Week 15: Urinary system

Question 1

Urinary System: Review

• Removes metabolic ________
• Removes ____________ from the body
• Removes drugs other foreign material from body
• Regulates water, electrolyte, acid-base balance
• Secretes erythropoietin
• Activates vitamin D
• Regulate _______________ through the renin-angiotensin-aldosterone system

Answer 1

• Removes metabolic wastes
• Removes hormones from the body
• Removes drugs other foreign material from body
• Regulates water, electrolyte, acid-base balance
• Secretes erythropoietin
• Activates vitamin D
• Regulate blood pressure through the renin-angiotensin-aldosterone system

Question 2

Kidneys
↓
Ureters
↓
_____________
↓
Urethra

Answer 2

Kidneys
↓
Ureters
↓
Urinary bladder
↓
Urethra

Question 3

Nephrons—functional units of the kidneys

Each kidney has over ___________ nephrons.

Renal ____________
- Glomerulus
- Bowman capsule

Renal __________
- Proximal convoluted tubules
- Loop of Henle
- Distal convoluted tubules
- Collecting duct

Answer 3

Each kidney has over a million nephrons.

Renal corpuscles
- Glomerulus
- Bowman capsule

Renal tubules
- Proximal convoluted tubules
- Loop of Henle
- Distal convoluted tubules
- Collecting duct

Question 4

Filtration
-In renal ____________
-Large volume of fluid passes from glomerular ___________ into the tubule (Bowman capsule)

Answer 4

-In renal corpuscles
-Large volume of fluid passes from glomerular capillaries into the tubule (Bowman capsule)

Question 5

Reabsorption

Transport mechanisms for reabsorption
- ________ transport
- Co-transport
- Osmosis—water

Proximal convoluted tubules
-Most of water ______________
- Glucose reabsorption
- Nutrients and electrolytes to maintain homeostasis

Answer 5

Transport mechanisms for reabsorption
- Active transport
- Co-transport
- Osmosis—water

Proximal convoluted tubules
-Most of water reabsorption
- Glucose reabsorption
- Nutrients and electrolytes to maintain homeostasis

Question 6

Hormones Involved in reabsorption
- ___________ hormone (ADH)
- Aldosterone
- ________ natriuretic hormone

Answer 6

• Antidiuretic hormone (ADH)
• Aldosterone
• Atrial natriuretic hormone

Question 7

Blood Flow through the Kidney - Specialized pattern:

Renal ________ → interlobar artery → arcuate artery → interlobular artery → afferent arteriole
→ glomerular ______________ → efferent arteriole → peritubular capillaries → interlobular vein → arcuate vein → interlobar vein → renal _______

Answer 7

Renal artery → interlobar artery → arcuate artery → interlobular artery → afferent arteriole
→ glomerular capillaries → efferent arteriole → peritubular capillaries → interlobular vein →
arcuate vein → interlobar vein → renal vein

Question 8

Glomerular Filtration Rate - control of arteriolar constriction by three factors:

____________
- Local adjustment in diameter of arterioles
- Made in response to changes in blood flow in kidneys

_____________ nervous system
- Increases vasoconstriction in both arterioles

____________
- Secreted by juxtaglomerular cells when blood flow to afferent arteriole is reduced
- Renin-angiotensin mechanism

Answer 8

Autoregulation
- Local adjustment in diameter of arterioles
- Made in response to changes in blood flow in kidneys

Sympathetic nervous system
- Increases vasoconstriction in both arterioles

Renin
- Secreted by juxtaglomerular cells when blood flow to afferent arteriole is reduced
- Renin-angiotensin mechanism

Question 9

Retention
- Inability to ___________ bladder
- May be accompanied by overflow incontinence
- Spinal cord injury at sacral level blocks micturition reflex
- May follow anesthesia (general or spinal)

Answer 9

• Inability to empty bladder
• May be accompanied by overflow incontinence
• Spinal cord injury at sacral level blocks micturition reflex
• May follow anesthesia (general or spinal)

Question 10

Urinalysis: Urinary Infection
- Heavy purulence and presence of _______________________________ organisms

Answer 10

gram-negative and gram-positive

Question 11

Urinalysis: Abnormal Constituents of Urine
- _______ (hematuria)
- Elevated _________ level (proteinuria, albuminuria)
- _________ (bacteriuria)

Answer 11

• Blood (hematuria)
• Elevated protein level (proteinuria, albuminuria)
• Bacteria (bacteriuria)

Question 12

Urinary casts
- Indicate inflammation of ______________

Specific gravity
- Indicates ability of tubules to ____________ urine
- Low specific gravity—dilute urine (with normal hydration)
- High specific gravity—concentrated urine (with normal hydration)
- Related to renal failure

Glucose and ketones
- Found when _____________ mellitus is not well controlled

Answer 12

Urinary casts
- Indicate inflammation of kidney tubules

Specific gravity
- Indicates ability of tubules to concentrate urine
- Low specific gravity—dilute urine (with normal hydration)
- High specific gravity—concentrated urine (with normal hydration)
- Related to renal failure

Glucose and ketones
- Found when diabetes mellitus is not well controlled

Question 13

Elevated renin levels Indicate _______ as a cause of hypertension

Answer 13

kidney

Question 14

Diuretic Drugs
- Used to remove excess _________ ions and _______ from the body
- Increased excretion of water though the kidneys
- Reduces fluid volume in tissues and blood
- Prescribed for many disorders
-Renal disease, hypertension, edema, congestive heart failure, liver disease, pulmonary edema
- Several different mechanisms to increase urine _________ based on specific drug
- Some drugs are potassium-wasting and some are potassium-sparing.

Answer 14

• Used to remove excess sodium ions and water from the body
• Increased excretion of water though the kidneys
• Reduces fluid volume in tissues and blood
• Prescribed for many disorders
  -Renal disease, hypertension, edema, congestive heart failure, liver disease, pulmonary edema
• Several different mechanisms to increase urine volume based on specific drug
• Some drugs are potassium-wasting and some are potassium-sparing.

Question 15

Dialysis
-Provides ____________ and reabsorption

Two forms
- Hemodialysis
-Peritoneal dialysis

• Sustains life during __________ failure
  -Used to treat patients with acute kidney failure
• For patients in end-stage renal failure

Answer 15

Dialysis
-Provides filtration and reabsorption

Two forms
- Hemodialysis
-Peritoneal dialysis

• Sustains life during kidney failure
  -Used to treat patients with acute kidney failure
• For patients in end-stage renal failure

Question 16

Hemodialysis
- In hospital, dialysis center, or home with special equipment and training
- Patient’s blood moves from an implanted shunt or catheter in an artery to ____________
- Exchange of wastes, fluids, and electrolytes
- Semipermeable membrane between blood and dialysis fluid (dialysate)
-Blood cells and proteins remain in blood.
- After exchange is completed, blood returned to _________________

Answer 16

• In hospital, dialysis center, or home with special equipment and training
• Patient’s blood moves from an implanted shunt or catheter in an artery to machine
• Exchange of wastes, fluids, and electrolytes
• Semipermeable membrane between blood and dialysis fluid (dialysate)
  -Blood cells and proteins remain in blood.
• After exchange is completed, blood returned to patient’s vein

Question 17

Hemodialysis (Cont.)
- Usually required ______ times a week
- Each lasts about 3 to 4 hours.

Potential complications
- Shunt may become infected.
- Blood ______ may form.
- Blood vessels involved in shunt may become sclerosed or damaged.
-Patient has an increased risk of infection with hepatitis B, hepatitis C, or HIV if Standard Precautions are not followed.

Answer 17

• Usually required three times a week
• Each lasts about 3 to 4 hours.

Potential complications
- Shunt may become infected.
- Blood clots may form.
- Blood vessels involved in shunt may become sclerosed or damaged.
-Patient has an increased risk of infection with hepatitis B, hepatitis C, or HIV if Standard Precautions are not followed.

Question 18

Peritoneal Dialysis
- Usually done on outpatient basis
- Peritoneal membrane serves as the semipermeable membrane.
- Catheter with entry and exit points is implanted into the __________________
- Dialyzing fluid is instilled into cavity
- Dialysate is drained from cavity via gravity into container

Answer 18

• Usually done on outpatient basis
• Peritoneal membrane serves as the semipermeable membrane.
• Catheter with entry and exit points is implanted into the peritoneal cavity
• Dialyzing fluid is instilled into cavity
• Dialysate is drained from cavity via gravity into container

Question 19

Peritoneal Dialysis (Cont.)
- Takes more _____ than hemodialysis
- Requires loose clothing to accommodate bag of fluid
- Major complication - ___________ resulting in peritonitis - With both types of dialysis

Answer 19

• Takes more time than hemodialysis
• Requires loose clothing to accommodate bag of fluid
• Major complication - Infection resulting in peritonitis - With both types of dialysis

Question 20

Urinary Tract Infections (UTIs)
- Very common infections
- Urine is an excellent ________ medium.

Lower urinary tract infections
- Cystitis
- Urethritis

Upper urinary tract infections
- Pyelonephritis

Common causative organism
_____________

Answer 20

Urinary Tract Infections (UTIs)
- Very common infections
- Urine is an excellent growth medium.

Lower urinary tract infections
- Cystitis
- Urethritis

Upper urinary tract infections
- Pyelonephritis

Common causative organism
- Escherichia coli

Question 21

Urinary Tract Infections (UTIs) (Cont.)

More common in women because of:
- Shortness of _________
-Proximity to ______

Older men
- Prostatic hypertrophy
- Urine retention

Congenital abnormalities in children

Other common predisposing factors
- Incontinence
-Retention of urine
- Direct contamination with fecal material

Answer 21

More common in women because of:
- Shortness of urethra
-Proximity to anus

Older men
- Prostatic hypertrophy
- Urine retention

Congenital abnormalities in children

Other common predisposing factors
- Incontinence
-Retention of urine
- Direct contamination with fecal material

Question 22

Cystitis and Urethritis
-Bladder wall (cystitis) and urethra (urethritis) are _________.
- _____________ bladder and reduced capacity
-Pain is common in pelvic area
- Dysuria, urgency, frequency, and nocturia
-Systemic signs may be present.
- Fever, malaise, nausea, leukocytosis
- Urine often _________, with unusual odor
- Urinalysis indicates bacteriuria, pyuria, microscopic hematuria

Answer 22

More common in women because of:
- Shortness of urethra
-Proximity to anus

Older men
- Prostatic hypertrophy
- Urine retention

Congenital abnormalities in children

Other common predisposing factors
- Incontinence
-Retention of urine
- Direct contamination with fecal material

Question 23

Pyelonephritis
- One or both kidneys involved
- From ureter into kidney
- Purulent __________ fills pelvis and calyces
- Recurrent or chronic infection can lead to scar tissue formation.

Answer 23

• One or both kidneys involved
• From ureter into kidney
• Purulent exudate fills pelvis and calyces
• Recurrent or chronic infection can lead to scar tissue formation.

Question 24

Pyelonephritis (Cont.)
- Signs of cystitis plus pain associated with renal disease
- Dull, aching pain in lower _____ or flank area
- Systemic signs include high temperature

Urinalysis
- Similar to cystitis
- Urinary _____ are present.
- Reflection of renal tubule involvement
- Treatment with antibacterials

Answer 24

• Signs of cystitis plus pain associated with renal disease
• Dull, aching pain in lower back or flank area
• Systemic signs include high temperature

Urinalysis
- Similar to cystitis
- Urinary casts are present.
- Reflection of renal tubule involvement
- Treatment with antibacterials

Question 25

Inflammatory Disorders: Glomerulonephritis -Many forms Presence of antistreptococcal (ASO) _________ - Formation of an antigen-antibody complex - Activates complement system - Inflammatory response in glomeruli - Severe ______________ response - Congestion and cell proliferation

Answer 25

Presence of antistreptococcal (ASO) antibodies - Formation of an antigen-antibody complex - Activates complement system - Inflammatory response in glomeruli - Severe inflammatory response - Congestion and cell proliferation

Question 26

Inflammatory Disorders—Glomerulonephritis (Cont.) - Urine becomes _____ and cloudy - Facial and periorbital _______ —initially - General edema follows - Elevated blood pressure -Caused by increased ______ secretion and decreased GFR - Flank or back pain - Edema and stretching of renal capsule - General signs of inflammation - Decreased urine output

Answer 26

- Urine becomes dark and cloudy - Facial and periorbital edema—initially - General edema follows - Elevated blood pressure -Caused by increased renin secretion and decreased GFR - Flank or back pain - Edema and stretching of renal capsule - General signs of inflammation - Decreased urine output

Question 27

Inflammatory Disorders: Glomerulonephritis Treatment - Sodium restriction possible - Protein and fluid intake decreased in severe cases - Drug treatment - ____________ to reduce inflammation - Antihypertensives

Answer 27

- Sodium restriction possible - Protein and fluid intake decreased in severe cases - Drug treatment - Glucocorticoids to reduce inflammation - Antihypertensives

Question 28

Inflammatory Disorders: Nephrotic Syndrome - Abnormality in ______________________ , increased permeability, large amounts of plasma proteins escape into filtrate - May be idiopathic in children 2 to 6 years old - May be secondary to SLE, exposure to nephrotoxins or drugs

Answer 28

- Abnormality in glomerular capillaries, increased permeability, large amounts of plasma proteins escape into filtrate - May be idiopathic in children 2 to 6 years old - May be secondary to SLE, exposure to nephrotoxins or drugs

Question 29

Nephrotic Syndrome: Pathophysiology - Hypoalbuminemia with decreased plasma osmotic pressure - Subsequent generalized edema -Blood pressure remains low or normal. - May be elevated depending on angiotensin II levels -Increased ___________ secretion in response to reduced blood volume -More severe edema -High blood cholesterol, lipoprotein in urine, lipiduria with milky appearance to urine

Answer 29

- Hypoalbuminemia with decreased plasma osmotic pressure - Subsequent generalized edema -Blood pressure remains low or normal. - May be elevated depending on angiotensin II levels -Increased aldosterone secretion in response to reduced blood volume -More severe edema -High blood cholesterol, lipoprotein in urine, lipiduria with milky appearance to urine

Question 30

Inflammatory Disorders: Nephrotic Syndrome (Cont.) Treatment - ____________ to reduce inflammation - ACE inhibitors may decrease protein loss in urine - Antihypertensives - ________ intake may be restricted.

Answer 30

- Glucocorticoids to reduce inflammation - ACE inhibitors may decrease protein loss in urine - Antihypertensives -Sodium intake may be restricted.

Question 31

Urolithiasis (Calculi) - Can develop anywhere in _______ tract - Stones may be small or very large. - Tend to form with: - Manifestations only occur with obstruction of urine flow. -May lead to infection - Hydronephrosis with dilation of calyces - If located in kidney or ureter and atrophy of renal tissue

Answer 31

- Can develop anywhere in urinary tract - Stones may be small or very large. - Tend to form with: - Manifestations only occur with obstruction of urine flow. -May lead to infection - Hydronephrosis with dilation of calyces - If located in kidney or ureter and atrophy of renal tissue

Question 32

Urolithiasis (Calculi) (Cont.) - Calculi composed of _______ salts - High urine calcium levels -Form readily with highly alkaline urine - Uric acid stones - Hyperuricemia - Gout, high-purine diets, cancer chemotherapy - Especially with acidic urine - Struvite and cystine stones - Stone formation depends on predisposing factor

Answer 32

- Calculi composed of calcium salts - High urine calcium levels -Form readily with highly alkaline urine - Uric acid stones - Hyperuricemia - Gout, high-purine diets, cancer chemotherapy - Especially with acidic urine - Struvite and cystine stones - Stone formation depends on predisposing factor

Question 33

Urolithiasis (Calculi) (Cont.) - Stones in kidney or bladder often asymptomatic - Frequent infections may lead to investigation. - Flank pain possible caused by distention of renal capsule - Renal colic caused by ________ of the ureter - Intense spasms of pain in flank area - Possible nausea and vomiting, cool moist skin, rapid pulse - Radiological examination confirms _________ of calculi

Answer 33

- Stones in kidney or bladder often asymptomatic - Frequent infections may lead to investigation. - Flank pain possible caused by distention of renal capsule - Renal colic caused by obstruction of the ureter - Intense spasms of pain in flank area - Possible nausea and vomiting, cool moist skin, rapid pulse - Radiological examination confirms location of calculi

Question 34

Urolithiasis (Calculi) (Cont.) Treatment -Small stones will be ________ eventually. - Extracorporeal shock wave lithotripsy (ESWL) - Laser lithotripsy - Drugs may be used to ________ stones partially. - Surgery Prevention - Treatment of underlying condition - Adjustment of urine pH through _________ modifications - Consistent increased fluid intake

Answer 34

Treatment -Small stones will be passed eventually. - Extracorporeal shock wave lithotripsy (ESWL) - Laser lithotripsy - Drugs may be used to dissolve stones partially. - Surgery Prevention - Treatment of underlying condition - Adjustment of urine pH through dietary modifications - Consistent increased fluid intake

Question 35

Tumors: Renal Cell Carcinoma - Primary tumor arising from the tubule epithelium - More often in renal cortex - Tends to symptomatic in early stages - Often has metastasized to liver, lung, bone, or CNS at time of diagnosis - Occurs more frequently in men and smokers - Treatment is _______________ . - Immunotherapy may be used in some cases. - Tumor is radioresistant, and chemotherapy is not used in most cases

Answer 35

- Primary tumor arising from the tubule epithelium - More often in renal cortex - Tends to symptomatic in early stages - Often has metastasized to liver, lung, bone, or CNS at time of diagnosis - Occurs more frequently in men and smokers - Treatment is removal of kidney. - Immunotherapy may be used in some cases. - Tumor is radioresistant, and chemotherapy is not used in most cases

Question 36

Tumors: Renal Cell Carcinoma Manifestations - Painless _________ initially - Gross or microscopic - Dull, aching flank pain - Palpable mass - Unexplained weight loss - Anemia or erythrocytosis - Paraneoplastic syndromes - Hypercalcemia or Cushing’s syndrome

Answer 36

- Painless hematuria initially - Gross or microscopic - Dull, aching flank pain - Palpable mass - Unexplained weight loss - Anemia or erythrocytosis - Paraneoplastic syndromes - Hypercalcemia or Cushing’s syndrome

Question 37

Tumors: Bladder Cancer - Most bladder tumors are ___________ & commonly arise from transitional epithelium of bladder. - Often develops as multiple tumors - Diagnosed by urine cytology and biopsy Early signs - Hematuria, dysuria - Infection common Tumor is invasive through wall to adjacent structures. - Metastasizes to pelvic lymph nodes, liver, and bone

Answer 37

- Most bladder tumors are malignant & commonly arise from transitional epithelium of bladder. - Often develops as multiple tumors - Diagnosed by urine cytology and biopsy

Question 38

Tumors: Bladder Cancer (Cont.) Predisposing factors - Working with __________ in laboratories and industry - Particularly aniline dyes, rubber, aluminum - ________ smoking - Recurrent infections - Heavy intake of _________ Treatment - Surgical resection of tumor - Chemotherapy and radiation - Photoradiation successful in some early cases

Answer 38

Predisposing factors - Working with chemicals in laboratories and industry - Particularly aniline dyes, rubber, aluminum - Cigarette smoking - Recurrent infections - Heavy intake of analgesics Treatment - Surgical resection of tumor - Chemotherapy and radiation - Photoradiation successful in some early cases

Question 39

Vascular Disorders: Nephrosclerosis Involves ________ changes in the kidney - Some occur normally with aging. Thickening and __________ of the walls of arterioles and small arteries Narrowing of the blood vessel lumen - Reduction of ______ supply to kidney - Stimulation of renin - Increased blood pressure Continued ischemia - Destruction of renal ________ - Chronic renal failure

Answer 39

Involves vascular changes in the kidney - Some occur normally with aging. Thickening and hardening of the walls of arterioles and small arteries Narrowing of the blood vessel lumen - Reduction of blood supply to kidney - Stimulation of renin - Increased blood pressure Continued ischemia - Destruction of renal tissue - Chronic renal failure

Question 40

Nephrosclerosis (Cont.) - Can be primary _______ developed in kidney - May be secondary to essential hypertension Treatment - ___________ agents - Diuretics - Beta blockers - ________ intake should be reduced.

Answer 40

- Can be primary lesion developed in kidney - May be secondary to essential hypertension Treatment - Antihypertensive agents - Diuretics - Beta blockers - Sodium intake should be reduced.

Question 41

Congenital Disorders - Vesicoureteral reflux Agenesis -Failure of one kidney to ________ Hypoplasia - Failure to develop to normal _____ Ectopic kidney - Kidney and ureter displaced out of normal position “Horseshoe” kidney - _________ of the two kidneys

Answer 41

Congenital Disorders - Vesicoureteral reflux Agenesis -Failure of one kidney to develop Hypoplasia - Failure to develop to normal size Ectopic kidney - Kidney and ureter displaced out of normal position “Horseshoe” kidney - Fusion of the two kidneys

Question 42

Adult Polycystic Kidney - Autosomal dominant gene on chromosome 16 -No indications in child and young adults - First manifestations usually around age 40 years - Multiple cysts develop in both kidneys. - Enlargement of kidneys -Compression and destruction of kidney tissue - Chronic renal failure - Diagnosis by abdominal CT scanning or MRI

Answer 42

- Autosomal dominant gene on chromosome 16 -No indications in child and young adults - First manifestations usually around age 40 years - Multiple cysts develop in both kidneys. - Enlargement of kidneys -Compression and destruction of kidney tissue - Chronic renal failure - Diagnosis by abdominal CT scanning or MRI

Question 43

Wilms’ Tumor -Most common tumor in ________ - Defects in tumor suppressor genes on chromosome ____ - May occur in conjunction with other congenital disorders - Usually unilateral - Large encapsulated mass - Pulmonary metastases may be present at diagnosis.

Answer 43

-Most common tumor in children - Defects in tumor suppressor genes on chromosome 11 - May occur in conjunction with other congenital disorders - Usually unilateral - Large encapsulated mass - Pulmonary metastases may be present at diagnosis.

Question 44

Acute Renal Failure Causes - Acute bilateral kidney diseases - Severe, prolonged circulatory shock or heart failure - ___________ - Drugs, chemicals, or toxins -Mechanical __________ (occasionally) - Calculi, blood clots, tumors - Block urine flow beyond kidneys

Answer 44

- Acute bilateral kidney diseases - Severe, prolonged circulatory shock or heart failure -Nephrotoxins - Drugs, chemicals, or toxins -Mechanical obstruction (occasionally) - Calculi, blood clots, tumors - Block urine flow beyond kidneys

Question 45

Acute Renal Failure (Cont.) -Sudden onset Blood tests - Elevated serum urea nitrogen and creatinine levels - Metabolic acidosis and hyperkalemia Treatment - Identify and remove or treat primary problem to minimize risk of necrosis and permanent kidney damage - ________ to normalize body fluids and maintain homeostasis

Answer 45

Blood tests - Elevated serum urea nitrogen and creatinine levels - Metabolic acidosis and hyperkalemia Treatment - Identify and remove or treat primary problem to minimize risk of necrosis and permanent kidney damage - Dialysis to normalize body fluids and maintain homeostasis

Question 46

Chronic Renal Failure -Gradual ____________ destruction of the kidneys over a long period of time -Asymptomatic in early stages May result from - Chronic __________ disease -Congenital polycystic kidney disease - Systemic disorders - Low-level exposure to nephrotoxins over sustained period of time

Answer 46

-Gradual irreversible destruction of the kidneys over a long period of time -Asymptomatic in early stages May result from - Chronic kidney disease -Congenital polycystic kidney disease - Systemic disorders - Low-level exposure to nephrotoxins over sustained period of time

Question 47

Chronic Renal Failure: Stages Decreased renal reserve - Decrease in ______ - Higher than normal serum creatinine levels - No apparent clinical symptoms Renal insufficiency - Decreased GFR to about 20% of normal - Significant retention of nitrogen wastes - Excretion of large volumes of dilute urine - Decreased erythropoiesis - Elevated blood pressure End-stage renal failure - Negligible ______ - Fluid, electrolytes, and wastes ___________ in body -Azotemia, anemia, and acidosis (three As) - All body systems affected - Marked oliguria or anuria - Regular dialysis or kidney transplantation - To maintain patient’s life

Answer 47

Decreased renal reserve - Decrease in GFR - Higher than normal serum creatinine levels - No apparent clinical symptoms Renal insufficiency - Decreased GFR to about 20% of normal - Significant retention of nitrogen wastes - Excretion of large volumes of dilute urine - Decreased erythropoiesis - Elevated blood pressure End-stage renal failure - Negligible GFR - Fluid, electrolytes, and wastes retained in body -Azotemia, anemia, and acidosis (three As) - All body systems affected - Marked oliguria or anuria - Regular dialysis or kidney transplantation - To maintain patient’s life

Question 48

Chronic Renal Failure (Cont.) Early signs - Increased __________ output General signs - Bone marrow depression and impaired cell function - Caused by increased wastes and altered blood chemistry - Elevated blood pressure Complete failure - __________ - Dry, pruritic, hyperpigmented skin, easy bruising - Peripheral neuropathy - Impotence in men, menstrual irregularities in women - Encephalopathy - Congestive ________ failure, dysrhythmias -Failure to activate vitamin D - Possible uremic frost on the skin - Systemic infections

Answer 48

Early signs - Increased urinary output General signs - Bone marrow depression and impaired cell function - Caused by increased wastes and altered blood chemistry - Elevated blood pressure Complete failure - Oliguria - Dry, pruritic, hyperpigmented skin, easy bruising - Peripheral neuropathy - Impotence in men, menstrual irregularities in women - Encephalopathy - Congestive heart failure, dysrhythmias -Failure to activate vitamin D - Possible uremic frost on the skin - Systemic infections

Question 49

Chronic Renal Failure (Cont.) Diagnostic tests - Anemia, acidosis, and azotemia are the key indicators of chronic renal failure. Treatment—all body systems are affected. - Difficult to maintain _______________ of fluids, electrolytes, and acid-base balance - Drugs to stimulate erythropoiesis - Drugs to treat cardiovascular problems - Intake of fluid, electrolytes, protein must be ___________ - Dialysis or transplantation

Answer 49

Diagnostic tests - Anemia, acidosis, and azotemia are the key indicators of chronic renal failure. Treatment—all body systems are affected. - Difficult to maintain homeostasis of fluids, electrolytes, and acid-base balance - Drugs to stimulate erythropoiesis - Drugs to treat cardiovascular problems - Intake of fluid, electrolytes, protein must be restricted - Dialysis or transplantation