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Renal System KSU-Nursing


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How does aging affect the renal system?
-kindeys shrink
-kidneys progressively lose function
-urination changes

how do nutritional changes affect the renal system?
-ingestion of protein causes progressive damange to the glomeruli

what percentage of nephrons are housed in the cortex?
what percentage of nephrons are housed in the medulla?
What is the function of the cortex?
extretory and regulates eletrolytes
what is the function of the medulla?
concentrates and dilutes.
what does the afferent arteriole do?
supplies the glomerulus with blood
what does the efferent arteriole do?
drains blood from the glomerulus
what is the bowman's campsule?
responsible for formation of the ultrafiltrate from blood
where the filtering takes place
what is absorbed in the proximal tubule?
65% of the H2O is absorbed here. reabsorbs Na, Cl, K, bicarb, glucose, urea, and amino acids
when glucose is above 300 what occurs?
the glucose will spill out into the urine
what determines the rate of blood flow through the glomerulus?
blood pressure
what is a normal GFR?
125 ml/min
define GFR
the volume of plasma filtered from the glomerular capillaries into Bowmans capsule each minute.
what affects GFR?
-renal blood flow
-permeability of glomerular membrane
-# of working nephrons
-resin and angiotensin system
-cardiac output

what eletrolytes are regulated by the kidney?
K, Ca, Mg, Na, Cl
What are the functions of the kidney?
-fluid and electrolyte regulation
-acid base balance
-excretion of wastes
-regulation of BP (by resin andgiotensin system)
-stimulation of RBC production

what does a elevated serum creatinine mean?
kidneys are not working correctly.
why should patients not been given Mg or K if their kidneys are failing?
Because they cannot filter and excrete them properly so they can build up in the body.
what are some functions of the kidney?
-regulation of calcium and phosphorus
-excretion of foreign chemicals
-vitamin D metabolism
-synthesize hormones
-insulin degradation

describe the renin angitensin system
low bp via afferent vessels cause the kidneys to release renin which turns angioteninogen into angiotensin I and angiotensin I is converted to angiotensin II via angiotensinase which causes aldosterone to be released from adrenal cortex. This causes the increase of BP by vessel contriction and aldosterone stimulates the kidneys to absorb more Na and water which raises BP.
Where do Sartins function in the renin-angiotensin system?
sartins stop angiotensin II from releasing aldosterone.
where do ACE inhibitors function in the renin-angiotensin system?
ACE inhibitors inhibit the enzyme that turns angiotensin I to angiotensin II.
How do you do a 24 hour creatinine test?
collect urine for 24 hours. make sure you throw the first urine sample away and collect the rest of the urine for 24 hours and put on ice. draw serum creatinine to determine GFR
what happens to the hgb and hct when the kidneys are not functioning correctly?
the Hgb and Hct will be decreased because the kidneys are not producing eyrthopoieten which triggers the bone marrow to make RBCs
What information do you get from an urinalysis?
-specific gravity
-ketones (glucose >240)
-leukocyte esterase

what is cystitis?
inflammation of the lining of the urinary tract caused by bacteria, usually E.coli (80%)

also called a UTI

what are some causes for cystitis?
-descending bacteria
-ascending bacteria
-poor perineal hygiene
-post menopause
-indwelling catheter

what are the symptoms of cystitis?
cloudy urine

what is stress incontinence?
the involuntary loss of urine during activities that increase abdominal and detrusor pressure

causes: sneeze, cough, laugh

urge incontinence
the involuntary loss of urine associated with a strong desire to urinate

causes: bladder or spinal cord lesion

overflow urinary incontinence
the involuntary loss of urine associated with over distension of the bladder when the bladder's capacity has reached it maximum.

causes: patients with neurogenic bladder or enlarged prostate

functional incontinence
when a person cannot physically get to the bathroom.

causes: broken hip or knee or leg.

drug incontinence
occurs when a patient is on a certain drug such as
alpha adrenergic blockers

what is glomerulonephritis?
inflammation and increased cells in the glomeruli in both kidneys caused by an immunologic response

can be acute or chronic

usually caused by the strep bacteria

acute symptoms of glomerulonephritis
-hx of strep infection -fever, chills, nausea, vomiting, anorexia -edema -CHF symptoms -pleural effusion -hematuria -proteinuria -oliguria (
chronic symptoms of glomerulonephritis
-headache in the morning
-abdominal/flank pain
-blurred vision
-manifestations of CHF
-mental cloudiness
-metallic taste in mouth

Diagnosis of Glomerulonephritis
-Urine analysis
-lab results
-elevated antistreptolysin
-decreased GFR
-decreased Hgb and Hct
-increased BUN and CR
-increased WBC
-increased specific gravity
-positive for strep
-decreased urine output

what is pyelonephritis?
bacterial infection of the renal pelvis, tubules, and interstitial tissues in the kidney.

usually caused by E.coli

can be acute or chronic

nephrons are replaced by scar tissue

risk factors for pyelonephritis
-ecoli infection (primary rx)
-renal calculi

acute symptoms of pyelonephritis
-enlarged kidneys
-parenchymal abscess
-accumulation of polymorphonuclear lymphocytes
-high fever
-flank pain
-cloudy, blood, foul smelling (dead fish) urine
-tenderness, colicky pain

chronic symptoms of pyelonephritis
-may have no symptoms
-may be discovered by HTN
-less painful

what is urolithiasis?
urinary calculi- presence of a stone anywhere in the urinary tract. stones may be composed of
-uric acid

risk factors of urolithiasis
-men 30-50 years of age
-previous hx
-hydration status
-metabolic disturbances
-livinig in the stone belt
-high diet in purines
-neurogenic bladder
-hx of female genitalia mutilation
-medications (ie. Ca supplements)

signs and symptoms of urolithiasis
-urine retention

why should you use a thiazide diuretic for kidney stones?
because it gets rid of excess calcium.
what are some risk factors for bladder tumors?
-tobacco use
-toxins in environment esp work related
-chronic UTIs
-most sommon cancer in males
-usually >60 yrs age

what are the signs and symptoms of bladder tumor?
-painless hematuria
-frequency, urgency, dysuria
-changes in voiding patterns

risk factors for renal tumors
-develop in tissues that collect urine
-associated with bladder cancer
-90% develop in surface lining cells
-unknown cause
-more likely in white males 60-70 yrs old
-balkan descent
-family hx
-over use of analgesics
-recurrent kidney stones

signs and symptoms of renal tumors
-bladder irritation
-pelvic pain
-painlenss hematuria
-flank pain
-palpable abd mass
-weight loss

what is a cutaneous ureterostomy?
ureters are brought out to skin in one or more stomas
what is a ileal conduit?
most common and permanent
ileum with a blood supply acts as a reservior as urine flows freely through a stoma to a pouch
what is a continent urostomy?
ureters drain into a reservoir that has a valves stoma and the stoma is cathed to remove urine
what is benign protatic hyperplasia? (BPH)
enlargement of the prostate gland.
what is the Prostate specific antigen assay? (PSA)
this is a test for prostate cancer. if the levels are >4 the chances of the male having prostate cancer is great.
what causes BPH?
testosterone causes the prostate tissues to enlarge
what medicine is usually given to BPH patients to help them urinate?
alpha adrenergic blockers are given to male patients to help relax smooth muscle of bladder
what is the number one killing cancer in men and women?
lung cancer
what is the most common cancer in men?
prostate cancer
What is Acute renal failure?
-sudden onset, but reversible
-oliguria, nonoliguria and azotemia
-four stages
-symptoms vary
-goal is to keep patients alive until the lesions on the kidney heal.
-40-60% mortality

what is chronic renal failure?
-slow progression

What are the symptoms during stage 1 and 2 renal failure?
BUN and creatinine may be normal or slightly high
patient is asymptomatic
unaffected nephrons
decreased GFR
BP increases

what are the symptoms are stages 3 and 4 in chronic renal failure?
>75% of renal tissue is dstroyed
GFR is decreased
increased BUN
increased creatinine
may have anemia
decreased Hgb and Hct
azotemia is mild
nocturia and polyuria
decreased appetite

what symptoms occur in stage 5 renal failure?
the nephrons of the kidney do not work
patient needs dialysis or transplant to live
what is the renal diet?
fluid restriction 1000-1500cc per day
low protein diet 60-80 grams if in early stage CRF
high protein if in ESRD
low potassium (60mEq)
low sodium (2gms)
increased calories

what are some high food sources of K?
salt substitutes
prune juice
dried beans and lentils
nuts, chocolate, coconut

what are some high food sources of phosphorous?
milk products
chicken an beef liver
whoel grain breads and cereals
peanut butter

what is the purpose of dialysis?
removes excess fluid
corrects acidosis
replenishes bicabonate levels
removes end product of protein metabolism
maintain safe concentration of serum electrolytes

complications of dialysis
pyrogenic reaction
dialyzer reaction
diequlibrium syndrome
cardiac disrhythmias
clotted access

what is an AV fistula?
-an internal anastomosis of an artery and vein
-located in the forearm, upper arm, upper thigh
-initial use 8-12 weeks after surgery

what is a AV graft?
synthetic vessel tubing tunneled beneath the skin connecting a artery to a vein.
located forearm, upper arm, or inner thigh
intial use can be as early as 1-2 weeks but generally 4-6 weeks
some patient may be able to use immediately after surgery

what is a dual lumen hemodialysis catheter?
only use temporarily
can use immediately after placement
should not be used for more than 14 days
locared in the subclavian, internal jugular, or femoral vein
if put in the femoral vein patient cannot be sitting
not very pliable
no cuff to prevent bacterial travel

what is peritoneal dialysis?
the dialyzing fluid is instilled intot he peritoneal cavity via a catheter placed in the abdomen using the peritoneum as the dialyzing membrane
what is continuous ambulatory peritoneal dialysis? (CAPD)
no machine needed
done 4 times a day

what is continuous cycle peritoneal dialysis? (CCPD)
a cycling machine is neede3 cycles are done at night
what are complications to peritoneal dialysis?
catheter problems
hernia formation
respiratory distress
self concept

what are contraindications for peritoneal dialysis?
hx of ruptered diverticula
abdominal disease
respiratory disease
recurrent peritonitis
back problems
multiple abdominal surgeries with scar tissue

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