Kidney Function and Anatomy

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Questions and Answers

Dilute urine can result from excessive fluid intake.

True (A)

The presence of bright yellow urine is indicative of chronic dehydration.

False (B)

A urine pH value greater than 7 indicates acidic urine.

False (B)

Pink to red urine may result from gross blood or certain medications.

<p>True (A)</p> Signup and view all the answers

A high-protein diet results in more alkaline urine.

<p>False (B)</p> Signup and view all the answers

A high fluid intake causes an increase in urine specific gravity.

<p>False (B)</p> Signup and view all the answers

Patients with kidney disease exhibit varying urine specific gravity with fluid intake.

<p>False (B)</p> Signup and view all the answers

Diabetes insipidus can result in a decreased urine specific gravity.

<p>True (A)</p> Signup and view all the answers

Computed Tomography (CT) is used to provide detailed information about renal blood vessels and tumors.

<p>True (A)</p> Signup and view all the answers

An osmolality range of 280 to 300 mOsm/kg is considered abnormal for kidney function.

<p>False (B)</p> Signup and view all the answers

Escherichia coli is known to be the most common pyelonephritis-causing organism.

<p>True (A)</p> Signup and view all the answers

Surgery for cystitis primarily focuses on eliminating infections rather than addressing physical obstructions.

<p>False (B)</p> Signup and view all the answers

Candida species are one of the common infecting organisms when the infection is bloodborne.

<p>True (A)</p> Signup and view all the answers

The presence of Enterococcus fecalis is uncommon among hospitalized patients.

<p>False (B)</p> Signup and view all the answers

Procedures like cystoscopy may be used to identify and remove obstructions in the urinary tract.

<p>True (A)</p> Signup and view all the answers

An elevated BUN-to-creatinine ratio indicates hypovolemia.

<p>True (A)</p> Signup and view all the answers

A normal BUN-to-creatinine ratio with elevated BUN indicates intrinsic kidney disease.

<p>False (B)</p> Signup and view all the answers

Urge urinary incontinence is characterized by loss of urine before reaching the toilet.

<p>True (A)</p> Signup and view all the answers

Stress urinary incontinence can result from increased abdominal pressure.

<p>True (A)</p> Signup and view all the answers

Urinary retention is indicated by a complete inability to empty the bladder.

<p>True (A)</p> Signup and view all the answers

Life-threatening complications from urinary problems are common.

<p>False (B)</p> Signup and view all the answers

Men are more frequently affected by urinary retention than women.

<p>False (B)</p> Signup and view all the answers

Inflammation of the urethral mucosa can be caused by instrumentation of the urinary tract.

<p>True (A)</p> Signup and view all the answers

Patients with uremic syndrome experience a metallic taste in the mouth.

<p>True (A)</p> Signup and view all the answers

The glomerular filtration rate (GFR) in end-stage kidney disease (ESKD) is greater than 29 mL/min.

<p>False (B)</p> Signup and view all the answers

Anorexia is a key feature of uremia.

<p>True (A)</p> Signup and view all the answers

Hypertension is one of the main causes of end-stage kidney disease.

<p>True (A)</p> Signup and view all the answers

Fluid, protein, and electrolyte restrictions are unnecessary for patients with uremic syndrome.

<p>False (B)</p> Signup and view all the answers

Muscle cramps are not typically associated with uremic syndrome.

<p>False (B)</p> Signup and view all the answers

Chronic kidney disease progresses through five stages based on estimated glomerular filtration rate.

<p>True (A)</p> Signup and view all the answers

Paresthesia is a symptom commonly observed in patients with uremic syndrome.

<p>True (A)</p> Signup and view all the answers

Asterixis is a possible sign of severe metabolic acidosis.

<p>True (A)</p> Signup and view all the answers

Patients with chronic kidney disease (CKD) do not experience any neurologic problems.

<p>False (B)</p> Signup and view all the answers

Signs of anemia in patients can include fatigue and pallor.

<p>True (A)</p> Signup and view all the answers

Kussmaul respirations are indicative of fluid volume deficiency.

<p>False (B)</p> Signup and view all the answers

Pneumonitis is a common respiratory manifestation in chronic kidney disease patients.

<p>False (B)</p> Signup and view all the answers

Bruising and petechiae may be signs of abnormal bleeding in CKD patients.

<p>True (A)</p> Signup and view all the answers

Tachypnea is a sign that may indicate effective fluid volume excretion.

<p>False (B)</p> Signup and view all the answers

An S3 heart sound is typically a sign of heart failure.

<p>True (A)</p> Signup and view all the answers

Flashcards

Urine color: Pale yellow

Indicates excess fluid intake, diuretic use, or kidney disease.

Urine color: Yellow to white

Possible indication of infection (pyuria) or vaginal cream use.

Urine color: Bright yellow

Suggests hemoglobin breakdown, red blood cells (RBC), or certain medications.

Urine color: Pink/red

Possible sign of blood in the urine (gross hematuria), post-surgery, or medications.

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Urine color: Orange/Amber

Indicates dehydration, excess bilirubin, or certain medications.

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Specific gravity

A measure of the concentration of dissolved substances in urine. It reflects how well the kidneys are diluting and concentrating urine.

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Fluid intake & specific gravity

High fluid intake results in lower urine specific gravity (more diluted urine).

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Kidney disease & specific gravity

Patients with kidney disease often have fixed urine specific gravity, meaning it doesn't change with fluid intake. This indicates impaired concentration.

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Osmolality

A more accurate measure of the kidney's ability to dilute and concentrate urine compared to specific gravity.

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Normal osmolality

The normal range for urine osmolality is 280 to 300 mOsm/kg. It reflects the kidney's ability to regulate solute concentration.

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What is the most common pyelonephritis-causing organism?

Escherichia coli is the most frequent cause of pyelonephritis.

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What organism is common in hospitalized patients with pyelonephritis?

Enterococcus fecalis is frequently found in hospitalized patients with pyelonephritis.

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What are some other organisms causing pyelonephritis besides E. coli and Enterococcus?

Other organisms associated with pyelonephritis include Proteus mirabilis, Klebsiella, and Pseudomonas aeruginosa.

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What organisms are common in bloodborne pyelonephritis?

Staphylococcus aureus, Candida species, and Salmonella species are common culprits in bloodborne pyelonephritis.

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What imaging procedures are used for pyelonephritis?

X-ray of the kidneys, ureters, and bladder (KUB) and IV urography are commonly used.

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BUN-to-Creatinine Ratio

A test that evaluates hydration status. An elevated ratio indicates hypovolemia. A normal ratio with elevated BUN suggests intrinsic kidney disease.

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Urinary Retention

A condition where the bladder is unable to fully empty, leading to a sensation of fullness, dribbling urine, dysuria, and bladder retention.

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Stress Urinary Incontinence

Involuntary leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, or exercising.

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Urge Urinary Incontinence

Sudden, uncontrollable urge to urinate, often resulting in urine loss before reaching the toilet.

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Contributing factors to Urinary Problems

Factors that can contribute to urinary problems include female gender, diabetes, pregnancy, neurological disorders, gout, decreased immune defenses, incomplete bladder emptying, inflammation of the urethra, instrumentation of the urinary tract, congenital abnormalities, and compression of the ureters.

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Pathophysiology of Urinary Problems

The underlying mechanisms that cause urinary problems include factors such as inflammation, infection, obstruction, nerve damage, and muscle weakness.

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Urinary Problems - Importance

Urinary problems are common and costly, often leading to significant functional, physical, and psychological changes that reduce quality of life.

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Life-threatening complications with Urinary Problems

While life-threatening complications are rare with urinary problems, they can still occur and should be addressed promptly.

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Uremia

A serious condition resulting from kidney failure where waste products build up in the blood, leading to various symptoms like fatigue, nausea, and muscle cramps.

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What are the stages of CKD?

Chronic kidney disease (CKD) progresses through 5 stages based on the estimated glomerular filtration rate (GFR), which measures how well the kidneys filter waste.

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What are the key features of uremia?

Uremia manifests with various symptoms like metallic taste, nausea, muscle cramps, fatigue, and edema, indicating the body's struggle to eliminate waste.

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GFR

Glomerular filtration rate (GFR) measures how well the kidneys filter waste products from the blood. A low GFR indicates impaired kidney function.

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What is CKD?

Chronic kidney disease (CKD) is a progressive loss of kidney function over time, eventually leading to kidney failure if not treated.

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What are the main causes of ESKD?

End-stage kidney disease (ESKD) is the final stage of CKD, often caused by hypertension (high blood pressure) or diabetes.

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Dietary restrictions for uremia

People with uremia need to restrict their intake of fluids, protein, and electrolytes to help manage waste buildup and maintain a healthy balance.

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What is renal replacement therapy?

Renal replacement therapy, such as dialysis or kidney transplant, is necessary when the kidneys can no longer function properly and is a life-saving intervention.

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Kussmaul Respirations

Deep, rapid breathing often seen in severe metabolic acidosis, a complication of CKD.

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Uremic Lung

Lung inflammation and fluid buildup that can occur in patients with CKD due to waste buildup in the body.

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Pleural Friction Rub

A grating sound heard during breathing caused by inflammation of the pleura, the lining of the lungs.

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Dialysis for Neurological Problems

Used to treat CKD when neurological problems arise, helping to remove waste and restore brain function.

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Fluid Volume Excess in CKD

Excess fluid in the body due to impaired kidney function, leading to hypertension, heart failure, and edema.

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Anemia in CKD

Decreased red blood cell count due to impaired erythropoietin production by the kidneys.

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Abnormal Bleeding in CKD

Increased bruising, petechiae, and bleeding due to impaired platelet function and blood clotting.

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Lab Tests for CKD

Routine blood tests include levels of electrolytes (calcium, phosphate, bicarbonate), hemoglobin, and hematocrit to monitor kidney function.

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Study Notes

Kidney Function and Elimination

  • Kidneys maintain body fluid volume and composition
  • Filter waste products
  • Regulate blood pressure and acid-base balance
  • Produce erythropoietin (RBC production)
  • Convert vitamin D to its active form
  • Ureters, bladder, and urethra are the drainage routes for urine excretion

Kidney Anatomy and Physiology in Adults

  • Located retroperitoneally, behind the peritoneal cavity
  • In adults, 4-5 inches long, 2-3 inches wide, 1 inch thick
  • Weighs about 8 oz (250 g)
  • Left kidney is slightly longer than the right

Kidney Functions

  • Glomerular filtration is the first step in urine formation
  • Filtration rate is about 180 liters/day.
  • The average normal glomerular filtration rate (GFR) is 125 mL/minute
  • About 1 to 3 liters of urine is excreted daily

Tubular Reabsorption

  • Second process in urine formation
  • Reabsorption maintains normal urine output (1-3 L/day)
  • Prevents dehydration
  • Influenced by hormones such as ADH and aldosterone

Other Important Kidney Functions

  • Regulation of blood pressure and fluid volume
  • Removal of waste products
  • Maintaining electrolyte homeostasis and acid-base balance
  • Erythropoietin production for red blood cell synthesis
  • Vitamin D activation

Hormonal Influences

  • Antidiuretic hormone (ADH) and aldosterone regulate urine concentration and volume.
  • They affect fluid and electrolyte balance.

Changes in Kidney Function with Age

  • Cortical tissue loss reduces kidney size
  • Reduced renal blood flow impacts filtration ability
  • Glomerular filtration rate (GFR) decreases with age, more drastically after age 45, impacting waste removal and fluid balance.
  • Urinary concentration capacity declines, increasing risk of dehydration and hypernatremia.
  • Changes in hormone levels (renin, aldosterone, vitamin D) can impact kidney function

Renal/Urinary System Changes Associated with Aging

  • Decreased renal blood flow
  • Thickening of blood vessels
  • Reduced kidney size impacting filtration process
  • Urinary concentration ability is reduced, leading to nocturia (increased urination at night)

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