CIS - GFR/Basement membrane dysfunction - McCormick

Question 1

Edemal proteinuria

Answer 1

Loss of plasma proteins - decreased oncotic pressure

Results in peripheral edema

Question 2

What does Angiotensin II constrict?

Answer 2

Efferent arteriole

Question 3

1st step in urine formation

Answer 3

Ultrafiltration through glomerular cap

Question 4

Where is glomerular cap hydrostatic pressure the highest?

Answer 4

At the afferent end - drives filtration

Decreases slightly along its length

Question 5

Plasma oncotic pressure

Answer 5

Increases along length of GC as plasma is filtered because large proteins remain
Oppose filtration and favor reabsorption

Question 6

Tamm-Horsfall

Answer 6

Non-plasma proteins
Produced in tubules
Protect apical surface

Question 7

Casts

Answer 7

Form because of stasis or disease

Question 8

Normal amount of proteins excreted per day?

Answer 8

140 mg

Can be as high as 200 in kids/preggo

Question 9

Proteinuria

Answer 9

> 300 mg protein in 24 hours

Question 10

Polyuria lab value

Answer 10

> 2000 ml

normal 1500

Question 11

Oliguria lab value

Answer 11

< 500 ml

Question 12

Problem with lab tests for urine protein?

Answer 12

Normal is 5mg/dl
BUT lower limit of tests is 15 mg/dl
Need to investigate any positive

Question 13

Complement lab test

Answer 13

If levels are low, it is complexing with bacteria

Question 14

RBC casts indicate?

Answer 14

Glomerular bleeding

Question 15

2 Methods for detecting protein in urine?

Answer 15

Dipstick - more sensitive to albumin
Sulfosalicylic acid test - detects all proteins
-ppts out

Question 16

Physiological causes of proteinuria?

Answer 16

Orthostasis - esp in kids, BM not developed

Strenuous physical activity

Question 17

4 pathophysiological origins of proteinuria

Answer 17

1. Loss of charge barrier
2. Loss of size
3. Failure of proximal tubule to reabsorb
4. Overload proteinuria - increased plasma conc of low MW, filterable proteins

Question 18

Primary edema

Answer 18

Due to loss of plasma proteins

Na and water retention

Question 19

Secondary edema

Answer 19

Due to elevated bp

Increase in bp is compensatory mechanism (Na+ and water retention) to counteract cap leakage

Question 20

Nephrotic syndrome

Answer 20

Scarring

Question 21

Primary cause of edema?

Answer 21

Hypoalbuminemia

- loss of proteins and retention of Na+ and water

Question 22

Why do patients with renal problems get hyperlipidemia?

Answer 22

Liver trying to compensate and throws out all proteins/lipids it can - hepatic lipoprotein synthesis

Question 23

Lipidemia

Answer 23

Due to glomerular capillary damage
Not only are proteins filtered, but also lipids
Maltese cross

Question 24

Why does pt have normal Na+ in face of increased retention of Na+?

Answer 24

RAAS
Increased body water content due to increased renal water absorption (ADH) and increased thirst
Triggered by decreased plasma volume