%-80% |
Uric Acid Stone |
low PH, 10% |
Cystine |
genetic, 3% |
Testing |
UA, serum calcium, uric acid, XR, cystoscope |
Surgery |
Lithotripsy - Shock wave stones < 2cm -Percutaneous Nephrolithotomy - stones > 2 cm under GA |
DIet |
2 1/2 - 3L /d, low sodium, low calcium |
IVP |
Intravenous pyelogram to look at kidneys and ureters |
Urine formation
glomerular filtration |
hydrostatic pressure, filters by size |
GFR |
125mL/m / 180L/d - influenced by BP and volume max 70mmhG |
2nd phase |
Tubular moves water back to blood, ADH/ALdosterine increases water reabsorption up to 220mg/d |
3rd phase tubular secretion |
solutes from blood to filter - potassium, iron, keeps homeostasis |
UTI
risks |
Female, increased age, catheters |
S/S |
Dysuria, frequency, urgency, pain, hematuria, suprapubic pain |
Causes |
E. coli |
Complications |
drug resistance, urethritis, pyelonephritis, renal assess |
Urethritis |
inflammation of urethra |
Cognitive issues |
falls, dizzy, lower appetite |
teaching points |
2-3L/D, Void after intercourse, |
Houdini |
Hematuria, obstruction, edema, surgery, end of life care, immobile |
get urine culture |
keep on ice |
TX |
Antibiotics |
Hypo/Hyper
Hyponatremia S/S |
Brain damage, seizures coma |
Hyponatremia TX |
salt, fluid restriction, IV fluids |
Hypernatremia S/S |
coma, seizures, delusions, thirst, tachy |
Hypernatremis Tx |
Increase fluids, decrease sodium, |
Hypokalemia S/s |
short QT, bradycardia |
Hypokalemia tX |
ALBUTEROL, DOPAMINE, DIURETICS, ST |
Hypomagnesium S/S |
HTN, hyperactivity, tachycardia, chvostek |
Hypomagnesium tx |
fall precautions, iv ma sulfate |
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Kidney Structure
Afferent arteriole |
Delivers arterial blood from the branches of the renal artery into the glomerulus |
Autoregulation of renal blood flow via vasoconstriction or vasodilation Renin-producing granular cells |
Efferent arteriole |
Delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta |
Autoregulation of renal blood flow via vasoconstriction vasodilation Renin-producing granular cells |
Glomerulus |
Capillary loops with thin, semipermeable membrane |
Site of glomerular filtration Glomerular filtration occurs when hydrostatic pressure (blood pressure) is greater than opposing forces (tubular filtrate and oncotic pressure) |
Bowman's capsule (BC) |
Thin membranous sac surrounding ⅞ of the glomerulus |
Collects glomerular filtrate (GF) and funnels it into the tubule |
Proximal convoluted tubule (PCT) |
Evolves from and is continuous with Bowman's capsule Specialized cellular lining facilitates tubular reabsorption |
Site for reabsorption of sodium, chloride, water, glucose, amino acids, potassium, calcium, bicarbonate, phosphate and urea |
Loop of Henle |
Continues from PTC Juxtamedullary nephrons dip deep into the medulla Permeable to water, urea, and sodium chloride |
Regulation of water balance |
Collecting ducts |
Collect formed urine from several tubules and deliver it into the renal pelvis |
heceptor sites for antidiuretic hormone regulation of water balance |
Bladder Cancer
Risk Factors |
begins in urothelial cells that line the bladder, men>women, chronic inflammation, carcinogens |
Manifestations |
hematuria, frequent/painful urination, back pain |
TX |
Chemo, radiation, surgery |
Surgeries |
cystectomy, urinary diversion |
neobladder |
no external pouch |
continent diversion |
stoma hiden in. umbilicus |
complications |
bleeding, clots, infection |
Acute renal failure
common in hospitalized patients |
oliguria, prenal |
HTN, lower CU, hypovolemia |
ABG interpretation
Normal |
PH: 7.35 PaCO2: 35-45 HCO3: 22-26 |
Metabolic Acidosis |
Low pH LOW HCO3 |
Metabolic Alkalosis |
High pH High HCO3 |
Respiratory Acidosis |
Low Ph High. PaCO2 |
Respiratory Alkalosis |
High PH Low PAco2 |
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Causes of Nephrotic Syndrome
Primary Glomerular Disease |
Membranous proliferative glomerulonephritis, Primary nephrotic syndrome, Focal glomerulonephritis, Inherited nephrotic disease |
Multisystem Disease |
Lupus |
Allergens |
Bee Sting |
Infection |
Strep |
Neoplasms |
Leukemia |
Drugs |
Penecillin, NSAID |
Acute Glomerulonephritis
inflammation |
3rd cause of kidney failure |
cause |
great b strep, autoimmune - lupus, good pastures |
S/S |
HTN, decrease output, decrease GFR, edema, proteinuria, hematuria, dysuria |
medications |
ABX, diuretics, plasmapheresis, protien restricted diet |
Benign Prostatic Hyperplasia
noncancerous enlargement of prostate |
S/S |
Difficulty urinating, bladder outlet obstruction (BOO) |
DX |
rectal exam, prostate specific antigen |
PSA |
elevates if prostate cancer |
medications |
Finasteride, dutasteride, tamsulosin |
surgeries |
TUIP, go home with foley |
FInasteride |
women don't touch, reduces size |
Tamusolin |
flowback |
TUIP |
incision into prostate to relieve compression and make urine flow easier |
CBI |
continuous bladder irrigation prevents blood clots |
TURP syndrome |
due to prostate irrigation - lower BP, Sodium and Hbg |
Prostate Cancer
slow growing malignant tumor |
risk |
African American, 50 years+ |
characteristics |
slow growing, asymptomatic, can meastitize to lymph nodes, bone, rectum, bladder |
DX |
curable early detection, PSA levels, rectal exam |
TX |
external radiation, prostatectomy, ABX |
teaching points |
symptoms go away 34-48hrs, don't quit ABX |
Urine Retention
<400ml |
Oliguric |
TX |
kiegels, scheduled bathroom, Bethanechol |
Cause |
anticholergenics |
Medications
Cymbalta |
depression, neuropathic pain |
oxybutynin |
decrease muscle spasms in bladder |
Tolterdoine |
overactive bladder |
darifenacine |
treats symptoms of overactive bladder |
Trospium |
overactive bladder |
Salifencin |
neurogenic overactivity |
PKA
common genetic disorder |
cysts |
autosomal dominate |
appears age 30-40 |
s/s |
HTN, obstruction, hematuria, pain |
DX |
UA, blood.bacteria, radiographic |
TX |
dialysis |
labs |
anemia, increases BUN, Creatinine, NA, K, HR, lower CA, fever |
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