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jwhughes
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Normal range for BUN? What does it measure
- 10-20mg/dL
- Measures concentration of urea in the blood
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BUN level during dehydration, ARF, and CHF
>20mg/dL (increase)
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What is a by-product of muscle metabolism
Creatinine
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Creatinine normal range
0.1-1.2 mg/dL
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As creatinine levels rise, what falls
GFR
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If creatinine is double in the blood, what is renal function
1/2 of nL functioning
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What is the essential part of examination in renal disease
urine
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What is abnormal in a urine test
RBC,s elevated WBC, bacterial protein, glucose, ketones
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What is obstructive uropathy
anatomical or functional defect causing blockage
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Complete obstruction of upper urinary tract, dilates ureter
Hydroureter
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Dilation of renal pelvis and calyces
Hydronephrosis
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collagen and proteins deposited in the kidney
Tubulointerstitial Fibrosis
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What forms of Obstructive Uropathy predispose pt to HTN b/c renin cascade is activated
- Hydroureter
- Hydronephrosis
- Tubulointerstitial Fibrosis
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What causes unobstructed kidney to increase in size of individual gloemruli and tubules but not total number of nephrons
Compensatory hypertrophy and hyperfunction
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Two types of calculi or urinary stones
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What are 70-80% of stones composed of
Calcium
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What stones consist of Mg+, NH3, PO4
Struvite
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What is struvite stones caused by
bacteria
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what gender is struvite more common in
women
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What stones are seen with gout
Uric acid
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What are symptoms of calculi or urinary stones
- Pain in groin (renal pelvis, proximal ureter)
- Lower abd (mid ureter)
- urgency or incontinent (lower ureter)
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What occurs when neurogenic bladder disrupts nL bladder filling/emptying
Lower Urinary Tract Obstruction
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What causes lower urinary tract obstruction
interruption of nerve supply to bladder
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What are common lower urinary tract obstructions
- Overactive bladder syndrome (OAB)
- Urethral strictures
- Prostatic enlargement
- pelvic organ prolapse
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What is detrusor overactivity that causes urgency, retention, or incontinence
Overactive bladder syndrome
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3 types of Renal/Bladder tumors
- Renal adenoma
- Renal cell carcinoma
- Bladder tumors
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What renal/bladder tumor is most common, usually in men, r/t tobacco, obesisty, analgesics
Renal Cell Carcinoma
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Where does renal cell carcinoma occur and where can it spread
- unilateral
- lungs, liver, bones
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What tumor is r/t smoking, working in chemical, rubber, or textile industries
Bladder
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Sx of bladder cancer
asymptomatic or hemouria
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Difference between Cystitis and Pyelonephritis infection
- C-bladder, lower tract
- P-kidney/pelvis/interstitial-upper tract
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Pt presents to clinic with low back, suprapubic pain with painful, burning urination. BP is 156-90. He c/o needing to pee really bad all the time and noticed blood in his cloudy urine. WHat do u suspect he has
Cystitis
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Pt presents to the clinic with fever, chills, backache and pain, n/v, needing to pee real bad all the time, and has CVA tenderness. What do u suspect he has
Pyelonephritis
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What is Cystitis caused by
urinary obstruction, prostatitis, ascending infection with ecoli
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What causes Pyelonephritis
Inflammation or scarring of tubules, ascending infection with Ecoli, fungi, virus, or obstruction
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What causes urine reflux or residual urine
Pyelonephritis
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What is glomerulonephritis
glomeular damage caused by immune response, toxins/drugs, vascular disorders, DM, LE
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When does glomerulonephritis begin
After antibodies against glomeular basement membrane have localized in glomerular capillary wall
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How does glomerulonephritis change membrane action? What are the consequences?
Decreases membrane permeability leading to passage of protein and RBCs into urine
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Most common cause of Glomerulonephritis
Poststreptococcal groupn(group A beta-hemolytic strep)
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What is increased permeability in glomeruli and protein leakage
Nephrotic syndrome
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When reviewing a pt's urine test, you notice there is protein. Upon looking at his bloodwork, there is an increase in lipids (tryglercerides) and decreased albumin (protein). What do you suspect he has, and what 3 causes could occur with this disease?
- Nephrotic Syndrome
- Genetic Defects
- DM
- SLE
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What is rapid deterioration of renal function
Acute renal failure
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What causes decrease in glomerular filtration, elevated BUN and Creatinine, and oliguria
Acute kidney failure
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Name 3 types of renal failure
- Prerenal
- Intrarenal
- Postrenal
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What type of acute kidney failure occurs due to hypoperfusion of the kidney and name two examples
- Prerenal
- Cardiac failure-hypovolemia
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What type of acute kidney failure is caused by nephrotoxic drugs such as antibiotics causing acute tubular necrosis
Intrarenal
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What type of acute renal failure follows an obstruction of urinary flow and give some examples
- Postrenal
- edema, tumors, stones, clots, prostatic hyperplasia, urethral strictures
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Stages of Acute renal failure
- Oliguria
- Diuresis
- recovery of renal function
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What is uremia
chronic kidney disease
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When do s/s present during chronic renal failure
GFR and renal function decline to 25%
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What type of renal failure is associated with HTN, DM, or intrinsic kidney disease
Chronic Renal Failure
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What contributes to tubulointerstitial injury leading to fibrosis
Proteinuria
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What is characterized by a decline in renal function and accumulation of toxins in the blood.
Uremic State
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What results from a uremic state
- Electrolyte imbalances, volume depletion, and metabolic acidosis
- BUN and Creatinine Increase
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Pt presents to clinic with BP of 170/98, preicarditis, bone deminarelization, attention deficit, anemia, bleeding, n/v/d, prutitis, pigrmantation, infertility, decreased libido, and A WHOLE LOT MORE
Uremic State
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