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Pathophysiology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Tubular reabsorption

A 
movement of fluid and water from tubular lumen (urine) to peritubular
capillary plasma (blood)
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2
Q

Tubular secretion

A

movement from capillary (blood) to tubular lumen (urine)

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3
Q

Excretion

A

elimination of a substance in the final urine

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4
Q

PCT

A

Reabsorbs MOST ions and some molecules that have been filtered from blood into urine:
– Puts back into the blood Na+, Cl‐, K+, glucose, – Requires active transport

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5
Q

Loop of Henle

A

Function: create a concentration gradient to reabsorb water and concentrate the urine

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6
Q

Descending limb

A
  • Thin
  • No active transport – osmosis only here
  • Water will move out of the urine (reabsorbed) • Urine becomes very concentrated (hypertonic)
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7
Q

Thick ascending limb

A
  • Actively transports ions out of the urine (reabsorbed)

* Urine will become less concentrated (hypotonic) • Passes urine into the DCT

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8
Q

Distal convoluted tubule (DCT)

A

• More reabsorption of substances by active transport

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9
Q

Primary Kidney Function

A

The primary function of the kidney is to maintain a stable internal environment for optimal cell and tissue metabolism.

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10
Q

What hormones do the kidneys secrete

A

secretes the hormones renin for regulation of blood pressure, erythrocyte production
erythropoietin,
1,25‐dihydroxy‐vitamin D3 calcium metabolism

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11
Q

Where are the kidneys located

A

posterior region of the abdominal cavity behind the peritoneum

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12
Q

Cortex

A

outer layer of the kidney

contains all of the glomeruli, most of the proximal tubules, and some segments of the distal tubule.

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13
Q

Medulla

A

Forms the inner part of the kidney and consists of region called the pyramids

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14
Q

Renal columns

A

are an extension of the cortex and lie between the pyramids and extend to the renal pelvis

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15
Q

Minor calyces

A

receive urine from the collecting ducts through the renal papilla

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16
Q

Major calyces

A

join to form the renal pelvis which connects with the proximal end of the ureter

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17
Q

Nephron

A

Functional unit of kidney

A tubular structure with subunits that include the renal corpuscle (includes glomerulus, Bowman capsule and mesangial cells), proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting duct, all of which contribute to the formation of urine.

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18
Q

Glomerulus

A

Synthesizes nitric oxide (vasodilator) and endothelin‐1 vasoconstrictor) to regulate blood flow and control GFR.

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19
Q

Afferent arteriole

A

Brings blood in

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20
Q

Juxtaglomerular cells

A

produce renin, JGA is formed by the afferent arteriole and a portion of the DCT and regulates renal blood flow and glomerular filtration

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21
Q

Macula densa

A

Na and Cl sensing cells

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22
Q

Podocytes

A

adhere to basement membrane of glomerular capillaries. Gaps between them allow filtration.

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23
Q

Efferent arteriole

A

exits the glomerulus.

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24
Q

GFR

A

The filtration of the plasma per unit of time, directly related to the perfusion pressure in the glomerular capillaries

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25
Q

How are resistance and pressure

A

They are affected in same direction

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26
Q

Neural regulation BP decreases

A

aortic baroreceptors sense it, increase sympathetic

output (epinephrine), which results in vasoconstriction and decreases GFR

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27
Q

Decreased GFR diminishes

A

excretion of Na and H2O, resulting in increase in blood volume…increasing BP

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28
Q

Angiotensin II

A

Produced sustemically and within kidneys; constricts afferent and efferent arterioles decreases RBF and GFR

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29
Q

Function of PCT

A

reabsorption of most ions; active transport

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30
Q

Loop of Henle

Thin

A

Descending-highly permeable to water, not ion, no active transport

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31
Q

Loop of Henle

Thick

A

ascending-actively transports ions into interstitium and passes urine into the DCT

32
Q

Distal convoluted tubule (DCT):

A

reabsorption and secretion of ions, creates dilute

fluid. Secretes H+ contributing to acid‐base balance.

33
Q

Collecting duct:

A

Principal cells (reabsorb Na+ and H20, secrete K+); intercalated cells (secrete H+ and reabsorb K+)

34
Q

Concentration/dilution of urine occurs mainly

A

in the loop, DCT and collecting duct.

35
Q

Diuretics

A

enhance urine flow
they interfere with renal Na reabsorption and decrease
extracellular fluid volume

36
Q

Glucose

A

normally entirely reabsorbed should be negative

37
Q

Nitrates:

A

should be negative, positive with some bacteria

38
Q

Ketones

A

By products of fat breakdown. Positive in starvation and diabetic ketoacidosis

39
Q

Albumin

A

Normally doesn’t make it past glomerulus. Positive in glomerular failure

40
Q

Hemoglobin

A

Normally not free, positive in RBC breakdown

41
Q

Myoglobin

A

Normally not free, positive in muscle breakdown

42
Q

Leukocyte esterase

A

Enzyme in white blood cells normally not present in urine, should be negative

43
Q

Urine Sediment

A

Urine sediment is a microscopic analysis; it can cover everything from crystals, casts, RBCs, WBCs, and urothelial cells including urothelial cells with cancer or la cart

44
Q

Blood Urea Nitrogen

A
  • Reflect urine concentrating ability and glomerular filtration
  • Rises in states of dehydration as well as in acute and chronic renal failure because passage of fluid through the renal tubules is slowed
45
Q

As BUN levels increase

A

GFR drops

46
Q

Normal BUN level in adults

A

10-20mg/dL

47
Q

Normal plasma creatinine

A

.7-1.2 mg/dL

This is most useful in monitoring over time; it takes 7‐10 days for creatinine to stabilize when GFR declines. Less useful in acute renal failure.

48
Q

GFR declines what happens to creat

A

creat increases proportionally

49
Q

Creatinine Clearance

A
  • Estimates GFR

- Requires 24‐hour volume or urine and 1 blood draw for plasmacreatinine

50
Q

GFR formula

A

Urine Creat x Urine Volume)/Plasma Creat

51
Q

Renal and urinary function can be affected by a variety of disorders including

A

Infection (most common)
Obstruction by stones, tumors, or inflammatory edema
Dysfunction from kidney disorders or systemic disease

52
Q

Urinary tract obstruction

A
  • Interference with flow of urine at any site along the urinary tract
  • Obstruction impedes flow, leads to dilation of structures prior to the obstruction, increases risk of infection and impairs renal function
  • Anatomic changes in the urinary system related to an obstruction are called obstructive uropathy
53
Q

Upper Urinary Tract Obstruction

A

Compression of calyx, ureteropelvic junction, ureterovesical junction (within kidney, ureter, before bladder)
Stones
Causes increased pressure, dilation of ureter, renal pelvises, calyces and renal parenchyma prior to obstruction

54
Q

Causes of upper urinary tract obstruction

A

Stones *, compression from abnormal vessel, tumor, abdominal inflammation and scarring

55
Q

upper urinary tract obstruction effect on GFR

A

Increased pressure transmits back to glomerulus, decreasing glomerular blood flow and ultimately, GFR

56
Q

Hydronephrosis

A

Lots of obstruction leads to hydronephrosis. The renal pelvis expands which increases the intra‐renal pressure. Renal pyramids infarct, and nephrons are destroyed. The cortex atrophies, and the remaining kidney scars (tubulointerstitial fibrosis) and becomes dysfunctional.

57
Q

calculi

A

Made of crystals, proteins or other substances; classified by the primary substance from which they are formed
Can be in the kidney or urinary tract (ureters, urethra, bladder)

58
Q

calculi clinical presentation:

A

renal colic‐ severe, off‐and‐on flank pain, urinary urgency, frequency, blood in urine

59
Q

Calcium oxalate and calcium phosphate calculi

A

calcium and oxalate precipitate to form stone in the renal pelvis. Cutting dietary calcium is NOT recommended since dietary calcium binds dietary oxalate in the gut – the gut can handle some “stones”

60
Q

Lower Urinary Tract Obstruction 4

A

Disorders of the bladder‐ primarily of urine storage or emptying
• Incontinence
• Neurogenic bladder
• Urethral obstruction: stricture, prostate enlargement, tumor
• Pregnancy‐related

61
Q

UTI

A

Inflammation of urinary epithelium usually caused by gut bacteria
Can occur anywhere along the urinary tract
treated with antibiotics

62
Q

UTI symptoms

A

frequency, dysuria, urgency, and low back and/or suprapubic pain or asymptomatic

63
Q

Urine culture of specific microorganisms

A

with counts of 10,000/ml

or more

64
Q

Complicated UTI presents with

A

fever, develop when there is an abnormality in the urinary tract and/or a condition that compromises ability to defend against infection (spinal cord injury, HIV, DM)

65
Q

Cystitis:

A

bladder inflammation

66
Q

Pyelonephritis:

A

inflammation of upper urinary tract

67
Q

Recurrent UTI :

A

3+ UTIs in 12 mos or 2+ in 6 mos

68
Q

uti risk factors

A

Premature newborns, pre‐pubertal children, pregnant and sexually active females, females treated with antibiotics (disrupt vaginal flora), spermicide users, estrogen‐deficient post‐menopausal women, individuals with indwelling catheters, people with diabetes mellitus, neurogenic bladder, urinary obstruction.

69
Q

protective urinary mechanisms for UTI

A

Washed out of the urethra during urination
• Low pH and high osmolality of urea
• Secretions from the uroepithelium: Bactericidaleffect
• Women: Mucus‐secreting glands
• Men:Length of the male urethra

70
Q

Glomerulopathies

A

• Disorders that directly affect the

significant cause of chronic kidney disease and end‐stage renal failure worldwide.

71
Q

Acute Glomerulonephritis

A

Inflammation of the glomerulus

72
Q

primary glomerular injury:

A

immunologic responses, ischemia, free

radicals, drugs, toxins, vascular disorders, infection

73
Q

Secondary glomerular injury:

A

result of systemic diseases, including diabetes mellitus, systemic lupus erythematosus,

74
Q

Patho of glomerulonephritis

A

Formation of immune complexes (antigen/antibody) in the circulation with
subsequent deposition in glomerulus
Antibodies produced against the organism that cross‐react with the glomerular endothelial cells

75
Q

Glomerulonephritis effects

A

Decreased glomerular filtration rate (GFR)
– Decreased glomerular perfusion (glomerular blood flow) as a result of inflammation – Glomerular sclerosis (scarring)
– Thickening of the glomerular basement membrane, but increased permeability to proteins and red blood cells

76
Q

Nephrotic

A

massive loss of protein
frothy urine
anasarca
urine contains massive amounts of proteins/microscopice amount or no blood

77
Q

nephritic syndrome

A

Usually also extra‐renal syndromes (lupus, history of strep, goodpastures also affects lung)
Urine contains massive amounts of blood and varying degrees of protein, which is not usually severe

Pathophysiology (6 decks)

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