lecture 1 approach to the renal pt

Osteopathic Manipulative Medicine 6109 with Various at Nova Southeastern University

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By: rafa mart
Created: 2011-01-06
Size: 20 flashcards
Views: 13

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assessment of renal function is

test GFR using

convenient and reproducible marker

freely filtered, not reabsorbed or secreted marker

(creatinine normal blood is .7-1.4 mg/dl)

creatinine clearance formula

Ccr=Ucr x V/Pcr

U= urine P=plasma C=clearance

Normal range is 95-105 ml/min

cockcroft gault formula

used to bedside assessment-->no urine collected

Ccr=[(140-age) x mas in kilograms]/( 72 x Pcr)

x .85 for women

BUN is

final breakdown of protein metabolism

freely filtered , not secreted but reabsorbed in tubules

usually BUN:CR is 10-20:1

disproportionately high

BUN indicates

prerenal azotemia-->dehydration

GI bleeding

steroids

sepsis/catabolism

protein excess

disproportionately low BUN indicates

protein deficiency

liver disease

muscle breakdwon-->rhabdomyolysis

azotemia

retained nitrogenous waste products in the blood

uremia

clinical syndrome caused by kidney failure either chronic or acute characterize by significant azotemi, as well as other findings

urine dipstick findings

nitrite-->presence of urease splitting bacteria

ketones-->starvation, ketoacidosis

leucocyte esterase-->WBC>4/hpf

urobillnogen-->excess conjugated billirubin

urinary sediment formed elements

cells

casts

crystals

microorganisms

RBC in urinary sediment

indicates

inflammation

infection

trauma

stone

dysmorphic RBC--glomerular injury

WBC in urinary sediment

pyuria-->puss in urine--> if >$

infection-->at least 5-10

eosinophillia-->wrights or haensels stain

allergic interstitial nephritis

atheroembolic disease

Epithileal cells in urinary sediment

renal tubular epithelial cells

acute tubular necrosis, glomerularnephritis

oval fat badies

lipid laden tubular cells assoc w/ nephrotic syndrom

casts

condition of low flow, alkaline pH

hyaline cast-->in prerenal azotemia

rbc cast-->acute glomerulonephritis

wbc cast-->acute pyelonephritis, interstitial nephritis

epithelia casts-->ARF, dirty prigment(granular cast)

waxy cast

tubular atrophey

subacute/chronic renal disease

chrystals

urate crystals-->acidic urine, acute uric acid nephropathy, rhabdo

ca oxalate crystals-->MC kidney stone, acidic urine, Eth glycon poisoning

cystine crystal-->cystinuria

ca phospate crystal-->alkaline urine

urine sodium

Una low-->volume depleted

Una high-->renal failure, diuretics

fractional excretion of sodium formula

FEna(%)=(Una x Pcr) + (Pna x Ucr) x 100

^FE-->kidney is failing and unable to conserve Na and H2)

distinguishes intrinsic renal failur from prerenal azotemia

urine anion gap

UAG=Una + Uk - Ucl

UAG>0 suggest renal causes

UAG<0 suggest GI causes

renal syndromes

pre-renal-->lft hrt to afferent arteriole, including volume and perfusion

renal-->glomerular, tubulointerstial, vasculature

post renal-->obstruction from renal pelvis to urethral meatus

About this deck

By: rafa mart
Created: 2011-01-06
Size: 20 flashcards
Views: 13

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
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