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Pathophysiology: Part 2 > 3) Chronic Kidney Disease > Flashcards

3) Chronic Kidney Disease Flashcards

1
Q

Where does the glomerulus receive blood from and where does it go afterwards?

A

The cluster of tiny capillaries receives blood from the afferent Arterioles and filters it through to the Bowman’s Capsule

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2
Q

What is the normal GFR range of an adult?

A

The glomerular filtration rate range for an adult is 100- 125mL/min

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3
Q

Name the three GFR formulas.

A

CrCl by Cockcroft Gault
eGFR by MDRD
eGFR by CKD EPI

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4
Q

What occurs with creatinine levels when renal filtration is impaired?

A

Because this muscle metabolism byproduct is filtrate do by the glomerulus, it will become elevated when impaired.

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5
Q

Define the nephron.

A

Basical functional unit of the kidney
Composed of: Bowmans capsule, glomerulus, proximal consulted tubule, loop of Henle, distal convoluted tubule, collecting duct

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6
Q

The movement of substances into the tubule to be eliminated

A

Secretion

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7
Q

The movement out of the tubule into the capillaries, so the substance can be maintained in the body.

A

Reabsorption

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8
Q

What is the primary role of the proximal convoluted tubule?

A

Receives blood from the Bowmans capsule. This is where reabsorption and secretion occur.

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9
Q

What is the role of the loop of Henle?

A

It receives fluid from the proximal tubule. It has the role of reabsorption of mainly water, Na, Cl, and Mg.
*loop diuretics block Na and water reabsorption

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10
Q

Following the loop of Henle is the distal convoluted tubule which participates in the following actions:

A

Na and water reabsorption
K, H and phosphorous secretion
*thiazide diuretics work here

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11
Q

The distal convoluted tubule is followed by the collecting duct, which does these final actions:

A

Na reabsorption
K secretion dependant on aldosterone hormone.
Excretion of acids, therefore an acid-base balancing
*ADH affects H2O permeability of collecting duct

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12
Q

Why is urea only a general indicator of renal function?

A

Because it is reabsorbed in the kidneys and is affected by other disease processes.
Urea will increase before serum creatinine in patients with acute kidney injury

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13
Q

In chronic kidney disease, what occurs with the electrolyte levels?

A

Decreased reabsorption in the tubules causes edema and swelling through water and Na levels
Hyperkalemia (increase in blood potassium) due to inability to increase excretion through distal tubules.
Hyperphosphatemia (increase in blood phosphorous) due to inability to decrease reabsorption in proximal tubule
Hypermagnesemia (increase in blood magnesium) inability to decrease reabsorption in loop of Henle

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14
Q

What is the pH range that the kidneys maintain in kidney arterial blood?

A

7.35- 7.45

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15
Q

The Renin-Angiotensin System controls what?

A

Blood pressure

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16
Q

What hormone stimulates red blood cell production?

A

Erythropoietin in bone marrow when kidneys sense low oxygen levels.

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17
Q

In chronic kidney disease, what occurs in EPO levels?

A

EPO production goes down and there is a decrease in RBCs and hemoglobin.

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18
Q

What are the four types of renal failure?

A

Pseudo
Pre-renal
Intrinsic
Post-renal

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19
Q

When the renal tubular secretion of creatinine is blocked the serum creatinine levels becomes elevated, what type of renal failure is this?

A

Pseudo renal failure

20
Q

What kind of kidney disease occurs with a decrease of blood flow to kidney, decreasing the GFR?

A

Pre-Renal Kidney Failure

21
Q

What are the three main medical causes Pre-renal kidney issues?

A

Intravascular volume depletion
Decline in effective blood volume
Decrease in pressure In glomerulus

22
Q

The three types of intrinsic acute kidney injury are:

A

Acute tubular necrosis
Acute interstitial nephritis
Glomerulonephritis

23
Q

Acute tubular necrosis is the most common cause of intrinsic failure and is characterized by what?

A

Ischemia in the kidney which produces cell damage to tubules

*Meds that induce: aminoglycosides, amphotericin B, intravenous contrast dye

24
Q

This type of intrinsic kidney injury is an inflammatory disorder of the renal interstitium with drugs being the most common of the causes.

A

Acute interstitial nephritis

25
Q

Inflammation of the glomerulus due to immune system stimulation is what intrinsic kidney injury?

A

Glomerulonephritis which can be caused by DNA, proteins, viruses and bacteria

26
Q

Post-Renal acute kidney injury has three main causes which obstruct the urinary flow:

A

Kidney stones
Bladder tumor
Urethral tumor
Crystal deposition in renal tubules

27
Q

What filters the blood in hemodialysis?

A

The semi-permeable dialyzer

28
Q

What filters the blood in peritoneal dialysis?

A

The peritoneal membrane

29
Q

Name the four factors that predict drug removal during dialysis.

A

Molecular weight
Protein Binding
Volume of distribution
Clearance (renal and nonrenal)

30
Q

Up to what size (MW) of drug can be removed by the hemodialyzer?

A

20,000 Daltons

31
Q

What are the two primary drug binding proteins?

A

Albumin and alpha1- glycoproteins

32
Q

The distribution of drug throughout the body is described as what?

A

Volume of distribution

33
Q

A small Volume of distribution indicates what compared to a large volume of distribution?

A

Small: primarily stays in the blood compartment
Large: all through fluids and tissues outside of blood

34
Q

Drugs with large Vd exhibit less dialyzability, why is this?

A

Because there’s a small percentage of the drug in the blood and therefore it is not accessible to the dialyzer.

35
Q

If a drug is easily metabolized, how does this affect clearance?

A

If metabolized very little will be very little renally excreted.

36
Q

What are the three access points for hemodialysis?

A

AV fistula
Dialysis graft
Dialysis catheter

37
Q

What is done with the AV fistula?

A

There is a direct connection between an artery and a vein, normally done on the lower arm.

38
Q

The catheter enters what part of the heart?

A

Super vena cava

39
Q

The three types of renal replacement therapy include:

A

Hemodialysis
Peritoneal dialysis
Kidney Transplant

40
Q

There are three types of hemodialysis. How often are each required to be done?

A

3x a week in a dialysis center
Nocturnal: done at home 6x a week
Daily: short (2 hour), 5-6x a week

41
Q

What does peritoneal dialysis consist of?

A

Continuous ambulatory consists of 4- 5 exchanges/day with patient hanging a bag and a long dwell in the evening
Automated allows for patient to hook up at night and do exchange while asleep

42
Q

What does diffusion allow for in dialysis?

A

Can control dialysis treatment bath to either remove or add electrolytes to blood (K, Ca, Mg, bicarbonate). Uses concentration gradient

43
Q

What controls the amount of fluid removed from a patient in dialysis to achieve their dry weight?

A

Ultrafiltration (using pressure gradient) to achieve the prescribed fluid loss

44
Q

What occurs when the sodium levels are increased in dialysis?

A

The rate of osmosis is increased, increasing the sodium level of the plasma.

45
Q

What are the two methods that are used to remove the excess fluid form the body?

A

Ultrafiltration and osmosis

Pathophysiology: Part 2 (7 decks)

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