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Applied Pathophysiology > Chronic Kidney Disease 1 > Flashcards

Chronic Kidney Disease 1 Flashcards

1
Q

What is a nephron?

A

basic functional unit of the kidney

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2
Q

What is the glomerulus?

A

cluster of tiny capillaries that receives blood from the afferent arteriole

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3
Q

What filters the blood after the glomerulus?

A

Bowman’s capsule

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4
Q

what is glomerular filtration rate? what is its importance?

A

volume of blood filtered by the glomerulus each minute

used for staging CKD and drug dosing

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5
Q

what is a normal GFR range?

A

100-125ml/min

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6
Q

what is the afferent arteriole?

A

arteriole though which blood enters the glomerulus

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7
Q

how can various medications affect the afferent arteriole?

A

can cause acute kidney injury by inhibiting vasodilation of afferent arteriole

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8
Q

what is the efferent arteriole?

A

arteriole through which blood leaves the glomerulus

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9
Q

how can various medications affect the efferent arteriole?

A

can cause AKI by inhibiting vasoconstriction of efferent arteriole

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10
Q

what is the proximal convoluted tubule?

A

receives fluid from Bowman’s capsule and reabsorbs ~80% of glomerular ultrafiltrate back into bloodstream

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11
Q

what is reabsorption?

A

movement out of the tubule into the capillary where it may be retained in the body (urine to blood)

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12
Q

what is usually reabsorbed by the kidneys?

A

nutrients (Glc, AAs)

electrolytes (Na, Ca, HCO3, PO4, K, Cl)

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13
Q

what is fanconi syndrome?

A

disorder of proximal tubule reabsorption, leading to rickets, metabolic acidosis, hypokalemia, and hypophosphatemia

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14
Q

what is secretion?

A

movement into the tubule, so that the substance may be eliminated (blood to urine)

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15
Q

what is usually secreted by the kidneys?

A

creatinine
uric acid
certain drugs

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16
Q

What is the loop of Henle?

A

receives fluid from the proximal tubule

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17
Q

what is the function of the loop of Henle?

A

reabsorption of water (descending), Na, Cl, and Mg (ascending)

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18
Q

what is the distal convoluted tubule?

A

receives fluid from the loop of henle

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19
Q

what is the function of the the distal tubule?

A

reabsorption of Na and water

secretion of K, H, and phosphorus

20
Q

what is the collecting duct?

A

receives fluid from distal tubule

21
Q

what is the function of the collecting duct?

A

reabsorption of Na
secretion of K
acid base balance (excretion of acids)

22
Q

what hormone affects H2O permeability in the collecting duct? What happens to the urine when you increase/decrease levels of this hormone?

A

Anti-diuretic hormone (ADH) aka vasopressin

incr. ADH = concentrated urine
decr. ADH = dilute urine

23
Q

what are 5 functions of the kidneys?

A

1) filter urea
2) electrolyte control
3) acid-base balance
4) blood pressure control
5) hormone production

24
Q

what is urea?

A

a waste product of protein metabolism

25
Q

why is measuring urea levels important? what are the clinical utilities?

A

general indicator of renal function:
urea:sCr ratio > 70 means dehydration
urea increases before sCr in patients with AKI

26
Q

what are normal urea levels?

A

2.5-8mmol/L

27
Q

what role do kidneys play in acid-base balance?

A

maintain the pH of arterial blood between 7.35-7.45 through aci-base regulation

28
Q

what do the kidneys do in the case of acidosis?

A

reabsorb all filtered HCO3 into the extracellular and produce extra HCO3 to bring [H+] back to normal

29
Q

what do the kidneys do in the case of alkalosis?

A

kidneys don’t reabsorb HCO3, so it gets secreted, bringing [H+] back to normal

30
Q

how are the kidneys involved in blood pressure control?

A

Renin-angiotensin-aldosterone system (RAAS)
decrease in BP leads to renin release. angiotensin 1 is activated? and converted to angiotensin 2 via angiotensin converting enzyme
this causes vasoconstriction, aldosterone secretion (water and Na retention) and thirst stimulated to increase BP

31
Q

how are the kidneys involved in hormone production?

A

produce erythropoietin and secrete EPO when there is low oxygen in the blood

32
Q

what is erythropoietin?

A

stimulates RBC production in bone marrow

33
Q 
what happens to the following electrolytes in the case of CKD:
Na/water
K
Phosphorus
Mg
A

Na/water - edema/swelling (not able to decrease reabsorption by tubules)
K - hyperkalemia (not able to incr. excretion from distal tubule)
P - hyperphosphatemia (not able to decr. reabsorption in proximal tubule and incr. excretion from distal tubule)
Mg - hypermagnesemia (not able to decrease reabsorption in loop of Henle)

34
Q

what are the 4 types of renal failure? which is the most common cause of AKI?

A

pseudo renal failure
pre renal failure - most common cause
intrinsic AKI
post renal failure

35
Q

what is pseudo renal failure?

A

falsely elevated sCr due to inhibition of renal tubular secretion of sCr

36
Q

what is pre-renal AKI?

A

decreased blood flow to kidney

37
Q

what are 3 potential causes of pre-renal failure?

A

intravascular volume depletion
decrease in ineffective blood volume (advanced liver disease, meds)
decreased pressure in glomerulus (afferent arteriole vasoconstriction, efferent arteriole vasodilation)

38
Q

what is intrinsic AKI?

A

structural damage to kidney, effecting the glomerulus or the tubules

39
Q

what are 3 different kinds of intrinsic AKI? which is the most common?

A

Acute tubular necrosis (ATN) - most common
acute interstitial nephritis
glomerulonephritis

40
Q

what is acute tubular necrosis?

A

ischemia in kidney producing cell damage to tubules, typically caused by meds

41
Q

what is acute interstitial nephritis?

A

inflammatory disorder of renal interstitium, typically caused by different meds

42
Q

what is glomerulonephritis?

A

results from the stimulation of the immune system leading to inflammation of the glomerulus, caused by different bacteria and viruses

43
Q

what is post-renal failure?

A

obstruction of urine flow

44
Q

what are possible causes of post-renal failure?

A

kidney stones
bladder tumour/obstruction
urethral stricture/tumour
crystal deposition in renal tubules (caused by meds)

45
Q

what is creatinine?

A

a byproduct of muscle metabolism that is freely filtered by the glomerulus and used as a marker for GFR

46
Q

what is the creatinine clearance equation?

A

CrCl (mL/min/72kg) =( (140-age)(88.4)x(0.85 if female))/sCr

47
Q

what is a normal sCr range?

A

80-120 umol/L

Applied Pathophysiology (11 decks)

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