Kidney and Glomerular Disorders Flashcards
What are the 5 main functions of the kidneys
o Excretion of metabolic waste
o Adjustment of blood pH by excretion of acid
o Adjustment of plasma salt concentration by excreting salt and water
o Adjustment of blood volume and blood pressure by secretion of renin
o Stimulation of RBC production by secretion of renin and erythropoietin
What is the functional unit of the kidney
Nephron
Describe the flow of fluid in the kidney
• The fluid come through the kidney via the afferent arteriole
o The pressure is high
• The fluid leave the glomerulus through the efferent arteriole
These cells provide support to the kidney
Mesengeal cells
These cells notice pressure changes
Juxtaglomerular cells
How do juxtaglomerular cells respond to changes in pressure
o They secrete renin in response to low blood pressure
o This begins the RAA cascade system
What layer is associated with the basement membrane
Visceral layer
Describe Bowmans capsule
- Were solutes are moved across (water, salt, and glucose)
* Proteins and RBC can’t pass through because they are too large
This is a large volume of unprocessed fluid
Glomerular filtration
Describe the movement of fluid in the glomerulus
It crosses from the blood into the urinary space of the glomeruls
This is the fluid that is reabsorbed
Glomerular filtrate
This is the fluid that remains and is not absorbed
Urine
Describe GFR
o Decreases with age because nephrons die as you age
o If you have diabetes, hypertension, or atherosclerosis your nephrons die sooner
o Usually greater than 100 for a healthy person
T/F- The kidney will reabsorb glucose
True
What is an example of a problem reabsorbing glucose
Diabetes
Describe the effects of hyperglycemia on urine
- people with hyperglycemia will secrete glucose and spill it in their urine (diabetics)
- As a result of glucose in the urine- your body wants to dilute it so it draws more water out into the urine
What does urine contain
- Creatinine
- Urea
What does the urine not contain
- Blood
- Sugar
- Protein
What does it mean if you have creatinine in your urine?
- Muscle breakdown byproduct
- If this is high your kidneys aren’t filtering properly
What are things looked at in a urine test?
Bacteria, bile, bile pigments, color, clarity, glucose, blood, ketones, sediment, odor, pH, protein, specific gravity
How is a urinalysis done
Dipstick
What is measured in a urinalysis
pH, blood, protein, sugar, ketone, nitrites, glucoesterase, glucose (diabetic)
Describe when ketone is found in urine
o High in people that haven’t eaten or people with eating disorders
What does microscopic examination of the urine detect
- WBC
- Bacteria
- Crystals
- Protein casts
- Abnormal cells in the urine
A renal disorder that…
o Non-symptomatic but you have abnormal labs
o Has elevated BUN and creatinine but no symptoms
Axotemia
A renal disorder that... o Renal failure with signs and symptoms o Abnormal labs o Elevated BUN, creatinine, hypertension, edema, oliguria o Decreased RBC due to decreases EPO o Hypertension- increases Renin
Uremia
A renal disorder that…
Can develop in days or weeks
o Reversible- if kidney damage goes over a threshold that you have destroyed enough nephrons that it can escalate to chronic (fall in GFR)
o Hypoperfusion- causes kidney to decrease
o Resuscitates with fluids
Acute renal disorder
A renal disorder that…
o Takes longer to happen
o Persistent acute renal failure
o You can have chronic renal failure with azotemia
o Kidneys are atrophied- because they are under perfused
Chronic Renal Disorder
Describe nephritic syndrome
o Decreased urine, hematuria, hypertension, oliguria
o BLOOD
o Glomerular inflammation
o Always involves the glomerulus
o Chronic glomerulonephritis is end stage chronic glomerular disease
o Glomerular disease can be secondary to systemic disease
Describe nephrotic syndrome
o Marked proteinuria- this causes hypoalbuminemia- causes generalized edema
o Results from glomerular injury-
o Results in osmotic edema- because you are losing protein (low albumin)
Lose protein- lose the ability of fluid to stay in
Fluid restriction- because they can’t keep fluid in the intravascular space
Kidney patients are swollen because they retain fluid fast
They can go into heart failure really quick
Remove the fluid- or have it taken off
o LOSE PROTEINNNNNNN!!!
o You can see protein cased- example of how protein is spilled out
Describe lupus nephritis
o Type 3 hypersensitivity
o Complexes deposit into different areas
What are the majority of glomerular diseases caused by?
Type 3 hypersensitivities
What does autoimmune glomerular disease result in?
o Leads to primary glomerular disease
o Antibody antigen causes compliment and that causes inflammation
o Continual injury can lead from acute to chronic and can cause scarring
o The injury causes leaky vessels
A type of glomerular nephritis that…
o Autoimmune
o Complexes settle in your kidneys and causes the acute nephritic syndrome
o Causes blood in the urine
Poststreptococcal Gomerular nephritis
Type of glomerular nephritis that…
o Is the most common cause of nephrotic syndrome
o Immunoglobulin deposits cause thickening of basement mem
o Can be limited and managed
Membranous Glomerular nephritis
Type of glomerular nephritis that…
o Progressive and rapid
o Worsening of glomerular nephritis
o These patients end up on dialysis
Crescentic
Type of glomerular nephritis that…
o most common cause for secondary kidney disease
o Can lead to diabetic disease
o Monitor for protein
o They can lose the function to the kidney
o Proteins deposit into the capillaries and interfere with filtering process
Diabetic Glomerular Sclerosis
Describe ATI (Acute tubular necrosis)
o Getting injury- could be due to shock, toxins, myoglobin (seen a lot- myoglobin is part of muscles- elevated during muscle breakdown) aka rhabdomylisis- this causes acute injury to the kidneys- so the BUN and creatinine are high
o Ischemia can cause this
o CHF
Describe Chronic Tubular Necrosis
o Chronic anti-inflammatories
o Get pale cortex
o Get acute renal failure
o Can get azotemia with acute renal failure
What are the 3 causes of Chronic Tubular necrosis
- Pre-renal
- Renal
- Post-Renal
Describe pre-renal chronic tubular necrosis
Not getting volume to the kidney- the problem is caused when the liquid is not getting to the kidney
Decreased perfusion, dehydration, hemorrhage
Ex. CHF
Describe renal chronic tubular necrosis
Disease in the kidney itself
Ex. Mass in kidney
Describe post-renal chronic tubular necrosis
Obstructive force
Ex. Enlarged prostate because the urethra goes right through the prostrate- you get a backflow of urine- this can cause dilation of the ureter
Kidney stone- hydronephosis- fluid around the kidney and this can cause infection
Manage the amount of urine- and relate that to the kidney function
What are the 2 types of tubular and Interstitial disorders
- Acute
- Chronic
Describe causes of acute tubular injury
Shock
Toxin
Myoglobin
Drugs
Describe causes of chronic tubular injury
-Analgesic nephropathy
Describe secondary TID
A consequence of some other condition
What are 3 examples of secondary TID
o Infection
o Reflux
o Obstruction
