Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nephrology > Applied Physiology of Renal Disease > Flashcards

Applied Physiology of Renal Disease Flashcards

1
Q

What are the 4 lab results that Nephrotic Syndrome is characterized by

A
  1. > 4g/24 hours proteinuria (normal is 0.3)
  2. Low serum albumin
  3. Hyperlipidemia (elevated cholesterol, LDL, triglyc)
  4. Urine microscopy - OVAL FAT BODIES (maltese crosses) = foamy urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some symptoms are Nephrotic Syndrome?

A

Edema
Hypercoagulability
Immunocompromised state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the dysfunctional part of the glomerulus that causes Nephrotic syndrome

A

something wrong with the foot processes of podocytes (can be seen as missing foot processes in microscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some causes of Nephrotic syndrome?

A
  1. membranous nephropathy
  2. Focal segmental glomerulosclerosis (FSGS)
  3. Amyloidosis
  4. MPGN, IgA, lupus (usually present as nephritic though)
  5. rare - diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why does Nephrotic syndrome cause edema?

A

lowered albumin in the blood = lowered oncotic pressure to draw fluid back into the capillaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why does Nephotic syndrome cause Hyperlipidemia?

A

The liver reacts to hypoalbuminemia and starts craning out a bunch of lipids = increased LDL, triglycerides, cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Hyperlipidemia associated with and what 2 things does it cause a signficant increase in risk in?

A

Nephrotic syndrome

increases risk in: atherogenesis + cardiac risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What rare dermatological symptom can be seen with nephrotic syndrome

A

Xanthelasmas (from hyperlipidemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are two nephrotic complications

A
  1. Hypercoagulability (DVT, PE) increased liver prod of coagulable factors
  2. Increased risk of infection (loss of IgG through urine, fragile skin, loss of ZINC + TRANSFERRIN)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are symptoms of Nephritic Syndrome?

A

headache, Hx of cough, rash, DARK BROWN URINE, HTN (from sodium retention)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some lab signs of Nephritic Syndrome?

A

Acute kidney failure GFR ~10
Urine: RBCs and small proteinuria
Red cell casts + dysmorphic RBCs (mickey mouse ears)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What part of the glomerulus is injured in Nephritic Syndrome

A

injury to GBM or endothelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are causes of nephritic syndromes

A

Most common: SLE, IgA nephropathy

ANCA related, MPGN, Anti-GBM disease, Post streptococcal GN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you differentiate between Nephrotic and Nephritis syndrome?

A

Nephrotic: insidious, edema, high proteinuria
Nephritic: Abrupt, HTN, increase Jugular venous pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are presenting Sx of End Stage Renal Disease

A 
Altered Mental Status
Emaciated/Lethargic
Rash
Volume Overload
Muscle Wasting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are lab signs of End Stage Renal Disease

A 
Renal failure
Acidosis
Anemia
low Vit D
high PTH
high Phosphate
UREMIC FROST!!!!! - rare in US (chronic kidney disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the two general functions of the kidney?

A
  1. Clearance (toxins, meds, electrolytes)

2. Hormonal (activation of 1,25 hydroxy Vit D, ERYTHROPOIETIN)

18
Q

What are 3 indications of ESRD

A
  1. Uremia
  2. Bone metabolism problems (hyperparathyroidism)
  3. Anemia
19
Q

What are Sx of Uremia

A 
Lethargy
Anorexia/weight loss (meats have metallic taste)
ASTERIXIS
pericarditis
itching
increased bleeding
***UREMIA IS NOT CAUSED BY UREA
20
Q

Why does dialysis not work very well with Uremia?

A

Uremic toxins produced by gut bacteria (p-cresyl, indole) are bound to albumin = not excreted very well

21
Q

What lab result indicated Uremia

A

BUN approached ~100mg/dL

22
Q

What can cause falsely low/high BUN?

A

falsely low - poor diet

falsely high - steroids, GI bleeding

23
Q

What are signs of Uremic pericarditis, and what is this a hard indication for?

A

pericardial pain, rub
unexplained cardiomegaly, hemodynamic instability
Tx: Aggressive Hemodialysis

24
Q

What 3 things are Uremic Pericarditis associated with

A
  1. Underdialysis
  2. Concurrent viral infections
  3. systemic disease (Lupus)
25
Q

What is the treatment for Uremic Pericarditis

A

Aggressive hemodialysis

pericardial drainage

26
Q

What are 4 bone metabolism findings in ESRD?

A
  1. Elevated phosphorus
  2. Elevated PTH
  3. Low Calcium
  4. Low Vit D
27
Q

What fx do 1,25(OH)2D3 have on the parathyroid gland and the GI tract? What happens in ESRD?

A

normally:
parathyroid gland - decreases activity
GI - increases absorption of calcium phosphate (increase bone mineralization)
ESRD - Vit is not activated by kidneys

28
Q

What is the most common disease of bone metabolism in ESDR patients and what are the Sx

A

Secondary hyperparathyroidism:

elevated PTH, phosphorus, and low calcium

29
Q

How do you distinguish Secondary hyperparathyroidism from primary and tertiary hyperparathyrodism?

A

secondary - low calcium

30
Q

What is the pathophysiology of Secondary parathyroidism

A

initial insult = low clearance of phosphate (low GFR)

Increased FGF23, reduced Vit D - factors that increase parathyroid activity

31
Q

What is the Tx for high parathyroid hormone? (prone to fractures)

A

Vit D, Calcimimetics, parathyroidectomy

32
Q

What is the Tx for high phosphorus

A

dietary control, PHOSPHATE BINDERS,

reduce parathyroid hormone (Vit, Calcimimetics)

33
Q

What are the side fx of Tx for high parathyroid hormone

A
  1. hypocalcemia (parathyroid gland thinks Ca levels are fine)
  2. parathyroidectomy - “hungry bone syndrome” - bone sucks up all Ca (hypocalcemia)
34
Q

What causes Tertiary Hyperparathyroidism and what are the Sx

A

seen in pt with chronic secondary hyperparathyroidism
lab: high phosphorus, high PTH, HYPERCALCEMIA
Sx: hyperplasia of thyroid gland

35
Q

What is the treatment for tertiary hyperparathyroidism

A

parathyroidectomy, calcimimetic

36
Q

How does ESRD cause Anemia?

A

Low erythropoietin (kidney exposed to HIF-2)
Chronic Inflammation
Iron deficiency - poor diet
increased bleeding

37
Q

What two things must be corrected before treating anemia with EPO in ESRD

A

chronic inflammation, iron deficiency

38
Q

What are Sx of Pre-renal Kidney Injury

A
  1. Low Urine sodium (increased RAAS)
    –Fractional excretion of Sodium <1%
  2. Hyaline Casts - clear, hard to see
    caused by precipitation of Tamm Horsefall Proteins
  3. Orthostatic hypotension
    Treatment - give more fluids
39
Q

What are symptoms of Acute Tubular Necrosis

A
  1. high urine sodium

2. Urine shows MUDDY BROWN CASTS (degraded tubular cells)

40
Q

What is the pathophysiology of Acute Tubular Necrosis

A

Acute kidney injury by: hypotension, sepsis, meds
two mechanism:
1. tubule obstruction by sloughing tubular cells
–tubular cells are sensitive to ischemia
2. very high sodium loss
Tx: supportive

Nephrology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions