Lust 2

Question 1

What are the indicators we use for Kidney Function?

Answer 1

Blood

• Serum Creatinine
  
  • creatinine= breakdown product of muscle
  • completely excreted
  • measure of kidney filtration
  • High Serum Creatinine=Kidney Dysfunction
• BUN=Blood Urea Nitrogen
  
  • High plasma BUN=Azotemia
  • Bad indicator of GFR bc it rises with dehydraiton, high protein diet, or muscle breakdown
• Serum Creatinine=better measure of kidney fxn

Question 2

Other Common Signs of Kidney Disorder

Answer 2

• Physical
  
  • CVA tenderness
• Urine:
  
  • Proteinuria (microalbuminuria)
  • Hematuria
  • positive leukocyte esterase
    
    • _​_measures the amount of enzyme secreted by WBCs
    • high amount=bladder or kidney infection
• Caution:
  
  • IV contrast enhanced imaging studies
    
    • avoid=radiopaque dye cause renal failure
  • Dehydration
    
    • increases the risk

Question 3

Guide to renal disease classification:

Answer 3

• Pre-renal causes
  
  • Cardiovascular
• Glomerular Diseases
  
  • Filtration at glomerular capillaries
  • Reabsorption at peritubular capillaries
• Tubular/Interstitial Diseases
  
  • Epithelial Transport
• Post-renal causes
  
  • Ureter
  • bladder
  • urethra
  • micturition reflex

Question 4

Acute Kidney Injury

Answer 4

• Aka Acute Renal Failure
• decreased glomerular filltration of blood in AKI leads to azotemia, High serum creatinine, and fluid retention
• Abrupt insult to the kidney that causes a rapid decrease in renal filtration funciton (Decrease GFR)
• Accumulation of nitrogen waste products in body due to decline in function
• Common cause
  
  • ischemia of kidney
• Other causes:
  
  • prerenal
  • intrarenal (Glomerular or tubular)
  • post renal
• With Proper interventions, normal renal function can return
  
  • 2 weeks to 3 months of initial event

Question 5

Postrenal Dysfunction

Answer 5

• Caused by:
  
  • obstructive uropathy
    
    • prevents urine outflow from kidneys
• Examples:
  
  • kidney stone
  • prostate gland hyperplasia

Question 6

Nephrolithiasis

Answer 6

• formation of Calculi/stones in the kidney
• stones can travel down ureter or bladder

Question 7

Most common Renal Calculi

Answer 7

• Calcium Stones
• Struvite uric acid stones
• Cystine Stones

Question 8

Renal Calculi

Answer 8

• 75% consist of calcium
• most composed of calcium oxalate

Question 9

What are the different types of Kidney Stones

Answer 9

• Agony
• Pain
• Misery
• Calcium Stones
• Uric Acid Stones
• Struvite Stones
• Cystine Stones

Question 10

Uric Acid Stones

Answer 10

• 10% of kidney stones
• Seen in patients with:
  
  • low urine pH
  • low urine volume
• Associated with:
  
  • Chronic Diarrhea
  • volume depletion
  • high animal protein diet
  • myeloproliferative disorders

Question 11

Calcium Oxalate Stones

Answer 11

• 60-80% of kidney stones
• Most preventable cause:
  
  • dehydration
  • low urine output
• Other factors:
  
  • Diet
    
    • high sodium intake
    • high oxalate intake
    • high protein oxalate

Question 12

Symptoms of Nephrolithiasis

Answer 12

• Pain
  
  • Severe Abdominal Pain
  • Flank pain around to groin
  • Colicky pain caused by ureter spasms
• Hematuria
• Crystalluria

Question 13

Nephrolithiasis: Risk Factors

Answer 13

• Genetic Susceptibility
• Dehydration
• Hypercalcemia-excessive calcium intake
• Hyperparathyroidism
• GOUT
• Hyperuricemia
• Urinary Tract Infection; proteus
• Immobility
• Large quantities of soft drinks

Question 14

Nephrolithiasis: Treatment

Answer 14

• High fluid intake (>3L/day) to flush out stone
• Lithotripsy
• Surgery if not relief
• Strain urine to catch stone
• Save stones for analysis
• Dietary changes to keep urine acidic or alkaline
  
  • depends on stone composition

Question 15

Lithotripsy

Answer 15

• When stone will not pass by itself
• ultrasound shock waves
  
  • breakdown into smaller parts to pass through ureters

Question 16

Nephrolithiasis: Complications

Answer 16

Infection of Hydronephrosis

• Hydronephrosis
  
  • stone causes back pressure in renal pelvis
  • occurs when edema and distention of renal pelvis occurs
• Prolonged hydronephrosis causes:
  
  • compressin of kidney tissue
  • ischemia
  • irreversible kidney damage

Question 17

recall: Urination after ureter

Answer 17

• Default mode is to automatically void bladder when stretched
• Basic reflex is a spinal reflex arc
• Over-ride on external sphincter is CNS controlled
• external sphincter
  
  • skeletal muscle
  • voluntary control
• Bladder at rest: Sympathetic Input Dominant
  
  • relaxed
    
    • Detrusor muscle
  • Contracted:
    
    • ureteral sphincter and internal sphincter
    • ureter
• Micturition Reflex: PNS tone
  
  • actiavted by stretch receptors
  • relaxed:
    
    • sphincters
  • Contracts:
    
    • Detrusor

Question 18

Neurogenic Bladder

Answer 18

• Lack of nerve supply to the bladder
• Person can’t feel when bladder is full
• Must use catheter to void
• Brain
  
  • Cerebral Palsy
  • Dementia
  • Parkinson’s
  • Stroke
• Spinal Cord
  
  • AIDS
  • MS
  • Polio
  • Spinal Cord injury
• Peripheral Nerve/NMJ
  
  • Diabetic neuropathy
  • Myathenia Gravis
  • Pelvic Plexus injury

Question 19

Types of Incontinence

Answer 19

• Stress Incontinence
  
  • increased abdominal pressure under stress
    
    • weak pelvic floor musclees
• Urge Incontinence
  
  • involuntary contraction of bladder muscles
• Overflow
  
  • blocked urethra
• Neurogenic
  
  • impaired nervous system

Question 20

Abnormal Prostate

Answer 20

• Prostatitis
  
  • acute symptoms of urinary infeciton
  • Obstructive symptoms
  • Perineal or suprapubic pain
• Benign Prostatic Hyperplasia
  
  • Most common benign tumor in men
  • Obstructive or irritative voiding symptoms
• Prostate Cancer
  
  • PSA unreliable
  • typically asymptomatic

Question 21

Overactive Bladder

Answer 21

Sympathetic nerve damage

Question 22

Atonic Bladder

Answer 22

Aka Paralytic Bladder

Damage to parasympathetic nerve

Question 23

Signs and symptoms of bladder dysfunction

Answer 23

• Hesitancy
• Urgency
• Frequency
• Incontinence