Kidneys by Uchenna

• 1 million cells each kidney
• Consists of glomerulus and tubules

• 2 types
• Juxtamedullary
• (15%)
• Cortical
• (85%)

*know where drugs work and how dysfunction of each area manifests

• Consists of compact tuft of capillaries – Bowman’s capsule
• Fluid and particles filtered into Bowman’s space

• 4 segments
• Proximal convoluted tubule
• Loop of Henle Distal
• Convoluted tubule
• Collecting tubule

• Begins with filtration of fluid into Bowman’s space
• Chemical composition similar to plasma, except almost no proteins – cannot pass through glomerular wall
• Approx 125ml filtrate formed each minute (Glomerular filtration rate = GFR) Protouria is issue with filtration
• High pressure system (60mmHg)
• Innervated by Sympathetic nervous system, renin-angiotensin-aldosterone system

• Nearly all of Glomerular filtrate reaborbed in normal circumstances
• Water and urea passively absorbed
• Sodium, potassium, chloride, calcium, phosphate ions, glucose, amino acids are actively transported across cell membranes

• Proximal tubule – 65% of all reabsorption along with nutrients (ex. Glucose)
• Loop of Henle – concentration of urine- reabsorbs more NA and CL than water Distal and collecting tubules – reabsorbs sodium and chloride, impermeable to water – dilutes tubular fluid

ADH effects kidney to concentrate or dilute urine to respond to changes in osmolality of ECFADH controls permeability of tubules

• Kidneys filter 1000ml – 1300ml blood/minute and receive 20% - 25% of cardiac output
• Neural and Humoral Control
• Dopamine
• Angiotensin II
• ADH
• Autoregulatory
• Blood flow varies based on arterial pressure
• Juxtaglomerular Complex
• Plays feedback role in release of renin

• Product of purine metabolism
• Urea Elimination
• End product of protein metabolism
• Drug Elimination

• Renal Clearance
• Volume of plasma cleared each minute Every substance has its own clearance rate Ex: glucose normally should be zero
• Regulation of Na+ and K+ elimination Regulated by GFR and humoral agents Regulation of pH Conserves base bicarbonate and eliminates H+ ions

• Product of purine metabolism
• Urea Elimination
• End product of protein metabolism
• Drug Elimination

• Renin-Angiotensin-Aldosterone System
• Renin synthesized in juxtaglomerular nephrons of kidneys

• Erythropoetin
• Most formed in kidneys
• Responsible for RBC formation in bone marrow

• Vitamin D
• Activation occurs in kidneys

• Single specimens
• 24 hour collections

• Glomerular Filtration Rate
• Creatinine Clearance – 115 – 125ml/min

• Blood Tests
• Serum creatinine – 0.6 – 1.2mg/dl
• BUN – 8 – 20 mg/dl

• Color
• Clarity
• Glucose
• RBCs
• WBCs
• Protein
• Ketones

• Congenital Disorders
• Most of amniotic fluid is fetal urine – indicator of fetal kidney function
• 　
• Simple and Acquired Renal Cysts
• 　
• Medullary Cystic Disease
• Cause of renal failure in up to 25% of children

• Autosomal dominant disorder
• Manifestations: pain as cysts enlarge, hematuria, UTI from infected cysts, HTN, may progress to ESRD
• Dx: US, CT
• Tx: control of sx, HTN, dialysis and renal transplant in ESRD cases

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• Obstruction causes stasis of urine in kidney → renal calculi, infection, dilation of renal pelvis and eventual renal atrophy

Manifestations: pain, s/s uti, s/s renal dysfunction

Crystalline materials of normally excreted by products in urine

• Types of stones
• Calcium – most common
• Magnesium – often associated with infection
• Aka: struvite stones
• Uric acid – usually present in acidic urine
• Cystine – rare

• Manifestations: pain, nausea, vomiting
• Dx: Xray, US, CT, IVP, urinalysis
• Tx: pain relief, fluids, surgery, stone

• Most pathogens enter via urethra
• Can affect lower or upper urinary tract
• Factors that predispose patients
• Host defenses
• Pathogen virulence
• Obstruction
• Reflux
• Catheters
• Manifestations: urgency, frequency, dysuria, pelvic or back pain, cloudy or foul smelling urine, fever
• Dx: UA and urine c/s, US, CT
• Tx: Antibiotics

• Acute
• Caused by infection
• Chronic
• Caused by infection or other problems such as reflux

• Manifestations: abrupt onset of fever, malaise, chills, back pain, CVA tenderness, dysuria, frequency
• Dx: UA, urine c/s
• Tx: Antibiotics

• hematuria with RBC casts, ↓ GFR, azotemia, oliguria, HTN
• Caused by diseases that provke inflammatory responses in cells of glomeruli
• 3 types
• Acute Proliferative Glomerulonephritis
• Usually caused by strep infection
• Rapidly Progressive Glomerulonephritis
• Numerous causes (Lupus, vasculitis, etc)
• IgA Nephropathy

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• Problem that results in excessive loss of protein (>3.5g/24h) from increased glomerular permeability
• Edema and hyperlipdemia characteristic
• Can be acute or chronic in nature

• Drugs can impair blood flow, damage nephrons, form crystals which cause obstruction or by producing hypersensitive reactions
• Ex: sulfa drugs, PCNs, NSAIDs, ASA

• Many causes
• SLE – caused by deposits on immune-complexes in glomerular wall
• Diabetes – elevations in glucose alter glomerular membrane and increase amount of protein in filtrate
• Hypertension – causes sclerosis of renal arteries, reducing blood flow

• most common primary neoplasm of young children
• Dx: CT
• Tx: Surgery, chemo, RTx
• Adult Kidney Cancer
• Dx: CT, MRI
• Tx: Surgery, chemo

• Kidneys not able to remove body’s metabolic wastes which disrupts fluid volume, electrolyte balance, acid-base balance
• Two Types
• Acute
• Chronic

• Phases
• Onset
• Maintenance
• Recovery
• Dx: urine tests, serum BUN, Cr
• Tx: ID cause, avoidance of nephrotoxic substances, strict I&O, dialysis

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• Develops when renal function < 25% of normal or when GFR <15ml/min

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• Dialysis
• Hemodialysis
• Peritoneal Dialysis
• Renal Transplant
• Dietary Management

• Congenital: congenital narrowing of external meatus
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• Acquired: BPH
• Can cause urinary stasis → UTI, hydroneprosis, kidney damage

Spastic Bladder - failure to store urine due to reflex bladder spasm with a decrease in bladder urine volume

• Flaccid Bladder – atony of the bladder allowing for overfilling
• Non-relaxing External Sphincter

• Stress Incontinence
• Involuntary loss of urine associated with activities (ex. Coughing)
• Urge / Overactive
• Urgency and frequency associated with hyperactivity of the detrusor muscle
• May or may not cause involuntary loss of urine
• Overflow
• Involuntary loss of urine when bladder pressure exceeds urethral pressure

• Dx: blood tests, urine tests, voiding diary, stress test, urodynamic studies
• Tx: kegel exercises, toileting schedule, medications, surgery

• Who is at risk for CAUTIs?
• How can nurses reduce the risk of CAUTIs in patients undergoing urinary catheterization?