Medical Renal System
Main function of renal system
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- Lithotripsy
- Several types, new are outside body, old are in water
- What foods are high in oxalates?
- Spinach, Rhubarb, Asparagus, Cabbage, Tomatoes, Beets, Nuts, Chocolate, Tea, Worcestershire sauce, Parsley
- What is left in after lithotripsy?
- Self-retaining stent left for 1-2wks to promote sand passage
- Interventions for cystine crystals
- Incr. hydration, alpha penicillamine/tiopionin to prevent cystine crystal., K citrate to maintain alkalinity (keeps K in blood, not urine)
- Hemodialysis vs. peritoneal dialysis in CRF
- Hemodialysis drops potassium levels in 30mins to 2 hrs while peritoneal takes loner.
- why does CRF become a systemic disease?
- damage to other systems secondary to renal failure.
- Treatment of wilms' tumor
- Surgery, radiation, chemotherapy (actinomyvcin D and vincristine)
- How is wilms' tumor usually detected?
- Abdominal swelling and distention
- common causes of ARF in elderly
- Already low GFR, hypotension, dehydration, diuretics, aminoglycoside therapy, obstruction such as BPH
- Stage 1 of ARF
- Oliguric phase, secondary to reduction in GFR
- Tx of poststreptococcal glomerulonephritis
- Diuretics, sntihypertensives, restrict protein if BUN elevated.
- Mineral changes in CRF
- elevated potassium/magnesium, changes in calcium, sodium is normal to low, metabolic acidosis., altereed carb. metabolism, elev. triglyc.
- Predisposing factors for cystine crystals
- Genetic (recessive), Defective cystine absorp. in GI/Kidney, Acidic urine.
- effects of ARF on patients
- alt. mental status r/t uremia, alt. sensory perception, alt. thought process, fatigue, anxiety, high risk of infection.
- cytotoxic autoimmune disease that affects kidney and lung tissue
- Goodpasture's syndrome
- How should a clean-catch urine sample be acquired?
- Sterile container, cleanse area, pee, then catch
- How do you calculate the fluid restriction for ARF?
- 500-600cc plus previous 24hr output
- Cardiovascular alterations in CRF
- HTN, CHF, uremic pericarditis, accelerated atherosclerosis
- What foods are high in calcium (avoid in calcium phosphate stones)
- Cheese, dairy, Beans (not green), lentils, Fish w/ small bones, Dried fruit, Nuts, Chocolate/Cocoa/Ovaltine
- Objective nursing assessment for cystitis
- Fever, hematuria, suprapubic tenderness, lab results, leukocyte esterase (enzyme w/ pus), palpable kidney (esp. Left or entire Right)
- What is cool about pyridium (Phenazopyridine)
- Orange pee!
- 1st stage of CRF
- Diminished renal reserve. Normal BUN and creatinine and absence of symptoms.
- What should you not do to a wilms' tumor?
- PALPATE!
- Predisposing factors for Struvite stones
- 3-4times more common in women than men
- 2 common pre-renal causes
- Hypovolemia, nephrotoxic drugs.
- Normal creatinine
- 0.5-1.5mg/dl
- who has the highest incidence of infection in ARF?
- those in ARF because of surgery or trauma
- Reproductive system alterations in CRF
- infertility and decreased libido
- manifestation of stage 1 ARF
- change in urinary output (oliguria=<400ml), low Na, High K, Low Ca. Uremia--causes confusion!
- Interventions for uric acid stones
- Dec. urinary conc. of uric acids; Alkaline urine with potassium citrate (lowers K), Allopurinol, Decrease urinary purines.
- Length of ARF stage 2
- 1-3wks
- ESRD S&S
- GFR <5-10%, creatinine clearance is <5-10ml/min. Can't carry out ADLs
- What are predisposing factors for calcium oxalate stones?
- Family hx (independent of urinary PH!)
- 3rd stage of CRF
- ESRD
- acute renal failure
- Rapid decline in function, Elevation in BUN (Azotemia), elevated creatinine, elevated potassium, with or without oliguria.
- Endocrine system alterations in CRF
- present as hypothyroidism even though T3,T4 levels are low to normal
- What is metastatic calcification
- Calcium phosphate deposts in soft tissue, common sites are blood vessels, joints, lung, muscles, myocardium, eye (uremic red eye)
- How long can it take for full recovery from ARF?
- 12 months
- WHen does recovery phase of ARF begin?
- When GFR increases so that BUN and creatinine levels stabilize and then decrease
- Signs of bladder cancer
- Lots/painless hematuria.
- In whom does goodpasture's syndrome occur?
- It's rare, mostly in young males who smoke
- When urine is more acidic, what is less soluble?
- Uric acid and crystalline.
- Skin alterations in CRF
- yellow color from urinary chromogens, pruritus from dry skin/calcium phosphate deposits, dry brittle hair, alopecia.
- What does acute poststreptococcal glomerulonephritis cause?
- inflammatory mediators, GFR decreas, leaky capillaries, incr. permeability of glomerulerus to larger proteins.
- Post-op urinary retention causes
- Hypovolemia, atropine/anesthesia, sedatives, sweeling/irritation from foley, supine position.
- Incontinent urinary diversion
- Diversion to the skin such as ileal conduit where 6-8in of ileum used as conduit for drainage. Ureters to colon, brought out.
- What is produced by the kidneys that regulates RBC and blood volume
- Erythpoietin
- uremia
- symptomatic asotemia
- Tx for glomerulonephritis
- Rest, na/fluid restrict, diuretics, antihypertensives, protein adjust...Renal pts should have low protein diet.
- Normal BUN:Creatinine ratio
- 10:1
- What is the most common kidney stone (35-35%)
- Calcium Oxalate
- How are small kidney stones removed?
- Cystoscopy (general or local anesthesia)
- What is osteitis fibrosa?
- Calcium reabsorption from the bones and replaced with fibrous tissue
- How is bladder cancer classified?
- Jewett-Strong-Marshall system of superficial, invasive and metastatic based on invasion of tumor into bladder wall.
- In whom is wilms' tumor most common?
- Infants and children (40% is hereditary)
- Nursing implementations for kidney stones
- Bed rest, hydration, turn q2h to move stone, strain the urine, educate re diet, PH, urinalysis
- Progressive, irreversible destruction of the nephrons
- Chronic renal failure
- Causes of urinary retention
- antiypertensives, antiparkinsonian, antihistamines, anticholinergics, antispamodics, sedatives, anesthetics
- What is osteomalacia
- Lack of mineralization in new bones
- Neurological alterations in CRF
- Anxiety, alt. mental stat., hallucinations. Peripheral neuropathy, dialysis encephalopathy.
- What type of stone composes 8-10% of all stones?
- Calcium Phosphate.
- Uric acid stones compose what percentage of all stones?
- 5-8%
- Main function of renal system Main function of renal system
- Regulate volume and composition of ECF, excrete waste products.
- When is nephrolithiasis most common?
- Summer (dehydration), industrialization increases too.
- What is the most common cause of death from ARF?
- Infection
- Normal BUN
- 10-30mg/dl (affected by protein
- Continent urinary diversion
- Intra-abdominal reservoir that is catheterizable or dumps into the anus. Bowel segments often used
- 2nd stage of CRF
- Renal insufficiency
- presentation of cystitis
- Frequency, urgency, suprapubic pain/spasms, dysuria, foul-smelling urine, pyuria.
- Normal creatinine clearance
- 85-135ml/min (approximates GFR)
- How are large stones removed?
- Cystolitholapaxy (Crushed by lithotrie, then bladder irrigated to remove sand.
- what is IVP
- intravenous pyelogram - localize degree/site of obstruction and confirm stone presence (Dye given in AC vein)
- Complications of PNL
- infection, bleeding, adjacent structure damage
- Diagnosing cystitis
- Clean-catch urine for WBC >100,000/blood, culture. (if negative, may be caused by irritants.
- Stage 2 of ARF
- Increase urine (1-3L/day or more), inability to concentrate urine, low creatinine clearance, high BUN, high serum creatinine.
- What foods are high/moderate in purines?
- Sardines, herring, Mussels, Meat-based soups, Organ meat (sweetbread,kidney, liver), Game (goose, venison). AVOID IN URIC ACID STONES
- At what ages is nephrolithiasis most prevalent?
- 29-55
- Post-op care for bladder cancer tx
- Lots of PO water, I&Os, avoid alcohol, analgesics, stool softeners, sitz baths (relax muscles, dec. urine retention), routine cystoscopies.
- causes of Neurogenic bladder
- CVA, CNS tumors, MS, DM neuropathy, spinal cord injury
- Glomerulonephritis
- Inflammation of golmerula, immune disorder process and results in slcerosis, scarring, renal failure
- When can you not use ICP
- when pt. is on dialysis
- Stones in the renal pelvis may need what procedure?
- percutaneous nephrolithotomy (PNL)
- Interventions for struvite stones
- Antimicrobials, AHA (lithostat to decr. pH), surgical removal, acidify urine, cranberry juice
- Therapeutic interventions for calcium oxalate
- Incr. hydration, Decrease oxalates, Thiazide diuretics, Cholestyramine to bind oxalate, Calcium lactate to precipitate oxalate in GI
- Indications for stone removal
- Too large, infection, impairing renal function/lodged in renal pelvis, persistent pain/nausea, pt. has only 1 kidney
- 10-15% of stones
- Struvite
- Pulmonary S&S of goodpasture's
- Insufficiency, crackles, rhonchi
- Respiratory alterations in CRF
- Kussmaul's respirations, pulmonary edema, pleurisy, pleural effusion, dyspnea
- What is PNL?
- nephroscope inserted into kidney pelvis, stones crushed w/ ultrasound, wash remove sand.Tube left in to remove fragments so ureter is patent
- Intravesical therapy
- Instilling chemo right into the bladder, retain 2 hrs, turning q15ming--weekly for 6-12wks.
- System that controls BP
- Renin-angiotension-aldosterone (RAAS)
- GI alterations in CRF
- total tract inflammation secondary to anemia.
- Presentation of neurogenic bladder
- urgency, frequency, incontinence or inability to urinate.
- Pyelonephritis
- Bacteria traveled to kidney, inflammation of renal parenchyma and collecting system (including renal pelvis)
- Nutritional therapy for ARF
- low protein 1-1.5g/kg, 35-55kcal/kg body wt of non-protein, 20-40% of total calories by fat, restrict sodium to prevent CHF, HTN
- signs of glomerulonephritis
- RBC, WBC, casts, proteinuria, hematuria, incr. BUN
- Tx for bladder cancer
- Remove bladder, TUR (transurethral resection), laser surgery, open loop resection,
- What are 3 causes of kidney infections?
- Indwelling cath, neurogenic bladder (can't regulate emptying), urinary retention.
- What bacteria are urea-splitting?
- Protein, Klebsiella, pseudomonas, some staph.
- What is the most sensitive renal function test?
- Creatinine
- Normal GFR
- 125ml/min
- Psychological alterations in CRF
- personality and behavioral changes, labile emotions, withdrawal, depression.
- What do infected kidney stone look like?
- Stag-horn appearance
- How to do a 24hr urine sample
- Urinate and discard 1st specimen. This is start time. save all the next urinations.
- How to avoid UTI recurrence
- hygiene, empty bladder before/after sex, void q2h, hydration, avoid right clothing
- S&S of poststreptococcal glomerulonephritis
- Proteinuria, hematuria, edma, HTN, increased BUN
- Care of ARF patients
- Treat cause, fluid restriction, nutrition therapy, lower potassium, calcium supplement, TPN/enteric feeding, dialysis.
- Where is the highest incidence of nephrolithiasis?
- Southweat, Southeast, Midwest.
- Renal S&S of goodpasture's
- Hematuria, proteinuria, renal failure, elevated BUN and serum creatinine
- Tx of goodpasture's
- Plasmaphoresis (remove antibodies from circulation), immunosuppressants, dialysis, kidney transplant
- Wilms' tumor
- Cancerous encapsulated tumor on kidney.
- Kidneys regulate acid/base: what is acid and what is base?
- Potassium=acid, bicarb=base
- Most common type of bladder cancer
- Transitional cell carcinoma
- Cystitis
- Infection or inflammation of bladder wall (more women than men)
- Ways to reduce potassium
- IV insulin (moves K into cells), sodium bicarb, calcium gluconate, dialysis, sodium polystyrene sulfonate (kayexelate), 4-50mEq diet restrict.
- S&S of renal insufficiency (2nd stage)
- GFR is 25% of normal, BUN/creat increased. Easily fatigued, HA, pruritus, Nausea. When decr/ conc., polyuria/nocturia develop
- What is less soluble the more alkaline the urine?
- Calcium and phosphate
- What are predisposing factors to calcium phosphate stones?
- Alkaline urine, primary hyperparathryoidism
- What is common after lithotripsy?
- Hematuria (bright red, turning dark/smokey over time)
- How do bacterial infections affect urine?
- cause urine to be more alkaline and contribute to stone formation
- Acute poststreptococcal glomerulonephritis
- GABHS travels to kidneys 5-21 days after tonsil/throat infection or impetigo. Antibodies to strep antigen deposit in glomeruli.-inflam.
- Predisposing factors for uric acid stones?
- Jewish Males (35-55), Gout, Acid urine, inherited condition.
- Symptoms of kidney stones
- Back/flank pain, hematuria, renal colic, N/V, shock (cool, moist skin), ureterovesical junction=pin radiate to testicles, labia, groin.
- Causes of urethral obstruction
- Congenital, BPH, fecal impaction, tumor, psychological problems.
- What kidney stones are only 1-2%?
- Cystine
- signs of pyelonephritis
- leukocytosis, shift to left w. banded neutrophils, bacteruria, hematuria, cast cells (in shape of tubules)
- How much cardiac output goes to kidneys?
- >15% (20-25%)
- Kidneys have a role in activating what vitamin?
- Vitamin D
- Term for kidney tone disease
- Nephrolithiasis
- Musculoskeletal system alterations in CRF
- lack of vit. D metab,/calcium=osteomalacia, osteitis fibrosa, metastatic calcification.
- What are therapeutic measures for calcium phosphate stones?
- Treat the underlying cause (parathyroid removal), acidify urine
- What is retrograde pyelogram
- Dye directly into kidney, can be used in pts. with kidney disease