Pharm Care: Nephrology

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ARF: acute renal failure
ATN: acute tubular necrosis
BUN: Blood, urea, nitrogen
CAPD: continuous ambulatory periteneal dialysis
CrCl: Creatin Clearance
CRF: Chronic renal failure
ESRD: end stage renal disease
GFR: glomerular filtration rate
HD: Hemodialysis
IVP: intravenous pyelography
What is pyelography?: Dye injected and observed
PD: peritenal dialysis
RF: Renal failure
SCr: Serum creatanin
UTI: Urinary Tract Infection
Anuria/Anuresis: Definition: Inability to form/excrete urine (<50ml/day)
How much urine is excreted in pt. with anuria?: <50 ml/day
How much urine is extreted in normal adults?: 1000-1500 mL/day
How much urine per day is excreted in pt. with oliguria?: 50-450 ml/day
Azotemia: Definition: excess of nitrogen in the blood, result of kidney insuficiency
Cystitis: Definition: Inflamation of the bladder
Dysuria: painful urination
Enuresis: Definition: Involuntary discharge of urine
Incontinence: Definition: Inability to control evacuative function (urine & bowel)
What is another word for urination?: Micturition
Nephrolithiasis: Definition: Kidney Stones
Medical term for "kidney stones"?: Nephrolithiasis
Nocturia: Definition: Urination at night, excessive (common in men with benign prostate infection and women in their 9th month of pregnancy)
Oliguria: Definition: reduced urination (50-450 ml/day)
Prostatis: Definition: Inflamation of the prostate gland
Proteinuria: protein in the urine
Pyelonephritis: Definition: Inflamation of the kidney
Uremia: Definition: buildup of waste products in blood; toxic condition
Urosepsis: Definition: buildup of waste products in the blood; urine that is not eliminated goes into body tissues
Voiding: Definition: Elimination of solid or liquid waste
Hpf: High power field (refers to microscope)
I&O: Intake and Output (found in graphic portion of chart)
U/A: urinalysis
UhCG: Urine human chorionic gonadotropin; excreted in certain conditions
Albuminuria: protein in the urine
Glucosuria: glucose in the urine
Hematuria: blood in the urine
Name the 7 types of urine collection.: Random
Clean catch (midstream)
Double/Second Voided
First morning
Fasting
Timed
Catheter Collection
Identify the normal physiochemical properties in an analysis of urine: Color - Volume - Appearance - Specific Gravity - Osmolality - Odor -: Color - straw is normal
Volume - depends on intake
Appearance - clear is normal
Specific Gravity - depends on intake (1.001-1.035)
Osmolality - 50-1400mOsm/kg
Odor -
What is the normal specific gravity of urine?: Depends on intake; 1.001-1.035
What is the normal osmolality for urine?: 50-1400mOsm/kg
In a chemical exam. what is the pH range of urine?: depends on intake; 4.5-8.5
In a chemical exam. what is the normal range of protein in urine?: 0-150mg/day
What chemicals should NOT appear in urine?: glucose, ketones, bilirubin, occult blood, nitrate
What is bilirubin?: A by product of the liver; will make the urine REALLY dark
What are the 4 things examined in an analysis of urine?: Physiochemical properties
Chemical Examination
Microscopic Examination
Bacterial Screen
If the amount of protein in the urine is reported as "negative" how many mg/dl of protien is the pt. excreting?: 0-5mg/dl
If the amount of protein in the urine is reported as "trace" how many mg/dl of protien is the pt. excreting?: 5-20mg/dl
If the amount of protein in the urine is reported as "+1" how many mg/dl of protien is the pt. excreting?: >20-100 mg/dl
If the amount of protein in the urine is reported as "+2" how many mg/dl of protien is the pt. excreting?: >100-300 mg/dl
If the amount of protein in the urine is reported as "+3" how many mg/dl of protien is the pt. excreting?: >300-1000 mg/dl
If the amount of protein in the urine is reported as "+4" how many mg/dl of protien is the pt. excreting?: >1000mg/dl
What are the two parts of a bacterial screen?: Gram Stain
Colony count
In a microscopic examination of the urine what is a normal finding for the following? Epithelial cells: 0-2/hpf
In a microscopic examination of the urine what is a normal finding for the following? Casts: hyaline (normal)
wbc, rbc, granular-waxy and braod casts
In a microscopic examination of the urine what is a normal finding for the following? Crystals: uric acid, oxalate

if numerous it is abnormal
In a microscopic examination of the urine what is a normal finding for the following? WBC: 0-5/hpf
In a microscopic examination of the urine what is a normal finding for the following? WBC exterase: none is normal; may suggest there is a UTI if present
In a microscopic examination of the urine what is a normal finding for the following? Bacteria: none is normal
In a microscopic examination of the urine what is a normal finding for the following? Yeast: none is normal (both males and females can have yeast infections)
In a microscopic examination of the urine what is a normal finding for the following? RBCs: 0-3/hpf is normal
In a microscopic examination of the urine what is a normal finding for the following? Other organisms (ex: trichomonas, parasites): none is normal
What are some types of urine tests?: Diabetes urine tests, pregnancy tests, ovulation test, toxicology screening, etc.
What does a diabetes urine test examine?: glucose and ketones
What hormone is detected in pregnancy tests?: UhCG
What hormone is tested in an ovulation test?: Leutinizing hormone test
What does a toxicology screening test examine?: illicit drug use, other drugs/substances
APAP: Acetometaphin
ASA: asprin
Main example of a barbiturate?: Phenobarbital
What are phenothiazines?: Anti-psychotics
What are the main catecholamines?: epinephrine and norepinephrine
What type of urine test is usually administered to pt. with multiple myeloma?: 24hour collection of urine (examined for protein)
What substance changes the color of urine to light (due to diuresis)?: alcohol
What drugs change the color of urine to blue/green?: amitriptyline and triamterene
What drug changes the color of urine red?: deferoxamine
What drug changes the color of urine black or dark?: iron salts
What drug changes the color of urine dark?: metronidazole (antibiotic)
What drug changes the color of urine orange?: Warfarin
What drugs change the color of urine orange/red?: Phenazopyridine and Rifampin
What class is the drug amitriptyline?: antidepressant, tricyclic antidepressant
Alcohol changes urine color to....?: light (due to diuresis)
Amitriptyline changes urine color to....?: blue/green
Deferoxamine changes urine color to....?: red
Iron salts change urine color to....?: black or dark
Metronidazole changes urine color to....?: dark
What class is the drug Metronidazole?: antibiotic
Warfarin changes urine color to....?: orange
Phenazopyridine changes urine color to....?: orange/red
Riboflavin changes urine color to....?: yellow (bright)
Rifampin changes urine color to....?: orange/red
Triamterene changes urine color to....?: blue/green
Triamterene is used to....?: incease blood pressure
Does the following drug increase or decrease pH? Acetazolamide: increase
Does the following drug increase or decrease pH? amphotericin B: increase
Does the following drug increase or decrease pH? sodium bicarbonate: increase
Does the following drug increase or decrease pH? potassium citrate: increase
Does the following drug increase or decrease pH? ammonium chloride: decrease
Does the following drug increase or decrease pH? ascorbic acid: decrease
List some diagnostic tests to evaluate the kidneys.: urinalysis, KUB, IVP, renal angiography, renal bniopsy, cystoscopy, renal ultrasound, serum chemistries
FeNa: Fractional excretion of sodium
What is the FeNa used for?: to differentiate between prerenal and parenchymal acute renal failure
What is parenchymal acute renal failure?: not a problem with the kidney itself but a problem somewhere else that affects the kidneys (ex: heart, profusion issues)
Equation for FeNa: FeNa = [(Urine Na)(Plasma Cr) / (Urine Cr) (Plasma Na)] * 100
Creatinine is a by-product of ________ __________.: muscle metabolism
T/F: Creatine is reabsorbed: False; creatine is produced and excreted at a constate rate, it is NOT absorbed
Measuring creatinine clearance gived an adequate estimate of ___________.: Glomerular Filtration Rate
What represents the results of protein metabolism and provides an index of glomerular filtration?: BUN
T/F: Urea does not undergo reabsorption: False, urea undergoes reabsorption and therefore is an inaccurate indicator of renal fxn
What percent of urea undergoes reabsorption?: 40-60%
Normal CrCl for males? (ml/min): 85-125ml/min
Normal CrCl for females? (ml/min): 75-115 ml/min
Uses of CrCl: 1. Determine efficience of the kidneys clearing creatinine from the blood
2. assess renal fnx especially GFR
3. monitor progression of renal failure
What equation is used to estimate CrCl?: Cockcroft-Gault equation
Equation for CrCl for males? for females?: CrCl = [(140-age)(wt in kg)] / [(72)(SCr)]

**multiply by 0.85 for females**
Multiply the Cockcroft-Gault equation by _____ for females.: 0.85
What are the three phases of ARF?: 1. oliguric phase
2.non-oliguric (diabetic)
3. recovery phase/convalescent phase
Is the following a diagnostic test for acute renal failure or chronic renal failure?: fluid and electrolyte status: acute
Is the following a diagnostic test for ARF or CRF?: fluid and electrolyte status: acute
Is the following a diagnostic test for ARF or CRF?: BUN/Scr ratio: acute
Is the following a diagnostic test for ARF or CRF?: urinalysis: acute
Is the following a diagnostic test for ARF or CRF?: KUB: acute
KUB: Kidneys, Ureters, Bladder
Is the following a diagnostic test for ARF or CRF?: Renal ultrasound: acute
Is the following a diagnostic test for ARF or CRF?: IVP: acute
Is the following a diagnostic test for ARF or CRF?: renal biopsy: both acute and chronic
What type of test is a KUB?: abdominal xray
Is the following a diagnostic test for ARF or CRF?: CrCl (measured or calculated): acute
Is the following a diagnostic test for ARF or CRF?: assessment of symptomatology: chronic
Is the following a diagnostic test for ARF or CRF?: physical findings: chronic
Is the following a diagnostic test for ARF or CRF?: Labs - BUN, SCr, CrCl, fluid, serum and urinary electrolytes, etc.: chronic
Is the following a diagnostic test for ARF or CRF?: Xrays (chest, bone, kidney size/renal scan): chronic
Is the following a diagnostic test for ARF or CRF?: neurologic tests (PE, nerve conduction, velocity tests, EEG): CHRONIC
What are the two main drawbacks to estimating CrCl?: -estimation
-must assume creatinine production and excretion are CONSTANT
Causes of ARF: 1. Prerenal azotemia
2. Renal (intrinsic) failure
3. Post renal azotemia
Etiologies: 1. Prerenal azotemia 2. Renal (intrinsic) failure 3. Post renal azotemia: ARF
Cause of Prerenal azotemia: result of combination of hypovolemia, hypotension and decreased renal perfusion
S/S of ARF: S/S:
-related to cause
-azotemia, increased SCr, other electrolyte disturbances
S/S: -related to cause -azotemia, increased SCr, other electrolyte disturbances: S/S of ARF
What are the main factors that allow for diagnosis of ARF?: -Sudden increase in BUN or SCr
-Often accompanied by oliguria
-Oliguria is self-limiting over a few days to 4-6 weeks
-Sudden increase in BUN or SCr -Often accompanied by oliguria -Oliguria is self-limiting over a few days to 4-6 weeks: ARF
Etiologies of CRF: Etiologies:
-Worsening ARF
-Glomerulonephritis/glomerulopathy
-Polycystic kidney disease (genetic)
-Interstitial nephritis
-Obstructive uropathy
-Congentital or inherited disorders
-DM
-Hypertension
-Gout nephropathy
-Nephrolithiasis
Etiologies: -Worsening ARF -Glomerulonephritis/glomerulopathy -Polycystic kidney disease (genetic) -Interstitial nephritis -Obstructive uropathy -Congentital or inherited disorders -DM -Hypertension -Gout neph: CRF
Define nephrolithiasis: untreated kidney stones
What are some key factors in diagnosis of CRF?: Diagnosis:
-Progressive azotemia over weeks and months
-May be a consequence of many primary glomerular and tubular diseases
-ypertension develops in the majority of patient
Diagnosis: -Progressive azotemia over weeks and months -May be a consequence of many primary glomerular and tubular diseases -ypertension develops in the majority of patient: CRF
Fluid and Electrolyte S/S of CRF: 1.Hyponatremia/Hypernatremia
2.Hyperkalemia
3.Hypocalcemia
4. Hyperphosphatemia
5. Fluid retention
6. Metabolic acidosis
1.Hyponatremia/Hypernatremia 2.Hyperkalemia 3.Hypocalcemia 4. Hyperphosphatemia 5. Fluid retention 6. Metabolic acidosis: Fluid and electrolyte S/S of CRF
Define uremia: A toxic condition resulting from kidney disease in which there is retention in the bloodstream of waste products normally excreted in the urine. Also called azotemia .
Definition: A toxic condition resulting from kidney disease in which there is retention in the bloodstream of waste products normally excreted in the urine.: uremia/azotemia
Another name for uremia?: azotemia
General S/S of CRF (uremic manifestation): fatigue, weakness, ill-appearance, muscle wasting
GI S/S of CRF (uremic manifestation): anorexia, n/v, dysguesia, GI bleeding, ulcers
Skin S/S of CRF (uremic manifestation): pallor or hyperpigmentation, itching, bruising, uremica frost
HEENT S/S of CRF (uremic manifestation): uriniferous breath, retinopathy
Neuro/psych S/S of CRF (uremic manifestation): numbness, twitching, irritability, insomnia, muscle cramps, drowsiness, asterixis, myoclonus, coma, depression, anxiety, psychosis
GU S/S of CRF (uremic manifestation): loss of libido, nocturia
CV S/S of CRF (uremic manifestation): dyspnea, edema, pericardial pain or inflamation
HEME S/S of CRF (uremic manifestation): anemia, hemostatic abnormalities, immune suppression
ENDOCRINE S/S of CRF (uremic manifestation): metabolic bone disease de to decreased vit D an calcium absorption, altered thyroid fnx, gonadal dysfunction

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