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Chapter 36
Alterations of Renal and Urinary Tract Function
141
Nursing
Graduate
04/16/2012

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Term
What is a urinary tract obstruction?
Definition
Any interference with urine flow
Term
What is the etiology of a urinary tract obstruction?
Definition
Anatomical
Functional
Term
What does severity of a urinary tract obstruction depend on?
Definition
Location
Unilateral or Bilateral
Duration
Cause
Term
What is another term for kidney stones?
Definition
Calculi
Term
What are clinical manifestations of kidney stones?
Definition
Renal colic or pain
Term
What are risk factors of kidney stones?
Definition
Male
Age 20-40
Inadequate fluid intake
Living in desert or tropical region
Term
What is the primary factor of developing kidney stones?
Definition
Inadequate fluid intake
Term
What are factors of living in desert or tropical region that lead to kidney stones?
Definition
Temperature
Humidity
Fluids
Diet
Term
How do you evaluate and manage kidney stones?
Definition
Stone analysis
Kidney-ureter-bladder (KUB)
Intravenous pyelogram (IVP)
Computed tomography (CT) of abdomen
Term
What is treatment for kidney stones
Definition
Stone removal
Term
What are kidney stones made of?
Definition
mineral salts
Term
What type of mineral salts make up kidney stones?
Definition
-Calcium oxalate/phosphate -70-80%
-Struvite (magnesium, ammonium, phosphate) – 15%
-Uric acid - 7%
Term
What is a neurogenic lower urinary tract problems cause?
Definition
Problems with urine storage or emptying
Term
What is the etiology of neurogenic lower urinary tract problems?
Definition
Neurogenic
Anatomic
Term
What is a neurogenic bladder?
Definition
A general term for the class of problems
Term
What is dyssynergia?
Definition
Loss of coordinated neuromuscular contraction
Term
What is detrusor hyperreflexia?
Definition
Bladder empties when full
Term
Overactive bladder syndromes causes involuntary __?
Definition
Contractions
Term
What happens to detrusor muscle in overactive bladder syndrome?
Definition
Too weak to empty bladder
Term
What does overactive bladder syndrome result in?
Definition
Urinary retention with overflow
Term
What type of incontinence does overactive bladder syndrome cause?
Definition
Stress incontinence
Term
What are anatomical causes of resistance to flow in lower urinary tract?
Definition
Urethral stricture
Enlarged prostate
Pelvic organ prolapse
Term
What is urethral stricture?
Definition
Narrowed urethra
Term
What causes urethral stricture?
Definition
Infection
Injury
Surgical manipulation
Scarring
Term
What is treatment for urethral stricture?
Definition
Urethral dilation
Term
What is another term for pelvic organ prolapse in women?
Definition
Cystocele
Term
What happens during cystocele?
Definition
Bladder prolapses into vagina
Term
How do you treat cystocele?
Definition
Pessary (vaginal implant)
Term
What are benign renal tumors called?
Definition
Adenomas
Term
True or False: Adenomas are usually small and asymptomatic
Definition
True
Term
Which tumors are more common in renal tumors?
Definition
Carcinoms
Term
What are clinical manifestations of renal tumors?
Definition
Hematuria
Flank pain
Term
What is treatment of renal tumors?
Definition
Nephrectomy
Chemo
Radiation
Term
What percentage of all malignant tumors are bladder tumors?
Definition
1%
Term
Where are common metastasis of bladder tumors?
Definition
Lymph nodes
Liver
Bone
Lungs
Term
What increases risk of bladder tumor?
Definition
Smoking
Term
What are clinical manifestations of bladder tumors?
Definition
Hematuria
Term
True or False: Urinary tract infections are uncommon
Definition
False (very common)
Term
What are 2 types of UTI?
Definition
Acute
Chronic
Term
What is UTI inflammation of?
Definition
Urinary epithelium
Term
What is UTI caused by?
Definition
Bacteria (escherichia coli)
Term
Who is UTI more common in?
Definition
Women
Term
Why is UTI more common in women?
Definition
Short length of the urethra
Term
What is acute cystitis?
Definition
Inflammation of the bladder
Term
What are clinical manifestations of acute cystitis?
Definition
Low back or suprapubic pain
Frequency
Dysuria
Urgency
Burning pain with urination
Hematuria
Cloudy urine
Term
What is treatment of acute cystitis?
Definition
Antimicrobial therapy
Increased fluid intake
Avoidance of bladder irritants
Urinary analgesics
Term
What is interstitial cystitis?
Definition
Nonbacterial cystitis
Term
What is cause of interstitial cystitis?
Definition
Unknown
Term
What are clinical manifestations of interstitial cystitis?
Definition
Bladder fullness
Frequency
Small urine volume
Chronic pelvic pain
Term
What is acute pyelonephritis?
Definition
Upper urinary tract infection
Term
What structures are involved in acute pyelonephritis?
Definition
Ureter
Renal pelvis
Renal parenchyma
Term
What are contributing factors to acute pyelonephritis?
Definition
Cystitis
Urinary tract obstruction with reflux infection
Females
Term
Women are how many more times likely than men to get acute pyelonephrits?
Definition
5X
Term
What are clinical manifestations of acute pyelonephritis?
Definition
Flank pain or back ache
Abdominal pain
Fever
Chills
Nausea and vomiting
Costovertebral tenderness
Purulent urine
Term
True or False: Acute pyelonephritis can become a chronic condition?
Definition
True (Chronic pyelonephritis)
Term
What is the difference between cystitis and pyelonephritis?
Definition
-Cystitis - inflammation of bladder
-Pyelonephritis - upper urinary tract infection
Term
What type of onset are glomerular disorders?
Definition
Sudden or Insidious
Term
What can cause glomerular disorders?
Definition
hypertension
edema
elevated blood urea nitrogen (BUN)
Term
What happens to GFR in glomerular disorders?
Definition
Decreases
Term
What does a decreased GFR cause?
Definition
Elevated plasma creatinine
Elevated urea
Reduced creatinine clearance
Term
What is etioloy of glomerular disorders?
Definition
Decreased:
-glomerular membrane surface area
-glomerular capillary blood flow
-blood hydrostatic pressure
Term
What happens to plasma proteins in glomerular disorders?
Definition
Pass into urine
Term
What does plasma proteins passing into the urine cause?
Definition
Increased glomerular capillary permeability
Nephrotic Syndrome
Loss of negative ionic charge barrier
Term
What does hypoalbuminemia cause?
Definition
plasma fluid to move into interstitial spaces which causes edema
Term
Nephrotic syndrome produces?
Definition
Susceptibility to infection
Term
What are a group of diseases that cause glomerular damage?
Definition
Glomerulonephritis
Term
What is the most common cause of chronic renal failure and end-stage renal disease (ESRD)?
Definition
Glomerulonephritis
Term
What is etiology of Glomerulonephritis?
Definition
Immune responses - most common
Drugs or toxins
Hepatitis
Vascular disorders
Systemic diseases
Viral causes
Term
What is acute glomerulonephritis associated with?
Definition
Streptococcal infection
Term
What happens in acute glomerulonephritis?
Definition
Antigen/antibody complexes form and deposit in glomerulus
Term
What does acute glomerulonephritis activate?
Definition
Complement
Term
Acute glomerulonephritis causes recruitment/activation of?
Definition
Immune cells and mediators
Term
Acute glomerulonephritis causes a decrease in?
Definition
GFR
Term
What does a decrease in GFR in acute glomerulonephritis cause?
Definition
-Decreased glomerular perfusion due to inflammation
-Glomerular sclerosis (scarring)
-Thickening of the glomerular basement membrane (but increased permeability to proteins)
Term
What are clinical manifestations of acute glomerulonephritis?
Definition
Hematuria
Proteinuria
Eventual oliguria
Term
What does hematuria look like?
Definition
Smoky, brown-tinged urine
Red blood cell casts
Term
What does proteinuria cause?
Definition
Low serum albumin
Edema
Term
What is oliguria?
Definition
Urine output < 30mL/hour or <400 mL/day
Term
What is acute renal failure (ARF)?
Definition
Sudden and rapidly progressive within hours
Term
True or False: Acute renal failure is not reversible?
Definition
False (Often reversible)
Term
What is acute renal failure an abrupt reduction in?
Definition
Renal function
Term
What can acute renal failure be classified as?
Definition
Pre renal failure
Intra renal failure
Post renal failure
Term
What is the most common cause of ARF?
Definition
Prerenal ARF
Term
What is PreRenal ARF?
Definition
Impaired renal blood flow r/t sudden reduction in perfusion to the kidneys
Term
What does PreRenal ARF do to GFR?
Definition
Decline
Term
Why does GFR decline in PreRenal ARF?
Definition
GFR declines due to decrease filtration pressure resulting in oliguria
Term
What does ischemia in PreRenal ARF cause?
Definition
hypoxic injury and acute tubular necrosis (ATN)
Term
What is damaged in intrarenal ARF?
Definition
Renal parenchyma
Term
What is most common cause of intrarenal ARF?
Definition
ATN
Term
What can cause intrarenal ARF?
Definition
ATN
Vascular disease
Toxic injury
Term
What vascular disease can cause intrarenal ARF?
Definition
Malignant hypertension
Term
What toxic injuries can cause intrarenal ARF?
Definition
Drugs (antibiotics - nephrotoxins)
Term
What does postrenal ARF occur with?
Definition
urinary tract obstructions that affect both kidneys
Term
What does postrenal ARF increase?
Definition
Intraluminal pressure upstream
Term
What happens to GFR in postrenal ARF?
Definition
Decrease
Term
What are associated conditions with postrenal ARF?
Definition
Prostatic hypertrophy
Bladder outlet obstruction
Bilateral ureteral obstruction
Term
A person with acute renal failure is prescribed glucose and insulin. The nurse understands this is intended to:
Definition
Reduce serum potassium concentration
Term
What are clinical manifestations of ARF?
Definition
Azotemia
Uremia
Oliguria/anuria
Hyperkalemia
Metabolic acidosis
Hypertension (volume overload)
Term
What is azotemia?
Definition
increased urea and creatinine levels
Term
What is uremia?
Definition
increased urea and creatinine levels
Term
What are clinical manifestations associated with uremia?
Definition
fatigue, anorexia, nausea, vomiting, diarrhea, weight loss,
pruritus, edema, neurologic changes
Term
What are symptoms of ARF related to?
Definition
retention of toxic wastes, deficiency states, and electrolyte disorders
Term
What is chronic renal failure?
Definition
retention of toxic wastes, deficiency states, and electrolyte disorders
Term
True or False: Chronic renal failure affects most all organ system?
Definition
True
Term
Chronic renal failure is a progressive condition leading to?
Definition
Reduced renal reserve
Renal insufficiency
Renal failure
Term
End-stage renal disease (ESRD) causes alterations in?
Definition
Creatinine and urea clearance
Na and water balance
Phosphate and calcium balance
Potassium balance
Acid-base balance
Term
What systems does chronic renal failure affect?
Definition
Skeletal and bone alterations
Cardiopulmonary
Neurologic
Hematologic
Gastrointestinal
Integument
Immunologic
Reproductive
Term
What systems are involved in multiorgan/multisystem failure?
Definition
CV
Neurologic
Hematologic
GI
Term
What happens to CV system in multisystem failure?
Definition
-Hypertension, heart failure
-Atherosclerosis, stroke, coronary artery disease
Term
What does hypertension and heart failure cause in multisystem failure?
Definition
Volume overload
Hyperactivity of renin system
Term
What does atherosclerosis, stroke, and coronary artery disease cause?
Definition
Dyslipidemia
Term
What happens to neurologic system in multisystem failure?
Definition
Neuropathies
Encephalopathy
Term
What happens to the hematologic system in multisystem failure?
Definition
Anemia
Platelet defects
Term
Why do you have anemia in multisystem failure?
Definition
Lack of erythropoietin
Term
What do platelet defects cause in multisystem failure?
Definition
Bleeding disorders
Term
What happens to GI during multisystem failure?
Definition
Nausea and vomiting
Anorexia
Uremic
Term
What happens to metabolic system in multisystem failures?
Definition
Altered protein, lipid, CHO metabolism
Term
What happens to integumentary/musculoskeletal system during multisystem failures?
Definition
Hyperphosphatemia and Hypocalcemia
Hyperparathyroidism
Brittle bones
Skin changes
Term
What skin changes are present in multisystem failures?
Definition
Bruises
Itching
Uremic frost
Yellowing
Term
What happens to immune system during multisystem failures?
Definition
Immunosupression
Term
What happens to endocrine system during multisystem failure?
Definition
Insulin resistance
Decreased sex hormones
Term
What happens during chronic renal failure progression?
Definition
Reduced renal reserve
Renal insufficiency
Renal failure
Term
What happens to GFR when there is reduced renal reserve?
Definition
Reduced to 50%
Term
What are clinical symptoms of reduced renal reserve?
Definition
None
Term
What may be elevated with reduced renal reserve?
Definition
BUN
Term
What happens to GFR with renal insufficiency?
Definition
Declines to 25%
Term
What happens to remaining nephrons?
Definition
Compensation
Term
What are clinical symptoms?
Definition
Mild uremia
Mild anemia
Term
What do you see an increase in renal insufficiency?
Definition
BUN
Creatinine
Term
What happens during stress with renal insufficiency?
Definition
Impaired renal function
Term
What happens in renal failure?
Definition
Significant loss of function
Term
What is GFR in renal failure?
Definition
<20%
Term
What is there an increase in with renal failure?
Definition
BUN
Creatinine
Term
What are symptoms of renal failure?
Definition
Oliguria
Metabolic acidosis
Electrolyte imbalance
Severe anemia
Increasing uremia
Term
What electrolyte imbalances will you see in renal failure?
Definition
Hyperkalemia
Hypernatremia
Term
True or False: There will be effects on non-renal organs in renal failure?
Definition
True
Term
What happens to GFR in ESRD?
Definition
Near absence - <5 (likely near 0)
Term
What are clinical manifestations of ESRD?
Definition
-Severe uremia
-Severe water, electrolyte, acid-base imbalances
-Multiorgan /multisystem failure
Term
A person with chronic renal failure develops a pH of 7.23. The nurse understands this indicates the person has:
Definition
reduced bicarbonate reabsorption
Term
Individuals with chronic renal failure have:
Definition
prolonged coagulation
Term
Why would a person be on dialysis or need a transplant?
Definition
-Immediately life threatening, e.g. hyperkalemia
-Severe uremia and multi-organ effects
-Metabolic acidemia
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