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Anuria
Urine output of less than 100ml/day
hemodialysis
the process of cleansing the patients blood via the movement of dissolved particles from one fluid compartment into another across a semipermeable membrane. the clients blood flows through onefluid compartment, and the dialysate is in another fluid compartment.
nephrolithiasis
the formation of kidney stones. Kidney stones are formed in renal parenchyma
oliguria
urine output of less than 400ml/day
urolithiasis
formation of urinary stones or calculi. Urinary calculi are formed in the ureter.
Normal renal function values
BUN 8-25
Serum Creatinine 0.6-1.3
serum Uric acid level 2.5-8.0
urine output 30ml/hr minimum
KUB (kidneys, ureters, and bladder)
xray of the urinary system
Bladderultrasonography
bladder scanning, ultrasound of the residual fluid in the bladder
CT scan
provides sectional scans of kidney and urinary tract
IV pyelography
radioactive dye, with an xray showing the kidney function.

assess for iodine alergies, seafood alergies
Renal angiography
a radioactivedyethrough a catheter inserted through femoral artery to examine the renal blood flow

assess for iodine alergies, seafood alergies, inform about a burning sensation.
Cystoscopy and Biopsy
The bladder mucosa is examined for inflammation, calculi, tumors, by means of a cystoscope, biopsy may be obtained this rought

Cyst- bladder
Renal biospy
insertion of a needle into kidney to obtain a sample of tissue for examination
Kidney function
Filtration
Electrolyte Excretion
Waste Clearance
Storage of urine
Regulation of:
Water excretion
Acid-Base balance
Blood pressure
Calcium-phosphorate balance
Synthesize eryropoietin
BUN levels
BUN is higher is diet has more protein
BUN is the kidney filtration indicator

Normal Adult Range: 7 - 18 mg/dl
Creatinine Lab value
Creatinine, serum 0.6 - 1.2 mg/dl
Renal Hormones and Enzymes
ADH, Aldosterone, Atrial Natriuretic peptide,
Renin
Erythrpoietin
ADH
Forces body to retain water
Increases urin concentration
Aldosterone
Increases the absorption of sodium and water
secreted by adrenal cortex
Atrial Natriretic Peptide
Stimulates vasoldilation and increases glomeluar filtration
Promotes sodium loss via urine

Sent by heart muscles when fluid to much fluid is present so that water will follow the sodium
Renin
A protein released by the kidneys when you have decreased sodium or low blood pressure
Erythropoeitin
Stimulates red blood cell production

Normal kidney Urine production
Kidneys produce 750-2000 cc/urine/day Avg. Output is 60cc/hr Must have at least 30cc/hr
Diagnostic Tests- Urinalysis
Collect first void of the day: best results pH 4.5-8 Specific gravity 1.010-1.026 ↑ protein = proteinuria ↑ glucose = glycosuria RBC’s 0-4; WBC 0-5; Casts (protein) 0
BUN/Creatinine ratio
10:1
HGB/HCT affected by renal
erythropoeitin isnt produced in renal failure thus the HGB and HCt will be out of wack, low, and oxygenation will plummit, anemia is then present.
UTI
40% of noscomial infection from Foley Catheter: kinks or blockage Women more prone than men- wiping wrong, sex without urinating afterwards. Lower UTI’s respond well to treatment, ascend and can infect the kidney
Upper UTI
Renal parenchyma, pelvis, and ureters Typically causes fever, chills, flank pain Example Pyelonephritis: Inflammation of renal parenchyma and collecting system
Lower UTI
Lower urinary tract Usually no systemic manifestations Example Cystitis-inflammation of bladder wall
cystitis
Inflammation of the bladder Most common site of UTI S/S:  May be asymptomatic, frequency, urgency, dysuria, suprapubic and low back pain More serious: Hematuria, cloudy urine, flank pain UA, C&S, antibiotics Bladder is inflammed, most common UTI, and be asystimatic for a long time C&S- culture and sensitivity is required. Most common in women due to short urethra.  
pyelonephritis
Inflammation of kidney and renal pelvis Infectious nature, can destroy renal structure Usually ascending in nature S/S chills, fever, vomiting, flank pain, leukocytosis, bacteria and pus in the urine Can cause sepsis if not treated Treat cause, relieve obstruction, antibiotics
Pylelonephritis Manifestations
Flank pain Lower urinary tract symptoms characteristic of cystitis Costovertebral tenderness usually present on affected side Dx: Ultrasound, CT Scan, IVP, U/A Bacteriuria and pyuria still persist
Pyelonephritis Drug therapy
Antibiotics and lots of fluids to "wash" it out. NSAID's or antipyretics for fevers and discomfort.
Urosepsis
Systemic infection from a urologic source Prompt diagnosis and treatment Can lead to septic shock and death Septic shock is outcome of gram-negative organism that is not treated/responds to antibiotic therapy. Takes a few days to show-up, blood infection, septic shock is very fast moving.
Septic Shock
decreased B/P, renal perfussion, vasodilation, Cardiac output goes down. DIC possible. In beginning: tachycardia, raised b/p
Glomerulonephritis
Immunologic process Recovery usually complete Untreated may cause destruction of renal tissue; renal insufficiency The molecules become too big once IgA is introduced and latches onto intruders. Causes coca cola colored urine.
Bactrim
Antibiotic:
Treats uncomplicated or initial infections
Inexspensive
Taken BID
Macrodantin

Antibiotic: given 3-4 times daily
Long term use for pulmonary fibrosis
neuropathies
Levaquin
Antibiotic:
Treats complicated infections
Urised

Urinary analgesic Methylene Blue
turns urine blue or green
Relieves UTI Symptoms
used with antibiotics.
Pyridium
Relieves pain, burning sensation and frequency,and urgency of urination that are symptomatic of lower UTI
Turns urine orange-red STAINS CLOTHING!!!!
STOP!!! is creatinine clearance is <50ml/min
Ditropan

Antispasmodics (urinary) Relaxes smooth muscle in urinary tract by inhibiting acetylcholine

Anticholinergic agents first line medications Inhibit bladder contractions Indications Neurogenic bladder Overactive bladder Contraindicated cardiac, renal, hepatic and prostate problems Side effects drowsiness, blurred vision, dry mouth
Urolithiasis
Stones
Kidney Stones = Urolithiasis Types of Stones: Calcium, Magnesium, Uric Acid pH may inhibit stone formation

S/S of Urolithiasis
Very painful, flank pain, cannot void, or diminished voiding.
Nephrostomy tube care
Assess for bleeding at site Assessment of skin Ensure unobstructed drainage NEVER clamp the tube NEVER irrigate the tube without orders Encourage fluids PO Use aseptic technique Accurate I/O
Benign Prostatic Hypertrophy (BPH)
Enlarges about age 50 Signs and symptoms: hesitancy, frequency, nocturia, hematuria, pain Diagnostic PSA, Cystoscopy Surgical Intervention: Transurethral resection of the prostate (TURP) Post-op care: CBI, 3-5 glass set up Surgical Intervention: Supra pubic catheter
Prostate cancer
Detected by rectal exam, Prostate Surface Antigen PSA Medications: Hormone therapy to inhibit testosterone production Radiation therapy Surgical removal Post op complications Cancer causes blood clots! PSA normal range blood test 0-4
Chronic renal failure
Progressive, irreversible loss of kidney function over time, or ARF that never resolves (GFR<10%) Common causes:  Glomerulonephritis, DM, HTN Complete loss of function results in: Retention of nitrogenous wastes Fluid & Electrolyte Imbalances Fluid Retention Vomiting & diarrhea Anemia Calcium/Phos imbalances Metabolic Acidosis- kidney unable to hold on to bicarb In plain talk…if the kidneys don’t work…wastes build up, fluids are retained, no new blood is made, and no calcium is absorbed!
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