Anatomy, Clinical Manifestations of Renal Disease, Laboratory Tests Flashcards
What is a part of the juxtaglomerular apparatus?
- Macula densa region of the thick ascending limb
- Extraglomerular mesangial cells
- Renin/angiotensin II-producing granular cells of the afferent arterioles
What is a part of the filtration barrier?
- Capillary endothelium
- Basement membrane
- Foot processes of podocytes
What affects the filtration barrier?
- Size and charge
What is the endothelium permeable to?
- Water
- Small solutes
- Smal proteins
What is not permeable to the endothelium?
- Large proteins
- RBCs
- WBCs
- Platelets
What do the endothelial cells do?
- Negatively express glycoproteins which minimize filtration of negatively charged proteins like albumin
- Synthesize vasoactive substances that are important in controlling renal plasma flow
Where are glomeruli seen?
- Renal cortex (seen on biopsy)
What kind of waste products does the kidney get rid of?
- Body’s concentration of water
- Salt
- Calcium
- Phosphorus
- Other anions and cations
How does the kidney act as an endocrine organ?
- Secreting hormones like erythropoietin, renin, and prostaglandins, and regulating vitamin D metabolism
What are some warning signs of kidney disease?
- Creatinine and BUN blood test outside the normal range
- Glomerular filtration rate less than 60
- Blood and/or protein in the urine
- High blood pressure
- More frequent urination, particularly at night; difficult or painful urinartion
- Puffiness around eyes, swelling of hands and feet
How are the fluids and electrolytes affected in acute or chronic kidney dysfunction?
- Dehydration
- Edema
- Hyperkalemia
- Metabolic acidosis
How is the calcium phosphate and bone affected in acute or chronic kidney dysfunction?
- Hyperphosphatemia
- Hypocalcemia
- Secondary hyperparathyroidism
- Renal osteodystrophy
What hematological signs are seen in acute/chronic kidney dysfunction?
- Anemia
- Bleeding diathesis
What cardiopulmonary signs are seen in acute/chronic kidney dysfunction?
- HTN
- CHF
- Cardiomyopathy
- Pulmonary edema
- Uremic pericarditis
What GI signs are seen in acute/chronic kidney dysfunction?
- N/V
- Bleeding
- Esophagitis/gastritis/colitis
What neuromuscular signs are seen in acute/chronic kidney dysfunction?
- Myopathy
- Peripheral neuropathy
- Encephalopathy
What dermatologic signs are seen in acute/chronic kidney dysfunction?
- Sallow color
- Pruritus
- Dermatitis
What is azotemia?
- Biochemical abnormality that refers to an elevation of BUN and creatinine levels
- Related largely to a decreased GFR
What causes uremia?
- When azotemia leads to clinical signs and symptoms associated with biochemical abnormalities
What are the signs of uremia?
- Cognitive dysfunction
- Fatigue
- SOB
- Loss of appetite
- Muscle cramps
- N/V
- Itching
- Unexplained weight loss
- Metallic taste
What is the characteristic sign of uremia?
- Uremic frost –> striking white cutaneous finding
What is the ideal ratio of BUN to creatinine?
- Between 10/1 and 20/1
What are the renal causes of azotemia?
- Glomerulonephritis
- Pyelonephritis
- Diabetes mellitus
- Nephrotoxic drugs
- Renal failure
- Anabolic steroid use
What are the postrenal causes of azotemia?
- Urinary tract obstruction
1. Stones/neoplasm
2. Bladder/urethral abnormality
3. Bladder outlet obstruction
What is GFR?
- Test used to check how well the kidneys are working
- Estimates how much blood passes through the glomeruli each minute
What is GFR estimated from?
- From serum creatinine level and some or all of the following:
1. Gender
2. Age
3. Weight
4. Race
What is a normal GFR?
- 90mL/min
What is nephritis sydrome?
- Acute onset of either grossly visible hematuria (red blood cells in urine) OR
- Microscopic hematuria with dysmorphic red cells and red cell casts on UA, diminished GFR, mild to moderate proteinuria, and HTN
What is nephrotic syndrome?
- Heavy proteinuria (more than 3.5g/day)
- Hypoalbuminemia
- Severe edema
- Hyperlipidemia
- Lipiduria
What is acute kidney injury characterized by?
- Rapid decline in GFR with concurrent dysfunction of fluid and electrolyte balance
- Retention of metabolic waste products normally excreted by the kidney
- Manifested by oliguria or anuria
What is chronic kidney disease defined as?
- Presence of a diminished GFR that is persistently less than 60 mL/min for at least 3 months, from any cause, and/or persistent albuminuria
