intro to nephro Flashcards

1
Q

Glomerulus

A

tuft of capillaries interposed between the afferent and efferent arterioles-housed in an epithelial cell capsule: bowmans capsule.

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2
Q

filtrate must pass through 3 layers

A

fenestrated endothelial cell, glomerular basement membrane, epithelial cell

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3
Q

JGA

A

contains macula densa and JG cells located in the afferent arteriole. JGA cells also synthesize and store prorenin which is cleaved into active renin and secreted into the afferent arteriole in response to renal hypoperfusion

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4
Q

tubuloglomerular feedback

A

mechanism of autoregulation. mediated by cells in the macula densa which sense the change in NaCl delivery. this helps to regulate GFR.

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5
Q

functions of the kidney

A
regulate volume and composition
adjusting excretion of water and electrolytes
excretion of waste and metabolic breakdown products
hormonal regulation
EPO production
Vitamin D metabolism
renin angiotensin aldosterone axis
regulation of low BP or blood volume
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6
Q

hormonal regulation-kidney function

A

metabolic degradation of peptide hormones such as pituitary hormones, glucagon, insulin

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7
Q

renin-angiotensin-aldosterone axis

A

renin is produced in JGA cells from prorenin. It is secreted into the afferent arteriole in response to various stimuli which cause renal hypoperfusion such as low BP, and decreased effective circulating volume.

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8
Q

Renin converts angiotensin 1->2 which causes:

A
systemic vasoconstriction (raising systemic BP)
Na and water re absorption in PT which helps to restore volume
Secretion of aldosterone
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9
Q

upper urinary tract symptoms of renal disease

A

flank pain or tenderness: renal infection, infarction, GN, rarely obstruction

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10
Q

Lower urinary tract infection symptoms

A

dysuria, frequency, urgency

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11
Q

bladder outflow obstruction symptoms

A

impaired urinary flow, hesitancy, dribbling, incomplete emptying of bladder

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12
Q

sphincter or bladder wall dysfunction symptoms

A

urinary retention, incontinence, enuresis

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13
Q

increased urine pH think:

A

infection with urea splitting organism

systemic alkalosis, renal tubular acidosis, carbonic anhydrase inhibitors

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14
Q

urinalysis finding of protein in urine

A

persistent indicates renal disease.

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15
Q

BUN

A
increases seen with
*dietary intake (high protein)
*high catabolic rate and tissue breakdown (hemorrhage, trauma, glucocorticoid therapy)
*dehydration
normal to low
*muscle wasting and liver disease
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16
Q

GFR estimation

A

24 hour creatinine clearance most common

also can use cockcroft-gault or MDRD formula

17
Q

cockcroft-gault equation

A

(140-age) X (body weight in kg)/72 X SCr (women multiply result of .85

18
Q

renal ultrasound is used for:

A

assess size, shape, and location of kidneys.

  • masses
  • obstruction/hydronephrosis
  • fluid collections or other signs of inflammation/infection
  • MAY detect nephrolithiasis
19
Q

indications for renal ultrasound

A

hematuria, acute kidney injury, flank pain, safe during pregnancy

20
Q

intravenous pyelogram

A
  • contrast is administered via IV
  • helpful in identifying obstruction and stones
  • contrast CT has taken its place in most institutions
  • risk of contrast induced nephropathy
21
Q

CT scan

A
  • helpful in evaluation of stones, renal masses, complex cysts, perinephric and vascular pathology
  • CI is pregnancy and no contrast with renal disease
  • gold standard for nephrolithiasis and doesn’t require contrast
22
Q

renal MRI indications

A

hematuria, renal mass, suspected renal vascular issue

23
Q

MRI is better than CT for:

A

characterizing abnormal tissues/masses especially when there is concern for malignancy.

24
Q

cystoscopy indications

A
  • frequent UTIs
  • hematuria
  • incontinence or overactive bladder
  • painful urination, chronic pelvic pain, or interstitial cystitis
  • nephrolithiasis that is obstructing and unlikely to pass
  • mass, polyp, suspected malignancy
25
Q

voiding cystourethrogram (VCUG)

A

a radiologic study during which a radiologist observes contrast movement from the bladder and urethra.
-looking for signs of vesicoureteral reflux, extravasation of contrast or obstacle to bladder emptying.

26
Q

indications for VCUG

A

recurrent UTI, bladder trauma or rupture, suspected obstruction