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total urine output less than 100 ml in 24 hours
increased blood urea nitrogen and serum creatinine levels suggestive of renal impairment without outward symptoms.
pain with voiding
feeling to void often. usually voiding small amounts every hour
Decreased urine output between 100-400ml in 24 hours
increased urine output greater then 2000ml in 24 hours
full blown manifestations of renal failure
- Produced by protein and muscle breakdown.
Blood Urea Nitrogen BUN
- Byproduct of protein breakdown in the liver
- 8-23mg/dL 60-90yo
abnormal Serum creatinine
- increased: =renal impairment
- decreased:=may be caused by decreased muscle mass
- increased:=hepatic/renal disease, dehydration or decreased renal perfusion, high protein diet, infectionm stressm steroid use, GI bleeding, blood in tissues.
- decreased:=may indicate malnutrition, fluid volume excess, severe hepatic damage
- helps to determine nonrenal factors such as poor renal perfusion, dehydration.
- mass ratio:12:1 TO 20:1
- moe ratio: 48.5:1 to 80.8:1
- increased: fluid volume deficit, obstructive uropathy, catabolic state, high protein diet
- decreased:fluid volume excess, acute renal tubular acidosis
- Urinary tract infection: inflammation of the bladder may be caused by irritation, infection from bacteris, viruses and fungi, or parasites. infectious cystitis is the most common.
- noninfectious cystitis is caused by irritation by chemicals or raditation.
factors contributing to infectious cystits (UTI)
Obstruction, stones(calculi), vesicoureteral reflux, DM, alkalotic urine, women, Age, Sexual activity, recent use of antibiotics.
rare chronic inflammation of the entire lower urinary tract
spread of infection from the urinary tract to the bloodstream
Prevention of UTI
drink 2-3L of fluid, sleep, proper nutrtion, cleanse peri area, empty bladder after intercourse, cranberry juice, apple cider, vitamin C, take full course of antibiotics.
an abnormal thickening, of the bladder wall caused by urinary retention, and obstruction
- inflammation of the urethra, s/s similar to UTI
- most common cause in men is STDs
- in men: burning/difficulty urinating
- in women: in postmenopausal women because of decreased estrogen levels.
- narrowed areas of the urethra
- may be caused by gonorrhea, trauma during catheterization,urologic procedures or childbirth.occur more often in men. may be a factor in reoccuring UTIs
- rarely cause pain but do caused obstruction of urine flow.
the surgical removal of the affected area with or without grafting to create a larger opening.long term tx for urethal strictures.
involuntary loss of urine during activites that increase abdominal and detrusor(bladder muscle) pressure
the involuntary loss of urine asssociated with a strong desire to urinate. Patients cannot suppress the signal from the bladder muscle to the brain that it is time to urinate.
detrusor hyperreflxia (reflex incontinence)
- the abnormal detrusor contractions result from neurologic abnormalities.
- -stroke, MS, spinal cord lesions may be the cause.
the involuntary loss of urine associated with overdistention of the bladder when the bladder's capacity has reached it's maximum
a combination of stress, urge and overflow incontinence
leakage of urine caused by factors other than disease of lower urinary tract
transient causes of incontinence
incontinence gets better with the treatment of underlying causes
Factors contributing to Urinary incontinence
- drugs:CNS depressants, opioid analgesics, diuretics, anticholinergics(alter cognition and urge to void)
- disease: brain damage, arthritis, parkinsons. Depression
- Inadequate resources:patients afraid to ambulate,
prescence of stones(calculi) in the urinary tract.unknown causes. biut may have a metabolic risk factor:hypercalcemia, hyperoxaluria(excess oxalate)Hyperuricemia(gout)struvite, cystinuria-insoluable cystine crystals in the urine.
formation of stones in the kidneys
formation of stones in the ureter
enlargement of the kidney caused by blockage of urine lower in the tract and the filling of the kidney with urine.
Dietary tx for renal stones.
avoid Oxalate (spinach, black tea, rhubarb)limit animal protein, reduce calcium intake, limit phosphate intake(dairy products, organ meats, whole grains. decrease uric acid intake, organ meats, poultry, fish, gravies, red wines, sardines.
Polycystic kidney disease (PKD)
- inherited disorder in which fluid filled cysts develop in the nephrons.d/t abnormal cell division. control of HTNis top priority.
- S/S:abdominal flank pain, HTN, nocturia, increased abdominal girth, constipation, bloody, cloudy urine, kidney stones.
bacterial infection of the upper urinary tract (kidney, renal pelvis). d/t urinary tract defect, obstruction
- involves acute tissue inflammation, tubular cell necrosis, amd possible abscess formation.healthy tissue can lie in the inflammed necrotic tissue.
- S/S fever chills, tachycardia, flank back pain, CVA, abd discomfort, general malaise, nocturia, burning, urgency, frequency, of urination.
Immunorenal disorder, 3RD leading cause of end stage kidney disease.
results in glomerular injury
a condition of increased glomerular permability that allows larger particles to pass through the membrane into the urine and then be excreted, which causes massive amounts of protein to be lost, edema formation
types of renal failure
-intrinsic, prerenal failure, postrenal failure
With intrinsic renal failure, there is a fixed specific gravity and the urine tests definitely positive for proteinuria. In prerenal failure, the specific gravity is high, and there is very little or no proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. There is no disorder known as atypical renal failure.
renal artery embolization
Renal artery embolization may be done instead of radiation therapy to shrink the kidney tumor by cutting off its blood supply and impairing its overall vascularity. A secondary benefit is that it reduces the risk of hemorrhage during surgery. This procedure can be accomplished in a number of ways, including placement of an absorbable gelatin sponge (Gelfoam), barium, a balloon, metal coil, or any of various other substances.
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