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Pathophysiology > Kidney and Glomerular Disorders > Flashcards

Kidney and Glomerular Disorders Flashcards

1
Q

What are the 5 main functions of the kidneys

A

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

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2
Q

What is the functional unit of the kidney

A

Nephron

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3
Q

Describe the flow of fluid in the kidney

A

• The fluid come through the kidney via the afferent arteriole
o The pressure is high
• The fluid leave the glomerulus through the efferent arteriole

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4
Q

These cells provide support to the kidney

A

Mesengeal cells

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5
Q

These cells notice pressure changes

A

Juxtaglomerular cells

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6
Q

How do juxtaglomerular cells respond to changes in pressure

A

o They secrete renin in response to low blood pressure

o This begins the RAA cascade system

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7
Q

What layer is associated with the basement membrane

A

Visceral layer

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8
Q

Describe Bowmans capsule

A
  • Were solutes are moved across (water, salt, and glucose)

* Proteins and RBC can’t pass through because they are too large

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9
Q

This is a large volume of unprocessed fluid

A

Glomerular filtration

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10
Q

Describe the movement of fluid in the glomerulus

A

It crosses from the blood into the urinary space of the glomeruls

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11
Q

This is the fluid that is reabsorbed

A

Glomerular filtrate

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12
Q

This is the fluid that remains and is not absorbed

A

Urine

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13
Q

Describe GFR

A

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

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14
Q

T/F- The kidney will reabsorb glucose

A

True

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15
Q

What is an example of a problem reabsorbing glucose

A

Diabetes

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16
Q

Describe the effects of hyperglycemia on urine

A
  • 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
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17
Q

What does urine contain

A
  • Creatinine

- Urea

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18
Q

What does the urine not contain

A
  • Blood
  • Sugar
  • Protein
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19
Q

What does it mean if you have creatinine in your urine?

A
  • Muscle breakdown byproduct

- If this is high your kidneys aren’t filtering properly

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20
Q

What are things looked at in a urine test?

A

 Bacteria, bile, bile pigments, color, clarity, glucose, blood, ketones, sediment, odor, pH, protein, specific gravity

21
Q

How is a urinalysis done

A

Dipstick

22
Q

What is measured in a urinalysis

A

pH, blood, protein, sugar, ketone, nitrites, glucoesterase, glucose (diabetic)

23
Q

Describe when ketone is found in urine

A

o High in people that haven’t eaten or people with eating disorders

24
Q

What does microscopic examination of the urine detect

A
  • WBC
  • Bacteria
  • Crystals
  • Protein casts
  • Abnormal cells in the urine
25
Q

A renal disorder that…
o Non-symptomatic but you have abnormal labs
o Has elevated BUN and creatinine but no symptoms

A

Axotemia

26
Q 
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
A

Uremia

27
Q

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

A

Acute renal disorder

28
Q

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

A

Chronic Renal Disorder

29
Q

Describe nephritic syndrome

A

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

30
Q

Describe nephrotic syndrome

A

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

31
Q

Describe lupus nephritis

A

o Type 3 hypersensitivity

o Complexes deposit into different areas

32
Q

What are the majority of glomerular diseases caused by?

A

Type 3 hypersensitivities

33
Q

What does autoimmune glomerular disease result in?

A

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

34
Q

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

A

Poststreptococcal Gomerular nephritis

35
Q

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

A

Membranous Glomerular nephritis

36
Q

Type of glomerular nephritis that…
o Progressive and rapid
o Worsening of glomerular nephritis
o These patients end up on dialysis

A

Crescentic

37
Q

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

A

Diabetic Glomerular Sclerosis

38
Q

Describe ATI (Acute tubular necrosis)

A

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

39
Q

Describe Chronic Tubular Necrosis

A

o Chronic anti-inflammatories
o Get pale cortex
o Get acute renal failure
o Can get azotemia with acute renal failure

40
Q

What are the 3 causes of Chronic Tubular necrosis

A
  • Pre-renal
  • Renal
  • Post-Renal
41
Q

Describe pre-renal chronic tubular necrosis

A

 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

42
Q

Describe renal chronic tubular necrosis

A

 Disease in the kidney itself

 Ex. Mass in kidney

43
Q

Describe post-renal chronic tubular necrosis

A

 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

44
Q

What are the 2 types of tubular and Interstitial disorders

A
  • Acute

- Chronic

45
Q

Describe causes of acute tubular injury

A

 Shock
 Toxin
 Myoglobin
 Drugs

46
Q

Describe causes of chronic tubular injury

A

-Analgesic nephropathy

47
Q

Describe secondary TID

A

A consequence of some other condition

48
Q

What are 3 examples of secondary TID

A

o Infection
o Reflux
o Obstruction

Pathophysiology (18 decks)

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