1. Renal and Urological Systems

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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

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

12. 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

13. 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

14. 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

15. 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

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