NR507 / NR 507 Midterm Exam (Latest ):
Advanced Pathophysiology
Acute renal failure - ANS-Reversible
Determining prognosis- kidneys respond to diuretic with good output; this indicates that
kidneys are functioning well
Acute Pyelonephritis - ANS-Diagnosing by clinical symptoms alone can be difficult; can
be similar to cystitis
Diagnosis established by:
-Urine culture
-Urinalysis (WBC casts indicates pyelonephritis, but may not always be present)
-Signs/Symptoms
-Complicated pyelonephritis requires blood cultures and urinary tract imaging
Renal Calculi (Renal Stones) - ANS-Goals of Treatment:
Manage acute pain
Promote passage of stone
Reduce size of stone
Prevent new stone formation
Chronic Renal Failure - ANS-Chronic Kidney Disease (CKD) is a progressive loss of
renal function associated with systemic disease such as hypertension, diabetes mellitus
(most significant risk factor), systemic lupus erythematosus or intrinsic kidney disease
CKD stage is determined by estimates of GFR and albuminuria
Who is a candidate for dialysis? - ANS-End-stage renal disease (ESRD) is the final
stage of CKD with the number one cause being diabetes mellitus combined with
hypertension. At this point, the patient is completely dependent on dialysis to survive.
CKD is classified into five stages and is based on the patient's GFR rather than
symptoms.
Patients will need dialysis when the following symptoms are present:
--Metabolic acidosis.
--Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an
indication for dialysis. --Hyperkalemia by itself is not an indication for dialysis.
--Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and
include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol).
--Fluid volume overload that is not responsive to diuretics.
--Uremic symptoms due to nitrogenous wastes in the blood stream.
Stage I CKD - ANS-There is kidney damage with normal or elevated GFR
90-120
, Stage II CKD - ANS-There is kidney damage with mild decrease in GFR
60-89
Stage III CKD - ANS-There is a moderate decrease in GFR
30-59
Stage IV CKD - ANS-There is a severe decrease in GFR
15-29
Stage V CKD - ANS-Kidney failure- End-stage renal disease
<15 (dialysis) Once Stage IV is reached, progression to Stage V is inevitable as well as
dialysis or kidney transplant
Complications of Decreased GFR - ANS-Anemia
Hypertension
Decreased calcium absorption
Hyperlipidemia
Heart failure
Left ventricular hypertrophy
Fluid volume overload
Hyperkalemia
Hyperparathyroidism
Hyperphosphatemia
Metabolic acidosis
Malnutrition (late complication)
GERD - ANS-Warning signs include: Symptoms over age of 50:
-Dysphagia (difficulty swallowing)
-Odynophagia (pain on swallowing)
-Nausea and vomiting
-Weight loss
-Melena
-Early satiety (feeling full after eating very little food
Hiatal Hernia - ANS-Often asymptomatic
Generally, a wide variety of symptoms develop later in life and are associated with other
GI disorders, primarily GERD
--Sliding hiatal hernia: treatment usually conservative. Individuals can diminish reflux by
eating small, frequent meals and avoiding the recumbent position after eating.
Abdominal supports and tight clothing are avoided and weight control recommended for
obese individuals.
Advanced Pathophysiology
Acute renal failure - ANS-Reversible
Determining prognosis- kidneys respond to diuretic with good output; this indicates that
kidneys are functioning well
Acute Pyelonephritis - ANS-Diagnosing by clinical symptoms alone can be difficult; can
be similar to cystitis
Diagnosis established by:
-Urine culture
-Urinalysis (WBC casts indicates pyelonephritis, but may not always be present)
-Signs/Symptoms
-Complicated pyelonephritis requires blood cultures and urinary tract imaging
Renal Calculi (Renal Stones) - ANS-Goals of Treatment:
Manage acute pain
Promote passage of stone
Reduce size of stone
Prevent new stone formation
Chronic Renal Failure - ANS-Chronic Kidney Disease (CKD) is a progressive loss of
renal function associated with systemic disease such as hypertension, diabetes mellitus
(most significant risk factor), systemic lupus erythematosus or intrinsic kidney disease
CKD stage is determined by estimates of GFR and albuminuria
Who is a candidate for dialysis? - ANS-End-stage renal disease (ESRD) is the final
stage of CKD with the number one cause being diabetes mellitus combined with
hypertension. At this point, the patient is completely dependent on dialysis to survive.
CKD is classified into five stages and is based on the patient's GFR rather than
symptoms.
Patients will need dialysis when the following symptoms are present:
--Metabolic acidosis.
--Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an
indication for dialysis. --Hyperkalemia by itself is not an indication for dialysis.
--Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and
include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol).
--Fluid volume overload that is not responsive to diuretics.
--Uremic symptoms due to nitrogenous wastes in the blood stream.
Stage I CKD - ANS-There is kidney damage with normal or elevated GFR
90-120
, Stage II CKD - ANS-There is kidney damage with mild decrease in GFR
60-89
Stage III CKD - ANS-There is a moderate decrease in GFR
30-59
Stage IV CKD - ANS-There is a severe decrease in GFR
15-29
Stage V CKD - ANS-Kidney failure- End-stage renal disease
<15 (dialysis) Once Stage IV is reached, progression to Stage V is inevitable as well as
dialysis or kidney transplant
Complications of Decreased GFR - ANS-Anemia
Hypertension
Decreased calcium absorption
Hyperlipidemia
Heart failure
Left ventricular hypertrophy
Fluid volume overload
Hyperkalemia
Hyperparathyroidism
Hyperphosphatemia
Metabolic acidosis
Malnutrition (late complication)
GERD - ANS-Warning signs include: Symptoms over age of 50:
-Dysphagia (difficulty swallowing)
-Odynophagia (pain on swallowing)
-Nausea and vomiting
-Weight loss
-Melena
-Early satiety (feeling full after eating very little food
Hiatal Hernia - ANS-Often asymptomatic
Generally, a wide variety of symptoms develop later in life and are associated with other
GI disorders, primarily GERD
--Sliding hiatal hernia: treatment usually conservative. Individuals can diminish reflux by
eating small, frequent meals and avoiding the recumbent position after eating.
Abdominal supports and tight clothing are avoided and weight control recommended for
obese individuals.
