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How does the kidney regulate endocrine function?
Renin = BP
Erytrhopoetine= RBC prod.
Ca+/Phosphorus balance = activate Vit D, incr Ca+ absorption=Calcitrol
Why do we have to urinate when we are cold?
vasoconstriction pushes excess fluid out to keep body warm and gets rid of that fluid via urine
__________ will produce concentrated urine _______ will produce dilute urine
diaphoresis + eating salty food= conc.
drinking and cold weather = dilute
kidneys can't remove urea
wastes accumulate disrupting endocrine/metabolic fx
rapid reduction in urine output
tubular cell death and regeneration
acute renal failure
Problems between the collecting ducts and the bladder cause
urine collection and storage problems=postrenal
_____________ is a classic reason for drop in GFR is an early sign of___________
hypoperfusion of the kidneys
What causes renal artery obstruction and contributes to hypoperfusion of the kidneys?
Vomiting, diarrhea, poor fluid intake, fever, diruetics and HF all contribute to _______________
shock = hypoperfusion of kidneys
Actual parenchymal damage to the glomeruli, interstitial nephritis, acute glomerulonephritis, tubular necrosis, ischemia and toxins cause problems where?
In burns and crush injuries ___________ is released causing renal toxicity, ishemia or both
(released from muscle injury)
Common genetic kidney disease that becomes symptomatic after 30 with hematuria, chronic UTI's and HTN
What are common causes of psi rise in the tubules?
Bilateral renal alculi
Secondary to constant UTI's which causes acute neutrophilic inflamm exudates and small abscesses
From most to least what area of the kidneys cause acute renal failure?
Pre-renal = 55%
Renal parenchymal (intrinsic) = 40%
What are the major systemic disease that cause kidney failure?
Rhabdomyolosis (ETOH, heat stroke, cocain, siezures, low Phosphate, DVT/VTE)
high metabolic rate = high fluid need and larger % of body weight that is water is characteristic of
infants and children
What are s's of pediatric moderate volume deficit?
BP= normal or low
50-90mL/Kg fluid loss + gray skin + poor turgor + very dry mucous membranes + oliguria + 2-3sec cap refill
Moderate volume deficit in children
What indicates mild vol. deficit in children?
dry mucous membranes
Puls=normal or increased
drawn facial expression
mottled skin + very poor turgor + parched membranes + oliguria + azotemia
Severe vol deficit in children
What changes as we age in respect to kidney fx?
Renal blood flow
ability to concerntrate urine
less able to adjust vol, secrete solute load, bladder elasticity, weaker sphincter, decr bladder capacity, BPH
geronotological differences in fluid balance/renal fx
hypoperfusion AEB ^BUN, ^ Creatinine, decr output, urine NaCL decr <20mEq/L, ^ urine specific gravity
Parenchymal damage AEB, ^BUN, ^ creatinine, variable output often decr, urine NaCL incr >40mEq/L, low normal 1.010 spec. grav.
Obstruction AEB ^BUN, ^Creatinine, decr or sudden anuria, NaCL decr <20mEq/L, variable urine spec. grav.
All will alter GFR
Why do people develop Hyperkalemia in ARF?
declining GFR = can't excrete K+
protein catabolism = release of K+ into body fluids
ARF managment includes
tx life threatening cond = K+, fluid crisis
ID cause=hypovolemia, toxicity, obstruction
Tx reversible = hydrate, remove drug, relieve obstruction
How do we determine maintenance of fluid volume?
clin status of pt
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