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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
How are resistance and pressure
They are affected in same direction
26
Neural regulation BP decreases
aortic baroreceptors sense it, increase sympathetic | output (epinephrine), which results in vasoconstriction and decreases GFR
27
Decreased GFR diminishes
excretion of Na and H2O, resulting in increase in blood volume...increasing BP
28
Angiotensin II
Produced sustemically and within kidneys; constricts afferent and efferent arterioles decreases RBF and GFR
29
Function of PCT
reabsorption of most ions; active transport
30
Loop of Henle | Thin
Descending-highly permeable to water, not ion, no active transport
31
Loop of Henle | Thick
ascending-actively transports ions into interstitium and passes urine into the DCT
32
Distal convoluted tubule (DCT):
reabsorption and secretion of ions, creates dilute | fluid. Secretes H+ contributing to acid‐base balance.
33
Collecting duct:
Principal cells (reabsorb Na+ and H20, secrete K+); intercalated cells (secrete H+ and reabsorb K+)
34
Concentration/dilution of urine occurs mainly
in the loop, DCT and collecting duct.
35
Diuretics
enhance urine flow they interfere with renal Na reabsorption and decrease extracellular fluid volume
36
Glucose
normally entirely reabsorbed should be negative
37
Nitrates:
should be negative, positive with some bacteria
38
Ketones
By products of fat breakdown. Positive in starvation and diabetic ketoacidosis
39
Albumin
Normally doesn't make it past glomerulus. Positive in glomerular failure
40
Hemoglobin
Normally not free, positive in RBC breakdown
41
Myoglobin
Normally not free, positive in muscle breakdown
42
Leukocyte esterase
Enzyme in white blood cells normally not present in urine, should be negative
43
Urine Sediment
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
Blood Urea Nitrogen
- 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
As BUN levels increase
GFR drops
46
Normal BUN level in adults
10-20mg/dL
47
Normal plasma creatinine
.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
GFR declines what happens to creat
creat increases proportionally
49
Creatinine Clearance
- Estimates GFR | - Requires 24‐hour volume or urine and 1 blood draw for plasmacreatinine
50
GFR formula
Urine Creat x Urine Volume)/Plasma Creat
51
Renal and urinary function can be affected by a variety of disorders including
Infection (most common) Obstruction by stones, tumors, or inflammatory edema Dysfunction from kidney disorders or systemic disease
52
Urinary tract obstruction
- 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
Upper Urinary Tract Obstruction
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
Causes of upper urinary tract obstruction
Stones *, compression from abnormal vessel, tumor, abdominal inflammation and scarring
55
upper urinary tract obstruction effect on GFR
Increased pressure transmits back to glomerulus, decreasing glomerular blood flow and ultimately, GFR
56
Hydronephrosis
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
calculi
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
calculi clinical presentation:
renal colic‐ severe, off‐and‐on flank pain, urinary urgency, frequency, blood in urine
59
Calcium oxalate and calcium phosphate calculi
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
Lower Urinary Tract Obstruction 4
Disorders of the bladder‐ primarily of urine storage or emptying • Incontinence • Neurogenic bladder • Urethral obstruction: stricture, prostate enlargement, tumor • Pregnancy‐related
61
UTI
Inflammation of urinary epithelium usually caused by gut bacteria Can occur anywhere along the urinary tract treated with antibiotics
62
UTI symptoms
frequency, dysuria, urgency, and low back and/or suprapubic pain or asymptomatic
63
Urine culture of specific microorganisms
with counts of 10,000/ml | or more
64
Complicated UTI presents with
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
Cystitis:
bladder inflammation
66
Pyelonephritis:
inflammation of upper urinary tract
67
Recurrent UTI :
3+ UTIs in 12 mos or 2+ in 6 mos
68
uti risk factors
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
protective urinary mechanisms for UTI
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
Glomerulopathies
• Disorders that directly affect the | significant cause of chronic kidney disease and end‐stage renal failure worldwide.
71
Acute Glomerulonephritis
Inflammation of the glomerulus
72
primary glomerular injury:
immunologic responses, ischemia, free | radicals, drugs, toxins, vascular disorders, infection
73
Secondary glomerular injury:
result of systemic diseases, including diabetes mellitus, systemic lupus erythematosus,
74
Patho of glomerulonephritis
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
Glomerulonephritis effects
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
Nephrotic
massive loss of protein frothy urine anasarca urine contains massive amounts of proteins/microscopice amount or no blood
77
nephritic syndrome
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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