Renal Physiology
Kidney function changes associated with aging
Reduce blood flow to kidneys, Thickened glomerular and tubular basement membranes, decreased tubule length, decreased glomerular filtration rate, nocturnal polyuria, decreased kidney mass, and risk for dehydration.
What is acute pyelonephritis?
A bacterial infection of the renal pelvis, tubles, and interstitial tissue of one or both kidneys.
S/S of Acute glomerulonephritis
Fatigue, HTN, Hematuria, Proteinuria, Decreased urine output, Nausea, Vomiting, Fever, Flu-like Symptoms
Food should be avoid based on the types of stones: Calcium, Uric Acid, Cystine, Oxalate
Calcium: milk, yogurt, cheese
Uric Acid: food high in purine, shellfish, asparagus, mushrooms, organ meat
Cystine: low protein diet
Oxalate: Food high in Oxalate, spinach, swiss chard, chocolate, peanuts, and pecans
UTI Risk factors
Hygiene, obstructions, urinary retention/stasis, sexually active women, catheterization, incontinence supplies, women, increase age, antibiotic use
Risk Factors for renal diseases
Advanced age, BPH, Diabetes, HTN, Immobilization, Hypovolemic shock, Spinal cord injury, pregnancy, Medication, family and genetic, Demographic information, Recent pelvic surgery, Systemic lupus erythematosus...
Phases of AKI
Initiation/Onset phase(prevention/detection), Maintenance/Oliguric phase(prevent overload/promote perfusion), Diuretic Phase(monitor for dehydration, electrolyte imbalances), Recovery phase(prevent CKD, ESRD).
Diagnostic/Treatment of Acute Pyelonephritis
Diagnostic: Ultrasound, CT scan, unalysis, urine culture/sensitivity
Treatment: Antibiotics, hydration, pain medication, education
What is the first indicator of renal impairment?
microalbuminuria
UTI S/S
Elders S/S
General population: Cloudy, foul odor, burning/pain when peeing, retention, hematuria, and lower back pain
Elders
Early symptoms: malaise, nocturia, fever, urgency,
Onset of UTI: urinary incontinence, delirium,
Renal Function Tests
Renal Concentration (specific gravity/urine osmolality), Creatinine, BUN, GFR
Treatment for Hyperkalemia due to AKI
Sodium polystyrene (Kayexalate), Insulin+D50, Diuresis, Hemodialysis
Types of Nephronlithiasis (kidney stones)
Calcium oxalate, Uric acid, Calcium phosphate, Cystine
S/S of BPH
Hard time maintaining stream, frequency, dribbling after voiding, dysuria, hematuria, infections.
UTI Diagnostic
Urine culture, Cellular studies (check presence of white blood cells, micro hematuria with acute UTIs), X-ray, CT, ultrasound.
Diagnostic exams
Urinalysis, Urine Culture, X-ray, CT scan, MRI, General Ultrasound, Bladder ultrasonography, Renal Angiography, Biopsy...
Treatment/Intervention for AKI
Monitor fluid and electrolyte balance,monitor input and out put, maintain Map >65, nutrition (low protein diet, high carbohydrate diet, TPN, tube feeds, low Na/K/PO4), medications, CRRT (continuous renal replacement therapy), done in ICU/OR, dialyzes 24 hours/day, hydration/pressors to increase BP. Fluid restriction(depends on phase), treat cause
Treatment/Intervention of Kidney stone
ESWL(Lithotripsy, strain the urine and send stones for chemical analysis), Electrohydraulic lithotripsy, pain medications(opioids, NSAIDS, spasmolytics), Surgery(stent placement, retrograde uteroscopy- stone removed with scope, percutaneous nephrolithotomy- needle into collecting system and stone removed with laser )
Treatment of BPH
Fluids, Coude catheter, TURP surgery (removal of part of the prostate through scope) after normal for pee to be light pink, dark pink/red lots of blood and not good!), medication(Flomax/Proscar)
UTI intervention/prevention
Antibiotics, Phenazopyridine(Urinary analgesic agent), Hygine, Adequate fluid intake, encourage cranberry juice, avoid coffe, tea, colas, alcohol(urinary tract irrtants), Voiding habits(urinate regularly, urinate after sexual activity), cotton underwear and loose clothing, avoid catheterization if possible, monitor for complications like sepsis.
Name functions of the kidney
Control of blood pressure(secretion of renin), Control of water balance, Excretion of waste products, Regulation of electrolytes, Regulation of acid-base balance, Regulation of red blood cell production, Synthesis of vitamin D to the active form (1,25-dihydroxycholecalciferol), and secretion of prostaglandins.
Causes of Pre-Renal AKI
Dceresed blood flow to kidneys, Blood/fluid loss (hemorrhage), Impaired cardiac efficiency(Arrhythmias, Cardiogenic shock, heart failure, MI), Vasodilation (Anaphylaxis, Sepsis)
Causes of Intra-Renal AKI
Disorders that disrupt structures of kidney, infections, medications/nephrotoxic agents (antibiotics, contrast dye, heavy metals, Nsaids, Ace inhibitors), Hemoglobinuria(transfusion reaction, hemolytic anemia), illicit drugs, gasoline/kerosene.
Causes of Post-Renal AKI
Urinary tract obstruction: BPH, blood clots, calculi(stones), stricture, tumors
Give acceptable and unacceptable reasons of the use of catheter
Acceptable: Acute urinary retention or obstruction, Perioperative use in selected surgeries, Assist healing of perineal and sacral wounds in incontinent patients, Hospice/comfort/palliative care, Required immobilization for trauma or surgery, Chronic indwelling urinary catheter on admission, require strict in and out monitor in ICU for critical ill pt
Unacceptable reason: Urine output monitoring outside the ICU, Incontinence without a sacral or perineal pressure sore, Prolong postoperative use, Morbid obesity, Immobility, Confusion/dementia, Patient request