EXAM 3 Flashcards
ANURIA
O urine
Acute renal failure
BUN
Increase number of cells in the prostate; urination retention,; sign of renal failure OR dehydration, cause urinal overload,
Acute-post renal failure
Creatinine
A normal creatinine. 1.2 or less the higher the worst the kidney function
High creatinine clearance is good kidney function
The Highre the GFR the better the kidney function
Dialysis
A treatment to filter the blood.. the machine acts like the kidney.
Halitosis
Bad breath; too much toxins building up from acute renal failure
Intrarenal
Inside of the kidney is starting to be damage and lead to renal failure. Damage to kidney itself
Medication and infectious process can occcur
Nephrolithiasis
Kidney stones; leads to kidney failure.. causes post renal failure
Nephrotoxic
Something that cause damage. To the kidneys
Medications, Motrin, antibiotics.
Oliguria
A low urine output
<30 ml and its 400 ml or less
Polyuria
Increase urinationhappens in diabetics
Pre-renal
Hypovelemic shock.. something that prevent kidneys form getting blood flow;
decrease effective blood flow to the kidney and cause a decrease in the glomerular filtration rate (GFR). Both kidneys need to be affected as one kidney is still more than adequate for normal kidney function.
Post-renal
Not common; Results from obstruction of urine outflow from the kidneys • Calculi, strictures, bladder tumors, BPH (most common) • Treat the underlying cause of obstruction
Puritis
Happens with itching of the skin; accute renal failure.
Glands of the Endocrine system
Pituitary, thyroid, parathyroid, adrenal glands
Organs that produce hormones
Pancreas, gonads, hypothalamus
Hormones
Help regulation in the body. -regulate water and electrolytes -respond to adverse conditions like infections -help with growth and development - reproduction - pregnancy maintenance -digestion -nutrient storage Hypothalamus release these hormones There are Paracrine hormone and Autocrine hormones
Paracrine
Paracrine hormone produces action LOCALLY on other cells
Autocrine
Produces action on the cells from which they were produced
Renal Agenesis
No kidney formation; there are two types of renal agenesis
- bilateral: no kidney formation and baby dies within a couple of days
-unilateral: there is one kidney that hasn’t developed; only have ONE kidney. Lead to hypertrophy.
Usually we know when a baby has no kidney or one kidney before birth because of psychographs. But unilateral are usually discovered by accident, once the patient is experiencing renal failure.
Renal Hypoplasia
Kidneys are small in size. They can be bilateral or unilateral.
Renal Dysplasia
is a condition in which one or both of a baby’s kidneys develop abnormally in the womb, often causing cysts (fluid-filled sacs) to replace normal kidney tissue. /A lot of cysts that develop within the kidneys that leads to destroying the inside of the kidney.
S/S HTN, develop a Wilms tumor (tumor within the kidneys)
Hvae to do a sonogram to see how the kidneys are functioning. And monitor blood pressure
Cystic Diseases of the kidney
Can be multiple, vary in size; can be affect a person or not (symptomatic or asymptomatic), acquired or hereditary
Ex: autosomal dominant polycystic kidney disease, autosomal
recessive polycystic kidney disease, nephronophthisis, medullary
cystic disease
Autosomal dominant polycystic kidney disease
Develop later in life. Usually its unilateral.Most common inherited kidney. Disease. Multiple expanding cysts destroy kidney structure and cause renal
failure
Manifestations: pain, hematuria, UTI’s and HTN
Use CT scans to diagnose
-contttrol pain UTI and BP
Autosomal recessive polycystic kidney disease
This is a childhood disease; usually present at birth and progresses rapidly.
It’s B/L (bilateral), masses on kidneys and lower back, impaired lung development, HTN and they are most likely to die before they can leave the hospital.
Nephronophthisis
Occurs in children;
-small kidneys, multiple cysts, progresses to CKD (Chronic kidney disease), and causes polyuria (excessive urination), polydipsia ( abnormally great thirst), enuresis (bed wetting)
Polyuria
Excessive urination
Polydipsia
Extreme abnormal thirst
Enuresis
Bed wetting
Medullary Cystic Kidney Disease
Occur in adults, chronic kidney disease, small kidneys, polyuria, polydipsia, enuresis.
Simple and Aquired renal cysts
These are the ones that dont really affect the patient or then can cause symptoms. If they doo cause symptoms, its usually gonna cause flank pain (lower back pain), hematuria (urine in the blood), urinary tract infection and HTN. Common in people over 50. Use US (ultrasound) CT scan to. Diagnose.
Acute Nephrotic Syndrome
An inflammatory response that occurs when a patient is experiencing an infection (SLE ‘Systemic Lupus) or it occurred after an infection
S/S: sudden onset of hematuria (blood in urine), proteinuria (protein in urine), decreased GFR (glomerular filtration rate), oliguria (the production of abnormally small amounts of urine.), edema, HTN
Oliguria
the production of abnormally small amounts of urine.
40ml or less
glomerular filtration rate (GFR)
is a blood test that checks how well your kidneys are working. Your kidneys have tiny filters called glomeruli. These filters help remove waste and excess fluid from the blood. A GFR test estimates how much blood passes through these filters each minute.S
Hematuria
Blood in urine
Proyeinuria
Protein in urine.
Acute post infectious glomerulonephritis
Develop this after a strep infection(strains of group A beta-hemolytic streptococci) ,( 7-10 days post-infection.
Its rare in the U.S.
SS: oliguria, hematuria, edema (especially face and hands), HTN
Treatment: antibiotics (ABX), supportive care and it usually resolves
Acute Pyelonephritis
Caused by E. Coli ; bacterial infection
Common in females. Because of our anatomy.
Uncomplicated- because the person’s renal structure has no abnormality in it. We can treat them less aggressively compared to ones who is more complicated.
Acute onset: shaking, chills, fevers, constant pain in groin and lower back and its usually on one side (unilateral), dysuria (difficulty or painful urination), urgency to pee
-treatment: antibiotic for 10-14 days.
Renal Failure
Has two diff. Components : acute or chronic
Acute Kidney injury (AKI) or Chronic Kidney Disease (CKD)
When the kidneys fail to remove metabolic end products from the blood and regulate the fluid, electrolyte and pH balance of the Extracellular fluid
Acute Kidney Injury (AKI)
If we can find out why the patient has acute renal failure, we can treat it immediately and reverse it if recognized early
- abrupt decline within 48hours in kidney function, fluid and electrolyte balance is disrupted.
-25-80% mortality rate, depending on the cause.
-increase creatinine, reduced urine production
-can be caused by blood clot in artery/obstruction and lead to decrease blood flow without ischemic injury. Taking meds can cause AKI
There are three types of acute renal failure:
1. Prerenal
2. Intrarenal
3. Post renal
Prerenal and intrarenal account for 80-90% (common)
BUN/Cr: BUN 8-20, cr <1.2 Kidney biopsy (we try to avoid this)
S/S: decreased urine output, fluid retention (edema, pulmonary congestion), HTN,
If untreated, it causes neuromuscular irrability, somnolent (sleepy and drowsiness), coma and death.
Chronic kidney disease (CKD)
Develops over the course of the years; irreversible damage and can lead to dialysis.
Decline of renal function in 3months or more.
Causes: HTN, DM, SLE (Systemic lupus erythematosus)
Check GFR
S/S: early stages are asymptomatic, as it progresses fluid,
electrolyte and acid-base disturbances, hyperkalemia, HTN,
anemia
AKI Prerenal Injury
Most common; Prerenal means that the kidneys are not gettin adequate blood flow, that means that they can’t work correctly and go into failure
/Most common, characterized by marked decrease in renal
blood flow • Can be reversed if the cause of the decreased blood flow can
be identified and corrected before kidney damage occurs
Causes: depletion of vascular volume, which leads to hypotension, not getting adequate. Blood flow.
Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBS), NSAIDS (Non-steroidal anti-inflammatory drugs)
ELDERLY ARE AT INCREASED RISK
AKI Post Renal injury
Results from obstruction of urine outflow from the kidneys
-like Calculi (kidney stones), bladder tumors, BPH (benign prostatic hyperplasia) BPH IS THE MOST COMMON
AKI Intrarenal Kidney Injury
Damage to the kidneys ITSELF
Ex: infections, DM (every time blood sugar goes up, causes damage to blood vessels), glomerulonephritis, nephrotoxic substances.
Immunity
Protection from infectious disease
Immune response
collective coordinated response of cells and molecules of the immune system.
Innate immunity
natural immunity, early rapid response Innate Immune system consists of: • Epithelial barrier (skin) • Phagocytic neutrophils • Macrophages • Dendritic cells
Adaptive immunity
specific or acquired immunity, less rapid but more effective response focused response to specific foreign agent
/faster over time after repeated exposure.
This happened when we get exposed to an antigen, or get the immunization. Develop antibodies.
There are two different types:
Humoral immunity
Cell-mediated immunity
Macrophages
Cell goes killing invading organism and then get rid of them; engulf dead cells, also identify as antigen-presenting cell …”i recognize that this is the flu”. For adaptive immunity (long lived)
Granulocytes
Part of the WBC, help with the phagocytosis as well
Includes: neutrophils (phagocytosis), basophils,, and eosinophils.
When these are elevated, that means that there is an infection (neutrophils, & basophils)
When eosinophils are elevated.. sign of allergic reaction
Lymphocytes
B—lymphocytes-Help with antibodies production.
- T—lymphocytes- cell-mediated immunity
T—helper cells: help B lymphocytes produce antibodies.
Central Lymphoid Tissue
(Bone marrow, thymus)This is the actually fluid that gets rid of the bad stuff.
-Immune cell production and maturation.
Peripheral lymphoid tissue
Lymph nodes: Goes through the lymph nodes.. lymph gets rid of the bad stuff and lymph nodes keeps the good stuff. /remove protein rich fluid (lymph), filter foreign material before it goes back to the blood, and center for proliferation and response of immune cells.
Spleen
Helps with immune response; left abdominal cavity, filters antigens from the blood,
and is important in response to systemic infections
Epithelial barrier
Physical and chemical barriers between internal
environment and pathogens of external world
• Includes epidermis (skin): protective barrier, keratin,
chemical create salty acidic environment, antibacterial
proteins
• Lining of Respiratory, GI and Urogenital tracts : mucus
traps and washes away microorganisms,
cilia: move microbes trapped in mucus to throat then sneezing and
coughing removes them
Phagocytic leukocytes
Neutrophils early responding respond first followed by
Macrophages that engulf and digest microbes
Dendrites
Try to link the initial response with the NOW adaptive response/ derived from bone marrow, link innate and adaptive
immunity responses/ Dendrites are appendages that are designed to receive communications from other cells.
NK cells
They help the lymphocytes recognize the bad cells in the body and the cells that are stressed; help get rid of them/ Class of lymphocytes recognize infected and stressed cells
respond by killing these cells
Opsonins
bind to and tag microorganisms for more
efficient recognition
Ex: tagging a foreign cell to let others know to engulf it
Cytokinine
Are part of the immune response to cause inflammation; released from leukocytes, regulate activity of other cells, aid in the initiation
of the adaptive immune response
What are the 3 ways of recognition of recognizing microbes?
A complement system to activate the adaptive immune system. Consist of a group of protein activated by microbes and promote inflammation and destruction of microbes
- Classical Pathway
- Lecitin Pathway
- Alternative Pathway
Classical pathway
An immune response that recognizes an antibody and starts to form the immune response to that specific microbe.
Lecitin Pathway
It uses protein to bind to the bad cells/ dead cells/infected cells
Alternative pathway
Helps with the recognition of specific microbes and start the immune response.
Antigens
Also called immunogens; What causes the problems in the body (come from a bacteria, fungus, virus, parasite…)
- stimulates an immune response
- are recognized by receptors on immune cells and antibodies are formed
Cells of adaptive immunity
- T-lymphocytes
- CD4+ helper T Cells
- Antigen presenting cells
T-lymphocytes
Make the T cells be specific to certain organism/Differentiate into helper T cells, regulatory T-cells and cytotoxic Tcells
Provide cell-mediated immunity.
CD4+ helper T cells
Trigger immune response and and help the B cells form into antibody producing cells.
Antigen presenting cells
The cells that have the antigen on the surface and say “this is the organism that’s causing the problem”.. if we seen this before, we know what to do, if we don’t we are gong to figure it out
And present this antigen peptide to CD4+ helper T cells.
Humoral Immunity
A type of adaptive immunity;
primary response; the first time the body been exposed to the antigen. The body develops antibodies
Latent period: before detection of antibody.
Secondary (memory) response: occurs on a second exposure to an antigen (ex: Got the flu shot.. a week later.. the body knows what do to.. and the body attacks the pathogen and the have mild symptoms)
Primary Immune response
antigen first introduced into the body
• Latent period before detection of antibody
• Activation takes 1-2 weeks, but can be several weeks before there is a
detectable antibody. Ex- HIV
Secondary (memory) response
occurs on second or subsequent exposure to an antigen
• Rise in antibodies occurs quicker and reaches higher level because of memory
cells
• Booster shots ex: tetanus utilizes memory cells
Immunoglobulins
IgG: the infection is gone when it’s elevated
IgA: they have it
IgM:
IgD:
IgE: when this is elevated that means they have an allergy
Active Immunity
Body has been exposed and has to do the work to make the antibodies;
Acquired through immunization or actually having the
disease
• Depends on response to antigen by persons immune
system
• Long lasting
• Requires a few days to a few weeks to after first exposure
for sufficient immune response
• Responds within a few hours in subsequent exposures
• Can improve on subsequent exposures
Passive Immunity
Immunity (antibodies) transferred from another source; the body doesnt have to do the work.
Infant from mom in utero or breast milk • Maternal IgG crosses placenta and protects baby for 3-6 months
(moms antibodies) • Can also be given by transfer of antibodies from other people or
animals • Immune serum, gamma globulin short term protection against
infectious agents
Tolerance
Inhibition of immune response, non reactive to self antigens while producing immunity to foreign agents, can lead to
inability to respond to infectious agents
What causes cellular injury?
Trauma, environmental irritants (from dangerous as bleach to pollen), micro-organisms, free radical damage (radiation processed foods), hypoxia (decreased oxygen), surgery.
Leukocytes
Neutrophils and macrophages. They remove debris
Inflammation
Prepares injured area for healing, Leukocytes (neutrophils and macrophages) remove debris
and provide growth factors
• Nutrients (proteins, glucose, vitamins) provide the building
blocks for cells
• Clotting factors and platelets limit damage
Kinin cascade
A protein that is activated during a cellular injury and releases Bradykinin which causes pain, vasodilatation and vascular permeability.
Clotting cascade
Is a plasma protein that is activated during cellular injury; prevents further bleeding
Complement cascade
Stimulates the opsonins, chemotactic factors (chemical response), anaphylatoxins (which releases histamines)
Histamine
Similar to bradykinin, it is a potent vasodilator.
The vascular response to a cellular injury
Histamine and Bradykinin stimulate vasodilation • Increased blood flow to the area causes redness (rubor) and
heat (calor) • Leakage of protein rich plasma into the interstitial spaces
cause swelling • Bradykinin also causes pain (dolor) • Cells unable to function
The cellular response to an cellular injury
Send out chemicals to the area to make sure we have a healing process… we initiate neutrophils to:
• Marginate: move to the capillary walls
• Emigrate: squeeze through capillary pores
• Migrate: through chemotaxis to the injury..saying “THERES AN INJURY”
• Phagocytosis: facilitated by opsonization (acts to facilitate
adherence of WBC to bacteria
The 5 signs of inflammation
- redness
- heat
- swelling
- pain
- loss of function
Excudate
Drainage; when someone has an injury, there’s drainage
• Serous: watery, like plasma
• Fibrinous: clotted
• Serosanguinous: clear, pink, blood tinged/contains or relates to both blood and the liquid part of blood (serum).
• Sanguinous: bloody
• Purulent (suppurative): pus
Elevated ESR
It’s a blood test; ESR (erythrocyte sedimentation rate); when its elevated, thas a sign of inflammation.
ESR IS INCREASED PLASMA PROTEINS
The 3 systestemic signs of inflammation
- Fever: is one of the first sign; caused by cytokines
- Leukocytosis: increased WBC (more than 11k)
- Elevated ESR
- Elevated CRP:
4 stages of fever
Prodromal: nonspecific complaints, mild HA (headache), fatigue
• Chill: during which temp rises
• Flush: skin warm and red • Defervescence stage: initiation of sweating
Chronic inflammation
May occur due to: Chronic infection or contamination • Continuous exposure to irritants • Immune System abnormalities
Ex: immune response is constantly activated
- chronic inflammation may lead to: Granuloma formation (an oversized scar), Giant cell formation (ex: an inflamed artery from chronic inflammation), and cancers
Stages of wound healing
- Inflammation: usually last 1-2 days
- Proliferation and new tissue formation: 2-8 weeks for maximum strength to be achieved, may involve regeneration and resolution, or repair w/ scar tissue but loss of function.
- Remodeling and maturation: up to 2years
TGF-B (transforming growth factor beta)
Stimulates the collagen and provide the lattice for the wound to heal. This happens during wound healing process
VEGE (vascular endothelial growth factor)
Stimulates angiogenesis (new blood vessels growth); this happens during wound healing; allows the wound to grow new blood vessel growth.
MMP (matrix metalloproteinases)
Helps remodel collagen and fibrin during the wound healing process.. to fill in the scar tissue
Homocysteine level
Do a blood test and if its elevated,, they are at risk for heart attack and stroke. Because they are low in folate levels, vitamin b and riboflavin (less than 15 mcmol/L)
-the elevate levels of homocysteine inhibits AC cascade and increases endothelial damage in arteries.
*C-reactive Protein
A blood test;CRP; elevated CRP rate (greater. Than 3mg/L) indicates risk of heart attack
Average U.S population: 1-3.
Low risk is than 1
Hypersensitivity Disorders
An allergic reaction/ an overreaction of an immune response when someone is allergic
There’s different types.. Type I - IV
Type I Immediate Hypersensitivity disorder
Referred to allergic reaction; Have an IMMEDIATE reaction; IgE mediated
Begins rapidly (usually within minutes of an antigen challenge)
Ex: When someone has elevated esoonphill reactions.. exposed to an antigen (dust, pollen, food …) cause an inflammatory response like hives, watery eyes…
Typical allergens- pollen, house dust, mites, animal dander, foods and
chemicals such as PCN and antibiotics
• Cytokinines secreted differentiate B cells into IgE which act as growth
factors for mast cells and activate eosinophils
Type I has 2 phases:
1. Primary/ intermediate phase response (5-30 mins that lasts 60 mins) Vasodilation (histamine/bradykinin)
• Vascular leakage ( histamine)
• Smooth muscle contraction (histamine/bradykinin)
- Secondary/late phase (2-8hr later, can last days)
Intense infiltration of tissue with eosinophils and other
acute or inflammatory cells
• Epithelial cell damage
• Leukotrienes and prostaglandins produce response
Systemic Anaphylactic Reaction (Type I)
Life threatening; can occur within minutes of exposure
-Huge release of histamine and MASSIVE vasodialation, widespread edema, difficult breathing, vascular shock.
Results from antigen introduced by injection- insect sting, or
absorption across skin, GI mucosa
• Level of severity depends on level of sensitization
• Treatment- airway, IV, epinephrine(relaxes bronchoconstriction,
increases BP)
• Pt should have epi-pen, family members should be trained, medi-alert
bracelet
Local (Atopic) Reaction (Type I)
It’s basically where you’re exposed and get a local allergic reaction.
Ex: laundry detergent, new skin product, mosquito bite
Mediated by igE (mast cell reaction)
Most common disorders- hives, allergic rhinitis (hayfever),
atopic dermatitis, food allergies and some forms of asthma
Allergic Rhinitis (Type I)
Pollen, dust, pet dander,, swelling water eyes, runny nose, patients can feel very tired..
diagnosis: do a smear from eye, nose.. and eye if they are allergic based on their levels of eosinophils
Use topical Benadryl , antihistamines, decogestions, desititation (introduced a lil bit more .. and body decreases reaction)
Food Allergies (Type I)
Any food can trigger- most common are milk, eggs, peanuts,
tree nuts, seafood, cooking food may change symptoms
• Acute response (hives and anaphylaxis), Chronic (asthma,
atpic dermatitis and GI disorders) •
Can occur at any age, but usually childhood
Type II Hypersensitivity
ANTIBODY;antibody mediated disorders; bedmates by IgG or IgM antibodies that fight against antigens on cell surfaces or connective tissue.
Common: when someone gets a blood transfusion and its the wrong blood transfusion. The cells are gonna interact and break down the blood products and it can potentially be deadly.
RHO positive while pregnant.
Ex- some people are allergic to heparin.. 3 days later their pallets are broken down; caused body to destroy their own patlets.
3 types of type II:
- Destruction meaning they are destroying some cellular product.
- Causing inflammation
- causing dysfunction in cells
Type III Immune complex- Mediated disorder
RELATED TO AN AUTOIMMUNE DISEASE. When they have cell mediated distruction; this is related to an autoimmune disease or process.
Ex: vasculitis (inflammation of the blood cells that is caused by systemic lupus), local immune complex disease
Type IV mediated hypersensitivity
Allergic contact dermatitis: its a delayed type hypersensitivity reaction (12-24 hours post exposure); with atopic reactions you get redness and swelling, but with the allergic contact dermatitis is much more difficult; get blisters that break off, weeping moves, can be caused by cosmetics, soaps, powder.. but its such a significant reaction
-Hypersensitivity Pneumonitis: delayed type hypersensitivity reaction. inhale something into their lungs and caused inflammation, unfourtaneltly, this can be permanent. Sometimes it can go away or not. / exposed to inhaled organic dusts or
occupational antigens; labored breathing, dry cough, chills, fever,
headache, chronic exposure may lead to chronic lung disease with
little reversibility
Transplantation
Taking cells, tissues or organs (graft) from on individual (donor) to
another (recipient)
• Rejection is a major barrier to transplantation- recipients immune
system recognizes the graft as foreign and attacks it.
• Hyperacute rejection: occurs almost IMMEDIATELY after
transplantation, caused by existing recipient antibodies and initiate
type III Arthus- type sensitivity
• Acute rejection- occurs within first few weeks or months
• Chronic rejection occurs over prolonged period, caused by T-cell
cytokines that damage BV causing ischemic damage to graft tissue
Autoimmune Disease
Are when body doesnt recognize itself.. its an over reactive immune response..
can e caused by infections. We treat them depends how its attacking
Can use steroids to decrease inflammatory response.
If we stop that immune response.. put patient at risk for infection/
Disruption in self-tolerance that results in damage to body tissues by
immune system • Self-tolerance is maintained through central and peripheral
mechanisms that delete autoreactive B or T cells that suppress or
inactivate immune responses that destroy host cells, defects in this
mechanism predispose to autoimmune disease
• May be triggered by environmental stimuli, infections, genetic
predisposition
• Treatment based on tissue involved, immunosuppressive drugs,
steroids
*10 warning signs of primary immunodeficiency
Immunodeficiency disorder is the opposite of auto immune disorder.
Immunodeficiency means that the person does not a sufficient immune response; put them at risk for infections.
10 warning signs are:
• 4 or more new ear infections in 1 year
• 2 or more serious infections in 1 year
• 2 or more months on antibiotics with little effect • 2 or more PNA (pneumonia) within 1 year
• Failure of infant to gain weight or grow normally
• Recurrent deep skin or organ abscess
• Persistant thrush, fungal infections of skin
• Need for IV ABX (antibiotics)
• 2 or more deep seated infections including septicemia (sepsis, pneumonia)
• Family Hx
Acquired Immunodeficiency Syndrome (hiv/aids)
Develops significant immunosuppression;
Transmitted blood or body fluids that contain the virus, sexual contact
is the most frequent mode • Destroys CD4 cells
3 phases:
• Primary phase: shortly after infection- mono like symptoms/ flu
• Latency phase: may last for years
• Overt phase decrease in CD4 count (aids)
• Treatment involves drugs that interrupt replication of virus- no cure
• Treat opportunistic infections
Diagnose: using the ELISA-enzyme-linked immunosorbent assay
If ELISA is positive, we test using Western blot to confirm it. However, if the western blot is negative and the ELISA is positive, its a false positive.
CD4 cells
CD4 cells, also known as T cells, are white blood cells that fight infection and play an important role in your immune system. A CD4 count is used to check the health of the immune system in people infected with HIV (human immunodeficiency virus). HIV attacks and destroys CD4 cells.
Pregnancy and HIV
Women infected with HIV and transmit to offspring in utero, labor or
breast milk
• HIV antibody can be present in babies from the mother, uninfected
babies is usually disappears within 18 months
If it doesn’t disappear, the baby has HIV
