Kidney Health Quiz

Altered Urine Elimination - Urinary System

• Altered urine elimination comes in 4 types.
• Reviews clinical manifestations, diagnostic tools for these types.
• Infections (UTI, pyelonephritis) are a type. (Review chapter 5)
• Urolithiasis (kidney stones) are a type.
• Acute kidney failure is a type.
• Chronic renal (kidney) disease, and kidney failure are types.
• Polycystic kidney disease is a type.
• Urinary incontinence is a type.
• Benign prostatic hypertrophy is a type.
• Miscellaneous cancers of the urinary system and other urinary tract conditions are types.

Altered Elimination - General Causes

• Altered elimination is caused by altered motility.
• Altered neuromuscular function.
• Altered perfusion.
• Altered patency.
• Altered volume of excretion.
• Altered body fluid balance.

Altered Urinary Elimination - #1 (Motility)

• Reduced contraction of renal tubules and ureters.
• Etiology: cancer, stones, congenital.
• Complications of decreased motility include infection risk, urine stasis in tubules and/or bladder, formation of casts (renal cells), risk of obstruction, leading to altered reabsorption and secretion.

Altered Urinary Elimination #2 (Neuromuscular Function)

• Dysfunction of the bladder due to nervous system injury.
• Individuals at risk of neurogenic bladder include those with spinal cord injury.
• Symptoms include decreased sense of need to void (incontinence) or inability to fully empty bladder (retention).
• Treatment goals are preventing UTIs and controlling incontinence.
• Treatment includes catheterization.

Altered Urinary Elimination #3 (Perfusion)

• Altered perfusion involves inadequate blood supply to the kidney.
• Etiology: disseminated intravascular coagulation (DIC), shock, or drop in blood pressure (BP).
• Complications include ischemia and/or infarction (tissue death/damage) in the kidney, pain due to decreased oxygen (02), altered reabsorption and excretion, and renal failure.
• BP decreases during inflammation, such as in anaphylactic shock.

Altered Urinary Elimination #4 (Patency)

• Altered patency of ureters, urinary pelvis, etc. is due to obstruction (like stones).
• This results in a backup (stasis) of urine flow.
• Complications include dilation of structures proximal to the obstruction, stagnant urine, leading to infection, and injury to renal anatomy.

General Clinical Manifestations of Altered Urinary Elimination

• Altered volume of excretion: anorexia (decreased appetite), nausea, vomiting, and fever.
• Polyuria: excessive urine output.
• Oliguria: low urine output.
• Anuria: no urine output.
• Frequency: increased frequency of urination.
• Urgency: strong desire to urinate immediately.
• Dysuria: painful urination ("burning").
• Altered excretion characteristics: hematuria (blood in urine), pyuria (pus in urine), and proteinuria (protein in urine).

General Diagnostic Tests for Kidney Function

• Intravenous pyelogram (IVP).
• Cystogram (cysto=bladder), dye used for bladder x-ray.
• Cystoscopy; looking at the bladder with a scope.
• Bladder and kidney biopsy.
• Renal ultrasound, CT scan.
• Urine tests: urinalysis.
• Blood tests: glomerular filtration rate (GFR), serum creatinine, blood urea nitrogen (BUN), serum urea. All these indicators increase in kidney failure.

General Urinary Tests (Including Macroscopic and Microscopic Urine)

• Urine culture for C&S (culture and sensitivity) determines the best antibiotic to treat an infection.
• Macroscopic urine: visual inspection (color, clarity).
• Urine dipstick: measures pH, specific gravity, protein, glucose, ketones, nitrite (infection), leukocyte esterase, and blood.
• Microscopic urine evaluation: examines crystals, casts, squamous cells, white blood cells, and bacteria.

Urinary Catheterization

• Indwelling, in-and-out, and external urinary catheters.
• Indwelling catheters are at higher risk of leading to infection.
• Straight catheter is used for sample collection or bladder drainage.

Urolithiasis (Kidney Stones) - Pathophysiology

• Renal calculi (kidney stones) are solid masses that form in the renal system.
• Causes include urinary stasis, elevated urinary levels of salts, organic or inorganic acids (eg., calcium, uric acid).
• This can lead to renal tubule obstruction.

Urolithiasis - Clinical Manifestations

• Pain: Renal colic (severe, flank pain) that occurs during stone movement.
• Nausea and vomiting, hematuria (blood in urine).
• Acute pain, intermittent, radiating, excruciating; worse than childbirth.
• Non-colic pain, distension of renal calices or pelvis (dull, deep pain), varying intensity.

Urolithiasis - Diagnostic Criteria

• History of pain (lower back), pain radiating to the groin, pain with urination (urgency).
• Hematuria (blood in urine), fever, chills, nausea, vomiting.
• Imaging studies: CT scan, intravenous pyelogram (IVP), KUB (kidney, ureter, bladder X-ray).
• Laboratory analyses: urinalysis, lab analysis of calculi (stone) composition.

Urolithiasis - Treatment

• Supportive treatment with pain control.
• Increase fluid intake and help with the passage of stones by straining urine.
• Lithotripsy (ultrasound waves) to break up stones.
• Surgical removal of calculi (kidney stones).

Kidney Stones - Risk Factors and Prevention

• Risk factors: inadequate fluid intake, high protein/animal protein diets, high salt and sugar, low fiber diets, recurrent kidney/urinary tract infections, certain medical conditions, obesity, sedentary lifestyle.
• Prevention: hydration, low calcium oxalate diet.

Renal Failure - Clinical Example

• Kidney failure is the loss of kidney function to cleanse the blood of waste products (e.g., urea).
• This can convert urea to ammonia, which is toxic to the brain.
• Types: acute and chronic.
• Symptoms: decreased urine output, fluid retention (edema), shortness of breath, fatigue, confusion, nausea, weakness, and irregular heartbeat.

Acute Renal Injury/Failure

• Can be caused by decreased blood supply to the kidneys (compromised/insufficient perfusion).
• Etiology: hemorrhagic or surgical shock, embolism, heart failure (CHF), severe dehydration, medications, sepsis, and sudden drop in BP.
• Can be reversed.
• Complications: accumulation of urea (waste), ammonia, and toxemia.
• Fluid imbalance (hypervolemia), electrolyte imbalance (hyperkalemia), and acid-base imbalance (can't excrete H+).

Chronic Kidney Disease

• Slow onset, progressive kidney disease.
• Estimated glomerular filtration rate (eGFR) is used to categorize.
• Causes: diabetes, hypertension, glomerulonephritis.
• Video: https://www.youtube.com/watch?v=fv53QZRk4hs

Chronic Kidney Disease (CKD) - Pathophysiology of Hypertension Impact

• Hypertension thickens blood vessels in the glomerulus.
• This decreases the lumen size, causing decreased blood and oxygen to the kidney.

Chronic Kidney Disease (CKD) - Stages

• CKD is categorized based on estimated GFR levels.
• Stage 1-5; the higher the stage, the lower the GFR, and the worse the kidney function.

Chronic Kidney Disease - Pathophysiology Summary

• Kidney functions and its manifestations of decreased function/failure are described in a flow chart summary graphic.
• Complications include hypertension, hyperkalemia, anemia, edema, uremic symptoms, skeletal changes, pericarditis, coagulopathies, bleeding, acidosis, and hyperparathyroidism, leading to osteoporosis.

Clinical Manifestations of Kidney Failure Related to Kidney Function

• Edema, Infertility/impotence, bone weakness/fractures, anemia, hypertension, bleeding, acidosis.
• Appear only when over 75% of kidney function is destroyed.
• Diagnosis: Blood tests of eGFR, creatinine and BUN levels.

Long-Term Treatment of Kidney Failure

• 1. Dialysis (peritoneal or hemodialysis)
• eGFR 15 or less; 75% or less kidney function.
• 2. Kidney transplant

Hemodialysis

• Hemodialysis is a procedure during end-stage renal disease.
• A process where blood is filtered and cleansed and returned to the body.
• Requires vascular access: preferred access (AV fistula) or AV graft (if Fistula isn't an option).
• Another access is the Central Venous catheter.

Polycystic Kidney Disease (PKD)

• Genetic condition (autosomal dominant or recessive).
• Pathophysiology: growth of fluid-filled cysts in the kidneys.
• Clinical manifestations: reduced perfusion and tubule obstruction.
• Treatment: treat complications (infections; pain meds; hypertension). Dialysis may be needed eventually.

Urinary Incontinence

• Inability to voluntarily prevent urine discharge, a common issue.
• Etiology (causes) include nerve control (age, disease, stroke), reduced levels of estrogen, and abdominal muscle tone (multiple pregnancies or obesity).
• Types include: overflow (leakage), stress (coughing/sneezing), urge (infection, neurological).
• Functional incontinence refers to inability to toilet independently.
• Risk factors: elderly, paralysis, pregnancy, MS, parkinsons
• Other risk factors can be medications/complications with delivery with tissues. incontinence.
• Treatment: behavioral techniques, estrogen creams, collagen injections, medications to calm overactive bladder, surgical options (sling procedure).
• Diagnosis: urodynamic studies (cystometry, filling/emptying of bladder); post-void residual tests (check how much urine left after voiding).

Interstitial Cystitis

• Nonbacterial cystitis, inflammation of bladder lining, may be autoimmune.
• Pelvic pain, urinary frequency that mimics a UTI.
• Mostly affects young women.
• Diagnosis of exclusion; urinalysis, culture sensitivity.
• Treatment options: medications (pain, antidepressants, protecting meds); pelvic floor PT; bladder training; nutrition adjustments (low acid).

Benign Prostatic Hyperplasia (BPH)

• Enlargement of the prostate gland (benign).
• Common in men over 50 (50% of males age > 50 have it).
• Diagnosis: digital rectal exam (DRE) and PSA blood test (prostate specific antigen).
• Biopsy may be needed to test for cancer.
• Symptoms include nocturia (frequent urination at night), hesitancy (inability to start urination).
• Weak urinary stream, inability to fully empty bladder (possible excess urine in ureters, hydroureter, hydronephrosis, and UTIs).
• Treatment: medications like alpha-blockers (e.g., Flomax to relax muscle and improve flow) and surgery (transurethral resection of the prostate (TURP)).

Prostate Cancer

• Slow-growing neoplasm of the prostate gland, most common cause of male cancer-related death in those over 50.
• Often asymptomatic until metastasis.
• If symptomatic, symptoms are similar to benign prostatic hyperplasia (BPH).
• Diagnosis: digital rectal exam (DRE), monitoring PSA (prostate-specific antigen) blood levels and a biopsy for definitive diagnosis.
• Treatment options include surgery (prostatectomy), hormone therapy, and watchful waiting (monitoring).

Kidney Cancer (Adenocarcinoma)

• Risk factor: cigarette smoking, frequently metastasizes to the liver, brain, and bone. Symptoms may appear later in the process.
• Symptoms include painless hematuria, flank pain, and fever.
• Diagnosis: urinalysis, KUB x-ray, IVP-IVP and CT scan, and biopsy.
• Treatment: nephrectomy

Bladder Cancer

• Carcinoma of the bladder that arises from the bladder lining.
• Often metastasizes before symptoms are seen.
• Risk factors: smoking, exposure to chemicals, chronic cystitis.
• Symptoms: hematuria, dysuria, and nocturia (frequent urination at night).
• Diagnosis: cystoscopy and biopsy.

Test your knowledge on kidney functions, diseases, and treatments. This quiz covers important topics such as dialysis, Polycystic Kidney Disease (PKD), and urinary system complications. Enhance your understanding of renal health and associated conditions.