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Five risk factors for Renal Dz
Cardiovascular Dz; HTN; Ix; Polycystic kidney Dz; FamHx; Diabetes
The second most common cause of azotemia
Renal kidney Dz: Damage to the renal parenchyma; glomeruli are damaged and won't filter effectively.
Three parameters that INCREASE BUN & why
1. Dehydration (concentrates urea)
2. High Protein intake (produce more urea)
3. Blood in GI (GFR drops, so blood urea rises)
Three factors that DECREASE BUN & why
1. Liver failure: (not producing urea)
2. Malnutrition/Kwashiorkor: (no amine groups to make urea from) 3. SIADH (dilute urea)
Paired test used to distinguish pre- or post-renal azotemia from renal azotemia.
Normal: 10:1 w/ normal range values
Pre-renal: 20:1 (urea builds up as blood is "held back" from kidney
Renal: 10:1 (both elevate, but ratio holds)
Post-renal (early): 20:1 (urine "backs up" in system)
Renal Fx test that parallels GFR by 10%. When to order & drawbacks
CREATININE CLEARANCE test. Order when unsure on GFR or if approaching kidney failure.
Drawbacks: Affected by large red meat intake, requires 24-hour collection time
Formula to calculate creatine clearance
Males: wt X (140 - age)/72(serum creatinine);
Females: multiply above by 0.85
Malodorous urine types
1. "Fruity:" DM ketoacidosis;
2. Foul or fishy: UTI or STD (from urea splitting to NH3)
It is better for urine to be too ____ than too ____ (concentration values) Why? Follow-up test?
Because dilute urine can indicate kidney failure. Follow-up w/ URINE OSMOLALITY test
Tx for stage 3 nephropathy
ACE-I (Angiotensin Converting Enzyme inhibitor) or ARB (Angiotensin Receptor Blocker)
Test that identifies UTI & who to test
Nitrites (made from nitrates by UTI bacteria);
Test elderly, pregnant and symptomatic
Tests for female UTI or amniotic Ix in pregnancy, esp if vaginal discharge; reasons for false POS
Leucocyte Esterase; False POS: bleeding, parasites, heavy mucus; also Nitrite test (bacteria convert nitrate-->nitrite)
Pair of tests for liver damage & GB damage
Bilirubin & Urobilinogen.
Bilirubin should always be absent from urine.
Some Urobilinogen should always be present--
Elevated: Hepatic damage or hemolysis;
Depressed: Biliary obstruction
Urinary volumes and definitions
Oliguria: 100-400 mL/day;
Polyuria: >3000 mL/day
Anuria: <100 ml/day
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