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Why is creatinine an important lab value for renal function?Creatinine is removed from the body entirely by the kidneys, so an increased creatinine indicates kidney dysfunction.
What can happen if there is an obstruction in one kidney?Unilateral obstructions may have no signs or symptoms.
What happens to the unaffected kidney when there is a unilateral obstruction?The other kidney compensates and undergoes hypertrophy/hyperfunction to take on the workload of the obstructed kidney.
What are the three types of renal stones? Describe them.<b>Calcium stones (75%)</b>: Made of calcium oxalate or calcium phosphate. Hypercalcemia induced by hyperparathyroidism or immobility increases the risk of obtaining this.<br><b>Struvite-Staghorn stones:</b> Made of magnesium-ammonium-phosphate. Associated with UTIs and have a deer look to them.<br><b>Uric acid stones:</b> Associated with gout (deposits of uric acid in joints, usually the big toe.
What is stress incontinence?Loss of urine with increased abdominal pressure. Can come from coughing, lauging, or exercise.
Why might women be more at risk for stress incontinence?Women often encounter weakening pelvic floor muscles and bladder tone through pregnancy.<br>Further, a change in angle between the bladder and urethra can make for easier emptying of the bladder.
Describe the pathophysiology of a CAUTI.Bacteria attach to the catheter and form a biofilm that coats the catheter with colonies of bacteria.<br>The bacteria travel up the catheter leading to infection.<br>It makes up about 40% of HAIs.
Why is it hard to treat a UTI in patients with a foley catheter?Biofilm coats the catheter making it hard to treat.
What is nephrotic syndrome?A condition where the glomerulus has suffered damage and increases in permeability. This leads to a large loss of plasma proteins to the urine.
How does nephrotic syndrome cause edema?"The increased filtration of plasma proteins due to the increased permeability of glomerular capillaries causes decreased plasma oncotic pressure in the blood.<br>The decreased oncotic pressure decreases total plasma volume and lowers blood pressure.<br>The lowered plasma volume increases aldosterone production and ADH, causing sodium and water retention.<br>Retaining water along with the loss of plasma proteins leads to edema.<br><img src=""paste-6c6cec24c494518fc8459853f90839ab6b924528.jpg"">"
What does strep have to do with kidney disease?After strep infection, antigen-antibody complexes deposit in the glomerulus<br>This triggers inflammation, activation of complement, and inflammatory mediators.<br>The inflammatory response leads to glomerular damage, cell proliferation, decreased GFR, and increased permeability of the glomerulus.
What changes in the nephrons when a patient has high blood sugar/irritants?"Increased glucose increases blood flow to the glomerulus, increasing filtration pressure.<br>The increased filtration pressure causess capillary pores to grow and leak protein in the urine<br>Glucose incorporates in the glomerular tissue and tubular endothelial cells increase the reabsorption of proteins leading to nephron damage.<br><img src=""paste-7d262b2f5ab0d40e90d3c5840d35cba39dffbb63.jpg"">"
How does the kidney change due to chronic hypertension?There are sclerotic changes in the glomerulus and arterioles.<br>There is a change in glomerular structure and function<br>The kidneys decrease in size<br>Decreased perfusion of the kidney leading to ischemia and tubular atrophy<br>This can lead to end-stage renal disease
How can we detect diabetic glomerulosclerosis in patients early?Microalbuminuria is the first sign of diabetic glomerulosclerosis.
What is happening in the body during diabetic glomerulosclerosis?Prolonged exposure to irritants like sugar increase the filtration rate of proteins due to increased filtration pressure.
What is RIFLE criteria and how is it used?"It is a method to classify AKIs.<br><img alt=""RIFLE Criteria and AKIN Classification • LITFL • CCC Renal"" src=""RIFLE-criteria.jpg"">"
What happens during the initiation stage of acute tubular necrosis?<b>It is the time (24-36 hours) from the precipitating event to tubular injury.</b><br>The speed of onset is determined by the cause and underlying health or kidneys.<br>You can prevent injury at this phase.
What is the extension phase of acute tubular necrosis?It is the period of inflammation and cell injury.
What is the oliguric phase of acute tubular necrosis?The phase of ongoing renal dysfunction with the most severe symptoms. It can last weeks to months. There is little to no urine produced.
What happens during the recovery stage of acute tubular necrosis?There is tubular epithelial repair/regeneration.<br>Diuresis occurs to balance out, but it could be too much and you can lose a lot of fluid/electrolytes.
What is acute tubular necrosis?A common type of intrarenal syndrome that is either nephrotoxic or ischemic to the kidney tubules.
Describe the pathophysiology of hemolytic uremic syndrome.The causal agent triggers inflammation in the glomerulus and toxins bind to glycoproteins.<br>Glomerular arterioles swell and occlude the glomerulus with platelet/fibrin clots<br>This<b> decreases GFR</b>, causes hematuria and proteinuria<br>The platelets being used up causes<b> thrombocytopenia</b><br>Damage to erythrocytes causes <b>hemolytic anemia</b>
What electrolyte imbalance that occurs with CKD can lead to cardiac dysrhythmias?Potassium retention and hyperkalemia leading to cardiac dysrhythmias.
What substance produced in the body is the main culprit of causing glomerular hypertension?Angiotensin II
How is a patient treated/managed with end-stage CKD/stage 5?<b>They need dialysis/renal replacement therapy to survive.</b><br>They are given:<br>Recombinant erythropoeitin<br>Phosphate binding agents<br>Calcium supplements<br>Sodium bicarbonate<br>A fluid and sodium restriction<br>A renal diet<br>Hyperkalemia management<br>Monitored drug levels and dosing<br>Managed BP, BG, and hyperlipidemia
What are indicators for emergency treatment of CKD?Hyperkalemia<br>Fluid overload (trouble breathing)<br>Mental status changes are potentially life-threatening<br>Dialysis
How can the heart be impacted by kidney disease?Disruption of sodium and water balance can cause hypertension, increased RAAS activity and fluid retention, making it harder for the heart to pump.<br>Sodium and water retention increases vascular volume, causing edema and fluid volume overload/congestion.<br>The stress in addition to low vitamin D, abnormal calcium/phosphate levels can cause valvular disease and valve calcification.
What are some general labs that would be typical of CKD?<div><b>Phosphate: </b>High (normal 2.5 – 4.5 mg/dL)&nbsp;</div><div><b>Potassium:</b> Hyperkalemia (normal 3.5 – 5.5 mEq/L)&nbsp;</div><div><b>Calcium:</b> Hypocalcemia (normal 8.6 – 10.3 mg/dL)&nbsp;</div><div><b>Urine albumin to creatinine ratio UACR:</b> High (normal &lt; 30 mg/g or less)&nbsp;</div><div><b>Vitamin D:</b> Low&nbsp;<br></div>