Renal Function & Disorders Quiz

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Questions and Answers

What is the appropriate interpretation of a patient with a urine output of 25 mL per hour?

  • Normal urine output.
  • Oliguria. (correct)
  • Polyuria.
  • Anuria.

Which condition is indicated by a patient urinating more than 3 liters per day?

  • Oliguria.
  • Polyuria. (correct)
  • Anuria.
  • Acute kidney injury.

How should the nurse interpret a patient's fluid intake of 2,500 mL and an output of 1,800 mL over 24 hours?

  • Fluid overload is present.
  • Patient is experiencing dehydration.
  • Insensible fluid losses are accounting for the difference. (correct)
  • Fluid balance is normal.

In a patient with dehydration and a urine output of 300 mL in 24 hours, which finding is expected?

<p>Elevated urine specific gravity. (D)</p> Signup and view all the answers

If a patient has a total fluid intake of 3,000 mL and output of 4,000 mL in the past 24 hours, what is the most appropriate nursing intervention?

<p>Encourage the patient to increase fluid intake. (B)</p> Signup and view all the answers

What indicates fluid overload in a patient who has excessive urine output?

<p>Increased blood pressure. (C)</p> Signup and view all the answers

In cases of acute kidney injury, what is a typical urine output characteristic?

<p>Decreased output but not to anuria levels. (B)</p> Signup and view all the answers

Which of the following conditions can lead to an output of oliguria?

<p>Severe dehydration. (A)</p> Signup and view all the answers

What is the priority intervention for a patient with elevated BUN and normal creatinine levels?

<p>Hold nephrotoxic medications and monitor renal labs (D)</p> Signup and view all the answers

What is a key symptom that distinguishes pyelonephritis from uncomplicated UTIs?

<p>Flank pain with fever (D)</p> Signup and view all the answers

Which lab finding would most likely be present in a patient with glomerulonephritis?

<p>Red blood cell casts in the urine (C)</p> Signup and view all the answers

In a patient suspected of having vesicoureteral reflux and recurrent UTIs, which complication should be most closely monitored?

<p>Pyelonephritis (D)</p> Signup and view all the answers

What most accurately characterizes a complicated UTI in males?

<p>Any systemic symptoms or comorbidities (D)</p> Signup and view all the answers

Which presentation suggests the presence of a complicated UTI?

<p>Fever and CVA tenderness (B)</p> Signup and view all the answers

What type of UTI is indicated by dysuria and frequency but without systemic symptoms?

<p>Uncomplicated UTI (C)</p> Signup and view all the answers

Which symptom is a classic indication of pyelonephritis?

<p>Fever and flank pain (C)</p> Signup and view all the answers

What is the most appropriate initial intervention for a patient exhibiting signs of hypovolemia?

<p>Start IV fluids to address hypovolemia. (B)</p> Signup and view all the answers

What initial management should be taken for a patient with pyelonephritis and concern for sepsis?

<p>IV antibiotics and hospitalization (D)</p> Signup and view all the answers

What is the most common mechanism for developing pyelonephritis?

<p>Ascending infection from the bladder (A)</p> Signup and view all the answers

Which lab finding suggests that a patient is likely dehydrated?

<p>BUN of 35 mg/dL and creatinine of 0.9 mg/dL. (A)</p> Signup and view all the answers

What condition is most indicated by a specific gravity of 1.008 in a urinalysis?

<p>Overhydration. (B)</p> Signup and view all the answers

Which finding would most likely concern the nurse in a patient with recurrent UTIs?

<p>Fever and CVA tenderness (A)</p> Signup and view all the answers

What is the likely diagnosis for an elderly patient presenting with new-onset confusion and a urinalysis showing WBCs and bacteria?

<p>UTI with atypical presentation (B)</p> Signup and view all the answers

In a patient with elevated BUN and creatinine, which initial nursing action is most appropriate?

<p>Notify the provider immediately. (B)</p> Signup and view all the answers

Which finding in urinalysis typically suggests glomerular involvement?

<p>Red blood cell casts (A)</p> Signup and view all the answers

Which lab value is most concerning for a patient receiving potentially nephrotoxic medication?

<p>Creatinine 1.5 mg/dL. (A)</p> Signup and view all the answers

What is the most likely interpretation of elevated BUN and creatinine, alongside reduced GFR in an elderly patient?

<p>Chronic kidney disease. (C)</p> Signup and view all the answers

What intervention is best for a patient with a BUN of 60 mg/dL and creatinine of 3.2 mg/dL?

<p>Notify the provider immediately. (C)</p> Signup and view all the answers

Which is a critical factor in calculating GFR that could delay kidney disease diagnosis in African-American patients?

<p>Race-based adjustment. (B)</p> Signup and view all the answers

What is the expected clinical finding in a patient with symptoms of uremia?

<p>Altered mental status. (A)</p> Signup and view all the answers

For a patient presenting with fatigue and decreased urine output, what is the best initial step in management?

<p>Review medications for potential nephrotoxicity. (C)</p> Signup and view all the answers

A patient with a creatinine level of 1.7 mg/dL should most appropriately receive which intervention?

<p>Administer IV fluids to prevent dehydration. (C)</p> Signup and view all the answers

What might elevated BUN of 40 mg/dL and creatinine of 1.0 mg/dL indicate in a patient?

<p>Dehydration. (C)</p> Signup and view all the answers

What is the most appropriate next step in managing a patient with pyelonephritis?

<p>Admit for IV antibiotics and close monitoring. (B)</p> Signup and view all the answers

Which recommendation is the most important for UTI prevention?

<p>Void every 2–3 hours to prevent urinary stasis. (C)</p> Signup and view all the answers

What urine output is considered the minimum threshold to prevent oliguria?

<p>30 mL/hour (A)</p> Signup and view all the answers

What is the most appropriate advice for reducing the risk of recurrent UTIs?

<p>Void shortly after sexual intercourse. (B)</p> Signup and view all the answers

What should a nurse say regarding the completion of an antibiotic course?

<p>Completing your prescribed antibiotic course is crucial to prevent resistance. (B)</p> Signup and view all the answers

Who is most at risk of developing antibiotic resistance related to UTI treatment?

<p>A patient with recurrent UTIs who frequently stops antibiotics early. (B)</p> Signup and view all the answers

What is the appropriate intervention for a patient with recurrent UTIs and early termination of antibiotics?

<p>Prescribe a 3-day course of antibiotics and educate on completing the full course. (B)</p> Signup and view all the answers

Which patient presentation is most indicative of glomerulonephritis?

<p>Facial puffiness, flank pain, and hematuria. (C)</p> Signup and view all the answers

What urinalysis finding is the hallmark of glomerulonephritis?

<p>Proteinuria and hematuria (C)</p> Signup and view all the answers

What is the primary cause of proteinuria and hematuria in a patient with a history of strep throat?

<p>Post-infectious immune response (B)</p> Signup and view all the answers

Which clinical finding is a distinguishing factor between glomerulonephritis and pyelonephritis?

<p>Proteinuria (C)</p> Signup and view all the answers

Which condition is a significant risk factor for recurrent UTIs?

<p>Use of antibiotics without physician guidance (C)</p> Signup and view all the answers

What is the most effective way to ensure adequate hydration to prevent UTIs?

<p>Increase daily water consumption significantly. (B)</p> Signup and view all the answers

Which of the following findings is most characteristic of glomerulonephritis?

<p>Proteinuria and fluid retention (A)</p> Signup and view all the answers

What additional finding is commonly associated with fluid retention in glomerulonephritis?

<p>Facial edema (A)</p> Signup and view all the answers

Which condition is most likely indicated by the combination of sore throat, pitting edema, and cola-colored urine in a child?

<p>Post-streptococcal glomerulonephritis (A)</p> Signup and view all the answers

What is the most appropriate initial nursing intervention for a patient with a ureteral stone?

<p>Encourage fluid intake (D)</p> Signup and view all the answers

What dietary recommendation is crucial for a patient at risk for calcium oxalate stones?

<p>Avoid high-oxalate foods (D)</p> Signup and view all the answers

Which post-procedure finding after lithotripsy would be most concerning?

<p>Severe pain and difficulty urinating (D)</p> Signup and view all the answers

In a patient with a serum calcium level of 11.2 mg/dL, what should the nurse prioritize?

<p>Notify the provider about the hypercalcemia (D)</p> Signup and view all the answers

Which statement demonstrates a misconception about dietary recommendations to prevent kidney stones?

<p>I will limit my intake of dairy products. (D)</p> Signup and view all the answers

During an evaluation of glomerulonephritis, what laboratory finding is expected?

<p>Increased serum creatinine levels (C)</p> Signup and view all the answers

Which symptom is not typically associated with nephrolithiasis?

<p>Facial swelling (D)</p> Signup and view all the answers

What urine characteristic might indicate potential nephrolithiasis?

<p>High protein levels (D)</p> Signup and view all the answers

What is a common consequence of untreated post-streptococcal glomerulonephritis?

<p>Rapid kidney failure (A)</p> Signup and view all the answers

Which of the following is a primary cause of pyelonephritis?

<p>Bacterial infection (B)</p> Signup and view all the answers

What intervention should be avoided in the initial management of a patient with a ureteral stone?

<p>Urinary catheter insertion (B)</p> Signup and view all the answers

What urine output per hour is indicative of oliguria in a patient weighing 65 kg?

<p>25 mL/hour (C)</p> Signup and view all the answers

A patient with acute kidney injury displays an intake of 2,500 mL and an output of 1,800 mL in 24 hours. What does this suggest?

<p>Insensible fluid losses (D)</p> Signup and view all the answers

What renal condition is suggested by excessive urination greater than 3 liters a day?

<p>Polyuria (C)</p> Signup and view all the answers

What finding should the nurse expect in a dehydrated patient with only 300 mL of output in 24 hours?

<p>Increased urine specific gravity (A)</p> Signup and view all the answers

If a patient has a total fluid intake of 3,000 mL and an output of 4,000 mL in the past 24 hours, which intervention is appropriate?

<p>Increase fluid intake (B)</p> Signup and view all the answers

What term describes urine output that is less than 400 mL in 24 hours?

<p>Anuria (C)</p> Signup and view all the answers

What clinical intervention is indicated for a patient with persistent polyuria?

<p>Searching for underlying causes (A)</p> Signup and view all the answers

What physiologic response occurs with dehydration that affects urine concentration?

<p>Increased urine specific gravity (C)</p> Signup and view all the answers

What clinical sign is most indicative of hypovolemia in a patient?

<p>Dry mucous membranes (B)</p> Signup and view all the answers

How does elevated BUN with normal creatinine indicate dehydration?

<p>Creatinine remains stable in dehydration. (B)</p> Signup and view all the answers

What is a potential complication of using nephrotoxic antibiotics?

<p>Increased creatinine levels. (A)</p> Signup and view all the answers

In a patient with acute kidney injury, which lab result would raise the most concern?

<p>Creatinine of 2.5 mg/dL (D)</p> Signup and view all the answers

Which physiological effect does dehydration primarily have on the kidneys?

<p>Decreases renal perfusion. (A)</p> Signup and view all the answers

What finding would most likely indicate a process of chronic kidney disease rather than acute kidney injury in a patient?

<p>Stable presence of proteinuria. (C)</p> Signup and view all the answers

What symptom is commonly associated with uremia?

<p>Altered mental status. (A)</p> Signup and view all the answers

What is the most important nursing action after identifying significant kidney dysfunction?

<p>Notify the provider. (A)</p> Signup and view all the answers

Which of the following adjustments in calculating GFR could delay kidney disease diagnosis in African-American patients?

<p>Race-based adjustment. (B)</p> Signup and view all the answers

What laboratory result most strongly suggests a patient is not achieving adequate hydration?

<p>Specific gravity 1.030 (D)</p> Signup and view all the answers

In patients with a history of urinary tract infection, what condition should be monitored for?

<p>Acute pyelonephritis. (D)</p> Signup and view all the answers

Which laboratory value is most concerning for a patient receiving nephrotoxic medications?

<p>Creatinine 1.8 mg/dL (C)</p> Signup and view all the answers

What is the most likely result of administering diuretics to a patient with existing hypovolemia?

<p>Worsening volume deficit. (C)</p> Signup and view all the answers

Which symptom is uniquely associated with glomerulonephritis compared to pyelonephritis?

<p>Proteinuria and fluid retention (A)</p> Signup and view all the answers

Which finding would most likely be observed in a patient with glomerulonephritis?

<p>Facial edema (D)</p> Signup and view all the answers

What condition is indicated by a history of sore throat followed by pitting edema and cola-colored urine in a child?

<p>Post-streptococcal glomerulonephritis (D)</p> Signup and view all the answers

What is the initial priority intervention for a patient with severe flank pain due to a ureteral stone?

<p>Encourage the patient to drink 2-3 liters of fluid daily (D)</p> Signup and view all the answers

Which dietary change is recommended for preventing calcium oxalate kidney stones?

<p>Avoid high-oxalate foods like spinach and dark chocolate (B)</p> Signup and view all the answers

What post-procedure finding after lithotripsy would most raise concern?

<p>Severe pain and difficulty urinating (D)</p> Signup and view all the answers

Which follow-up action should a nurse prioritize for a patient with hypercalcemia and kidney stones?

<p>Notify the provider about the hypercalcemia (B)</p> Signup and view all the answers

Which patient statement reflects a misunderstanding of kidney stone prevention?

<p>I will limit my intake of dairy products. (B)</p> Signup and view all the answers

What is the most appropriate initial step for a patient with severe right flank pain and a 4-mm ureteral stone?

<p>Encourage fluid intake to achieve 3-4 liters of urinary output daily (B)</p> Signup and view all the answers

Which condition is most likely indicated by proteinuria, hematuria, and hypertension in a child after a strep throat infection?

<p>Post-streptococcal glomerulonephritis (A)</p> Signup and view all the answers

Which sign is indicative of fluid overload in patients with kidney issues?

<p>Facial edema (A)</p> Signup and view all the answers

What is the most likely result of consuming high-oxalate foods like spinach in someone with kidney stones?

<p>Heightened risk of calcium oxalate stones (D)</p> Signup and view all the answers

Which is a common symptom seen in glomerulonephritis that is not typical of pyelonephritis?

<p>Significant protein loss in urine (B)</p> Signup and view all the answers

A patient with nephrolithiasis complains of hematuria. Which additional finding could indicate a more serious complication?

<p>Severe abdominal pain (A)</p> Signup and view all the answers

What is the most significant lab finding that suggests a patient might be experiencing pyelonephritis?

<p>CVA tenderness (C)</p> Signup and view all the answers

In which circumstance should a nurse hold nephrotoxic medications?

<p>When a patient has low urine output (A)</p> Signup and view all the answers

What condition is most likely if a patient presents with flank pain, fever, and elevated WBCs?

<p>Pyelonephritis (D)</p> Signup and view all the answers

Which of the following symptoms is least likely associated with an uncomplicated UTI?

<p>Flank pain (B)</p> Signup and view all the answers

Which initial management step is most appropriate for a patient with pyelonephritis showing signs of sepsis?

<p>IV antibiotics and hospitalization (D)</p> Signup and view all the answers

What is the most appropriate diagnosis for an elderly patient with confusion, WBCs in urine, and positive nitrites?

<p>UTI with atypical presentation (B)</p> Signup and view all the answers

Which urinalysis finding is most indicative of glomerulonephritis?

<p>Red blood cell casts (C)</p> Signup and view all the answers

What complication should be monitored in a patient with vesicoureteral reflux?

<p>Pyelonephritis (B)</p> Signup and view all the answers

Which type of UTI is most often seen in males with systemic symptoms and complications?

<p>Complicated UTI (D)</p> Signup and view all the answers

When treating a patient with an uncomplicated UTI, which of the following components is unnecessary?

<p>IV antibiotic therapy (C)</p> Signup and view all the answers

What would most likely be a risk factor for recurrent UTIs?

<p>History of diabetes (D)</p> Signup and view all the answers

What is the primary management for a patient exhibiting dysuria and urinary frequency but no fever?

<p>Oral antibiotics (D)</p> Signup and view all the answers

Which factor distinctly differentiates complicated UTIs from uncomplicated ones in males?

<p>Gender of the patient (A)</p> Signup and view all the answers

A biologic male with fever and flank pain is likely experiencing which type of UTI?

<p>Complicated UTI (A)</p> Signup and view all the answers

What is the most appropriate next step in managing a patient with pyelonephritis and systemic symptoms?

<p>Admit for IV antibiotics and close monitoring. (A)</p> Signup and view all the answers

Which recommendation for UTI prevention should be emphasized as the most important?

<p>Void every 2–3 hours to prevent urinary stasis. (C)</p> Signup and view all the answers

What urine output indicates that a patient meets the minimum threshold to prevent oliguria?

<p>30 mL/hour (A)</p> Signup and view all the answers

What advice is most appropriate for a biologic female with recurrent UTIs?

<p>Void shortly after sexual intercourse. (D)</p> Signup and view all the answers

What should the nurse emphasize regarding antibiotic use to prevent resistance in UTI treatment?

<p>Completing your prescribed antibiotic course is crucial to prevent resistance. (C)</p> Signup and view all the answers

Which patient is at the greatest risk of developing antibiotic resistance related to UTI treatment?

<p>A patient with recurrent UTIs who frequently stops antibiotics early. (A)</p> Signup and view all the answers

In a case of uncomplicated UTI, what is the best intervention for a patient with a history of early antibiotic discontinuation?

<p>Prescribe a 3-day course of antibiotics and educate the patient on completing the full course. (D)</p> Signup and view all the answers

Which clinical presentation is most indicative of glomerulonephritis?

<p>Facial puffiness, flank pain, and hematuria. (C)</p> Signup and view all the answers

Which urinalysis finding is most characteristic of glomerulonephritis?

<p>Proteinuria and hematuria. (C)</p> Signup and view all the answers

What is the primary underlying cause of hypertension, proteinuria, and hematuria in a post-streptococcal patient?

<p>Post-infectious immune response. (B)</p> Signup and view all the answers

Which clinical finding is most likely to distinguish glomerulonephritis from pyelonephritis?

<p>Edema and proteinuria. (B)</p> Signup and view all the answers

Which of the following findings in a patient experiencing a UTI suggests the need for more extensive evaluation?

<p>Positive WBC casts. (C)</p> Signup and view all the answers

How can fluid intake impact the occurrence of UTIs?

<p>Decreased fluid intake increases UTI risk by promoting stasis. (A)</p> Signup and view all the answers

Which patient population is at higher risk for recurrent UTIs due to anatomical factors?

<p>Biologic females. (A)</p> Signup and view all the answers

Flashcards

Oliguria

Low urine output; less than 0.5 mL/kg/hour.

Polyuria

Excessive urination, greater than 3 liters per day.

Urine output

The amount of urine produced by the kidneys per unit of time.

Fluid balance

The state where intake and output of fluids are equal.

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Insensible fluid losses

Fluid loss through sweat, stool, and respiration that is not noticeable.

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Urine specific gravity

Measure of the concentration of dissolved substances in urine.

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Acute kidney injury

Sudden decrease in kidney function.

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Dehydration

Fluid loss exceeding fluid intake.

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BUN

Blood Urea Nitrogen (BUN) is a waste product produced by the liver, which is filtered by the kidneys and excreted in urine.

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Creatinine

Creatinine is a waste product produced by muscle breakdown and filtered by the kidneys.

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Hypovolemia

Hypovolemia is a condition in which the body is deficient in blood volume.

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Normal BUN & Creatinine

Normal values for BUN are 7-20 mg/dL and for Creatinine are 0.6-1.2 mg/dL.

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Elevated BUN & Creatinine

Increased BUN and Creatinine indicate impaired kidney function, potentially due to dehydration, acute kidney injury, chronic kidney disease, or other factors.

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Dehydration, High BUN & Normal Creatinine

A high BUN with a normal creatinine level suggests dehydration or high protein intake rather than acute or chronic kidney dysfunction.

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Chronic Kidney Disease

Chronic Kidney Disease (CKD) is long-term damage to the kidneys that worsens gradually over time.

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GFR

Glomerular Filtration Rate (GFR) measures how well the kidneys filter waste from the blood. It is a key indicator of kidney function.

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Race-based GFR Adjustment

Race-based adjustments can delay kidney diagnosis in African-American patients as it assumes higher muscle mass, artificially increasing their GFR.

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Uremia

Uremia is a buildup of nitrogenous waste products in the blood due to impaired kidney function.

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Nephrotoxic drugs

These drugs can harm the kidneys by directly damaging them.

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Specific Gravity

Specific Gravity measures the concentration of dissolved substances in urine.

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Dehydration & Urine Specific Gravity

A low specific gravity indicates dilute urine, which is consistent with overhydration or an inability of the kidneys to concentrate urine.

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Fluid Management in AKI

In AKI, fluid management is crucial to maintain adequate renal perfusion and minimize further kidney damage.

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Elevated BUN with normal creatinine

A lab finding that suggests dehydration, meaning the body is losing more water than it is taking in.

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Pyelonephritis

A kidney infection, usually caused by bacteria traveling up from the bladder.

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Cystitis

A bladder infection, often causing pain during urination and frequent urination.

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Glomerulonephritis

Inflammation of the tiny filtering units in the kidneys, often caused by an immune system reaction.

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CVA tenderness

Pain when pressing on the area over the kidneys in the back, often a sign of kidney infection.

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Vesicoureteral reflux

Urine flowing backward from the bladder up to the kidneys.

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Red blood cell casts in the urine

A sign of kidney damage, indicating blood cells escaping from the glomeruli.

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Leukocytosis

Elevated white blood cell count, often a sign of infection.

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Complicated UTI

A urinary tract infection that is more complex, often with systemic symptoms or factors that make treatment difficult.

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Uncomplicated UTI

A simple bladder infection, usually without systemic symptoms and easily treated.

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Atypical UTI presentation in elderly

Older adults may present with confusion or delirium instead of typical UTI symptoms due to the body's response to infection.

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UTI in males

All UTIs in males are considered complicated due to the anatomy of the male urinary tract.

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Recurrent UTI's

Frequent UTIs, often a sign of an underlying structural issue.

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Progression to pyelonephritis

When a UTI spreads from the bladder to the kidneys, causing a more serious infection.

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UTI in pregnant women

UTIs are more common and potentially more dangerous during pregnancy, requiring careful management.

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UTI prevention - Most important

Regular voiding every 2-3 hours to prevent urinary stasis. This flushes bacteria from the urinary tract.

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Adequate urine output

A minimum of 30 mL/hour, equivalent to 0.5 mL/kg/hour for a typical adult. This ensures proper urinary flushing.

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UTI risk reduction

Voiding shortly after sexual intercourse. This flushes bacteria from the urethra.

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Antibiotic resistance and UTIs

Completing the full course of prescribed antibiotics is crucial to prevent antibiotic resistance. Stopping early allows bacteria to survive and develop resistance.

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Glomerulonephritis hallmark finding

Proteinuria and hematuria. This is due to damage to the glomerular membrane, causing leakage of protein and blood into the urine.

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Post-streptococcal glomerulonephritis

A type of glomerulonephritis that occurs after a strep throat infection. It's an immune response to the infection, causing inflammation of the glomeruli.

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Glomerulonephritis vs. Pyelonephritis

Glomerulonephritis involves the glomeruli, causing proteinuria and hematuria, while pyelonephritis is an infection of the kidneys, usually causing fever, flank pain, and CVA tenderness.

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Uncomplicated UTI treatment

A short course of antibiotics (3 days is typical) is sufficient for most uncomplicated UTIs.

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Recurrent UTIs and non-compliance

Patients with recurrent UTIs often stop antibiotics early, increasing their risk of resistance. Education and adherence are key.

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Asymptomatic bacteriuria

Presence of bacteria in the urine without any symptoms. It may not require treatment but depends on individual circumstances.

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Prophylactic antibiotics for UTIs

Daily antibiotics may be considered for patients with frequent UTIs. This aims to prevent recurrence, but may lead to resistance.

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UTI prevention - Controversial options

Cranberry juice, probiotics, and avoiding caffeine are not universally effective or evidence-based for preventing UTIs.

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Dehydration & Elevated BUN

A high BUN level with a normal Creatinine level commonly points to dehydration, meaning the body is losing more water than it is taking in.

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What is a normal range for BUN?

The normal range for BUN (Blood Urea Nitrogen) is 7-20 mg/dL. This indicates healthy kidney function.

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What is a normal range for Creatinine?

The normal range for Creatinine is 0.6-1.2 mg/dL. This reflects healthy kidney function.

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What is the most likely cause of an elevated BUN with a normal Creatinine?

An elevated BUN with a normal Creatinine level is most likely caused by dehydration or high protein intake.

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Dehydration & Specific Gravity

A low specific gravity, indicating dilute urine, can suggest overhydration or an inability of the kidneys to concentrate urine.

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Elevated BUN, Normal Creatinine

A lab finding suggesting dehydration. The body loses more water than it takes in, resulting in a higher concentration of waste products like urea in the blood.

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Red Blood Cell Casts in Urine

A sign of kidney damage, indicating blood cells escaping from the filtering units (glomeruli) in the kidneys.

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Proteinuria

Presence of protein in the urine, indicating damage to the glomeruli.

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Hematuria

Presence of blood in the urine, often a sign of damage to the filtering units in the kidneys.

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Facial edema

Swelling of the face, often a sign of fluid overload in glomerulonephritis.

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Flank pain

Pain in the area of the kidneys, often a symptom of pyelonephritis.

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Kidney stones

Hard deposits that form in the kidneys, often causing pain and blockage in the urinary tract.

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Hematuria (kidney stones)

Blood in the urine, often a symptom of kidney stones.

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Lithotripsy

A procedure that uses shock waves to break up kidney stones, allowing them to pass more easily.

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Hypercalcemia

High levels of calcium in the blood, a potential risk factor for kidney stones.

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Dietary oxalate restriction

Avoiding foods high in oxalate, like spinach and dark chocolate, can help prevent kidney stones.

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Severe pain and difficulty urinating (after lithotripsy)

A concerning finding after lithotripsy, potentially indicating retained stone fragments or injury.

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Increased fluid intake for kidney stone prevention

Drinking plenty of water helps flush the kidneys and can help prevent stone formation.

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Study Notes

Renal Function & Disorders

  • Oliguria: Urine output less than 0.5 mL/kg/hour (e.g., 25 mL/hour in a 65 kg patient).
  • Polyuria: Excessive urination (>3 liters/day) often indicating conditions like diabetes mellitus or diabetes insipidus.
  • Anuria: Complete absence of urine output.
  • Fluid Balance: Intake and output should generally be balanced. Discrepancies can be due to insensible losses (sweat, stool, respiration).
  • Urine Specific Gravity: Reflects urine concentration; elevated specific gravity indicates dehydration.

Kidney Injury & Dysfunction

  • Acute Kidney Injury (AKI): Characterized by rapidly declining kidney function. Elevated BUN and creatinine are indicative.
  • Chronic Kidney Disease (CKD): Progressive loss of kidney function, often associated with chronic conditions, like hypertension. Elevated BUN and creatinine are indicative.
  • GFR (Glomerular Filtration Rate): Measures kidney function, calculated using various factors, including age and race. Race-based adjustments in GFR can lead to delayed diagnosis for African Americans.
  • Uremia: Accumulation of nitrogenous waste products in the blood, leading to systemic effects, including altered mental status and hyperkalemia.
  • BUN (Blood Urea Nitrogen) & Creatinine: Elevated levels indicate potential kidney dysfunction. Normal creatinine with elevated BUN suggests non-renal causes (dehydration, high protein diet).
  • Renal Protection: Dehydration can impair renal function. IV fluids help maintain renal perfusion.
  • Nephrotoxic Medications: Certain medications can damage kidneys. Monitoring renal function is crucial when administering them.

Urinary Tract Infections (UTIs)

  • Types of UTIs:
    • Cystitis (lower UTI): Involves the bladder, often characterized by dysuria (painful urination), urinary frequency, suprapubic pain, pyuria (pus), and positive nitrites in urine.
    • Pyelonephritis (upper UTI): Involves one or both kidneys, presenting with systemic symptoms like fever, flank pain, and CVA tenderness (costovertebral angle tenderness). Requires more intensive treatment than cystitis.
  • Complicated vs. uncomplicated UTIs: UTIs are classified as complicated if they occur in males, in patients with pre-existing conditions (like diabetes), or present with systemic signs. All in males are considered complicated.
  • Vesicoureteral Reflux (VUR): Backflow of urine from the bladder to the ureters, increasing risk of recurrent pyelonephritis, especially in women.
  • Glomerulonephritis: Involves inflammation of the glomeruli (filters in the kidneys), usually caused by an immune response after a recent infection (often strep throat). Characterized by proteinuria and hematuria (protein and blood in urine), facial puffiness (edema).

Kidney Stones (Nephrolithiasis)

  • Kidney Stones: Crystal formations in the kidney. Symptoms include severe flank pain, hematuria, nausea. Hydration (3-4 L/day) facilitates their natural passage.
  • Dietary Considerations: High oxalate foods (spinach, dark chocolate) should be limited and calcium intake managed appropriately to minimize stone formation.
  • Hypercalcemia: High blood calcium levels may contribute to stone formation. This requires prompt medical attention.
  • Post-Lithotripsy Considerations: Close monitoring for complications like severe pain and difficulty urinating, potentially needing surgery are important.

General Urinalysis Considerations

  • Specific Gravity: Low specific gravity suggests overhydration, while a high specific gravity indicates dehydration.
  • Urine Output: Adequate urine output (≥ 30 mL/hour) is crucial, preventing oliguria, which can arise from kidney issues.
  • UTI Prevention: Regular voiding, post-coital urination, and completing full courses of antibiotics are key to preventing urinary tract infections.

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