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830 > Kidney Disease Patho > Flashcards

Kidney Disease Patho Flashcards

1
Q

Kidneys

A
  • Paired, retroperitoneal organs just above the lower edge of ribs bilaterally
  • Received 20-25% of cardiac output
  • Functional units = nephrons
  • Born with ~1 million/kidney, do NOT regenerate
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2
Q

AKI

A
  • Acute Kidney Injury
  • Abrupt/rapid decrease in kidney functional
  • Possibly reversible if correct early
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3
Q

CKD

A
  • Chronic Kidney Disease
  • Progressive decrease in kidney function
  • Often irreversible
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4
Q

Types of AKI

A
  1. Prerenal
  2. Intrinsic - focus on drug-induced causes
  3. Postrenal
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5
Q

Prerenal AKI

A
  • Volume depletion - hemorrhage, GI losses, renal losses, skin loss, etc.
  • Decrease in BV - decreased CO, pulmonary hypertension, valvular disease, liver failure, sepsis, etc.
  • Functional - NSAIDs, ACEIs, ARBs, etc.
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6
Q

Intrinsic AKI

A
  • Vascular damage
  • Glomerular damage
  • Acute tubular necrosis
  • Acute interstitial nephritis
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7
Q

AKI Patho

A
  • Common denominator: decreased renal blood flow
  • Prerenal: compromised kidney perfusion leads to decreased GFR
  • Intrinsic: glomerular/tubular injury causing release of renal afferent arteriole vasoconstrictors
  • Postrenal: obstruction of urinary tract increases tubular pressure and decreases the filtration driving force
  • Decreased renal blood flow leads to cell ischemia and death
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8
Q

Glomerularnephritis

A

Causes by immune diseases, infections, and drugs
-Immune diseases: lupus, IgA nephropathy
-Infections: Stept, bacterial endocarditis
-Drugs: chronic heroin abuse
Symptoms: proteinuria, hematuria, edema, increased blood pressure, RBCs = mickey mouse

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9
Q

Polycystic Kidney Disease

A
  • Hereditary
  • Form noncancerous fluid-filled sacs
  • Disrupts kidney function
  • Presentation: enlarged abdomen, flank pain, hematuria, frequent UTI, increased BP
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10
Q

Other Diseases Causing AKI

A
  • Urinary tract obstruction: BPH
  • Anatomic urinary tract abnormalities - reflux
  • Recurrent UTI
  • Kidney stones
  • Unrecovered AKI
  • Drug-induced kidney disease
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11
Q

CKD Hypothesis

A
  • Initial kidney injury via decreased nephron mass or increased metabolic demand
  • Increased workload for remaining nephrons to maintain similar level of solute excretion
  • Residual nephrons compensate (renal reserve) => hypertrophy and hyperfiltration
  • Typically signs/symptoms are absent early on
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12
Q

Adaptions = Maladaptive

A
  • Residual nephron hyperfilter and hypertrophy to maintain GFR but also progress CKD
  • Increases glomerular capillary pressure, damages capillaries, leads to glomerulosclerosis
  • Signs/symptoms may not be apparent until 75% of nephrons or more are lost
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13
Q

Functions of Kidney (6)

A
  1. Waste Product Excretion: removal of urea, creatinine, drugs, etc.
  2. Bone Structure: vitamin D activation, calcium/phosphorous balance
  3. Blood Formation: EPO synthesis
  4. Blood Pressure: renin synthesis, sodium removal, water balance
  5. Acid-Base Regulation: H+/NH4+/HCO3- balance
  6. Cardiac Activity: potassium balance
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14
Q

AKI Definition

A
  • Increased SCr >= 0.3 mg/dL within 48 hours
  • Increased SCr >= 1.5 from baseline within 7 days
  • Decreased urine volume <0.5 mL/kg/hour for 6 hours
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15
Q

CKD Definition

A

-Abnormalities in kidney structure/function preset for 3 or more months
AND
-Implications for health
-Could also be defined by structural abnormalities AND/OR eGFR decreases

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16
Q

Uremia

A
  • Accumulation of nitrogenous waste products
  • Tons of symptoms associated with ESRD
  • Slide 18
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17
Q

AKI/CKD Relationships

A

AKI

  • Increased risk of CKD/ESRD
  • Possible AKI outcomes: GFR returning to baseline, decreased GFR, ESRD

CKD

  • Increased risk of AKI
  • *Go hand in hand**
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18
Q

Assessment of Kidney Function Options

A
  • Blood urea nitrogen (BUN)

- SCr

19
Q

BUN

A
  • Concentration increases in bloodstream as kidney function decreases
  • Less useful than SCr since it can be affects by outside factors
20
Q

Factors that Raise BUN

A
  • High protein diets
  • Corticosteoids and tetracyclines (catabolic effects)
  • Upper GI bleed
  • Dehydration
21
Q

Factors that Lower BUN

A
  • Malnourished

- Liver disease

22
Q

Cockcroft Gault Equation Information

A
  • Estimates kidney function in adults for medication dosing
  • Use IBW for normal weight patients, ABW for obese patients, and TBW for underweight patients for BW in equation
  • CrCl: mL/min
  • BW: kg
  • SCr: mg/dL
23
Q

Cockcroft Gault Equation

A

CrCl = [(140-age) * BW/72 * SCr] * (0.85 if female)

24
Q

MDRD Equation

A
  • Estimates GFR normalized to 1.73 m^2

- Used to stage CKD and for drug dosing

25
Q

CKD-EPI Equation

A
  • eGFR standardized
  • K = 0.7 for females and 0.9 for males
  • alpha = -0.329 for females and -0.411 for males
26
Q

Urinalysis

A
  • Tested for physical and chemical characteristics, microscopic exam of voided urine
  • Helps with diagnosis of renal disease and could contain early warning signs
27
Q

Macroscopic Analysis of Urine

A
  • Color
  • Clarity
  • Smell
28
Q

Color

A
  • Can change dramatically based on hydration and urine concentration
  • Color varies from colorless to dark yellow normally
29
Q

Red => Orange Urine Causes

A
  • Myoglobin: crush injuries, seizures, cocaine-induced muscle damage
  • Hgb/RBC: hemolysis (drugs, strenuous exercise), menstruation contamination, kidney stones
  • Food: carrots, beets, rhubarb
  • Drugs: rifampin, azo
30
Q

Brown => Black Urine Causes

A
  • Myoglobin: crush injuries, seizures, cocaine-induced muscle damage
  • Bile pigments: hemolysis, bleed into tissues, liver disease
  • Drugs: metronidazole, nitrofuratoin
31
Q

Blue => Green Urine Causes

A

-Drugs: Propofol and Amitriptyline

32
Q

Clarity

A
  • Normal = clear
  • Turbidity: sign of excessive cellular material from crystals or infection
  • Foam: proteinuria
33
Q

Formed Elements in Urine

A
  • Cells, casts, or crystals
  • Microorganisms: contamination, UTI
  • Reference: 0 to trace
34
Q

Cells in Urine

A

RBCs: reference = 0-3/hpf
-glomerulonephritis, infection, stones, polycystic disease

WBCs: reference = 0-2/hpf
-UTI, pyelonephritis, eosinophilurea

Tubular epithelial: reference = 0-1/hpt
-Tubular damage => acute tubular necrosis

Squamous cells
-Lower genital tract or skin contamination

35
Q

Casts

A
  • Cylindrical mass of proteins and/or cells
  • Few clear casts = normal
  • RBCs always pathological: renal hematuria, glomerulonephritis
  • WBCs - pyelonephritis or acute interstitial nephritis
  • Granular: pathogenic, acute tubular necrosis
36
Q

Crystals

A
  • Stores: calcium oxalate, uric acid, cystine

- Drugs: acyclovir, sulfonamides

37
Q

Urine Chemistry Elements

A
  • pH
  • Specific Gravity
  • Protein
  • Glucose
  • Ketone
  • Nitrite
  • Leukocyte estrase
38
Q

pH + Urine

A
  • Reference = 5-8

- Changes from acid-base disorders, various diseases, and drugs

39
Q

Specific Gravity + Urine

A
  • Reference = 1.003-1.030
  • Measures urine concentrating capability of kidneys
  • Low specific gravity occurs with diabetes insipidus
  • High specific gravity with syndrome of inappropriate antidiuretic hormone
40
Q

Protein + Urine

A
  • Reference = negative
  • Marker of kidney damage
  • Mild: 0 to +1 (10-30 mg/dL)
  • Moderate: +2 to +3 (100-300 mg/dL)
  • Overt: +4 (>2000 mg/dL
41
Q

Glucose + Urine

A
  • Reference = negative
  • Once blood glucose exceeds 180 mg/dL, more will appear in urine than normal
  • Due to uncontrolled DM
42
Q

Ketone + Urine

A
  • Reference = negative
  • Diabetic ketoacidosis
  • Fasting starvation
  • High ketone diets
43
Q

Nitrite + Urine

A
  • Reference = negative
  • Nitrate converted to nitrite by bacteria
  • Usually a marker of UTIs or other bacterial infections
44
Q

Leukocyte Estrase + Urine

A
  • Reference = negative
  • Enzyme released from white blood cells
  • Suggestive of UTI or other infection

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