10.27: intro Flashcards
Major functions of the kidney?
- Filtration
- Excretion
- Electrolyte / acid base homeostasis
- BP regulation
When are GFR calculations reliable?
- Only when ptn. is in steady state
- Calculations do not work once patient has renal impairment
Equation for fractional excretion of Na / urea?
= (Urine Na / Plasma Na) / (Urine Creatinine / Plasma Ca)
***Helps to determine cause of acute kidney injury
Components of the kidney?
- Glomeruli
- Tubules
- Interstitium
- Vasculature
- Renal calyx
Components of collecting system?
- Ureters
- Bladder
- Urethra
GFR equation?
(Urine creatinine x volume) / Plasma creatinine
Cockrost Gault GFR forluma?
( (140 - age) x weight (kg) x .85 (females)) / 72 x serum Cr
What is normal urine output?
1500 ml per day
What is Oliguria?
- Too little urine output
What is anuria?
No urine output
What is polyuria?
- > 3000 ml per day
- Too much urine output
What is azotemia?
- An elevation in renal indices
- Normally an increase in BUN
What is BUN?
“Blood urea nitrogen”
- Urea nitrogen is formed when protein breaks down
What is uremia?
- Syndrome that can accompany severe renal failure
1. Fatigue
2. Anorexia
3. Altered mental status
4. Serositis: effusion
5. Platelet dysfunction
6. Itching
What is AKI? ARF?
ARF: “Acute renal failure” old term
AKI: “Acute kidney injury” new term
What are CRI? CRF? CKD?
CRI: “Chronic renal insufficiency”
CRF: “Chronic renal failure”
CKD: “Chronic kidney disease” NEW TERM
What is ESRD?
- “End stage renal disease”
Parameters for AKI?
Abrupt drop in kidney function in 48 hours defined as:
- Increase serum Cr
- Oliguria
Characteristics of CKD?
- Progressive decrease in GFR over time
- Usually lasting at least 3 months
- With or without albuminuria
What is normal GFR?
> 90
What are the 5 stages of renal disease?
- Kidney damage with normal GFR > 90
- Kidney damage with GFR 60 - 89
- GFR 30 - 59
- GFR 15 - 29
- Kidney failure: GFR
What is hematuria?
Blood in the urine
What is nephrolithiasis?
- AKA “Kidney Stones”
- Presents as moderate to severe renal colic
- Ca oxalate and Ca phosphate most common
Another name for kidney stones?
Nephrolithiasis
What are dysmorphic RBCs in urine characteristic of?
- Glomerular hematuria
What is pyuria?
WBCs or pus in the urine
When are epithelial casts usually seen?
Acute tubular necrosis
When are fatty casts seen?
Lipiduria seen in nephrotic syndrome
When are hyaline casts seen?
- Dehydration
- Exercise
- Diuretic therapy
When are waxy casts seen?
Advanced kidney disease
What is nephrotic syndrome? Characteristics?
- > 3 - 3.5g / day of protein in urine
1. Hypoalbuminemia
2. Peripheral edema
3. Hyperlipidemia: to raise oncotic pressure
4. Thrombophilia: tendency to clot, in renal vein
5. Bland urinary sediment
6. Non inflammatory renal biopsy
- > 3 - 3.5g / day of protein in urine
Characteristics of nephritic syndrome?
- Inflammatory renal biopsy
- Active urinary sediment
- Variable proteinuria
- Azotemia / oliguria
- Mild Htn.
What is normal total body water?
- 60% total body weight
- 2/3 intracellular, 1/3 extra
- 1/4 of extra is plasma volume
- 3/4 extra is interstitial space
What are IV crystalloid solutions?
- Used in volume depletion
- Disperse across ECW
What are IV colloid solutions?
- Given in volume depletion
- Tend to stay in plasma volume
- Packed RBCs or albumin solution
Where is EPO produced?
Kidneys
Function of Vitamin D?
- Regulates Ca absorption and maintains normal levels of Ca and phosphorus
Where is vitamin D activated?
- In the kidneys
- Produced in liver
Why is anemia seen in advanced kidney disease?
EPO is made in kidney
Why is there decrease in vitamin D in kidney disease?
- Vitamin D is activated in kidney
What are the non specific symptoms of renal disease?
- Fever
- Pain
- Rash
- Eosinophilia
What type of molecules can be
- Small, uncharged un protein bound molecules
