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Composition of Blood, Filtrate, and Urine
- Water (L): Blood 180; Filtrate 180; Urine 1.4
- Cells: Blood Yes; Filtrate None; Urine None
- glucose (mg/L): Blood 1000; Filtrate 1000; Urine 0
- protein (mg/L): Blood 40,000; Filtrate 0-trace; Urine 0-trace
- urea (mg/L): Blood 260; Filtrate 260; Urine 18,000
- Na+ (mEq/L): Blood 142; Filtrate 142; Urine 128
- K+ (mEq/L): Blood 5; Filtrate 5; Urine 60
- HCO3- (mEq/L): Blood 28; Filtrate 28; Urine 14
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Urinalysis: Cloudy, Dark color, or unpleasant or unusual odor results
- cloudy: may indicate the presence of large amounts of protein, blood cells, or bacteria and pus
- dark color: may indicat hematuria, excessive bilirubin content, or highly concentrated urine
- unpleasant or unusual odor: may indicate infection or result from certain dietery components (asparagus) or medications
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UTIs
- very common
- most infections are ascending from perineal area then to bladder, ureters, kidneys
- common causative organism is Escherichia coli, a resident flora of intestine, that doesn't wash out when voiding
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Pathophysiology of cystitis
- infection
- the bladder wall and urethra are inflamed, red, swollen, and sometimes ulcerated
- bladder wall is irritated, hyperactive, and bladder capacity reduced
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signs and symptoms of cystisis
- pain in lower abdomen
- dysuria
- urgency
- frequent voiding
- nocturia
- systemic signs: fever, malaise, nausea, leukocytosis
- cloudy urine with unusual odor
- urinalysis indicates bacteria >100,000 per mm of urine, pyuria, microscopic hematuria
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Pathophysiology of pyelonephritis
- one or both kidneys may be involved
- infection extends from the ureter into the kidney
- purulent exudate fills the kidney pelvis and calces and the meddula is inflamed
- abscesses and necrosis is visible
- bilateral obstruction by inefection is likely to result in acute renal failure
- recurrent or chronic infection--> loss of tubule function and hydronephrosis--> if severe or bilateral, chronic renal failure
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Signs and symptoms of Pyelonephritis
- signs of cystisis
- dull aching pain in the lower back or Flank area
- systemic signs from cystitis
- urinalysis results similar to those for cystitis plus urinary casts
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urinary casts
- generated in the small distal convoluted tubules and collecting ducts of the kidney, and generally maintain their shape and composition as they pass the lower conveyances of the urinary system.
- Although the most common forms are benign, other forms are indicative of a pathologic state.
- Include: leukocytes or epithelial cells
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treatment of UTIs
- antibacterial drugs
- the tannin in cranberry juice seems to reduce capability of E. coli to adhere to bladder mucosa
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define Glomerulonephritis
- also known as glomerular nephritis
- abbreviated GN
- is a renal disease (usually of both kidneys) characterized by inflammation of the glomeruli, or small blood vessels in the kidneys.
- usually occurs as a secondary disease after an upper respiratory infection with Streptococcus
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Pathophysiology of glomerulonephritis
- the antistreptococcoal antibodies formed from the previous infection create an antigen-antibody complex that lodges in the glomerular capillaries, activates the complement system + cause inflammatory response in both kidneys
- Increased permiability--> leakage of proteins, RBCs into filtrate--> congestion
- when severe, congestion interferes with filtration--> decreased GFR--> retention of fluid and wastes--> acute renal failure if blood flow impaired--> decreased blood flow triggers Renin--> widespread vasocontriction and edema
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Signs and symptoms of glomerulonephritis
- dark and cloudy urine
- facial and periorbitol edema followed by generalized edema
- BP elevated
- flank pain develops
- general signs of inflammation including malaise, fatigue, headache, anorexia, nausea
- decreased urine output
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Diagnostic tests for glomerulonephritis
- blood tests show elevated serum urea and creatinine
- blood levels of streptococcal antibodies elevated
- metabolic acidosis
- urinalysis confirms proteinura, gross hematuria, and RBC casts
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urolithiasis
refers to the condition of having calculi or kidney stones
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pathophysiology of calculi
- tend to form when there is an excessive amount of relatively insoluble salts in the filtrate, esp. in hypercalcemia, or insufficient fluid intake
- also form from cell debris from infection
- urine is highly alkaline
- immobility may be possible because if stasis in urine
- may lead to hydronephrosis
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uric acid stones
- develop mostly with hyperuricemia esp. when urine is acidic
- Saturation levels of uric acid in blood may result in one form of kidney stones when the urate crystallizes in the kidney.
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signs and symptoms of kidney stones
- frequently asymptomatic unless found by looking for a source of frequent infection
- obstruction of the ureter causes renal colic
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renal colic
- due to obstruction of the ureter
- intense spasms of pain in the flank area radiating into the groin that last until the stone passes or is removed
- caused by vigorous contractions of the ureter in an effort to force the stone out
- may be accompanied by nausea and vomiting, cool moist skin, and rapid pulse
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hydronephrosis
- cystic distension of the kidney caused by the
- accumulation of urine in the renal pelvis as a result of obstruction to outflow and accompanied by atrophy of the kidney structure and cyst formation
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renal cell carcinoma
- adenocarcinoma of the kidney
- a primary tumor arising from the tubule of epithelium, more often in renal cortex
- often has metastasized to liver, lung, bone, or CNS at time of diagnosis
- more frequent in men and smokers
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signs and symptoms of renal cell carcinoma
- usually painless hematuria that might appear then disappear after 1-2 days
- dull, aching flank pain
- palpable mass
- unexplained weight loss
- anemia or erythrocytosis (depending on the tumors effect on erythropoietin)
- Paraneoplastic syndroms ie hypercalcemia (increased parathyroid hormone)or Cushing's syndrome (increased adrenocoirticotropic hormone)
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treatment for Renal Cell Carcinoma
nephrectomy
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Bladder Cancer
- often develops as multiple tumors and tends to recur
- diagnosed by urine cytology and biopsy
- tumor is invasive to adjacent sructions and metastasized through the blood to pelvic lymph nodes, liver, and bone
- Early Sign: painless hematuria, gross or microscopic. Dysuria or frequency; infection common.
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Wilms' Tumor
- nephroblastoma
- most common tumor occuring in children
- associated with defects on chromosome 11 + other congenital disorders
- presents as large encapsulated mass
- diagnosed at ages 2-5 when mass is obvious
- pulmonary metastases possible
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acute renal failure
- both kidneys must be involved
- often reversible if the primary problem is treated successfully
- kidneys may sustain permanent damage
- causes: severe and prolonged circ. shock or heart failure; shock associated with burns or crush injuries; nephrotoxins including NSAIDS, when exposure is intense; mechanical obstructions--calculi
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chronic renal failure
- the gradual irreversible destruction of the kidnesy over a long period of time.
- may result from chronic kidney disease, systemic disorders such as hypertension or diabetes, nephrotoxinscannot be stopped once it has begun
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pathophysiology of chronic renal failure
- Three stages: Decreased renal reserve, insufficiency, end-stage renal failure
- Decreased Renal Reserve: 60% nephrons lost but remaining nephrons adapt and increase capacity for filtration. No clinical signs.
- Insufficiency: 75% nephrons lost.indicated by a change in blood chemistry and manifestations. GFR decreased to 20% less,significant retention of nitrogenous wastes in blood. Marked by excretion of large volumes of dilute urine.
- End-stage renal failure: More than 90% nephrons lost. Uremia. Fluid, electrolytes, and wastes are retained in the body and all body systems affected. Marked oliguria/ anuria.
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Signs and symptoms of chronic renal failure
- Early signs: polyuria manifested as frequency and nocturia
- anorexia, nausea, anemia, fatigue, unintended weight loss, exercise intolerance
- bone marrow depression and impaired cell function caused by increased wastes
- high BP
- End-Stage: uremic signs are oliguria, dry pruritic and hyperpigmented skin, easy bruising
- peripheral neuropatyy--abnormal sensatiosn in the lower limbs
- impotence and decreased libido in men, menstrual irregularities in women
- encephalopathy
- CHF, arrhythmias
- failure of kidney to activate vit. D for Ca absorption and metabolisms, urinary retnetion of phosphate ion--> hypocalcemia and hyperphosphatemia with osteodytrophy, osteoporosis, and tetany
- possibly uremic frost on the skin and urinelike breath (terminal)
- systemic infections such as pneomonia
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azotemia
- a medical condition characterized by abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood.
- largely related to insufficient filtering of blood by the kidneys-->indicative of renal failure
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