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Patho And Pharm > Class Three > Flashcards

Class Three Flashcards

1
Q

Nephron

A

Located in the parenchyma
Composed of glomerulus and tubules
Selectively secretes and reabsorbs ions and filtrate day

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2
Q

Glomerulus

A

Tufts of capillaries which filter large plasma proteins and blood cells
Blood flows into the glomerular capillaries from the afferent arteriole and flows out into the efferent arteriole

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3
Q

Bowman’s capsule

A

The thin double walled capsule that surround the glomerulus
Fluid and particles from the blood are filtered through the glomerular membrane into the fluid filled space in bowmans capsule, then enter the PCT

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4
Q

Tubules

A

Inside the PCT, the loop of henle, and the DCT

PCT receives filtrate from glomerular capsule and reabsorbs water and electrolytes
Depending loop of henle passively reabsorbs water from filtrate
Ascending loop passively reabsorbs sodium and chloride - helps maintain osmolality
DCT actively and passively removes sodium and water

Filtered fluid is converted to urine in the tubules

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5
Q

GFR

A

The filtration of plasma per unit of time

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6
Q

Factors responsible for GFR

A

Directly related to perfusion pressure of the glomerular capillaries and the renal blood flow
If arterial pressure decreased to less than 60, or if vascular pressure increases, RBF decline and urine output decreases

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7
Q

Net effect of GFR

A

Move water and solutes into bowmans capsule, which creates primary urine

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8
Q

Renin

A

An enzyme

Released from nephron when the bp or fluid concentration in DCT is low

Catalyzes the splitting of angiotensin I from angiotensin
Then angiotensin I converts to angiotensin II as blood flows through the lung

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9
Q

Erythropoietin

A

Synthesized by the kidney

Stimulates bone marrow to produce RBCs in response to hypoxia

Produced by peritubular fibroblasts located in the juxtamedullary cortex after sending low oxygen

Kidney failure: anemia is due to inability to make epo

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10
Q

Normal renal function values

BUN
Serum creatinine
BUN/creatinine ratio
GFR

A

BUN: 10-20 mg/dL
Serum creatinine: 0.5-1.1 mg/dL
BUN/creatinine ratio: 6 to 25
GFR: greater than 90 ml/min

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11
Q

Azotemia

A

Elevated BUN

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12
Q

Normal urine output values

A

1-2 L per day

Minimum of 30 ml/hr

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13
Q

Anuria

A

No urine

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14
Q

Oliguria

A

Little urine

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15
Q

Dysuria

A

Painful or difficult urine

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16
Q

Polyuria

A

Abnormally large amounts of urine

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17
Q

Hematuria

A

Blood in urine

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18
Q

Pyuria

A

WBCs in the urine

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19
Q

Nephrotic syndrome

Seen in

More common with

Sediment

A

Excretion of 3.5 g or more protein in urine per day

Glomerulonephritis
DM, SLE, malignancies
Drugs

More common in children
Associated with more serious prognosis

Sediment: proteins, lipids, little blood

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20
Q

Nephritic syndrome

Seen in

Sediment

A

Hematuria and RBC casts in the urine, some proteinuria but less severe

Infection
Rapidly progressing glomerulonephritis

Blood with red cell casts
White cell casts
Not high levels of protein

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21
Q

Glomerulonephritis

Types

Symptoms

A

Acute, rapidly progressing, chronic

Hematuria with RBC casts: often smoky brown tinged, indicates blood from glomerulus
Proteinuria based on range
HTN
Decreased GFR: Na and water retention

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22
Q

Acute cystitis

A

Bladder infection, UTI
Most common in women
Lower frequency in children - but highest between 4 and 8

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23
Q

Acute cystitis causes/risk factors

A 
Sexual activity/pregnancy
Vesicoureteral reflux
Instrumentation, poor hygiene
Neurogenic bladder
Obstruction
DM
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24
Q

Acute cystitis symptoms

A 
Can be a symptomatic - 10% 
Dysuria 
Urinary frequency/urgency 
Suprapubic pain 
Hematuria
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25
Acute cystitis treatment
1-3 days of antibiotic | Can develop into pyelonephritis
26
Pyelonephritis
Infection of one or both upper urinary tracts (ureter, renal pelvis, interstitium) Inflammation of the renal pelvis and interstitium Most common route: from bladder to kidneys, but can occur in bloodstream
27
Pyelonephritis most common bacteria
E. Coli Proeus Pseudomonas (Instrumentation with last 2)
28
Pyelonephritis common causes
``` Kidney stone Vesicoureteral reflux Pregnancy Neurogenic bladder Instrumentation Female sexual trauma ```
29
Pyelonephritis types
Acute: fever, chills, and flank/groin pain Chronic: persistent/recurrent infection leading to scarring of one or both kidneys
30
Acute tubular necrosis causes
Acute kidney injury | Caused by ischemia and nephrotoxins
31
Acute tubular necrosis risk factors
``` Increased in volume depleted patients Elderly Pre existing renal disease Post op patients Anesthesia ```
32
Acute kidney injury
Abrupt reduction in GFR and increased BUN and creatinine | Occurs over days to weeks and is usually associated with oliguria
33
Cause of renal failure
Ischemic injury
34
Prerenal AKI
The most common Hypoperfusion to the kidneys ``` Hypovolemia: hemorrhagic blood loss Vasodilation: vascular pooling Increased renal vascular resistance Renal vascular obstruction Inadequate CO: shock, CHF ```
35
Intrarenal AKI
Usually caused by acute tubular necrosis Ischemic Nephrotoxic
36
Postrenal AKI
Very rare Obstruction to outflow Benign prostatic hypertrophy (BPH) Nephrolithiasis Tumors Diagnostic catheterization or the ureters causing edema
37
AKI with recovery of renal function | Initiation phase
Reduced perfusion or toxicity in which the kidney injury is evolving Prevention of injury is possible here
38
AKI with recovery of renal function | Maintenance phase
Aka oliguric phase: period of established kidney injury and dysfunction after the initiating event has been resolved May last weeks to months Urine output is lowest here, while creatinine and BUN levels increase
39
AKI with recovery of renal function | Recovery phase
Aka polyuric phase: glomerular function returns here, but regenerating tubules can’t concentrate the filtrate Diuresis is common here - with decline in creatinine and urea concentration and increase in creatinine clearance
40
AKI can progress to what?
CKD
41
CKD/kidney failure
Kidneys are able to maintain function until over 50% is damaged Defined as progressive loss of kidney function associated with systemic or intrinsic disease
42
Primary effects of azotemia/uremia in CKD
Irritating to all body tissue | when elevated in plasma, everything is affected
43
Signs and symptoms of CKD | Cardiovascular
``` Atherosclerosis HTN Pericarditis CHF Increased risk for ischemic disease or stroke ```
44
Signs and symptoms of CKD | Respiratory
Kussmauls Uremic pneumonitis Pulmonary edema from Na and water retention
45
Signs and symptoms of CKD | Hematologic
Anemia: reduced erythropoiesis Uremia: increased bleeding, RBC life span half of normal, risk for clots
46
Signs and symptoms of CKD | Dermatologic
Skin pallor Uremic pruritus Uremic frost
47
Signs and symptoms of CKD | GI
Early: N&V, hiccups, anorexia Severe weight loss - malnutrition GI ulcers - GI bleed Uremic fetor
48
Signs and symptoms of CKD | Neurologic
``` Drowsiness, poor memory Lack of concentration Seizures, coma Asterixis: neuromuscular irritability Peripheral neuropathy ```
49
Signs and symptoms of CKD | Musculoskeletal
Renal Osteodystrophy: indirect relationship between serum phosphorus and calcium levels As one decreases the other increases
50
Stages of CKD are determined by what?
GFR
51
Stage one CKD
Prevention is key Normal: more than 90 Normally no signs, HTN is common
52
Stage 2 CKD
Mild: 60-90 Subtle signs: HTN, increasing creatinine and urea levels
53
Stage 3 CKD
Moderate: 30-59 Signs: HTN, increasing creatinine and urea levels
54
Stage 5 CKD
Kidney failure: dialysis or transplant needed - less than 15 Signs: HTN, increasing creatinine and urea levels, epo deficiency anemia, hyperphosphatemia, increased triglycerides, metabolic acidosis, hyperkalemia, salt/water retention
55
Stage 4 CKD
Severe: 15-29 Signs: HTN, increasing creatinine and urea levels, epo deficiency anemia, hyperphosphatemia, increased triglycerides, metabolic acidosis, hyperkalemia, salt/water retention
56
Acid-base with CKD
When GFR drops to 25%, there’s a loss of 20-40 mEq of sodium per day Dietary intake must be maintained Kidney loses it’s ability to reg sodium and water balance Total body potassium concentration can reach life threatening levels Dialysis is used to control Metabolic acidosis occurs when GFR is 20-25% of normal May require alkali therapy or dialysis
57
Dietary consideration in CKD
Protein, phosphorus, and potassium restriction Na/water maintenance Vitamin d supplement Caloric intake
58
Nephrolithiasis
``` Renal calculi (kidney stones) Masses of crystals and proteins Common cause of infection 7% of women and 10% of men experience Recurrence in 30-50% within 5 years Most develop 1st by 50, most common in whites Kidney stone belt geographically Increased chance in sedentary occupation Genetics ```
59
Kidney stone symptoms
Pain: flank, costovertebral angle, radiates to groin, can be severe or colicky Hematuria: gross or microscopic Oliguria
60
Treatment of kidney stone
``` size may affect Pain management Lithotripsy Nephrolithotomy Analyze stones and corresponding interventions ```
61
Azotemia
Increased BUN levels and frequently increased creatinine levels Caused by renal insufficiency or failure
62
Uremia
Includes elevated blood urea and creatinine levels Fatigue, anorexia, vomiting, pruritus, and neurologic changes too Includes retention of toxic wastes, deficiency states, and electrolyte disorders

Patho And Pharm (6 decks)

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