1Assessment of the Renal System (2 ?, 1 alt)Palpation:osize & motilityoleft should be felt more easily than rightoshould feel small round pole between handsKidney Hormonesorenin->angiotensin II->aldosterone: holds onto Naoprostaglandins: cause vasodilation/constriction to help with Na secretionobradykinin: controls Afferent arterioles, Efferent Arteriolesoerythropoeitin: triggers RBC production in bone marrowoVitamin D activated (in liver & kidney) to absorb Ca ADH works on distal convoluted tubulesLasix works on Loop of HenleOpen afferent=more blood flowconstricted efferent=filters more, allows some protein throughGFR=>60Blood flow thru kidney=1200 ml/minspecific gravity of urine=1.010-1.030 based on specific gravity of waterAssessment:ogender, age, raceosocioeconomic factorsonutritionomedication history, procedure history with contrast mediumogenetic riskUrinalysis:ocolor, odor, turbidity: clear, light yellow with no odorospecific gravity: 1.010-1.030opH: <7 acid, >7 alkalineoglucose: 220 is threshold, then into urineoketonesoprotein: should not be present in urine; if in urine, then problem with GFR indicateonitrates, leukoesterase: should not be in urine (indicator of UTI)ocells, bacteria, crystalsCulture & SensitivityBlood tests:ocreatnineoBUNoBUN to creatnine ratio is 1:20oGFRoosmolarity: ^ osmolarity indicates dehydrationBladder scanopost void to see amount of urine left in bladderourinary stasis = ^ UTI riskRetrograde scanono worry of allergies because contrast dye in ureters only
2ochecks for blockagescystoscopyovisualization of bladder wall/urethra to detect tumors, inflammation, enlarged prostateocontraindicated in UTI, severely enlarged prostateIVPocontrast excreted via kidneys to bladder to visualize urinary tract & helps indicate renal functionocontraindicated in shellfish allergy, decreased renal function, first trimester pregnancyBladder Cancer (1?)May metastasize from colon, rectum, prostate, cervix to the bladderRisk Factors:osmokingochemical exposureoradiation therapy for cervical cancerochronic recurrent stonesochronic UTIManifestations:opainless hematuriaoUTIoalteration in voiding patternsopelvic/back pain after metastasisTx: chemo, radiation, surgeryDx: cystoscopy, CT, US, biopsyRenal Cancer (1?)Adenocarcinoma most commonRisk Factors:ogender (^ in men)osmokingoobesityoHTNoPKDochemical exposureManifestations:opainless hematuriaopalpable abdominal massodull flank painometastasisunexplained weight lossanemiaenergy lossDx: cystoscopy, US, renal biopsy, IVP, CTTx: radiation, chemo, surgery
3Glomerulonephritis (1?)Inflammation of glomeruli of both kidneys causing swelling & death of capillary cells within glomerulus Causes:opost-strep infectionobacterial/viral infectionoautoimmuneManifestations:ofever, chills, weaknessoabdominal/flank painooliguriaofluid overloadoHTNo
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- Fall '15
- urine output