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Kidney Anatomy & Physiology
Balance _____ & ____ transport
Excrete metabolic ______.
Conserve _____.
Regulate _____-_____ balance.
Secrete hormones to:
Regulate _____ ______
Erythropoetin
Calcium production
- Balance Solute & H2O transport
- Excrete metabolic waste
- conserve nutrients
- Regulate Acid-base balance
- Secrete hormones to:
- Regulate blood pressure
- Erythropoetin
- Calcium production
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Formation of urine:
Filtration pressure
______ push
______ pull
JG app ⇾ ___ ⇾ __⇾___ ⇾ Systemic vasocontriction
- Filtration pressure
- Hydrostatic push
- Osmotic pull
JG app ⇾ Renin ⇾ Angio I⇾ Angio II⇾ Systemic vasoconstriction
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Renal assessment
-Physical exam
Risk factors:
______ agents
Meds
A______
Contrast dyes
Heavy metals poison
Age
O_______
Diseases
Physical exam
- Risk factors:
- Nephrotoxic agents
- meds
- Anesthesia
- Contrast dyes
- Heavy metal poison
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Renal assessment: BUN
Ingest _____
Broken down into _____ _____
AA are catabolized in ______
Free ______ is formed
_____ are combined to form ______
______ goes into blood and trasported to kidney for excretion
Rough measurement of _____ function
Measures both
_____ function (excretory)
_____ function (metabolic)
Renal Assessment: BUN
- ingest protein
- Broken down into Amino acids
- AA are catabolized in liver
- Free Ammonia is formed
- Ammonia are combined to form Urea
- Urea goes into blood and transported to kidney for excretion
- Rough measurement of Renal function
- Measures both
- Renal function (excretory)
- Liver function (metabolic)
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Renal Assessment: BUN
Serum: ____ mg/dL
increased with:
_____ disease
High ____ diet
D_______
Reduced blood flow to kidney (C____, H___)
GI bleeding
S_____
_____ catabolism (starvation)
Decrease with
____ disease
Low _____ diet/ negative ____ balance
Over ______ (hemodilution)
_____ loss in urine
Renal assessment: BUN
- Serum: 6 - 20 mg/dL
- Increased with:
- Renal disease
- High protein diet (tube feeding, nutrients)
- Dehydration (hemo concentrated)
- Reduced blood flow to kidney (cardiac, hypovolemia)
- GI bleeding
- Sepsis
- Protein catabolism (starvation)
- Decreased with:
- Liver disease
- Low protein diet/ negative nitrogen balance
- Over hydration (hemodilution)
- Protein loss in urine
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Renal assessment: Creatinine (blood)
End product (catabolic product) of _____ and _____ metabolism.
Serum: _____ mg/dL
influenced by:
_____ mass
age
gender
____ = serious renal impairment
- End product (catabolic product) of muscle and protein metabolism.
- Serum: 0.6 - 1.3 mg/dL
- Influenced by:
- muscle mass
- age
- gender
- >4 mg/dL = serious renal impairment
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Renal assessment: creatinine clearance (urine)
Creatinine is filtered by the ______ but not reabsorbed by the ______.
Creatinine level in the urine is equivalent to the _____ = renal function
Creatinine is filtered by the glomeruli but not reabsorbed by the tubules. Creatinine level in the urine is equivalent to the GFR = renal function.
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Renal Assessment: Creatinine Clearance (urine)
_____ ml/min/1.73 m2
Results Influenced by
_____ masss
age
(Adult values decrease ____ mL/min with each decade of life (10 years) after 20 years because of decreased GFR)
Exercise
Diet high in _____
______ agents = ______
____ urine test or spot test
- 70 - 135 ml/min/1.73m2
- Results influeced by
- Muscle mass
- (adult values decrease 6.5 ml/min with each decade of life after 20 years.
- Exercise
- diet high in meat
- Nephrotoxic agents = increase
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Renal assessment: estimated GFR (eGFR)
Equation using
Serum ______
age
numbers that vary depending on ____ and ____
Used to recognize _____ _____ ____ in early stages
May not be accurate if you are younger than 18, pregnant, very _____, or very ______.
- Renal assessment: estimated GFR (eGFR)
- Equation using
- Serum creatinine
- age
- numbers that vary depending on sex and ethnicity
- Used to recognize chronic renal disease in early stages.
- May not be accuarate if you are younger than 18, pregnant, very overweight, or very muscular.
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Serum Cystatin C
New more accurate marker of ______ _____ ______.
Less altered by nonrenal factors than is the production of _________.
As age, loss of _____ mass, _______ muscle activity = serum ____ lower in older patients.
- New more accurate marker of glomerular filtration rate.
- Less altered by nonrenal factors than is the production of Creatinine.
- As age, loss of muscle mass, decreased muscle activity = serum creatinine lower in older patients.
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Microalbumin (MA) and Microalbumin/creatinine ratio
Random urine sample (10 mL) or 24-hr urine
Screening test on patients with chronic conditions, such as _____ and _______, that put them at an increased risk for developing _____ ______ - early indicator.
MA: albumin concentration in urine that is greater than normal but not detectable with routine testing.
Microalbumin (MA)
____ mg/L
MA/creatinine ratio
_____ mg/g
- Screening test on patients with chronic conditions, such as diabetes and hypertension, that put them at an increased risk for developing kidney failure -early indicator.
- Microalbumin (MA) <20 mg/L
- MA/creatinine ration
- 0 - 30 mg/g
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Who's at risk? Kidney cancer
Twice as many ____ as _____.
Over age ____
Cigarette smokers
Occupational exposures: A____, C_____, P______
High _____ diet
Obesity
Extended ______ treatment
Heredity
- Twice as many men as women
- Over age 55
- Cigarette smokers
- Occupational exposures: Asbestos, cadmium, petroleum
- High fat diet
- obesity
- extended dialysis treatment
- Heredity
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Signs and symptoms: Kidney cancer
____ without infection
____ blood pressure
Persistent _____
_____ of legs or ankles
Rapid, unexplained _______
Cardinal signs:
_____ in the urine
______/_____ mass or lump
_____ pain or lower back pain
- Signs and symptoms:
- Fever without infection
- High blood pressure
- Persistent fatigue
- Edema of legs or ankles
- Rapid, unexplained weight loss
- Cardinal signs:
- Blood in urine
- Abdominla/flank mass or lump
- Flank pain or lower back pain
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