NR 545 FINAL EXAM - - GRADED A+ Week 7 : renal and urological disorders

NR 545 FINAL EXAM -

WITH QUESTIONS AND DETAILED ANSWERS||ALREADY

GRADED A+

Week 7 : renal and urological disorders

• Questions can include pathophysiology, health assessment (normal and abnormal), and pharmacologic treatment • Review required readings, course lectures, case study and learning activity.Fluid and electrolyte balance- processes in the kidney • Hormones controls reabsorption of fluid and electrolytes

• Antidiuretic hormone

▪ From posterior pituitary; controls reabsorption of water by altering permeability of distal convoluted tubule and collecting duct

• Aldosterone

▪ Secreted by adrenal cortex; controls sodium reabsorption and water by exchanging Na ions for K or hydrogen ions in distal convoluted tubule

• Atrial natriuretic hormone

▪ From heart; 3 rd hormone controlling fluid balance by reducing Na and fluid reabsorption in kidneys Renal circulation process Laboratory testing- purpose and interpretation ; Age related urinary changes ; Conditions/diagnoses associated with urine color changes Diagnostic test • Urinalysis

• Constituents and characteristics of urine may vary w/ dietary intake, drugs, and care w/ which specimen is handled

o Urine is normally: clear, straw colored and has mild color

• Urine pH is 4.5-8.0
• Appearance

▪ Cloudy indicate presence of large amounts of protein, blood cells or bacteria and pus ▪ Dark color indicate hematuria (blood), excessive bilirubin content or highly concentrated urine ▪ Unpleasant or unusual odor indicate infection or result from certain dietary components or medications

• Abnormal constituents (present in significant quantities)

▪ Blood (hematuria) • small (microscopic) amounts of blood indicates infection, inflammation, or tumors in urinary tract • large numbers of RBC (gross hematuria) indicates increased glomerular permeability or hemorrhage in tract ▪ protein (proteinuria, albuminuria) • indicates leakage of albumin or mixed plasma proteins into filtrate d/t inflammation and increased glomerular permeability ▪ bacteria (bacteriuria) and pus (pyuria) • indicates infection in urinary tract ▪ urinary casts (microscopic sized molds of tubules, consisting of one or more cells (bacteria, protein, and so on)) • indicates inflammation of kidney tubules ▪ specific gravity • indicates ability of tubules to concentrate the urine • very low specific gravity= dilute urine; related to renal failure ▪ glucose and ketones (ketoacids) • found when DM is not well controlled • blood test

• elevated serum urea (BUN and Cr)

▪ indicate failure to excrete nitrogen wastes d/t decreased GFR ▪ results from protein metabolism

• metabolic acidosis (decreased pH and Bicarb)

▪ indicate decreased GFR and failure of tubules to control acid-base balance

• anemia (low hgb)

▪ indicated decreased erythropoietin secretion and/or bone marrow depression d/t accumulated wastes

• electrolytes

▪ depend on related fluid balance ▪ retention of fluid= GFR is decreased and may result in dilution effect

• antibody level antistreptolysin O (ASO) or antistreptokinase (ASK)

▪ used for dx of post-streptococcal glomerulonephritis

• renin

▪ indicate cause of HTN • other test

• culture and sensitivity on urine specimens

▪ used to identify the causative organism in urinary infection and select drug tx 1 / 2

• clearance test such as Cr or insulin clearance or radioisotopestudy

▪ used to assess GFR

• radiologic test such as radionuclide imagining, angiography, US, CT, MRI and IV pyelography(IVP)

▪ used to visualize structures and abnormalities in urinary system

• cystoscopy

▪ visualizes lower urinary tract and may be used in performing a biopsy or removing kidney stones

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