2 - Renal (Barker) Flashcards
What kind of capillaries make up the glomerulus?
fenestrated
Besides endothelial cells and podocytes, and the parietal epithelium what other types of cells are in the glomerulus and what is their fxn?
mesangial cells: structure, growth, health of the glomerulus
What are the clinical manifestations of renal disease?
acute kidney injury CKD HD and peritoneal dialysis drug-induced kidney disease nephritis sodium and water homeostasis ion homeostasis acid-base disorder tumors
How does renal disease present?
azotemia uremia proteinuria hematuria altered naturesis (leading to HTN) edema circulatory congestion
What is azotemia?
biochemical abnormality in which an elevation of BUN and sCR levels, which is largely related to decr GFR
What is uremia?
excess of urea and other nitrogenous waste in the blood.
chara’d not only by failure of renal excretory fxn but also by a host of metabolic and endocrine alterations incident to renal damge
secondary GI, mneuomuscular, and CV involvement
Describe acute kidney disease/injury/failure.
abupt decr in GFR or CrCl
RIFLE: risk, injury, failure, lodd of kidney fxn, and end-stage kidney disease classifications
based on the anatomical area of jinury or malfunction: prerenal, intrinsic, postrenal
Describe CKD.
chronic renal insufficiency or progressive kidney disease.
Progressive loss of function occuring over several months to years and is characterized by the gradual replacement of normal kidney architecture with parenchymal fibrosis.
Describe peritoneal dialysis.
involves intallation of dialysate into the peritoneal cavity via a permanent peritoneal catheter.
the peritoneal membrane liens the highly vascularized abdominal viscera and acts as the semipermeable membrane across which diffusion and ultrafiltration occur.
Substances are removed from the blood across the peritoneum via diffusion and ultrafiltration.
Excess plasma water is removed via ultrafiltrated created by osmotic pressure generated by various dextrose or icodextrin concentrations.
Describe hemodialysis.
involves the perfusion of blood and dialysate on oposite sides of semipermeable membrane. substances are removed from the blodo by diffusion and convection. excess plasma water is removed via ultrafiltration.
Describe drug-induced kidney disease.
Drugs trigger acute damage to renal structures resulting in altered function.
Ex. NSAIDs, thiazide diuretics, ASA+APAP.
Describe glomerulonephritis (GN).
one of most common causes of CRF.
primary or secondary (SLE, HTN, DM, etc.)
What is the pathogenesis of glomerular disease?
immune rxn!
- antibody-associated injury
- cell-mediated
- other mechanisms
What are the types of antibody-mediated glomerular injury?
- immune complex deposition
- anti-glomerular basement membrane antibodies
- antibody against glomerular antigen (membranous nephropathy)
What is the postulated sequence of epithelial cell injury?
antibodies to epithelial cell antigens, toxins cytokines, or other factors cause injury and detachment of epithelial cells and protein leakage through defective GBM and filtration slits.
What are the three major glomerular syndromes?
- Nephrotic
- Nephritic
- Chronic Glomerulonephritis
What is the Nephrotic Syndrome?
protein leakage only
the glomeruli are leaky
What is the Nephritic Syndrome?
protein and RBC leakage.
What is Nephrosis?
- Nephropathy (any disease of the kidney)
2. Degeneration of renal tubular epithelial
What is Nephritis?
inflammation of the kidney
(What are some types of nephrotic syndrome?)
- Minimal Change Disease (T Cell)
- Membranous Nephropathy (Ab)
- Focal Segmental Gomerulosclerosis (injur of visceral epithelial cells)
- Membraneoproliferaitive Glomerulonephritis (Ab)
What are Sx of Nephrotic Syndrome?
proteinuria
hypoalbuminemia
edema
hyperlipidemia and lipiduria
What are Sx of Nephritic Syndrome?
hematuria
oliguria
azotemia
hypertension
(What are some types of Nephritic Syndrome?)
- acute proliferative glomerulonephritis (Ab)
- Rapid Progressive Glomerulonephritis (?)
- IgA Nephropathy (Berger Disease) (IgA)
What are the pathways of infection leading to acute pyelonephritis?
-Hemotogenous infection results from bcteremic spread.
More common is ascending infx. which results from a combination of urinary bladder infx, vesicoureteral reflux, and intrarenal reflux.
What are cysts?
abnormal membranous sac that forms in the structure. could be filled with gas, liquid, semisolid.
What is the most common form of cystic renal diseas?
simple cysts
What is the definition of autosomal dominant (adult) polycystic kidney disease (APKD)?
multiple expanding cysts of both kidneys that ultimately destroy the intervening parenchyma
What is the pathogenesis of autosomal adult PDK?
inherited mutation of PKD1 or PKD2 gene in tubular cells
- abnormal cyst formation in both kidneys
- destroy interening parenchyma
- intermittent gross hematuria
- HTN and urinary infection–>fatal–>renal transplantation is necessary
What is the pathogenesis of autosomal recessive (childhood) polycystic kidney disease?
autosomal recessive inhertiance
mutation in PKHD1–fibrocysin (polyductin)
What are the clinical features of childhood PKD?
usual presents at birth
- young infants die quickly from pulmonary or renal failure
- survivors develop cirrhosis (congenital hepatic fibrosis)
What is diuresis?
increase in urine volume
What is natriuresis
increase in renal sodium excretion
What are the clinical uses of diuretics?
HTN, edema, CHF, kidney disease, hepatic cirrhosis, hypercalcemia, diabetes insipidus
What is the site of action of osmotic agents (mannitol)?
decrease water reabs in the PCT, loop, CD
What is the site of action of loop agents (furosemide)?
ascending loop of Henl, decrease ions reabs
What is the site of action of thiazides?
decrease NaCl reabsorption in the DCT
What is the site of action of aldosterone antagonists?
decrease NaCl reabs in the collecting duct
What is the site of action of ADH antagonists?
decrease water absorption in the collecting duct
What is the site of action of adenosine (diuretic)?
glomerulerus
PCT
Collecting duct
thick ascending limb
What are some examples of loop diuretics?
furosemide
bumetanide
ethacrynic acid
What occurs in the thick ascnending limb of the nephron?
NaCl reabs!
also Ca, Mg, K reabs
What are some examples of thiazides?
HCTZ
chlorthalidone
What controls Ca2+ reabs in the PCT?
parathyroid hormone
Describe the macula densa?
At intersection between glomerulus and DCT.
regulate blood pressure by sensing NaCl reabs.
the juxtaglomerular cells receive signal from the macula densa and release renin –> RAAS
Where do potassium-sparing diuretics work?
CD
block sodium reabs, so no need to excrete K
What are examples of K-sparing diuretics?
spironolactone
triamterene
amiloride
How does potassium move in the collecting duct?
moves into the urine in exchange for Na reabs.
Describe convective solute flow
solutes move with water along their concentration gradient
How do ions/solutes movee across membrane?
convective solute flow
simple diffusion
mediated:
channel-mediated diffusion
carri-ermedicated difusion
active: ATP-medaited
secondary acive:
symport
antiport
Drug targets for diuretics ae what kind of transporters?
active!
ATP, –>symport, –>antiport
