Renal and Urological Systems

Anatomy Kidneys: posterior upper abdomen on either side of the vertebral column at T12-L2 Review nephrons, renal pelvis, ureter, bladder, urethra

Kidney function Regulates pH, electrolyte and water balance Eliminates metabolic wastes Blood pressure regulation Glomerular filtration rate (GFR): gauge of renal function Measured by creatinine levels in blood, urine Normal value: 115 – 125 mL/min Blood urea nitrogen (BUN): measures byproduct of protein metabolism in liver

Urinary Regulation – Fluid Balance Dehydration Skin turgor Postural hypotension May lead to uremia (severe imbalances) and hypovolemic shock (not enough blood volume for the heart to pump) and progress to stupor/coma Edema Swelling of ankles and feet, muscle cramps Tissue injury and poor healing

Potassium Balance Normal=3.5-5.5 mEq/L Hypokalemia: decreased potassium in blood Muscle weakness, hyporeflexia Arrhythmias, postural hypotension Dizziness, confusion, nausea Respiratory distress Hyperkalemia: excess potassium (ARF) Muscle weakness; flaccid paralysis Tachycardia, then bradycardia, arrhythmias Nausea

Sodium Balance Normal=134-145 Hyponatremia: decreased sodium in blood Muscle weakness; skin clammy Hypotension, tachycardia, shock Anxiety, HA, convulsions Cyanosis when severe Hypernatremia: excess sodium Pitting and pulmonary edema Hypertension, tachycardia Agitation, restlessness, convulsions Flushed skin

Calcium Balance Hypocalcemia: decreased calcium in the blood Muscle spasms and cramps Paresthesias Arrhythmias, hypotension Hypercalcemia: excess calcium Hypotonia, bone pain, pathological fractures Drowsiness, confusion Heart block, cardiac arrest, HTN Weight loss

Magnesium Balance Hypomagnesemia: decreased magnesium Confusion, delusions, hallucinations Tetany, LE cramps Arrhythmias, vasodilation Hypermagnesemia: increased magnesium Hyporeflexia, flaccid paralysis Flush, lethargy, confusion Bradycardia, weak pulse, hypotension, cardiac arrest

Acid-Base Balance Normal serum pH=7.35-7.45 Metabolic acidosis: pH below 7.35 Metabolic alkalosis: pH above 7.45

Metabolic acidosis: pH below 7.35 Accumulation of acids Caused by diabetes, renal insufficiency, diarrhea Hyperventilation, weakness, dry skin, malaise May lead to stupor, coma and death

Metabolic alkalosis: pH above 7.45 Increase in bicarbonate accumulation Caused by excessive diuretics, vomiting, excessive anatacids Hypoventilation, dysrhythmias, muscle twitching, convulsions, coma, death

Respiratory Acidosis CO2 retention, impaired alveolar ventilation Caused by hypoventilation, over-sedation, COPD, hypermetabolism Observe for dyspnea, restlessness, hyperventilation cyanosis May lead to disorientation, stupor and death

Respiratory Alkalosis Diminished CO2, alveolar hyperventilation Caused by hyperventilation, hypoxia, impaired lung expansion, CHF, pulmonary embolism Observe for tachypnea, numbness and tingling, blurred vision, diaphoresis, muscle cramps, difficulty concentrating

Urinary tract infections (UTI) Lower UTI: bladder or urethra Frequency, foul smelling cloudy urine, suprapubic pain Upper UTI: kidneys Systemic – fever, chills, malaise, pain over costovertebral angle and over kidneys Increased risk with use of catheters, diabetes, women, autoimmunity, urinary reflux

Renal Failure May lead to multisystem failure HTN, dyspnea on exertion, heart failure Chronic pain, ischemic leg pain, cramps Edema (pulmonary and peripheral) Muscle weakness, peripheral neuropathy Osteomalacia, osteoporosis Pallor, anemia, dec endurance, ANS dysfunction

Dialysis Dialysis dementia Be aware of dialysis shunts (No BP over site) Peritoneal catheters Timing of rehab sessions around dialysis times/days