8: Renal Complaint Flashcards
CrCl
Creatinine clearance
ESRD
End stage renal disease
Uremia
Elevated levels of BUN
BUN
Blood urea nitrogen
What do BUN and Cr gauge?
Kidney function
Cr
Creatinine
How BUN works
Urea nitrogen is a waste product by liver -> travels from liver to kidneys for excretion
How does creatinine work?
Waste product of muscle breakdown, constantly excreted by kidneys
Seven things tested for in BMP (basic metabolic panel)
Na, K, Cl, bicarb, BUN, Cr, glucose
CMP: complete metabolic panel: BMP + which other six tests?
AST, ALT, AlkPhos, bilirubin, total protein, albumin
Specific gravity
Tests urine concentration (usually 1.01 to 1.03)
Nl pH of urine
4.5-8
Reference range for urine protein, glucose, blood, and bilirubin
0
Nitrites in urine?
Associated with UTI
Leukocyte esterase in urine?
Enzyme produced by WBCs, suspect infection
How to know if AKI progresses to CKD
If renal dysfunction is not resolved in 3 months
What are the 5 stages of CKD defined by?
GFR
What CKD stage is considered ESRD?
Stage 5
Renal ROS questions for suspected CKD
Urine output, frequency, hesitancy, foamy urine, urine color, smell, flank pain, dysuria, Hx stones, N/V, confusion, pruritis, metallic taste in mouth, fatigue
Asterixis
Cant hold hand with wrist extended
Uremic frost
Sweating out urea -> creates frosty look on skin
Three limitations to using GFR to Dx CKD
- Not reliable when GFR > 60
- Not reliable in AKI (changes too rapidly)
- Not reliable in low muscle mass pts
Complications in CKD
CVD, mineral and bone disease, Amelia, electrolyte abnormalities, metabolic acidosis, volume overload, uremia, HTN
Three types of renal replacement therapy (RRT)
- Hemodialysis
- Peritoneal dialysis
- Renal transplant
Five indicators for dialysis
- A: severe acidosis
- E: electrolyte disturbance
- I: ingestion of certain substances
- O: volume overload
- U: uremia
(AEIOU)
Asymptomatic bacteriuria
Presence of bacteria w/out sx
Cystitis
Bladder infection
Imaging of pyelonephritis
Mild cases -> no imaging
Severe cases -> CT abd/pelvis
Lloyd’s punch positive test
Pain in costovertebral angle with deep percussion/punch -> kidney path
Symp level of GU tract including bladder
T10-L2
Sympathetic innervation levels for upper and lower ureter
Upper: T10-11
Lower: T12-L2
Parasymp innervation to upper and lower ureter and bladder
Upper: vagus N
Lower: S2-S4
Bladder: S2-S4
Chapman’s reflex points
Group of palpable points occurring in predictable locations on the anterior
and posterior surfaces of the body that are reflections of the visceral
dysfunction or disease
