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Adv Pathophysiology > Chapter 33: Disorders of Renal Function > Flashcards

Chapter 33: Disorders of Renal Function Flashcards

1
Q

Hilus

A

medial border of the kidney where the renal artery enter and renal vein and ureters exit

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2
Q

Nephron

A

functional unit of kidney that cannot be regenerated

Two types: cortical (85%) and juxtamedullary (15%)

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3
Q

Juxtamedullary Nephrons

A

largely concerned with urine concentration

area where renin is released

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4
Q

Glomerulus

A

high-pressure capillary filtration system

encased in thin, double-walled capsule called Bowman’s Capsule

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5
Q

Afferent arterioles

A

carry blood containing nitrogenous wastes to glomerulus

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6
Q

Efferent arterioles

A

carry filtered pure blood from glomerulus back to the circulatory system

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7
Q

The PSNS causes bladder ____

A

emptying

contracts the detrusor muscle and relaxes the internal sphincter

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8
Q

The SNS promotes bladder _____

A

filling

relaxes the detrusor muscle and contracts the internal sphincter

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9
Q

The parasympathetic lower motor neruons for the detrusor muscle and external sphincter are located ______

A

in the sacral segments S2 - S4

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10
Q

Pelvic Nerve

A

part of the PSNS

acetylcholine bins to M3 receptor = contraction of detrusor muscle (sensation of needing to urinate)

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11
Q

Pudendal Nerve

A

somatic

acetylcholine binds to nicotinic receptors = causes external sphincters to contract (hold urine)

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12
Q

Hypogastric Nerve

A

SNS
norepinephrine binds to alpha and beta receptors
alpha 1 = contraction of the internal sphincter (not under our control)
beta 3 = relaxation of the detrusor muscle

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13
Q

Detrusor-Sphincter Dyssynergia

A

interruption of pontine control that results in inhibited spinal reflex-controlled contraction of bladder without relaxing the external sphincter

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14
Q

Glomerular Filtration Rate (GFR)

A

how much filtrate is formed every minute
measure of overall function of the kidney
serum creatinine levels reflect the GFR

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15
Q

Renal Threshold

A

plasma level at which a substance appears in the urine

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16
Q

Proximal Tubule

A

responsible for apprx 65% of all reabsorption and secretory processes
almost complete reabsorption of nutritionally important substances

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17
Q

Loop of Henle

A

absorbs more Na+ and Cl- than water
25% of filtered Na, Cl, and K is reabsorbed and allows for excretion of free water
loop diuretics work here

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18
Q

Distal and Collecting Tubules

A

relatively impermeable to water
determines final Na concentration of urine
have intercalated cells and principle cells

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19
Q

Intercalated Cells

A

reabsorbs K+ ions

secretes H+ ions and reabsorbs bicarb

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20
Q

Principle Cells

A

where aldosterone exerts its action

reabsorbs Na and facilitates movement of K+ into the urine

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21
Q

Antidiuretic Hormone (ADH)

A

assists in maintenance of the ECF volume by controlled the permeability of the medullary collecting tubules
released for posterior pituitary in response to increased osmolality

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22
Q

Aquaporin-2 channels

A

move into the cell membrane when ADH binds to vasopressin

results in increased water permeability

23
Q

Renal Function is innervated by ____

A

sympathetic nervous system (SNS)

increased SNS activity will cause vasoconstriction = decrease in renal blood flow

24
Q

______ causes vasoconstriction

A

Angiotensin II
ADH
Endothelin-1

25
Q

_____ causes vasodilation

A

dopamine
nitric oxide
prostaglandins

26
Q

Juxtaglomerular Complex

A

feedback control system that determines how much renin should be released to keep the BP within normal range (to maintain a constant GFR)

27
Q

Aldosterone

A

reabsorbs Na (water follows) and excretes K+

28
Q

Atrial Natriuretic Peptide (ANP)

A

secreted by atrial muscle cells
inhibits kidneys from reabsorbing Na and inhibits the renal secretion of renin (disrupts the RAAS)
works with BNP to decrease preload

29
Q

______ can compete with uric acid excretion

A

Salicylates

high uric acid seen in gout or renal calculi

30
Q

BUN

A

measures the kidney excretion of urea (end product of protein metabolism)
BUN = 10 - 20

31
Q

BUN is elevated in ______

A

kidney failure, high-protein diets, excessive muscle breakdown, and reduced GFR (dehydration)

32
Q

Serum Creatinine

A

measures skeletal muscle metabolism

poor test for elderly who have less muscle mass

33
Q

Drugs need to be _____, ______, and ______ to be excreted.

A

unbound, ionized, and water-soluble

34
Q

Erythropoietin

A

kidney is the main site that releases erythropoietin to produce more RBCs in response to tissue hypoxia

35
Q

Active form of _____ increases intestinal calcium absorption.

A 
vitamin D 
(active 1,25 dihydroxycholecalciferol = calcitriol)
36
Q

Parathyroid Hormone (PTH)

A

increases calcium in the blood and excretes phosphate

kidney is the site of PTH action

37
Q

RAAS

A

Renin – Angiotensin 1 – [ACE] = Angiotensin II and stimulates aldosterone = increase blood pressure

38
Q

Hydronephrosis

A

urine-filled dilation of the renal pelvis and calices d/t obstruction of outflow of urine

39
Q

Calcium Renal Calculus

A

caused by calcium supplements, calcium-containing antacids, foods high in oxalate, immobilization, hyperparathyroidism

40
Q

Magnesium-ammonium Phosphate Renal Calculi

A

staghorn stones
certain bacteria use urease to convert uric acid to ammonia (making urine more alkaline)
alkaline environment = crystalline Mg
tx the UTI and make urine more acidic

41
Q

Uric Acid Stones

A

seen with high purine diet, dehydration, and obesity
forms an acidic environment
tx w/ Probenecid, hydration, and make urine more alkaline

42
Q

Renal Colic

A

pain that accompanies stretching of duct or ureter

acute, intermittent (with peristaltic movement) and severe flank pain

43
Q

Noncolicky Pain

A

caused by stones that distend renal calyx or pelvis

dull, deep ache in flank or back exaggerated by movement and drinking large amounts of water

44
Q

Glomerulonephritis

A

inflammation of the capillary loops of the glomeruli

can be acute, rapidly progressive, or IgA neuropathy

45
Q

Acute Post-Infectious Glomerulonephritis

A

antigen-anitbody complexes are formed and trapped in the glomerulus following a strep infection causing dec in GFR and increased porosity

46
Q

Signs/Symptoms of Acute Glomerulonephritis

A 
hematuria
proteinuria
salt and water retention
azotemia
headache
47
Q

Rapidly Progressing Glomerulonephritis

A

build antibodies against the glomerular basement membrane and obstruct Bowman’s space
usually associated with autoimmune disorders like lupus (SLE) or Goodpasture’s

48
Q

S/Sx of Rapidly Progressing Glomerulonephritis

A

flu-like symptoms
oliguria
abdominal or flank pain

49
Q

IgA Neuropathy Glomerulonephritis

A

Buerger disease
deposits of IgA immune complexes deposit in the in glomerulus causing inflammation
common cause in Asians 20 - 30
gross hematuria is major sign

50
Q

Nephrotic Syndrome

A

protein wasting thta occurs with glomerular damage rsulting in large amounts of protein loss difficult to replace with diet

51
Q

S/Sx of Nephrotic Syndrome

A

edema (due to loss of colloidal oncotic pressure)
decreased BP
lipiduria, hyperlipidemia, hypoalbuminemia, loss of globulins (antibodies)

52
Q

Hypoalbuminemia puts patients at risk for _____

A

drug toxicity

drugs bind to albumin

53
Q

Pyelonephritis

A

inflammation of the kideny pelvis and parenchyma from a bacterial infection (most commonly E. coli)

54
Q

S/Sx of Pyelonephritis

A

absurpt onset of fever/chills
CVA tenderness
can have lower UTI symptoms
untreated can lead to sepsis and renal failure

Adv Pathophysiology (22 decks)

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