Feb 23, 2024 NR 507 Discussion: Alterations in Renal and Urinary Function
NR 507 Discussion: Alterations in Renal and Urinary Function
NR 507 Discussion: Alterations in Renal and Urinary Function
This has been a very informative week as we gained a deeper understanding of the renal system, its pathophysiology, the different disorders that stem from the kidneys and their causes, and what we often see in the hospital as manifestations of acute and chronic kidney failure (McCance & Huether, 2014). The kidneys play a vital role in helping to maintain homeostasis within our bodies by regulating fluid volume and removing toxins and waste our bodies produce. They use many different mediators to help in this role including adenosine, natriuretic peptides, etc. which help to maintain renal blow and different functions of the kidneys such as diuresis (McCance & Huether, 2014). One of the procedures perfumed in my department quite often is a paracentesis where we drain ascitic fluid from a patient; while the main cause is usually directed at the liver, the kidneys can also be a culprit for this condition. Having a full understanding of the pathophysiology behind the renal system will help to educate and answer questions patients are having as to why this is happening, why the fluid “keeps coming back”, etc. I also appreciated the refresher on how the filtration rate starts to decline in aging patients; this is a major consideration in prescribing medications to elderly patients and how the effects of medication and their durations change because of having a reduced filtration rate (McCance & Huether, 2014).
McCance, K. L. & Huether, S. E. (2014). Structure and Function of the Renal and Urologic Systems, Pathophysiology: The biologic basis for disease in adults and children, seventh edition (1063-1068). St. Louis, Missouri: Elsevier Mosby
This week has been a very interesting week with regards to our readings and trying to study for the midterm exam. We covered some great topics this week and I leaned towards the renal system and its function. At the beginning of my nursing career I worked on a Med/Surg unit and of course we had our fair share of UTI’s and Rental stone patients.
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Kidney stone– kidney stones affects 10% of people between the ages of twenty and sixty years old, and a recurrence rate within 5-10 years (Dawson & Tomson, 2012). Kidney stones are a result of the growth of crystals into stones. These crystals are formed in urine that is supersaturated with particular salts such as calcium oxalate, sodium urate, magnesium ammonium phosphate, or cysteine (Sakhaee, 2014). There are mainly four types of kidney stones.
Calcium oxalate stones are the most common type of stones, accounting for over 70% of all stones. These stones develop under a high degree of supersaturation, crystallization inhibitors, and urinary stagnation. Supersaturation occurs with high concentration of salt within the urine. These stones typically form by eating too much calcium or vitamin D. Genetics and certain medications can increase formation also (Rajat, Anu, & Sumeet, 2011).
Kidney stones tend to be located either at the area of prior injury or in gravity dependent locations such as lower pole calices. These stones can be small or large in size. Depending on the size of the stone, it can either be voided with urination, or if the stone is too large, lithotripsy or surgery may be required (Malan et al., 2011). Depending on the size of the stones, individuals may experience considerable pain during their journey through the urinary tract due to the sharp edges of the large stones that may gouge into the walls of the ureters and sometimes the urethra. This severe pain is called renal colic, and comes in waves that may cause the person to double over. Pain may be localized in the flank or pelvic area, and often to one side. Other symptoms include; nausea, vomiting, fever, sweating, difficulty voiding, and possible hematuria.
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Reference
Dawson, C. H., & Tomson, C. V. (2012). Kidney stone disease: pathophysiology, investigation and medical treatment. Clinical Medicine, 12(5), 467-471.
Rajat, M., Anu, W., Sumeet, G. (2011). New Frontiers on Nephrolithiasis: Pathophysiology andManagement of Kidney Stones. International Journal of Research in Avurveda & Pharmacy, 2(3), 775-786.
Sakhaee, K. (2014). Epidemiology and clinical pathophysiology of uric acid kidney stones. Journal Of Nephrology, 27(3), 241-245. doi:10.1007/s40620-013-0034-z
Week 4: Open Forum Discussion
This open forum is required but not graded. Please feel free to post questions related to content or assignments.
In our lesson this week, we covered the renal system and it’s functions. We learned about the various issues that can arise like an obstruction, calculi, an infection like a UTI, cystitis, and pyelonephritis, or an infection in the kidney. We then looked at common diseases and disorders that can occur in this system like cancer and nephrotic syndrome. Most of my time this week, however, is going toward studying for the midterm. Looking over the study guide, I found that I should probably take some extra time to look at epigenetics as it is a concept that I can sometimes struggle with. For some reason, DNA and genes and all the accompanying topics are definitely not my favorite part of biology, so I know I need to study those just a bit harder. Good luck on the exam everyone!
according to NR 507 Discussion: Alterations in Renal and Urinary Function, the renal and urinary function can be affected by a variety of disorders. The most common type of urinary dysfunction is infection. Stones, tumors, or inflammation also can obstruct the urinary tract. Renal function can be impaired by disorders of the kidney itself or by many other systemic diseases and ultimately may result in acute kidney injury or chronic kidney disease. Because the kidney filters the blood, it is directly linked to every other organ system. Renal failure, whether acute or chronic, is life-threatening.
Urinary Tract Obstruction
Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract (Figure 38-1). An obstruction may be anatomic or functional. It impedes flow proximal to the obstruction, dilates structures distal to the obstruction, increases risk for infection, and compromises renal function. Anatomic changes in the urinary system caused by obstruction are referred to as obstructive uropathy. The severity of an obstructive uropathy is determined by: (1) the location of the obstructive lesion, (2) the involvement of one or both upper urinary tracts (ureters and renal pelvis), (3) the completeness of the obstruction, (4) the duration of the obstruction, and (5) the nature of the obstructive lesion.1,2 Obstructions may be relieved or partially alleviated by correction of the obstruction, although permanent impairments occur if a complete or partial obstruction persists over weeks to months or longer.
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Upper Urinary Tract Obstruction
Common causes of upper urinary tract obstruction include stricture or congenital compression of a calyx or the ureteropelvic or ureterovesical junction (e.g., stones [calculi]); ureteral compression from an aberrant vessel, tumor, or abdominal inflammation and scarring (retroperitoneal fibrosis); or ureteral blockage from stones or a malignancy of the renal pelvis or ureter.
Obstruction of the upper urinary tract causes dilation of the ureter, renal pelvis, calyces, and renal parenchyma proximal to the site of urinary blockage.NR 507 Discussion: Alterations in Renal and Urinary Function states that dilation of the ureter is referred to as hydroureter (accumulation of urine in the ureter), and dilation of the renal pelvis and calyces proximal to a blockage leads to hydronephrosis (enlargement of the renal pelvis and calyces) or ureterohydronephrosis (dilation of both the ureter and the pelvicaliceal system) (Figure 38-2). Dilation of the upper urinary tract is an early response to obstruction and reflects smooth muscle hypertrophy and accumulation of urine above the level of blockage (urinary stasis/retention). The increased pressure is transmitted to the glomerulus, which decreases filtration. Unless the obstruction is relieved, this dilation leads to enlargement with tubulointerstitial fibrosis and apoptosis affecting the distal nephron and renal function. Tubulointerstitial fibrosis is the deposition of excessive amounts of extracellular matrix (collagen and other proteins). Deposition of extracellular matrix is a normal process of organ repair and maintenance, and the deposition of extracellular matrix is balanced by its breakdown under the influence of metalloproteinases. Multiple cytokines and growth factors have been implicated in the process of tubulointerstitial fibrosis and irreversible loss of kidney function, including transforming growth factor-beta-1 (TGF-β1), angiotensin II, aldosterone, and various tumor necrosis factors. Apoptosis is a normal process that the body uses to replace damaged or senescent cells with new ones (see Chapter 1), but the imbalance in growth factors provoked by obstruction leads to excess cellular destruction and death, ultimately resulting in loss of functioning nephrons and kidney damage.
This 16-year-old patient was presented to the PCP, and we diagnosed them with strep throat. The cells have gone through an extracellular matrix (McCance & Huether, 2019) and are now injured due to infection. The PCP prescribed the antibiotic to reverse the injury. The damage to the cell itself causes the patient to have a reddened pharynx and enlarged tonsils with white patches. The 16-year-old cells are also experiencing hypertrophy, causing an increase in size in the tonsils.
After this patient took two doses of amoxicillin 500mg, they experienced tongue and lips swelling, difficulty breathing, and audible wheezes. This patient is presenting with anaphylaxis. This is an IgE-mediated reaction. IgE antibodies are produced in the immune system. This is considered a type 1 hypersensitivity reaction. The binding of Fc receptors on mast cells and basophils to IgE triggers mast cells and creates an allergic reaction. Enzymes tryptase cause tissue damage, and TNF causes inflammation (Justiz-Vaillant & Zito, 2019).
Initially, when the patient was presented, they had no known drug allergies. The new drug allergy can connect to the infection, especially if it is recurrent. To verify that the amoxicillin allergy is a true allergy, the PCP can use an allergic test called a radioallergosorbent test (RAST) (Justiz-Vaillant & Zito, 2019).
The patient’s anaphylaxis is generalized and not systemic. A study showed that penicillin was reported for 40.7% of antibiotics causing anaphylaxis. In the same survey, it is said that the female gender is more likely to have drug-induced anaphylaxis. Patients with several comorbidities or other medications may also be at higher risk (Regateiro, Marques, & Gomes, 2020).
Reference:
Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions Download Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Regateiro, F. S., Marques, M. L., & Gomes, E. R. (2020). Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors. International Archives of Allergy and Immunology, 181(7), 481–487. https://doi.org/10.1159/000507445
This week our primary focus is on the renal system. I have always been fascinated with the renal system because it plays such a vital role in filtering out the unwanted substances in the blood stream and can affect all other body organs if the process is interrupted. In the healthcare field I feel it is very common to see renal diagnosis and complications of some diseases such as chronic renal disease. My grandmother had chronic renal disease and it was a long process that involved dialysis and many other health conditions as a result of the renal disease. One topic that I always find interesting in the renal system is obstruction such as kidney stones. While reading this week I found it interesting that depending on where the obstruction is located highly impacts the complications that arise. I have seen many individuals who have kidney stones present with severe flank pain, nausea, and vomiting. I have always found it interesting calcium is one of the main culprits of kidney stone formation. I have visualized a passed kidney stone before and was surprised that something so small can cause so much discomfort however, I have also visualized stones that I would have thought impossible to pass without surgical intervention. Healthcare continues to advance with treatment techniques to remove stones from the ureters of patients who will not be able to pass the stones on their own. I feel this is a very interesting topic along with all of the other great information learned this week in regards to the renal system. This week is also our midterm and I must admit I am very nervous to see the questions that will be asked. I have spent the week in an attempt to review all of the learned information and focus in on the study guide outline. I hope everyone succeeds and does great on the midterm and can continue our journeys to becoming advanced practice nurses.
Reference
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, Missouri: Mosby. Chapter 38.
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