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169 Cards in this Set

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ARF
acute renal failure
ATN
acute tubular necrosis
BUN
Blood, urea, nitrogen
CAPD
continuous ambulatory periteneal dialysis
CrCl
Creatin Clearance
CRF
Chronic renal failure
ESRD
end stage renal disease
GFR
glomerular filtration rate
HD
Hemodialysis
IVP
Intravenous pyelography
What is pyelography?
Dye injected and observed
PD
peritenal dialysis
RF
Renal failure
SCr
Serum creatanin
UTI
Urinary Tract Infection
Anuria/Anuresis
Definition: Inability to form/excrete urine (<50ml/day)
How much urine is excreted in pt. with anuria?
<50 ml/day
How much urine is extreted in normal adults?
1000-1500 mL/day
How much urine per day is excreted in pt. with oliguria?
50-450 ml/day
Azotemia
Definition: excess of nitrogen in the blood, result of kidney insuficiency
Cystitis
Definition: Inflamation of the bladder
Dysuria
Definition: Painful urination
Enuresis
Definition: Involuntary discharge of urine
Incontinence
Definition: Inability to control evacuative function (urine & bowel)
What is another word for urination?
Micturition
Nephrolithiasis
Definition: Kidney Stones
Medical term for "kidney stones"?
Nephrolithiasis
Nocturia
Definition: Urination at night, excessive (common in men with benign prostate infection and women in their 9th month of pregnancy)
Oliguria
Definition: reduced urination (50-450 ml/day)
Prostatis
Definition: Inflamation of the prostate gland
Proteinuria
Definition: protein in the urine
Pyelonephritis
Definition: Inflamation of the kidney
Uremia
Definition: buildup of waste products in blood; toxic condition
Urosepsis
Definition: buildup of waste products in the blood; urine that is not eliminated goes into body tissues
Voiding
Definition: Elimination of solid or liquid waste
Hpf
High power field (refers to microscope)
I&O
Intake and Output (found in graphic portion of chart)
U/A
urinalysis
UhCG
Urine human chorionic gonadotropin; excreted in certain conditions
Albuminuria
protein in the urine
Dysuria
painful urination
Glucosuria
glucose in the urine
Hematuria
blood in the urine
Proteinuria
protein in the urine
Name the 7 types of urine collection.
Random
Clean catch (midstream)
Double/Second Voided
First morning
Fasting
Timed
Catheter Collection
Identify the normal physiochemical properties in an analysis of urine:
Color -
Volume -
Appearance -
Specific Gravity -
Osmolality -
Odor -
Color - straw is normal
Volume - depends on intake
Appearance - clear is normal
Specific Gravity - depends on intake (1.001-1.035)
Osmolality - 50-1400mOsm/kg
Odor -
What is the normal specific gravity of urine?
Depends on intake; 1.001-1.035
What is the normal osmolality for urine?
50-1400mOsm/kg
In a chemical exam. what is the pH range of urine?
depends on intake; 4.5-8.5
In a chemical exam. what is the pH range of urine?
depends on intake; 4.5-8.5
In a chemical exam. what is the normal range of protein in urine?
0-150mg/day
What chemicals should NOT appear in urine?
glucose, ketones, bilirubin, occult blood, nitrate
What is bilirubin?
A by product of the liver; will make the urine REALLY dark
What are the 4 things examined in an analysis of urine?
Physiochemical properties
Chemical Examination
Microscopic Examination
Bacterial Screen
If the amount of protein in the urine is reported as "negative" how many mg/dl of protien is the pt. excreting?
0-5mg/dl
If the amount of protein in the urine is reported as "trace" how many mg/dl of protien is the pt. excreting?
5-20mg/dl
If the amount of protein in the urine is reported as "+1" how many mg/dl of protien is the pt. excreting?
>20-100 mg/dl
If the amount of protein in the urine is reported as "+2" how many mg/dl of protien is the pt. excreting?
>100-300 mg/dl
If the amount of protein in the urine is reported as "+3" how many mg/dl of protien is the pt. excreting?
>300-1000 mg/dl
If the amount of protein in the urine is reported as "+4" how many mg/dl of protien is the pt. excreting?
>1000mg/dl
What are the two parts of a bacterial screen?
Gram Stain
Colony count
In a microscopic examination of the urine what is a normal finding for the following?

Epithelial cells
0-2/hpf
In a microscopic examination of the urine what is a normal finding for the following?

Casts
hyaline (normal)
wbc, rbc, granular-waxy and braod casts
In a microscopic examination of the urine what is a normal finding for the following?

Crystals
uric acid, oxalate

if numerous it is abnormal
In a microscopic examination of the urine what is a normal finding for the following?

WBC
0-5/hpf
In a microscopic examination of the urine what is a normal finding for the following?

WBC exterase
none is normal; may suggest there is a UTI if present
In a microscopic examination of the urine what is a normal finding for the following?

Bacteria
none is normal
In a microscopic examination of the urine what is a normal finding for the following?

Yeast
none is normal (both males and females can have yeast infections)
In a microscopic examination of the urine what is a normal finding for the following?

RBCs
0-3/hpf is normal
In a microscopic examination of the urine what is a normal finding for the following?

Other organisms (ex: trichomonas, parasites)
none is normal
What are some types of urine tests?
Diabetes urine tests, pregnancy tests, ovulation test, toxicology screening, etc.
What does a diabetes urine test examine?
glucose and ketones
What hormone is detected in pregnancy tests?
UhCG
What hormone is tested in an ovulation test?
Leutinizing hormone test
What does a toxicology screening test examine?
illicit drug use, other drugs/substances
APAP
Acetometaphin
ASA
asprin
Main example of a barbiturate?
Phenobarbital
What are phenothiazines?
Anti-psychotics
What are the main catecholamines?
epinephrine and norepinephrine
What type of urine test is usually administered to pt. with multiple myeloma?
24hour collection of urine (examined for protein)
What substance changes the color of urine to light (due to diuresis)?
alcohol
What drugs change the color of urine to blue/green?
amitriptyline and triamterene
What drug changes the color of urine red?
deferoxamine
What drug changes the color of urine black or dark?
iron salts
What drug changes the color of urine dark?
metronidazole (antibiotic)
What drug changes the color of urine orange?
Warfarin
What drugs change the color of urine orange/red?
Phenazopyridine and Rifampin
What class is the drug amitriptyline?
antidepressant, tricyclic antidepressant
Alcohol changes urine color to....?
light (due to diuresis)
Amitriptyline changes urine color to....?
blue/green
Deferoxamine changes urine color to....?
red
Iron salts change urine color to....?
black or dark
Metronidazole changes urine color to....?
dark
What class is the drug Metronidazole?
antibiotic
Warfarin changes urine color to....?
orange
Phenazopyridine changes urine color to....?
orange/red
Riboflavin changes urine color to....?
yellow (bright)
Rifampin changes urine color to....?
orange/red
Triamterene changes urine color to....?
blue/green
Triamterene is used to....?
incease blood pressure
Does the following drug increase or decrease pH?

Acetazolamide
increase
Does the following drug increase or decrease pH?

amphotericin B
increase
Does the following drug increase or decrease pH?

sodium bicarbonate
increase
Does the following drug increase or decrease pH?

potassium citrate
increase
Does the following drug increase or decrease pH?

ammonium chloride
decrease
Does the following drug increase or decrease pH?

ascorbic acid
decrease
List some diagnostic tests to evaluate the kidneys.
urinalysis, KUB, IVP, renal angiography, renal bniopsy, cystoscopy, renal ultrasound, serum chemistries
FeNa
Fractional excretion of sodium
What is the FeNa used for?
to differentiate between prerenal and parenchymal acute renal failure
What is parenchymal acute renal failure?
not a problem with the kidney itself but a problem somewhere else that affects the kidneys (ex: heart, profusion issues)
Equation for FeNa
FeNa = [(Urine Na)(Plasma Cr) / (Urine Cr) (Plasma Na)] * 100
Creatinine is a by-product of ________ __________.
muscle metabolism
T/F: Creatine is reabsorbed
False; creatine is produced and excreted at a constate rate, it is NOT absorbed
Measuring creatinine clearance gived an adequate estimate of ___________.
Glomerular Filtration Rate
What represents the results of protein metabolism and provides an index of glomerular filtration?
BUN
T/F: Urea does not undergo reabsorption
False, urea undergoes reabsorption and therefore is an inaccurate indicator of renal fxn
What percent of urea undergoes reabsorption?
40-60%
Normal CrCl for males? (ml/min)
85-125ml/min
Normal CrCl for females? (ml/min)
75-115 ml/min
Uses of CrCl
1. Determine efficience of the kidneys clearing creatinine from the blood
2. assess renal fnx especially GFR
3. monitor progression of renal failure
What equation is used to estimate CrCl?
Cockcroft-Gault equation
Equation for CrCl for males? for females?
CrCl = [(140-age)(wt in kg)] / [(72)(SCr)]

**multiply by 0.85 for females**
Multiply the Cockcroft-Gault equation by _____ for females.
0.85
What are the three phases of ARF?
1. oliguric phase
2.non-oliguric (diabetic)
3. recovery phase/convalescent phase
Is the following a diagnostic test for acute renal failure or chronic renal failure?:

fluid and electrolyte status
acute
Is the following a diagnostic test for ARF or CRF?:

fluid and electrolyte status
acute
Is the following a diagnostic test for ARF or CRF?:

BUN/Scr ratio
acute
Is the following a diagnostic test for ARF or CRF?:

urinalysis
acute
Is the following a diagnostic test for ARF or CRF?:

KUB
acute
KUB
Kidneys, Ureters, Bladder
Is the following a diagnostic test for ARF or CRF?:

Renal ultrasound
acute
Is the following a diagnostic test for ARF or CRF?:

IVP
acute
Is the following a diagnostic test for ARF or CRF?:

renal biopsy
both acute and chronic
What type of test is a KUB?
abdominal xray
IVP
intravenous pyelography
Is the following a diagnostic test for ARF or CRF?:

CrCl (measured or calculated)
acute
Is the following a diagnostic test for ARF or CRF?:

assessment of symptomatology
chronic
Is the following a diagnostic test for ARF or CRF?:

physical findings
chronic
Is the following a diagnostic test for ARF or CRF?:

Labs - BUN, SCr, CrCl, fluid, serum and urinary electrolytes, etc.
chronic
Is the following a diagnostic test for ARF or CRF?:

Xrays (chest, bone, kidney size/renal scan)
chronic
Is the following a diagnostic test for ARF or CRF?:

neurologic tests (PE, nerve conduction, velocity tests, EEG)
CHRONIC
What are the two main drawbacks to estimating CrCl?
-estimation
-must assume creatinine production and excretion are CONSTANT
Causes of ARF
1. Prerenal azotemia
2. Renal (intrinsic) failure
3. Post renal azotemia
Etiologies:
1. Prerenal azotemia
2. Renal (intrinsic) failure
3. Post renal azotemia
ARF
Cause of Prerenal azotemia
result of combination of hypovolemia, hypotension and decreased renal perfusion
S/S of ARF
S/S:
-related to cause
-azotemia, increased SCr, other electrolyte disturbances
S/S:
-related to cause
-azotemia, increased SCr, other electrolyte disturbances
S/S of ARF
What are the main factors that allow for diagnosis of ARF?
-Sudden increase in BUN or SCr
-Often accompanied by oliguria
-Oliguria is self-limiting over a few days to 4-6 weeks
-Sudden increase in BUN or SCr
-Often accompanied by oliguria
-Oliguria is self-limiting over a few days to 4-6 weeks
ARF
Etiologies of CRF
Etiologies:
-Worsening ARF
-Glomerulonephritis/glomerulopathy
-Polycystic kidney disease (genetic)
-Interstitial nephritis
-Obstructive uropathy
-Congentital or inherited disorders
-DM
-Hypertension
-Gout nephropathy
-Nephrolithiasis
Etiologies:
-Worsening ARF
-Glomerulonephritis/glomerulopathy
-Polycystic kidney disease (genetic)
-Interstitial nephritis
-Obstructive uropathy
-Congentital or inherited disorders
-DM
-Hypertension
-Gout nephropathy
-Nephrolithiasis
CRF
Define nephrolithiasis
untreated kidney stones
What are some key factors in diagnosis of CRF?
Diagnosis:
-Progressive azotemia over weeks and months
-May be a consequence of many primary glomerular and tubular diseases
-ypertension develops in the majority of patient
Diagnosis:
-Progressive azotemia over weeks and months
-May be a consequence of many primary glomerular and tubular diseases
-ypertension develops in the majority of patient
CRF
Fluid and Electrolyte S/S of CRF
1.Hyponatremia/Hypernatremia
2.Hyperkalemia
3.Hypocalcemia
4. Hyperphosphatemia
5. Fluid retention
6. Metabolic acidosis
1.Hyponatremia/Hypernatremia
2.Hyperkalemia
3.Hypocalcemia
4. Hyperphosphatemia
5. Fluid retention
6. Metabolic acidosis
Fluid and electrolyte S/S of CRF
Define uremia
A toxic condition resulting from kidney disease in which there is retention in the bloodstream of waste products normally excreted in the urine. Also called azotemia .
Definition: A toxic condition resulting from kidney disease in which there is retention in the bloodstream of waste products normally excreted in the urine.
uremia/azotemia
Another name for uremia?
azotemia
General S/S of CRF (uremic manifestation)
fatigue, weakness, ill-appearance, muscle wasting
GI S/S of CRF (uremic manifestation)
anorexia, n/v, dysguesia, GI bleeding, ulcers
Skin S/S of CRF (uremic manifestation)
pallor or hyperpigmentation, itching, bruising, uremica frost
HEENT S/S of CRF (uremic manifestation)
uriniferous breath, retinopathy
Neuro/psych S/S of CRF (uremic manifestation)
numbness, twitching, irritability, insomnia, muscle cramps, drowsiness, asterixis, myoclonus, coma, depression, anxiety, psychosis
GU S/S of CRF (uremic manifestation)
loss of libido, nocturia
CV S/S of CRF (uremic manifestation)
dyspnea, edema, pericardial pain or inflamation
HEME S/S of CRF (uremic manifestation)
anemia, hemostatic abnormalities, immune suppression
ENDOCRINE S/S of CRF (uremic manifestation)
metabolic bone disease de to decreased vit D an calcium absorption, altered thyroid fnx, gonadal dysfunction