Kidney and renal pain
Nephralgia
Generally felt _________ __________; recorded as _________ _________ or ________ _______.
Costovertebral angle, CVA tenderness, flank pain
Generally felt at costovertebral angle; recorded as CVA tenderness or flank pain.
Why and how do we feel pain in the kidney
The pain can be caused by distention/inflammation of the renal capsule. Has a dull, constant character.
The renal capsule is the only part of the kidney with pain receptors.
What provides clues to intrarenal pathologies
Dipstick and microscopic urinalysis
KUB identifies
gross abnormalities related to size, position, and shape (may show renal calculi)
- Good for finding kidney stones
Renogram/renal scan shows renal __________ and __________.
vasculature and tumors
Name the congenital abnormalities
Kidneys do not develop in the fetus.
Some fetal kidney development.
Genetically transmitted renal disorder resuliting in fluid-filled cysts that can expand and disrupt urine formation and flow; may be localized to one area or affect both kidneys
Agensis
Hypoplasia
Cystic kidney Diseases.
True/False
Bilateral agenesis is compatible with life
FALSE
Bilateral agenesis is not compatible with life.
What causes compensatory hypertrophy in the kidneys.
Unilateral agenesis compensatory hypertrophy of functional kidney.
What are the two types of cystic kidney dieases
Autosomal recessive forms--- at birth
Autosomal dominant types ---- later in life
What are the three major risk factors for Renal Cell Carcinoma
Smoking, obesity, hypertension.
Metastases may be particuarlary resistant to ________, ___________, and _______________. (p53 mutation)
radiation, immunotherapy, and chemotherapy
What are the clinical manifestations of Renal Cell Carcinoma
CVA tenderness, hematuria, palpable mass
Most common Kidney cancer in children
Nephroblastoma (Wilms Tumor)
What are the clinical manifestation of Wilms Tumor
Palpable abdominal mass, my also have abdominal pain, hypertension, and/or hematuria
What is the term used when you have an infection in your kidney?
Pyelonephritis
These clinical manifestations are from what kidney disease?
CVA tenderness, fever, chills, Nausea, Vomiting, anorexia, which increases fever-induced dehydration
Acute Pyelonephritis
What is the diagnosis and treatment of Acute pyelonephritis?
Diagnosis: Presence of WBC casts indicative of upper UTI. If infection is really bad there can be hematuria and proteinuria.
Treatment: Promptly managed with antimicrobials to avoid decreased renal function.
What does the obstructive processes cause
Urine stasis
- predisposes to infection and structural damage
what are the common causes of obstruction in the kidney
Stones: most common, (composed of Calcium crystals; others include uric acid, struvite, cystine)
Tumors
Prostatic hypertrophy
strictures of the ureters or urethra.
Complete obstruction results in
Hydronephrosis, Decreased GFR, Ischemic kidney damage because of increased intraluminal pressure, Acute Tubular necrosis, and Chronic kidney disease.
Acute glomerulonephritis is caused by
immune response to variety of potential triggers
Attraction of immune cells to the area of inflammation results in __________ ____________ of the ___________ ____________
Lysosomal degradation of the basement membrane
Attraction of immune cells to the area of inflammation results in lysosomal degradation of the basement membrane
TRUE or FALSE
GFR may increase due to the dilation of mesangial cells, resulting in increased surface area for filtration
FALSE
GFR may fall due to contraction of mesangial cells, resulting in decreased surface area for filtration
Proteinuria, oliguria and azotemia, edema and hypertension are clinical manifestations of
Acute glomerulonephritis
What are the treatments for acute glumerulonephritis
steroids, plasmapheresis, supportive measures such as dietary and fluid management, Management of systemic and renal hypertension
Sclerosis and fibrosis of kidney is associated with?
Chronic glomerulonephritis
present with _________ ___________, with or without hematuria, and ___________ _________ ________ ___________
Present with persistent proteinuria, with or without hematuria, and slowly declining renal function.
TRUE/FALSE
Nephrotic Syndrome occurs due to increased glomerular permeability to proteins.
TRUE
In acute renal failure, a sudden reduction of kidney function causes a __________ ___________ _________ _________.
Decreased glomerular filtration rate (GFR)
If GFR is decreased what happens to urine output?
It decreases
If GFR is decreased, what is retained?
provide a common example.
nitrogenous waste products such as uric acid
If GFR is decreased, what happens to serum creatinine? Increase or decrease?
Increase
TRUE/FALSE
If GFR is decreased, there are disruptions in fluid, electrolyte, and acid-base balances, especially potassium.
TRUE
Renal function is monitored by ____________ _________, ______________ ________ and _____.
Serum creatinine, calculated GFR and BUN
What syndrome produces widespread systemic effects?
Uremic syndrome
What are the 3 sites of disruption in acute kidney injury?
Pre-renal
Post-renal
intrinsic/intrarenal
In acute kidney injury:
What is pre-renal disruption?
______ __________.
renal perfusion
In acute kidney injury:
What is post-renal disruption?
Urine flow ________ ______ _____ _______
distal to the kidney
In acute kidney injury:
What is intrinsic/intrarenal disruption?
Circumstances within the ________ _______ _______, ________, ________, or _____________.
kidney blood vessels, tubules, glomeruli, or interstitium.
Pre-renal kidney injuries are due to conditions that _______ _________ ____ _____ ________.
EXAMPLES: hypovolemia, hypotension, HF, renal artery obstruction, fever, vomiting, diarrhea, burns, overuse of diuretics, edema, ascites, drugs such as ACE inhibitors, angiotensin II blockers, NSAIDs.
Diminish perfusion of the kidney.
Pre-renal kidney Injury is characterized by _______ GFR, _________, _______ urine specific gravity and __________.
* ______ urine sodium.
low, oliguria, high, osmolarity.
* low
Pre-renal kidney injury prolong prerenal ARF which leads to ____ ______ _______.
Acute tubular necrosis (intrinsic).
Post-renal kidney injuries are due to ___________ _______ _____ ________ ________ _______ _______ ____ _____ ________.
Obstruction within the urinary collecting system distal to the kidney.
Where will post-renal kidney injury cause elevated pressure, and what does it impede?
In Bowman capsule, and impedes glomerular filtration.
Intrinsic/Intrarenal kidney injury is due to primary _______ _____ _____ ______ ____ ____ _______ _________.
dysfunction of the nephrons and the kidney itself.
in intrinsic/Intrarenal kidney injury
Most common problem within the renal tubules will result in ______ ______ _________.
Acute tubular necrosis (ATN)
ATN causes
_____________ insult and example________ _________.
__________ insults and example _________.
Nephrotoxic insult, contrast media
Ischemic insults, sepsis
2 pathophysiological processes of intrinsic/intrarenal kidney injury:
Vascular: ______ ________ _____ __________. which lead to ______ and _________.
Tubular: _________ and ____________ ____________, causes ______ ______ ______ ________, ____________ ___________.
renal blood flow decreased, hypoxia and vasoconstriction
Inflammation and reperfusion injury, causes casts, obstructs urine flow, tubular backleak.
What are the three phases of acute tubular necrosis?
prodromal, oliguric, post-oliguric
What is oliguria?
low urine production
TRUE/FALSE
is ATN self-limiting? (repairs itself)
True
What ATN stage?
-Oliguria/anuria
-Volume overload
-Hyperkalemia
-Azotemia/uremia
-Metabolic acidosis
Oliguric phase
What ATN stage?
-Injury has occured
-Normal or low UO
-High BUN and Cr
Prodromal Phase
What ATN stage?
-Fluid volume deficit
-Labs begin to normalize
Postoliguric Phase
Urine output to be considered oliguric?
<400ml per day
Urine output to be considered anuric?
<100ml per day
Volume overload causes _________ resulting in __________.
hypervolemia resulting in edema.
Chronic kidney disease:
Outcome of progressive and ________ ______ ______ _______ __________.
irrevocable loss of functional nephrons
What health problems could often be linked with chronic kidney disease?
Primarily hypertension and diabetes mellitus
Chronic kidney disease is defined as _______ ______ ________ or _______ _____ ____ _____ __________.
Decreased kidney function or kidney damage of 3 months duration. `
Chronic kidney disease also defined as GFR <______ml/minutes/1.73m2 for _____ months
60
3
What are the risk factors for chronic kidney disease?
-Unfortunately there are 9
Diabetes, hypertension, recurrent pyelonephritis, glomerulonephritis, polycystic kidney disease, family history of CKD, history of exposure to toxins, age over 65, ethnicity.
TRUE/FALSE
Chronic kidney disease is progressive and irreversible
TRUE
What is the normal GFR?
90-120ml
In chronic kidney disease:
GFR reduction occurs with nephron loss. Kidney compensates until _____% to ______% of ________ are __________/_____________.
75%-80% of nephrons are damaged/nonfunctional
What stage of chronic kidney disease according to nephron loss and clinical presentation?
-<75% nephron loss
-No signs/symptoms
-BUN and creatinine normal
-May not be diagnosed
Decreased renal reserve
What stage of chronic kidney disease according to nephron loss and clinical presentation?
-75%-90% nephron loss
-Polyuria
-nocturia
-Slight elevation in BUN
-Slight elevation in creatinine
-May be controlled by diet and meds.
Renal insufficiency
What stage of chronic kidney disease according to nephron loss and clinical presentation?
->90% nephron loss
-Azotemia/Uremia
-Fluid and electrolyte abnormalities
-Osteodystrophy
-Anemia
-Dialysis/transplantation essential
end-stage renal disease
What stage of chronic kidney disease according to GFR?
-Kidney damage with normal or increased GFR
-GFR >90ml/min/1.73m2
Stage 1
What stage of chronic kidney disease according to GFR?
-Mildly decreased GFR
-GFR 60-89ml/min/1.73m2
Stage 2
What stage of chronic kidney disease according to GFR?
-Moderately decreased GFR
-GFR 30-59ml/min/1.73m2
Stage 3
What stage of chronic kidney disease according to GFR?
-Severely decreased GFR
-GFR 15-29ml/min/1.73m2
Stage 4
What stage of chronic kidney disease according to GFR?
-End-Stage kidney disease
-GFR <15ml/min/1.73m2
Stage 5
What Complications of chronic kidney disease is associated with the following:
Hypervolemia escalated atherosclerotic process, heightened RAAS and SNS activity.
Hypertension and cardiovascular disease
What Complications of chronic kidney disease is associated with the following:
Retention of metabolic wastes; impaired healing, pruritus; dermatitis, uremic frost.
Uremic syndrome
What Complications of chronic kidney disease is associated with the following:
Retention of acidic waste products; hyperkalemia; kidneys lose ability to secrete H+ ions and bicarbonate.
Metabolic acidosis
What Complications of chronic kidney disease is associated with the following:
Retained potassium, phosphorus, magnesium
Electrolyte imbalances
What Complications of chronic kidney disease is associated with the following:
Elevated phosphorus and PTH causes altered bone/mineral metabolism
-Kidneys unable to produce active Vitamin D which prevent reabsorb calcium in small intestine
Bone and mineral disorders
What Complications of chronic kidney disease is associated with the following:
-lack of erythropoietin
-uremia shortens RBC life
-combination of worsening CKD, anemia, and heart failure (cardiorenal anemia syndrome)
Anemia
Clinical Management for Chronic Kidney Disease:
CKD causes fluid and electrolyte imbalances, what must be done if their sodium is <135mmol/L
Fluid restriction
Clinical Management for Chronic Kidney Disease:
CKD causes fluid and electrolyte imbalances, besides fluid what else must be restricted?
Protein, because they pull water into our blood vessels
In chronic kidney disease, what should be monitored to observe bone and mineral disorders, and when?
PTH, calcium and phosphorus if GFR is less than 60ml/min/1.73m2
In chronic kidney disease, to avoid malnutrition what must be limited?
Limit diet factors that could increase cardiovascular risk.
In patients with chronic kidney disease who have anemia, what should be given?
erythropoiesis-stimulating agents (ESA)/synthetic EPO such as epoetin alfa and darbepoetin alfa
Used for ATN and CKD stage 5 in order to remove metabolic wastes and correct fluid and electrolyte abnormalities.
Dialysis
What are the two types of dialysis
Hemodialysis and peritoneal dialysis
What is the most frequent and initial symptom of bladder
cancer?
Hematuria
Smoking is a risk factor for?
Bladder cancer
What can lead to recurrent cystitis?
Vesicoureteral reflux
What is the cause for the majority of urinary tract infections?
E.Coli
What type of incontinence may be idiopathic, due to bladder infection, radiation therapy, tumor or stones, or CNS damage?
Urge incontinence
What type of incontinence is due to weakening of pelvic muscles or intrinsic urethral sphincter deficiency
Stress incontinence
What is the effect of Sympathetic nervous system on urination?
L1 & L2
In charge of not voiding. It relaxes your muscles and contracts internal sphincter.
What is the effect of parasympathetic nervous on urination?
S1-S4
In charge of voiding by contracting dentirostral muscle and relaxing sphincter.
Can medication lead to secondary voiding dysfunction?
Yes
Anemia in people who have end-stage chronic renal disease is caused by
decreased secretion of erythropoietin.
The normal post-void residual urine in the bladder is
less than 100 mL
Absence of menstruation is called
amenorrhea.
The pathology report for a patient with penile cancer has this statement: The tumor involves the shaft of the penis. The cancer is at what stage?
Stage II
Explanation: Penile carcinoma is staged as follows: Stage I: The lesion is limited to the glans or foreskin. Stage II: The tumor involves the shaft of the penis. Stage III: The inguinal nodes are involved, but the lesion is operable. Stage IV: Disseminated disease.
Pelvic floor muscle training is appropriate for
urge incontinence.
A patient diagnosed with a micropenis must be evaluated for
endocrine disorders.
TRUE/FALSE
The most common cause of urinary obstruction in male newborns and infants is urethral valves.
True
Detrusor muscle overactivity can be improved by administration of
botulinum toxin.
The HPV vaccine is recommended for 11- to 12-year-old girls, but can be administered to girls as young as _____ years of age.
9
The patient reports persistent pelvic pain and urinary frequency and urgency. She says the pain improves when she empties her bladder. She does not have a fever and her repeated urinalyses over the past months have been normal, although she has a history of frequent bladder infections. She also has a history of fibromyalgia and hypothyroidism. Based on her history and complaints, her symptoms are characteristic of
interstitial cystitis.
Cervical cancer can be detected in the early, curable stage by the ________ test.
Papanicolaou
The most commonly ordered diagnostic test for evaluation of the urinary system is
ultrasonography.
The condition in which the urethra opens on the dorsal aspect of the penis is known as
epispadias.
It is true that fibrocystic breast disease:
-commonly progresses to breast cancer
-may be exacerbated by methylxanthines.
-is characterized by painless breast lumps.
-is a contraindication for progesterone birth control pills.
may be exacerbated by methylxanthines.
A breast lump that is painless, hard, and unmoving is most likely
carcinoma
Uterine prolapse is caused by a relaxation of the
cardinal ligaments.
A patient who has difficulty walking without assistance is incontinent of urine when help doesn’t get to her quickly enough. The term for this type of incontinence is
functional.
TRUE/FALSE
Hypotension is both a cause of chronic kidney disease and a result of chronic kidney disease.
False,
Hypertension is both a cause of chronic kidney disease and a result of chronic kidney disease.
The most common types of uterine tumors are known as
leiomyomas.
The expected treatment of a pregnant woman with hyperemesis gravidarum is
intravenous therapy.
The individual at highest risk of pyelonephritis who requires monitoring for signs of its occurrence is
woman who is paraplegic.
woman who is pregnant.
man who has glomerulonephritis.
man who has chronic urinary tract infections.
man who has chronic urinary tract infections.
The main clinical manifestation of a kidney stone obstructing the ureter is
renal colic.
What is renal colic?
Renal colic is the flank pain that occurs with obstruction of the proximal ureter or renal pelvis.
Glomerular disorders include
nephrotic syndrome.
Appropriate management of end-stage renal disease includes
erythropoietin administration.
The major underlying factor leading to the edema associated with glomerulonephritis and nephrotic syndrome is
proteinuria.
A patient with gouty arthritis develops renal calculi. The composition of these calculi is most likely to be
uric acid crystals.
Osteoporosis commonly occurs in patients with end-stage renal disease because of
hyperparathyroidism.
One of the most frequent causes of chronic kidney disease is
hypertension.
Which condition is caused by a genetic defect?
Polycystic kidney disease
The oliguric phase of acute tubular necrosis is characterized by
fluid excess and electrolyte imbalance.
Individuals with end-stage chronic renal disease are at risk for renal osteodystrophy and spontaneous bone fractures, because
They are deficient in active vitamin D.
The patient most at risk for postrenal acute kidney injury is a(n)
elderly patient with hypertrophy of the prostate.
In patients with polycystic kidney disease, renal failure is expected to progress over time as the cystic process destroys more nephrons. At what point will a patient reach end-stage renal disease?
Greater than 90% nephron loss
One of the most common causes of acute tubular necrosis (ATN) is
Ischemic conditions.
The organism most commonly associated with acute pyelonephritis is
Escherichia coli.
Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage may all contribute to renal failure by causing
acute tubular necrosis
The condition characterized by oliguria and hematuria is
acute glomerulonephritis.
It is true that polycystic kidney disease is
always rapidly fatal.
caused by a streptococcal infection.
associated with supernumerary kidney.
genetically transmitted.
genetically transmitted.
The most common direct cause of acute pyelonephritis is
infection by E. coli.
The condition associated with end-stage chronic renal disease that is the most immediately life threatening is
hyperkalemia.
The defining characteristic of severe acute kidney injury is
oliguria
The most frequent initial symptom of bladder cancer is
hematuria
A potential risk factor for breast cancer includes
early menarche and late first pregnancy.
Treatment of a uterine prolapse may involve the insertion of a(n) ________ to hold the uterus in place.
pessary.
TRUE/FALSE
The best intervention for acute kidney injury (AKI) is prevention.
TRUE
Dysfunctional uterine bleeding (DUB) is caused by
absent or diminished levels of progesterone.
A patient being treated for acute tubular necrosis (ATN) develops mild polyuria. The nurse responds to questions about why this occurring by stating
“His renal tubules are recovering, so he is making more urine, but he is not able to concentrate urine well, because he is not fully recovered.”
A person is unaware that his bladder is full of urine, but complains that he is leaking urine almost constantly. The most accurate term for this type of incontinence is
overflow.
A patient has ureteral colic. The manifestation that requires immediate notification of the physician is
chills and fever.
Sexual impotence is rarely because of
Primary causes
A 52-year-old female had a surgical procedure in which the breast, lymphatics, and underlying muscle were removed. The procedure performed was a
radical mastectomy.
In addition to renal colic pain, signs or symptoms of ureteral stones may frequently include
hematuria.
Excessive vomiting in pregnant women is known as
hyperemesis gravidarum.
The most helpful laboratory value in monitoring the progression of declining renal function is
serum creatinine.
The consequence of an upper urinary tract obstruction in a single ureter is
hydronephrosis.
The most common agent resulting in nephrotoxicity and subsequent acute tubular necrosis (ATN) in hospitalized patients is
contrast media.
Nephrotic syndrome does not usually cause
hematuria.
The most common type of renal stone is
calcium.
The most likely cause of acidosis in a patient with end-stage renal disease is
insufficient metabolic acid excretion resulting from nephron loss.
One cause of an extrinsic renal system obstruction is
pelvic tumor.
Signs consistent with a diagnosis of glomerulonephritis include
proteinuria.
At his most recent clinic visit, a patient with end-stage renal disease is noted to have edema, congestive signs in the pulmonary system, and a pericardial friction rub. Appropriate therapy at this time would include
initiation of dialysis.
A patient with renal disease is at risk for developing uremia as the nephrons progressively deteriorate, because
GFR declines.
Scrotal pain in males and labial pain in females may accompany renal pain as a result of
associated dermatomes.
A patient who reported a very painful sore throat 3 weeks ago is now diagnosed with acute post-streptococcal glomerulonephritis. When asked, “Why is my urine the color of coffee?”, the nurse responds
“Your immune system was activated by your sore throat and has caused some damage in your kidneys that allows red blood cells to leak into the fluid that becomes urine and make it coffee-colored.”
The pathophysiologic basis of acute glomerulonephritis is
an immune complex reaction.