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What is BUN
measures the concentration of urea in the blood.
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BUN rises in what disorders?
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Serum creatinine level
0.7-1.2 mg/dL
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Serum creatinine is a byproduct of
muscle metabolism
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_________________ levels are constant and proportional to muscle mass
serum creatinine
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when creatinine rises in plasm, _____ decreasing
- GFR
- if doubled, renal function probably 1/2 normal
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Urinalysis abnormals
- RBCs
- more than a few WBCs
- bacteria
- protein
- glucose
- ketones
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Obstructive uropathy is what
anatomical or functional defect causing blockage
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Hydroureter
complete obstruction of upper urinary tract, dilates ureter
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Hydronephrosis
dilation of renal pelvis and calyces
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Tubulointerstitial fibrosis
collagen and proteins deposited in kidney
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All forms of obstructive uropathy predispose to __________ because ____________________
hypertension
renin cascade is activated
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Compensatory hypertrophy and hyperfunction causes
unobstructed kidney to increase size of individiual glomeruli and tubules not total number of nephrons
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what percent of stones are composed of Ca+
70-80%
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Struvite stones contain __________ and are caused by __________. More prominent in what gender?
Mg+, NH3, PO4
bacteria
females
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Uric acid stones are seen in combination with what disorder?
gout
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pain in groin from renal calculi if located in
- renal pelvis
- proximal ureter
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pain in lower abdomen if renal calculi located in
mid ureter
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urgency or incontinent if renal calculi located in
lower ureter
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incendence of renal calculi increases in males after age
40
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Symptoms of renal calculi
- N/V
- Pain radiates in flank area
- sharp, sudden, sever pain (may be intermitent)
- hematuria
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Risk factors-etiology of kideny stones
- infection
- urinary stasis
- immobility
- hypercalcemia
- high uric acid
- high urinary oxalate level
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diagnosis for kidney stones
- UA
- Cystoscopy
- IVD
- Renal stone analysis
- KUB (x-ray)
- Serum calcium
- Serum oxalate
- Serum uric acid
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neurogenic bladder disrupts nml bladder filling/emptying is what?
Lower urinary tract obstruction
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Lower urinary tract obstruciton caused by
interruptionof nerve supply to bladder
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Lower urinary tract obstruction types
- Retention or incompetence
- Overactive bladder syndrome
- urethral strictures
- prostatic enlargement in men
- pelvic organ prolapse in women
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Overactive bladder syndrome
detrusor overactivity causes urgency, renention, stress incontinence
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renal adenomas
- uncommon
- may become malignant so surgically removed
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renal cell carcinoma is R/T
most common, usually in men.
tobacco use, obesity, long-term analgesic uses
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renal cell carcinoma is unilateral and spreads to
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bladder tumors related to
- smoking
- working in chemical, rubber, textile industries
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bladder tumor symptoms
- may be asymptomatic
- hematuria
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Cystitis is inflammation of the
bladder
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cystitis is what type of infection
lower tract
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Symptoms of cystitis
- low back/suprapubic pain
- painful burining on urination
- frequency
- urgency
- hematuria
- cloudy urine
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cystitis is caused by
- urinary obstruction
- prostatitis
- ascending infection with E. coli
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most common cause of UTI
e coli
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pyelonephritis is inflammation of the
kidney tubules, pelvis, interstitious
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pyelonephritis is what type of infection
upper tract
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symptoms of pyelonephritis
- fever
- chills
- backache
- abd pain
- N/V
- urgency
- frequency
- CVA tenderness
- Hypertension
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Pyelonephritis caused by
inflammation or scarring of tubules, ascending infection with E.coli, fungi or viruses, obstruction that causes urine reflux or residual urine
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Glomerulonephritis is what
glomerular damage caused by immune responses, toxins or drugs, vascular disroders, DM, LE
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______________ begins after antibodies against glomerular basement membrane have localized in glomerular capillarly wall
glomerulonephritis
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glomerulonephritis causes changes in what
membrane permeability
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glomerulonephritis permits passages of ___________________ into urine
protien and blood
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Glomerulonephritis associated with
poststreptococcal (group A beta-hemolytic streptococci)
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Nephrotic syndrome is
increased permeability in glomeruli and protein leakage
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Key features of nephrotic syndrome
- proteinuria
- edema
- hypoalbuminemia
- hyperlipidemias
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Causes of nephrotic syndrome
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Acute kidney injury causes
- Renal Failure
- Rapid deterioration of renal function
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Oliguria results as a symptom of what
acute kidney injury
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Acute kidney injury symptoms
- decrease in glomerular filtration
- elevated BUN and plasma creatinine
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Prerenal (before kidney) acute kidney injury causes
hypoperfusion of kidney (i.e. cardiac failure, hypovolemia)
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Intrarenal (within kidney) acute kidney injury is caused by
- nephrotoxic drugs such as antibiotics
- causes acute tubular necrosis
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Postrenal (after kidney)
causes obstruction of urinary flow
caused by edema, tumors, stones, clots, prostatic, hyperplasia, urethral strictures
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stages of acute kidney injury
Oliguria
Diuresis
Recovery of renal function
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Chronic kidney disease: Uremia usually has no signs or symptoms until
GFR and renal function decline to 25% of normal
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Uremia associated with
- hypertnetion
- DM
- or intrinsic kidney disease
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In uremia, proteinuria contributes to
tubulointerstitial inury leading to fibrosis
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In uremia, angiotensis 2 promotes
systemic hypertension
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Uremic state is characterized by
decline in renal function and accumulation of toxins in blood.
Electrolyte in imbalances, volume depletion and metabolic acidosis result
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What labs increase in Uremic State
BUN and creatinine
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Symptoms of Uremic state
- hypertension
- pericarditis
- bone dmeineralization
- fatigue
- attention deficit
- anemia
- bleeding
- diarrhea
- N/V
- Pruritis
- Pigmentation
- Infertility
- Decreased Libido
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Neurologic symtoms of kidney failure
- Fatigue
- Drowsiness
- Peripheral neuropathy
- irritability
- depression
- decreased concentration ability
- insomnia
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Respiratory CRF
- uremic lung
- pleuritis
- pulmonary edema
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Metabolic symptoms of CRF
- infertility
- decreased libido
- impotence
- amenorrhea
- delayed puberty
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Dermatologic CRF
- pallor
- pruritis
- dry skin
- yellow-gray color
- decreaed perspiration
- brittle dry hair
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Endocrine CRF
- hypothyroidism
- hyperparathyroidism
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Hematologic CRF
- anemia
- bleeding tendency
- susceptibility to infection
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Gastrointestinal CRF
- N/V
- anorexia
- GI bleeding
- Diarrhea
- Uremic floor
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Musculoskeletal CRF
- renal osteodystrophy
- osteomalacia
- osteitis fibrosa
- osteosclerosis
- soft tissue clacification
- retarded growth
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