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What dietary changes should be made to limit azotemia?
Limit protein to 1gm/kg/day Increase CHO. Limit Na
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How much fluid is a person allowed to have in renal failure, how is this calculated?
Allowed to have 500 ml for insensible loss added to urine output from the prior day.
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What is the most common cause of renal failure?
Diabetic Nephropathy
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Causes of intrinsic renal failure?
Glomerulonephritis, acute interstitial nephritis, vascular disease, HTN
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Where does creatinine come from?
End product of creatine metabolism from skeletal muscle
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What can Creatinine clearance approximate?
GFR
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What makes up the BUN?
Breakdown of protein from dietary and other sources. Elevated BUN = uremia.
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What is BUN a good indicator of?
Can note dehydration, diminished renal perfusion, and can be elevated from pre renal, renal, or post renal causes
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What is contraindicated in bilateral renal artery stenosis?
ACE/ARBs.
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What is an early indication of renal failure?
Proteinuria
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How are ACEI renoprotective?
Limit progression of renal impairment by reducing efferent arteriolar resistance
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What are some causes of Acute Glomerulonephritis causing Acute renal failure and what would BUN/Cr show and Urine show?
Post streptococcal infection, autoimmune diseases. Will see greater than a 20:1 BUN/Cr ratio. UA: Renal Casts and RBC
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What are some causes of ATN causing Acute renal failure and what would BUN/Cr show and Urine show?
Hypotension and Nephrotoxins can cause ATN. Will see BUN/Cr ratio of less than 20:1. UA: Granular Casts, renal tubular cells
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What are some causes of Acute interstitial nephritis causing Acute renal failure and what would BUN/Cr show and Urine show?
Allergic Reaction, Drug Reaction. BUN/Cr ratio will be less than 20:1 and UA: WBC casts and eosinophils
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What can cause an increase in uric acid level greater than 7.0?
Diuretics, gout, CRF, high protein diet, lymphoma, leukemia
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What race and sex is at greatest risk for kidney stones?
White Males
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What medications can cause kidney stones?
Excessive Vitamin C, excessive Vit D, calcium, steroids, acetazolamide (Diamox)
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What is the most common and second most common type of kidney stone?
Calcium oxylate stone, then uric acid stones
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How is Calcium oxylate stone treated and diet restriction?
Thiazide diuretics, hydration, Allopurinol, calcium binding agents and having adequate (yes adequate) intake of Calcium to help bind with free oxylate. A Restriction of oxalate-rich foods, such as chocolate, nuts, soybeans, rhubarb and spinach.
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How do thiazide diuretics work in calcium oxylate stones?
Decreases urinary excretion of calcium
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What kidney stones are caused by hyperparathyroidism?
Calcium Phosphate stones
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What causes struvite kidney stones?
Due to infection
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What is postural proteinuria and how is it diagnosed?
More protein is found in urine when standing erect. Therefore, test first morning urine and again a few hours later.
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What is considered oliguria?
<500ml/day
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What is considered anuria?
<100 ml/day
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When can activity return after renal biopsy?
No strenuous activity x2 weeks
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What is checked to diagnose pheochromocytoma?
24 hour urine for catecholamines and vanillylmadelic acide
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What is often the cause of glomerulonephritis?
Immunological response, often post beta hemolytic streptococcal infection, SLE
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Side effects of thiazide diuretics?
Hypokalemia, hyperglycemia, gout, hyperuricemia, hyperlipidemia
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How is urinary retention treated?
Cholinergic such as urecholine, Anticholinesterase MG drugs.
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What urinary tract surgery will cause certain impotence?
Total cystectomy. Removal of bladder, prostate and seminal vesicles occurs
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