|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
common in hospitalized patients
|
|
|
oliguria, prenal
|
HTN, lower CU, hypovolemia
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
<400ml
|
Oliguric
|
|
TX
|
kiegels, scheduled bathroom, Bethanechol
|
|
Cause
|
anticholergenics
|
|
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
|
|
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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