Chapter 26 Flashcards
In order to maintain homeostasis, the kidneys do what?
fluid volume, electrolytes, acid-base balance
Kidneys secret:
renin, Erythropoetin, Calcitrol (active form of vitamin D)
kidney functions (4)
- Filtration
- Reabsorption
- Secretion
- Excretion
when kidneys fail:
- less waste is removed
- can’t regulate fluid, electrolyte, PH balance
- Nitrogenous waste builds up (BUN, creatinine)
Renal function is approximated by testing the blood levels of what?
- BUN levels (blood urea nitrogen)
2. Creatinine levels (metabolic waste from muscle breakdown)
Acute Kidney Failure is usually ___
secondary to another disease or cause.
heart failure, dehydration, etc
What is secondary to diabetes and ^BP?
chronic kidney disease
* destroys nephrons and cant filter GFR
The most common form of AKI is?
Prerenal injury
- caused by decreased blood flow and is usually reversible
- shock, dehydration, vasoconstriction
Which type of kidney injury is caused by obstruction of some form?
Postrenal Injury
- obstruction below kidney: ureter, bladder, urethra
- enlarged prostate, tumors, stones
Intrinsic or Intrarenal injury is a result of what?
Acute Tubular necrosis
*death of epithelial cells in kidney tubules
Ischemia, toxins, intratubular obstruction
What are the 3 phases of ATN (acute tubular necrosis)
- Initiating phase- damage has happened
- Maintenance phase- oliguria, ^waste products, edema
- Recovery phase - tissue remodeling
What happens in tubular obstruction during acute tubular necrosis?
- castes are made
- clumping together of dead epithelial cells obstructs tubules
There are ___ stages of kidney disease
5
Stage 1: still able to compensate
Stage 5: GFR <15mL/minute
Chronic Kidney Manifestation
- Uremia/Azotemia #1
- altered fluid/electrolyte/ acid-base balance
- cardiovascular problems
- GI disorders
In chronic kidney disease, the kidneys lose their ability to reabsorb ____
Sodium: Salt water wasting
In CKD you also can’t filter ___ out of blood
Potassium: Hyperkalemia
With CKD, you lose your ability to regulate your PH. What does this cause?
- Metabolic Acidosis-
* heart palpitations, muscle weakness, bone pain*
Patients with CKD are more likely to die from ___ than CKD itself
Heart failure
in a healthy kidney, calcitrol does what?
helps the kidneys maintain blood calcium levels and promotes the formation of bone.
When the kidneys do not function properly, extra ______ is released into the blood to move ___ from inside the bones into the blood.
parathyroid hormone
calcium
when the kidneys aren’t functioning correctly they do what 2 things to end up leaching calcium fro bones?
- stop activating calcitriol. The low levels of calcitriol in the body create an imbalance of calcium in the blood.
- do not remove the phosphorus in the blood properly, so phosphorus levels rise in the blood. The extra phosphorus pulls calcium out of the bones, causing them to weaken.
Decreased Vitamin D activation increases: ___ and impairs ____
Parathyroid hormone (PTH) and impairs Osteoblasts
low bone turnover in osteoblasts
Osteomalacia
^ bone turnover in osteoclasts
Osteodystrophy
chronic kidney disease primarily effects what 2 systems:
blood and bone
Hematologic complications from CKD
- Anemia- hemolysis, bone marrow suppresion, decreased erythropoeitin
- decreased platelets- bleeding
the build up of nitrogenous waste products (uremia) suppresses ___ and the creation of __-
bone marrow and the creation of megarkyocytes: platelets
CKD manifestations: (4)
- Suppressed immune response
- Sexual Dysfunction
- Neurological Alterations- Restless leg syndrome
- Skin disorders- flakey skin, Terry Nails
