GU Study Guide

Anatomy of the kidney - Paired, bean-shaped organs. - Kidneys are located outside the peritoneal cavity in the back of the upper abdomen (retroperitoneal) - One kidney located on each side of the vertebral column at the level of the 12th thoracic to 3rd lumbar vertebra. - Blood supply to the kidney comes through the renal artery. - Nephron – this is the functional unit of the kidney Important components: – Glomerulus, a network of capillaries – Renal pyramids, renal cortex and renal medulla – Proximal convoluted tubule – Loop of Henle – Collecting duct – The primary function of the kidney is to filter the blood: Balance body fluids, remove waste products and drugs from the body. – Filtrate is essentially protein free plasma. – It reabsorbs water, electrolytes and other essentials. – Secretes unneeded materials as filtrate (in the urine). – Passing urine is urination (medical term is micturition). Inability to control urination is urinary incontinence. Autoregulatory mechanisms – Juxtaglomerular (JG) Complex • Releases RENIN which initiates the RAAS (renin – angiotensin 1 -angiotensin II – aldosterone system) to regulate BP • Aldosterone acts to regulate sodium & water reabsorption in response to decreased perfusion at the JG apparatus. – Renal clearance – Regulates sodium & potassium clearance. – Regulation of pH. – Uric acid, urea & drug elimination Endocrine function – Hormones: Angiotensin (RAAS) and Erythropoietin (RBCs) – Vitamin D to regulate calcium deposits in bone AND calcitrol is secreted to maintain calcium levels. NORMAL URINE is usually pale yellow to amber and clear. Foamy or bubbly urine indicates proteinuria. URINE TESTS – Urinalysis – indicates what is in the urine (protein, casts, blood, bacteria, etc.) ▪ GFR glomerular filtration rate – is a measure of how well the kidneys are filtering impurities ▪ Creatinine Clearance - is a measure of the amount of urine filtered per minute. Normal is 115-125 mL/min. ▪ BUN – this is a biproduct of protein metabolism – What does the urine eliminate? ▪ Renal clearance – clearing glucose and plasma etc ▪ Regulates sodium and potassium elimination ▪ Regulation of pH to maintain correct acid & bicarb levels ISSUES AND DISEASES: - Nephrolithiasis: Kidney Stones (Renal calculi) … Crystalline structures that form from metabolic salt formation and hypercalcemia. The formation of large kidney stones can block the collecting duct and/or renal pelvis causing postrenal AKI. – S&S = fever, chills, back & flank pain, hematuria – Diagnosis is made through observation of passed stones, ultrasound, & CT scans. – Treatment can include changes in diet, but medical treatment is Lithotripsy. Lithotripsy is a non-invasive procedure that uses shock waves to break up kidney stones into smaller pieces that can pass through the urinary tract. - Urinary tract infections most common cause is bacterial related to Escherichia Coli (E Coli) – Hospital acquitted UTI is when patients have in-dwelling catheters in the hospital. – Other causes can be related to female anatomy, bubble baths, & intercourse. – S&S = Urine retention/decreased output, bladder spasms, bladder pain, cloudy malodorous urine, and hematuria - Pyleonephritis – An infection of the upper tract, particularly the renal parenchyma and renal pelvis. Again, most often caused by bacteria. o S&S include dysuria, hematuria, and melodorous (odd smelling) urine. o Diagnostic tests include: Ultrasound, Abdominal CT scan & observation of passed stones. - Glomerulonephritis • • • • • • Characteristics Hematuria with red cell casts (seen on micro exam of urine) A diminished glomerular filtration rate (GFR) Azotemia (presence of nitrogenous wastes in the blood) Oliguria Hypertension Periorbital edema - Acute Glomerulonephritis – seen primarily in children but can occur in all ages • Generally occurs 7-12 days following infection with pharyngeal Group A β-hemolytic streptococcal infection (occasionally seen with skin infection) • COCA-COLA COLORED URINE Nephrotic Syndrome – leads to massive proteinuria that leads to hypoalbuminemia, lipid uria, generalized edema… Diagnosis is made when Proteinuria >3.5 g/d and presence of hematuria. o Treatment includes: diuretics, corticosteroids & infusion of 25% albumin – Acute kidney infection leads to: fluid retention, electrolyte imbalance and abnormal ammonia levels. - Chronic kidney disease is most often caused by diabetes, glomerulonephritis, and hypertension. - Renal Failure - A condition in which the kidneys fail to: remove metabolic end products from the blood and regulate the fluid, electrolyte, and pH balance of the extracellular fluids. - Labs for renal function include: GFR, creatinine clearance, BUN • Acute renal failure/Chronic renal Failure/End stage renal disease is 2 diagnosed when GFR < 15 mL/min/1.73 m • It is usually accompanied by S&S of uremia • Treatment includes the need to start renal replacement therapy such as hemodialysis (extracorporeal filtration) or kidney transplant. • • • • • • • Common causes of kidney disease include: Polycystic kidney disease Obstructions of the urinary tract Glomerulonephritis Cancers Autoimmune disorders Diseases of the heart or lungs • While there are many causes the two main/most common causes are: Hypertension & Diabetes • S&S include: fluid retention, electrolyte imbalance, abnormal ammonia levels. • Treatment includes transplantation and hemodialysis (extracorporeal blood filtration). -