1 - renal system

right
liver

maintain homeostasis by balancing fluids/electrolytes and making hormones

erythropoietin (RBCs)
renin (BP modulation)
calcitral (vitamin D to maintain Ca++ levels)

in response to hypoxemia!!

ppl with pulm/card disease have LOTS of rbcs and hemoglobin bc the kidneys are like popping their pussy to make up for the lack fo O2

1) BP drops/fluid volume drops

2) renin released from kidneys

3) renin + angiotensinogen = angiotensin 1

4) ACE released from lungs

5) ACE + angiotensin 1 = angiotensin 2

6) angiotensin 2 goes to the adrenal glands AND acts on blood vessels

7) adrenal glands release aldosterone (stimulated salt and water resorption) AND vasocontriction

8) BP up :))))))

blocks the release of ACE from the lungs --> prevents conversion of angiotensin 1 to 2

prevents rises in BP (via salt and water resorption and vasoconstriction)!

#diuretic

infectious inflammation at the basin of the kidney

acute: from under/ untreated UTI; infection travels up the ureter to kidney basin; fever, chills, headache, back pain and flank pain

chronic: injury, obstruction or reflux; leads to End Stage Renal Disease

diagnosis: urine analysis (bacteria, hematuria, leukocytosis)

treatment: long course of antibiotics (14 days)

no contraidications to activity (aside from like fatigue and malaise)
encourage to complete all antibiotics!!!!

infectious, inflammatory disease of the filtering units of the kidney (glomerulus); common cause of chronic renal failure (ESRD)

common comorbidities: diabetes, lupus, peripheral artery disease

signs and symptoms: hematuria, proteinuria, decreased urin output --> systemic edema, pulmonary edema, INCREASED BP

diagnosis: urine analysis with proteinuria, hematuria, pyuria

treatments:
-- low fat, low protein, low salt diet (very sad)
-- diuretics!! (ACE inhibitor is the first line; for BP r/x calcium channel blockers, beta blockers)
-- dialysis and transplantation

ELECTROLYTES ARE OFF!! muscle cramping (K+), muscle weakness, hemodynamic compromise, incr SBP

toxins stay in system eek

excess fatigue

BP prone to fluctuating a lot (disease elevates BP, dialysis drops BP, etc)

kindey stones!; crystal formations that cause urinary obstruction and pain (spiky ouch)

signs and symptoms: PAIN!!!!!!!!!!! flank pain, abdominal pain, back pain; urgency, frequency, hematuria

diagnosis: CT scan, ultrasound

treatment: (spoiler, there is no fun option)
-- if small, time and pain meds
-- if big, lithotripsy (shock waves) to break up stones into passable pieces

can cause decreased urine output but also urgency

serious pain and discomfort

breakdown of striated muscle
-- exertional
-- crush induced
-- fever, hyperthemia (extreme and prolonged)
-- meds
-- excessive alcohol
-- endocrine disorders, infections, electrolye abnormalities, etc

symptoms:
- local swelling, pain, weakness
- systemic fever, fatigue, hypotension, arrhytmias
- confusion, nausea, vomiting, dark urine, decreased urine output

diagnosis: decreased urine output, proteinuria

treatment:
-- PHYSICAL REST + CORRECT ELECTROLYET BALANCE

graded 1 (bruise) to 5 (basin and ureter disconnected)

symptoms: hematuria, low back pain, signs of internal bleeding, decreased urine output

dizziness
low BP
nausea
vomiting
skin tone discoloration
shock

diagnosis: ultrasound (FAST)

t/x:
-- conservaive t/x 4-6 weeks; just lay low and be nice to ur kidneys
-- excision if grade 5!! cannot reattach ureter

Focused Assessment using Sonogrpahy in Trauma

pretty reliable and quick form of ultrasound for traumatic injuries

trauma from contact, fall,or injury
just watch for symptoms

usually secondary to diabetes, HTN, chronic UTIs, primary renal dysfunction and advancing age

signs and symptoms:
-- SHORT TERM: incr weight, edema, mental status changes, fatigue, incr BP, nausea, vomiting, loss of apetite, low urine output
-- LONG TERM: bone demineralization, tendon avulsion, avascular necrosis, demyelination of PNS, anemia

diagnosis: lab tests

t/x:
diet
meds
renal replacement therapy
transplants

fast hemodialysis
slow hemodialysis
peritoneal dialysis
transplant

-- 3x per week for 3-4 hour sessions
-- A-V fistula necessary!!!!!!! fast arterial to slow venular = turbulence; need easy connection

-- continuous renal replacement therapy, continuous veno veno hemodialysis

-- slower and can be done at home

electrolyte fluid inserted into peritoneal space (abdominal cavity) via catheter

special ion balance will draw out waste products via osmosis

second bag drains fluid from space

*** gravity driven, can be done independently/overnight, tedious, risk of infection
*** 30-40 min 4x/day PR overnight

with good tissue typing, they tend to be really successful; live transplant >>> cadaver, but both good options

** btw, they keep the old kidney in ther eek

creatinine
BUN
GFR
electorlytes
microalbuminuria

result of natural breakdown of creatinine phosphate (PCr) in muscles; kidneys are supposed to filter her out

increase = kidneys aren't filtering OR excess PCr in blood (too much muscle breakdown)

anything above 2.0 is a lil concerning; dependent on muscle mass though

glomerular filtration rate!calculated by measuring any chemical that's common in the blood that is filtered and excreted by kidneys (neither reasorbed nor secreted)

creatinine clearance is an easy one since it's already at a steady-state ca in blood

early renal disease = large change in GFR, small change in creatinine; suddenly we're not filtering efficiently, and there's just a little effect on the actual amt of creatinine

advanced renal failure = large change in creatinine (amount), small change in GFR; we've been inefficient with filtering for a hot minute, now we're seeing a significant change in the amt of creatinine being filtered out

blood urea nitrogen is a measure of the amnt of nitrogen in the blood that comes from urea

indicative of kidney ORRRR liver damage!!!!!!

increase = kidneys aren't removing it OR elevated protein breakdown

decrease = liver problems, malnutrition, excessive alcohol, overhydration, pregnancy (not that significant tbh)

waste product from liver; result of protein digestion

7-25 mg/dL

dehydration
heart failure
GI bleed
high protein diet
steriod use
burns
fever

they all cause decreased blood flow in general, so there's just less volume for the kidneys to filter --> relatively low everything

they all result in increased protein breakdown --> greater production of urea --> more appears in urine

uremia!!! (buildup of other nitrogenous waste)

can cause:
altered cognitive function (encephalopathy)
impaired taste (dysgeusia)
loss of apetitie (anorexia)
nausea and vomiting
bleeding
skin discoloration

electrolyes are super important for maintaining homeostasis, and your kidneys have a huge role in regulating them

they regulate myocardial and neuro function, fluid balance, oxygen delivery, acid-base balance, etc

renal failure is the most common cause of electrolye distrubances

regulation of blood and body fluids
transmission of nerve impulses
heart activity
some metabolic functions

neuron function (muscle cramping, arrythmias)
osmotic balance (incr edema, incr seeping)

gastric metabolism
acid-base balance
CNS transmission
protein transport

the base in the acid-base balance!! increases pH!!

measures albumin levels in urine

healthy kidneys: albumin's large size and (-) charge mean that it doesn't get excreted in glomerulus

renal disease: albumin (and other similar proteins) can cross glomerulus bc of dysfunction

30-50 g/L

color:
should be straw to amber
abnormal is due to illness, diet or drugs

clarity/transparency:
should be clear
abnormal due to insoluble elements

constrict the Afferrent arteriole

can cause potential kidney damage

dilate the Efferent arteriole

protects kidneys