exam 1: renal disorders Flashcards
renal cortex:
dense outer section, contains glomeruli, renal columns
renal medulla
middle section, contains pyramids
pyramids papillae
empty into calyces in sinus (inner section)
where do the renal pyramids unite
in renal pelvis then go into ureter
primary functions of kidneys
- balancing h2o and wastes
- excrete waste
- conserve nutrients
- regulate acid base
- secrete renin
- synthesis and secrete erythropoietin
- secrete D3
- formation of urine
renal arteries
branch off into smaller afferent arteries wich flow into glomerulus
efferent arterioles
peritubular caps surrounding nephron which aid in reabsorption and secretion and bring o2 to kidney cells
how many liters of blood flow per minute does the glomarulus get
1-2
glomerular filtration membrane has how many layers
3 layers and is selectively permeable
the glomerular filtration rate depends on
- functioning healthy membrane
2. adequate perfusion pressure (high cap hydrostatic pressure)
what is the GFR
120-140 ml/min
how much of the total filtrate is actually excreted
1% or 1500ml
what filters through the G
all components of blood EXCEPT
RBC’s and plasma proteins
hematuria
RBC in urine
proteinuria
proteins in urine
what are the 3 main processes of the nephrons
- filtration
- reabsorption
- secretion
(4) . excretion
filtration
from blood into the glomerulus via osmosis and diffusion
What are the glomfiltrate
primary water Na K glucose urea
reabsorption:
movement of substances out of the renal tubules back into the bloodstream
(h2o, glucose, Na and other ions)
secretion:
movement of substances from the blood stream into the distal and collecting tubules
(H+, K, NH3, drugs)
excretion:
out of the body via urine…. peeing
Renal Hormones
Vitamin D
erythropoietin
Vitamin D
comes from diet and sun but are inactive but are then activated by liver and kidney
need D to absorbe Ca and phosphate
erythropoietin
synthed in the kidneys
stimulates bone marrow to produce RBC
hormones acting on kidneys
antidiuretic hormone
aldosterone
natriuretic peptides
antidiuretic hormone
from posterior pituitary gland and acts on kidneys to increase reabsorption of free water
aldosterone
rom adrenal cortes, acts on kidneys to increase reabsorption of Na and H2O
natriuretic peptides
(ANP and BNP)
from myocardium
releases in responses to increased blood volume and inhibits the RAA system
BUN test
waste product of cell metabolism
NL-10-20
must infuse continuously too much time
creatinine test
need only one blood sample
NL- .7-1.5/100 ml
more accurate than BUN
24 hour creatinine clearance test also done
increased H+
metabolic acidosis (decreased pH)
Azotemia
rapid decline (days-weeks) in GFR causes retention of metabolic waste
oliguria
output less than 400ml/day
acute kidney injury (acute renal failure)
sudden kidney failure of sudden loss of the kidneys to remove waste products and concentrate urine
renal insufficiency
decline in renal function to about 25% of normal
(starting to fail)
(can be reversed)
Etiologies of acute kidney failure
- prerenal (30-80%)
- intrarenal (10-40%)
- postrenal (5-15%)
prerenal
befor kidney- renal artery, afferent arteriole (blood pressure or flow problems)
Ischemia- renal failure
causes of prerenal
loss of blood or water= decreased BF to renal arteries
intrarenal
intrinsic (inside kidney)
causes of intrarenal
- tubular disease: necrosis or HTN
- vascular disease: occlusion
- glomerular disease: glomerulon ephritis
toxins
meds
trauma
post renal
below the kidney
obstruction of outflow
uti-> back flow-> renal failure
causes of post renal
crystals
any obstruction
paralysis of tubes
clinical presentation of ARF
often asymptomatic:
- increases blood urea nitrogen and serum creatine
- 1st olgiuria for 10-14 days
- over 3 l/day
clinical mani of ARF
R/T waste buildup:
- anorexia
- fatigue
- mental changes
- N/V
- pruitis
- Seizures if bun is high
R/T fluid overload:
- SOB
- crackles in lungs
- peripheral edema
R/T encephalopathy
- asterixix (flapping tremor)
- Myoclonus (muscle jerk)
Chronic Kidney Injury(CRF)
kidney is no longer able to maintain the homeostasis of body
stage 1 CRF
end stage- chronic/peristent
stage 2 CRF
uremic system clinical s/s appear
eitologies of CRF
- acute kidney disease that is unresolved
- slow and insidious over time
1. diabetic nephropathy
2. glomerulonephritis
3. long term HTN
kidney mani in ESRD
kidneys atrophy and scar tissue forms
10% of normal function remains
uremia symptoms prevalant
uremia symptoms
both seen in acute and chronic RF:
increase in urea and creatinine
symptoms seen in all areas of body
musculoskeletal uremia symptom
(renal osteodystrophy)
bone mineralization deficiency due to hyperphosphate and hypocalcemia
cardiovascular uremia symptoms
fluid overload, CHF, HTN
hematologic uremia symptoms
anemia (decreased erythropoietin)
GI uremia symptoms
urea=irritating=N/V and bleeding
dermatologic uremia symptoms
related to increased urea products:
-dryness, itching, yellow gry skin, pale beds, uremic frost
reproductive uremia symptoms
infertility, amenorrhea, impotence
respiratory uremia symptoms
lung congestion due to edema
neurologic uremia symptoms
fatigue
peripheral neuro irritibility
psychological uremia symptoms
depression
insomina
hyponatremia
due to fluid overload=dilution of na
hypocalcemia
due to Vitamin D issues
hyperphosphatemia
cannot excrete excess
hyperkalemia
cannot excrete excess
decreased hemoglobin and hematocrit
due to no erythropoietin
