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137 Cards in this Set
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When taking pt family history, 3 family related red flags for possible kidney problems?
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Polycystic, nephritis, stone
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What the heck is polycystic kidney disease?
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Polycystic kidney disease (PKD) is the fourth leading cause of kidney failure. PKD is a hereditary disorder. Polycystic kidney disease is when fluid-filled cysts grow in the kidneys. Many cysts form in each kidney which can lead to renal failure.
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What systemic diseases cause kidney problems (there are 4)?
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Lupus
DM HTN Sickle |
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What's potentially toxic to a kidney?
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etals, radiographic allergy
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What drugs can cause kidney problems?
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Antibiotics, NSAIDS, diuretics
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What are symptoms of kidney disease?
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Fever, weight loss, fatigue, rash, pruritis (that's itching) sore throat, dyspnea, chest pain, edema, anorexia, N/V, the kitchen sink
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Are there MORE symptoms of kidney disease?
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Polyuria (too much urine),
dysuria (difficut/painful urination), flank pain, hematuria |
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What are some of the cardio findings related to kidney disease?
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Edema, BP (loww maybe or high),
pericardial rub |
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What are some of the genito/urinary findings related to kidney disease?
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Prostate problems or palpable kidney
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What are some of the neurological findings related to kidney disease?
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Peripheral neuropathy
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Any encephalopathies?
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Yes - stupor due to excess nitrogens in blood.
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what's asterixis and what does this have to do with the kidneys?
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when you find muscle tremors due to acidosis - asterixis is involuntary, jerking or flapping movements, especially of the hands.
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diabeties and kidney disease - what's the link?
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Diabeties can damage the glomeruli and damage nerves needed for micturation
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What findings do you see with a fundoscope (in the eye) that are red flags for kidney disease?
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diabeties, Htn
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Lab exams for kidney?
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Urinalysis using dipstick or 3 glass collection.
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What are you looking for in the urinalysis?
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Protein, glucose, blood, nitrates, WBC, pH, casts
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What areas are the three glass collection method testing in men?
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urethra, prostate, bladder
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What are you looking for in a Chem screen?
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BUN, Creatinine, GFR
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What are you looking for in a CBC?
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anemia, infection
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What are you looking for in imaging?
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Using an Xray you will see radiopaque calculi.
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What might you see in an ultrasound?
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Masses, cysts, and hydronephrosis
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What is hydronephrosis?
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Abnormal enlargement of a kidney, which may be caused by blockage of the ureter (such as by a kidney stone) or chronic kidney disease that prevents urine from draining into the bladder
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What is an IVU and what does it have to do with kidneys,
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IVU is when you inject dye and xray its journey through the urinary system. Called a pyelogram
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What is a retrograde pyelogram?
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Hmmm dye moving backwards I suppose - wonder how they do that.....
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What are you looking for in an MRI/CT scan?
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Masses in/around the kidneys.
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Common sx of kidney disease?
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Frequency, Urgency, Dysuria.
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what could cause frequency (9 of them)?
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UTI, pregnancy, prolapsed uterus, foreign bodies, stones, excessive fluids, diuretics, DM, food sensitivities.
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What would cause urgency?
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UTI, small amounts of urine each time
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What causes dysuria?
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pain, UTI, STI (he emphasized that this was an Infection NOT an ST'D' disease)
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What are other symptoms of kidney disease?
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back pain, pyuria, casts, discharge
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What's pyuria?
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Pus (WBC's) in the urine - makes it cloudy
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What's the difference between pyuria with bacteria and pyuria without
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with bacteria = UTI
without bacteria = TB of the kidney |
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Leukocyte casts in a line - sign of:
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renal infection
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What is the cutoff for colony count in urine?
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Greater than 100,000 colonies means a problem (less could be normal).
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What could back pain mean?
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prostate or fibroids
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Wht could discharge mean?
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STI
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What could nocturia be a sign of?
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evening fluid intake, DM, BPH, early stage of disease
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What's enuresis?
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Bed/pants wetting
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What could cause enuresis?
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delayed neuro maturation,
hypoglycemia, bladder size, food sensitivities (he says - eat turkey at night for the tryptophan) |
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What can cause incontinence (5)?
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Urge, reflexes gone, stress, distended bladder, spastic bladder
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What are other stresses to the urethra causing incontinence?
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increase in pressure, cough, sneeze, valsalva, laugh
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What can cause a spastic bladder?
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Neuro, obstruction (ie tumor), childbirth
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What is renal colic?
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Pain that is unilateral,
crescendo,decresc pain, starts in flank, across costal-angle, across abdomen, along ureter, down inner thigh. |
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What causees renal colic?
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most often - renal calculi
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What are some other sx of renal calculi?
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N/V, chills, fever, hematuria, freq
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Hematuria alone is a sx of?
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stone
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Bacteria and pyuria alone are sx of?
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infection
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Xrays usually show stones
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not always
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most diagnostic test?
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U/S and IVU (the dye thing we discussed above)
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What volume defines polyuria?
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> 2.5L urine/day
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Could this be diabeties insipidus?
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yes, or just response to diuretics, sodium, or just drinking alot of fluids
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what's diabeties insipidus?
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A condition characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness. This condition may be caused by a defect in the pituitary gland or in the kidney. In diabetes insipidus, blood glucose levels are normal.
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What could the pituitary problem be?
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Anti diuretic hormone or vasopressin imbalance
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What is nephrotic Diabeties Insipidus?
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When the prob is in the kidney and not the brain.
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What are the pos causes of nephrotic DI?
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Kidney not responsive to ADH, renal failure, acute infection, drugs,
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More causes?
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High Ca, low K
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What are other concerns due to polyuria?
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dehydration, electorlyte loss
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What is psychogenic polydipsia?
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compulsive drinking (of H2O)
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What is Oliguria?
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Decreased urine <.5L/day
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What's anuria?
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<.1L/day
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Prerenal decrease due to?
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heart failure, liver cirrhosis, volume depletion
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What can cause renal disease?
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arterial obstruction and acute kidney disease.
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What can cause problems post renal?
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Obstruction, BPH, stones, trauma, (all these things cause decease peeing)
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Urine colors - Colorless?
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low concentration, DM, DI
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Cloudy White?
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alkaline urine, infection, epithelial cells, WBC, bacteria
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Yellow?
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B vitamins, concentrated tetracycline
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Orange?
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Liver issue here! urobilinogen, bile, pyridium, carrot juice.
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Red?
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Beets, candies, hemoglobin, cascara
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Blue-Green?
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liver issue - biliverdin, drugs, pseudomonas
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Brown-black?
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coca cola, bilirubin, glomeruloneph, hepatitis
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Blood in the urine?
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TITS
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What's TITS?
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Trauma, Infection, Tumor, Stones
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What's Cascara by the way?
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A common ingredient used in weight loss products. One of the few herbs approved by the FDA as an over-the-counter drug. It is a strong stimulant laxative.
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What'sbiliverdin?
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A green pigment, occurring in bile and sometimes formed by oxidation of bilirubin.
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What's pyridium?
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analgesic (trade name Pyridium) used to treat urinary tract infections
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What's urobilinogen?
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a chromogen formed in the intestine from the breakdown of bilirubin
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What kind of history do you have with hematuria?
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Frequency, urgency, pain, stones trauma drugs, duration and d/c (what's d/c?)
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What could hematuria be caused by if its painless?
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could be a tumor, cysts, exercise, UTI, sickle or renal and prostate problems
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What if it's painful?
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Stones and UTI
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Blood at the begining when you pee?
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Urethritis, cystitis,
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Blood at the end?
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bladder
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Blood throughout?
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prostate, bladder, kidney
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What about gross hematuria? (lots of blood)
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vaginal, beets and.... most serioslyy...coumarin!!
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What about microscopic blood?
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UTI, stone, tumor, exerrcise
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What do RNC casts and /or protein mean?
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glomerular probs has a smokey color.
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Big gross clots?
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a distal tumor
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When do you you get anemia as a result of hematuria?
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Very rarely
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What do you think when you think anemia?
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chronic disease, hematologic condition
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What labs for hematuria?
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Run UA, CBC, U/S IVU
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Physical exam for hematuria?
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bleeding disorders, petechia, ecchymosis
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What else should you check when you have hematuria?
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check spleen, lymph, prostate, flank pain, suprapubi tenderness and there may be a fever
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He has 3 slides on edema - lots is review like what's pitting edema etc.
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I skipped it
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Diseases where edema is prominent?
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Lymphedema, stroke (unilateral), trichinosis (worms), myxedema (hypothyroid, non pitting edema
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What are the sx of acute renal failure?
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Increasing azotemia, BUN
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What's azotemia?
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increase of nitro in the blood
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Renal failure - does it have oliguria (scanty urine production
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Can be with or without
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In 60 - 70% of renal cases - sx are?
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trauma, drugs, surgery obstruction, calculi, aneurysm, hemorrhage
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In 20-30% of renal failure cases?
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glomerulonephritis, SLE, Goodpasteure's
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What are some of the pre renal causes of Renal failure?
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dehydration, cardiac/hepatic failure, shock, burns
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What about post renal causes?
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Glomerular/tubular dysfunction, calculi, prostate, tumors
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What about renal causes of renal failure?
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Renal ischemia, drugs, glomerulonephritis, tubular necrosis
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Some sx of renal failure?
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lethargy, pulmonary edema, HT, CHF, oliguria, anuria
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What does the chem screen look like?
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elevated BUN/Creatinine note creatinine rises slower
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What are the other sx?
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Hyperkalemia, inc CO2, acidosis
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What di you see in a CBC?
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anemia
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What's in your urine for renal failure?
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RBC, WBC, possible casts and protein
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What if you have oliguria greater than 3 days?
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Severe renalfailure
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Treatment for renal failure?
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dialysis, limit water, sodium, potassium, protein
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Chronic renal failure is secondary to?
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HTN, CHF, SLE, NSAIDS, polycystic kidney, glomerulonephritis
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What happens if you take 2 ibuprof/day for 7 years?
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Chronic renal failure
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Chronic renal failure sx?
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Elevated BUN, creatinine, nocturia, fatugue, m twitch, neuropathy pruritis, bad taste, anorexia, diarrhea
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What happens in advanced renal failure?
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Decreased Na, and CA
Inc. Phos, K, CO2 normochromic anemia or normocytic |
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What else do you see in chronic renal failure?
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waxy casts, decreased protein and water intake
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What is nephrotic syndrome?
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Basement membrane of glomerulus
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Sx of nephrotic syndrome?
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severe proteinuria, hypoalbumenemia, edema, lare lipiduria. NOTE NO BLOOD
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Systemic dz that cause nephrotic syndrome?
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DM, tumor, leukemia, SLE, HIV
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What are other sx of mephrotic syndrome?
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Frothy urine, edema, anorexia, weakness, SOB, DOE, abdominal pain
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Lab results of Nephrotic?
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waxy casts - they get stuuck
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Pe of nephrotic?
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edema, m wasting, vertical white lines on nail, hypotension
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Nephiritic - aka glomerulonephritic caused by?
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Auto immune
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SX of nephritic?
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BLOOD!!!, RBC casts, slight proteinuria
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Other sx?
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HTN from increased blood volume by sodium retention and reduced GFR
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What causes this auto immune response in nephritic?
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Immune complexes, post strep, URI, pharyngitis, OM, staph
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Other sx of glomerulonephritis/ nephritic?
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lethargy, h/a, malaise, fever, flank pain, oliguria, dark urine, edema, HTN,
sometimes asymptomatic |
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What ELSE (goodness this sx list is even longer)?
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RBC casts, inc BUN/Creatinine, ESR up,
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Recovery from this?
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Good - though HTN and CHF can complicate
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What's glomerulonephritis?
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Sclerosis of glomeruli, proteinuria, hematuria, HTN, loss renal ftn
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Sx of chronic glomerulonephritis?
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N/V dyspnea, pruritis, fatigue
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what else in the blood for chronic?
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RBC, waxy casts
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Goodpasture's?
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Rare, hypersensitivity disorder against the basement membrane of the kidney and the lungs
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Prognosis?
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Poor - renal and lung hemorrhage, hematuria, hemoptysis
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Bergers DZ?
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AKA IgA nephropathy
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Sx of Berger's?
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recurrent hematuria, proteinuria, IgA onthe glomerular membrane. Serum has high IgA - shows on biopsy
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What's Henoch-Schonlein Purpura?
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I cant figure out what this has to do with kidneys other than you have hematuria, proteinuria, inc ESR, BUN, creatinine, sooo I guess kidneys....
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Sx of HSP?
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Vasculitis in skin, joint, and GI
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Other Sx?
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Arthritis in hands and feet, GI pain, vomiting, occult blood
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MORE SX (LAST CARD!!)
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Post URI leads to symetrical purpura over extensor surfaces and buttocks. There's a RASH
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