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Med Surg Renal and Urinary System Cheat Sheet by

Renal and urinary problems

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
AKA Kidney Stones

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
 

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
 

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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