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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
Q

Acute cystitis treatment

A

1-3 days of antibiotic

Can develop into pyelonephritis

26
Q

Pyelonephritis

A

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
Q

Pyelonephritis most common bacteria

A

E. Coli
Proeus
Pseudomonas
(Instrumentation with last 2)

28
Q

Pyelonephritis common causes

A 
Kidney stone
Vesicoureteral reflux
Pregnancy
Neurogenic bladder
Instrumentation
Female sexual trauma
29
Q

Pyelonephritis types

A

Acute: fever, chills, and flank/groin pain

Chronic: persistent/recurrent infection leading to scarring of one or both kidneys

30
Q

Acute tubular necrosis causes

A

Acute kidney injury

Caused by ischemia and nephrotoxins

31
Q

Acute tubular necrosis risk factors

A 
Increased in volume depleted patients
Elderly
Pre existing renal disease
Post op patients 
Anesthesia
32
Q

Acute kidney injury

A

Abrupt reduction in GFR and increased BUN and creatinine

Occurs over days to weeks and is usually associated with oliguria

33
Q

Cause of renal failure

A

Ischemic injury

34
Q

Prerenal AKI

A

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
Q

Intrarenal AKI

A

Usually caused by acute tubular necrosis
Ischemic
Nephrotoxic

36
Q

Postrenal AKI

A

Very rare
Obstruction to outflow

Benign prostatic hypertrophy (BPH)
Nephrolithiasis
Tumors
Diagnostic catheterization or the ureters causing edema

37
Q

AKI with recovery of renal function

Initiation phase

A

Reduced perfusion or toxicity in which the kidney injury is evolving

Prevention of injury is possible here

38
Q

AKI with recovery of renal function

Maintenance phase

A

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
Q

AKI with recovery of renal function

Recovery phase

A

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
Q

AKI can progress to what?

A

CKD

41
Q

CKD/kidney failure

A

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
Q

Primary effects of azotemia/uremia in CKD

A

Irritating to all body tissue

when elevated in plasma, everything is affected

43
Q

Signs and symptoms of CKD

Cardiovascular

A 
Atherosclerosis 
HTN
Pericarditis 
CHF 
Increased risk for ischemic disease or stroke
44
Q

Signs and symptoms of CKD

Respiratory

A

Kussmauls
Uremic pneumonitis
Pulmonary edema from Na and water retention

45
Q

Signs and symptoms of CKD

Hematologic

A

Anemia: reduced erythropoiesis
Uremia: increased bleeding, RBC life span half of normal, risk for clots

46
Q

Signs and symptoms of CKD

Dermatologic

A

Skin pallor
Uremic pruritus
Uremic frost

47
Q

Signs and symptoms of CKD

GI

A

Early: N&V, hiccups, anorexia

Severe weight loss - malnutrition
GI ulcers - GI bleed
Uremic fetor

48
Q

Signs and symptoms of CKD

Neurologic

A 
Drowsiness, poor memory 
Lack of concentration
Seizures, coma
Asterixis: neuromuscular irritability 
Peripheral neuropathy
49
Q

Signs and symptoms of CKD

Musculoskeletal

A

Renal Osteodystrophy: indirect relationship between serum phosphorus and calcium levels
As one decreases the other increases

50
Q

Stages of CKD are determined by what?

A

GFR

51
Q

Stage one CKD

A

Prevention is key

Normal: more than 90

Normally no signs, HTN is common

52
Q

Stage 2 CKD

A

Mild: 60-90

Subtle signs: HTN, increasing creatinine and urea levels

53
Q

Stage 3 CKD

A

Moderate: 30-59

Signs: HTN, increasing creatinine and urea levels

54
Q

Stage 5 CKD

A

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
Q

Stage 4 CKD

A

Severe: 15-29

Signs: HTN, increasing creatinine and urea levels, epo deficiency anemia, hyperphosphatemia, increased triglycerides, metabolic acidosis, hyperkalemia, salt/water retention

56
Q

Acid-base with CKD

A

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
Q

Dietary consideration in CKD

A

Protein, phosphorus, and potassium restriction
Na/water maintenance
Vitamin d supplement
Caloric intake

58
Q

Nephrolithiasis

A 
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
Q

Kidney stone symptoms

A

Pain: flank, costovertebral angle, radiates to groin, can be severe or colicky
Hematuria: gross or microscopic
Oliguria

60
Q

Treatment of kidney stone

A 
size may affect
Pain management 
Lithotripsy 
Nephrolithotomy
Analyze stones and corresponding interventions
61
Q

Azotemia

A

Increased BUN levels and frequently increased creatinine levels
Caused by renal insufficiency or failure

62
Q

Uremia

A

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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