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patho exam 4 > kidneys > Flashcards

kidneys Flashcards

1
Q

urine formation involves

A

filtration and tubular reabsorption

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2
Q

how do the kidneys regulate pH?

A

conserving HCO3- and eliminating H+

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3
Q

Renin-angiotensin-aldosterone mechanism (endocrine function)

A

BP regulation.
Angiotensin II: vasoconstrictor. acts on kidneys to decrease salt and water excretion. Also stimulates aldosterone.
Aldosterone: increases sodium reabsorption.

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4
Q

Erythropoietin (endocrine function)

A

regulation of RBC production.

people with end-stage kidney disease are often anemic because of an inability of the kidneys to produce erythropoietin

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5
Q

Vitamin D (endocrine function)

A

activated vitamin d. assists with calcium homeostasis

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6
Q

urine is a

A

clear, amber-colored fluid that is 95% water and 5% solutes

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7
Q

kidneys produce how much urine daily?

A

1.5 L

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8
Q

first voided urine specimens are good for

A

qualitative protein and specific gravity testing

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9
Q

most reliable urine specimen?

A

freshly voided

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10
Q

usual range for specific gravity?

A

1.010-1.025

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11
Q

specific gravity indicates

A

functional ability of the kidneys and hydration status. varies with concentration of solutes

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12
Q

how can the GFR be measured?

A

collection of timed samples of blood and urine

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13
Q

creatinine levels are a good measure of

A

the GFR

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14
Q

normal creatinine clearance is & role of creatinine

A

product of muscle mass and 115-125 mL/min

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15
Q

serum creatine levels are a good reflection of

A

GFR

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16
Q

blood tests in renal failure

A

Increased: blood urea nitrogen, K+, phosphate, and creatinine
Decreased: pH. Ca2+, and HCO3-

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17
Q

normal serum creatinine level indicates

A

normal renal function

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18
Q

serum creatinine levels used for

A

estimation of functional ability of kidneys

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19
Q

blood urea nitrogen (BUN)

A

end product of protein metabolism

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20
Q

BUN is related to

A

GFR

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21
Q

BUN is influenced by

A

GI bleeds, protein intake, and hydration status.

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22
Q

cystoscopy

A

visualization of bladder via insertion of cystoscope through the urethra to visualize urethra, bladder, and insertional sites.
Biopsy specimens, lesions, small stones, and foreign bodies via cystoscope.

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23
Q

ureteroscopy

A

smaller, thinner scope to remove stones from the ureter and aid ureteral strictures.

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24
Q

ultrasonography

A

visualize structures of kidneys

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25
Q

radiograph

A

determines shape, size, and position of the kidneys and observe radiopaque stones.

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26
Q

rise in serum creatinine to 3x normal value

A

means 75% renal function loss

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27
Q

creatinine levels 10mg/dL or more

A

90% renal function loss

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28
Q

ADPKD (autosomal dominant polycystic kidney disease)

A

most common hereditary form of renal cystic disease. results in the formation of destructive fluid-filled cysts in the kidney and other organs.

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29
Q

Other structures affected in ADPKD?

A

liver and less commonly the pancreas and spleen.

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30
Q

Possible mutations in ADPKD

A

GANAB gene and PKD1 and PKD2

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31
Q

ADPKD is the fourth leading cause of

A

end-stage renal disease in the US.

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32
Q

ADPKD has cysts that arise in

A

renal tubules from a few epithelial cells that have a high proliferation rate and are undifferentiated

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33
Q

What contributes to the destruction of normal kidney tissue in ADPKD?

A

apoptotic loss of renal tubular cells and accumulation of inflammatory mediators

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34
Q

What allows for dilation and cyst formation in ADPKD?

A

defective basement membrane underlying abnormal epithelium

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35
Q

Progress of ADPKD is

A

slow and end-stage renal failure is uncommon for adults before 40 years.

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36
Q

Initial manifestations of ADPKD

A

asymptomatic with normal kidney and liver formation

37
Q

progression of ADPKD

A

pain from enlarging cysts, hematuria from bleeding cysts, infected cysts from ascending UTIs, and hypertension

38
Q

The kidneys in people with ADPKD appear

A

enlarged with external contours distorted by cysts and are filled with straw-colored fluid.

39
Q

Extrarenal manifestations of ADPKD

A

aneurysms (frequent)

40
Q

Serious complications of ADPKD

A

subarachnoid or intracerebral hemorrhages can lead to death

41
Q

Renal calculi (kidney stones)

A

most common cause of upper urinary tract obstruction

42
Q

Kidney stones are

A

polycrystalline aggregates comprising materials that the kidneys normally excrete in the urine

43
Q

Factors that contribute to stone formation

A

supersaturated urine, presence of a nucleus (nidus) for crystal formation, and deficiency of inhibitors of stone formation

44
Q

supersaturations depends on

A

urinary pH, temperature, solute concentration, ionic strength, and complexation

45
Q

some people can experience supersaturation of their urine without kidney stone development due to

A

presence of natural stone inhibitors which include magnesium and citrate

46
Q

types of stones

A

calcium stones (oxalate or phosphate), magnesium ammonium phosphate stones, uric acid stones, and cystine stones

47
Q

Most kidney stones are

A

calcium stones- calcium oxalate, calcium phosphate, or combination of both

48
Q

calcium stones are associated with

A

increased concentrations of calcium in the blood and urine which can be caused by bone resorption due to immobility, bone disease, hyperparathyroidism, and renal tubular acidosis.

49
Q

uric acid stones are associated with

A

increased BMI and low urine pH.

50
Q

magnesium ammonium phosphate stones (struvite stones) form only in

A

alkaline urine (pH > 7.0) and in the presence of bacteria that possess the enzyme urease (splits urea into ammonium and CO2).

51
Q

how do struvite stones form?

A

phosphate levels in alkaline urine increase and magnesium is always present in the urine

52
Q

struvite stones are called what due to their shape?

A

staghorn stones

53
Q

magnesium ammonium phosphate stones are associated with

A

UTIs caused by urease-producing bacteria.

54
Q

struvite stones are too large to pass through urine and require

A

lithotripsy or surgical removal

55
Q

uric acid stones develop in conditions of

A

gout and high concentrations of uric acid in the urine. Form most readily in acidic urine.
hyperuricosuria also may contribute to calcium stone formation by acting as a nucleus for calcium oxalate stone formation.

56
Q

uric acid stones are not visible on

A

x-ray films

57
Q

Cystine stones represent a significant proportion of

A

childhood calculi and are seen in cystinuria, which results from an autosomal recessive genetic defect in renal transport of cystine so there is a decrease in cystine tubular absorption.

58
Q

cystine stones resemble

A

struvite stones except that infection is unlikely

59
Q

manifestations of UTI (acute cystitis)

A

frequency of urination, lower abdominal or back discomfort, and burning and pain on urination (dysuria). occasionally urine is cloudy and foul smelling.

60
Q

what population is most at risk for UTI development?

A

young sexually active women

61
Q

cause of uncomplicated UTI?

A

E. coli

62
Q

cause of complicated UTI?

A

Klebsiella, enterococcus, enterobacter, proteus, and pseudomonas

63
Q

risk factors for UTI?

A

factors that impact colonization (prior UTI, sexual activity with a new partner, and changes in vaginal flora via pH changes) and obstruction and reflux

64
Q

UTIs in older adults

A

second most common cause of infection

65
Q

UTIs in older adults is related to

A

normal age-related changes associated with immune function increase risk

66
Q

predisposing factors for UTIs in older adults

A

immobility, bladder outflow obstruction (BPH), bladder ischemia caused by urine retention, constipation, senile vaginitis, and diminished bactericidal activity of urine and prostatic secretions

67
Q

most important predictors for UTI in older adults

A

history of UTI

68
Q

Nephrotic syndrome is not a specific glomerular disease but a

A

group of clinical findings that result from increased glomerular permeability and loss of plasma proteins in the urine

69
Q

Nephrotic syndrome is characterized by

A

massive proteinuria, lipiduria, hypoalbulinemia, generalized edema, and hyperlipidemia.
proteinuria (>3.5)
hypoalbuminemia (<3)
hyperlipidemia (cholesterol >300)

70
Q

increase in glomerular permeability in nephrotic syndrome allows

A

proteins from the plasma to escape into the glomerular filtrate.

71
Q

hallmark of nephrotic syndrome?

A

generalized edema

72
Q

acute pyelonephritis is

A

an upper UTI specifically the renal parenchyma and renal pelvis

73
Q

people with the greatest risk for acute pyelonephritis

A

diabetics

74
Q

less frequent and more serious type of acute pyelonephritis

A

necrotizing pyelonephritis: necrosis of renal papillae. common in diabetics and can be a comp. of acute pyelonephritis if there is urinary tract obstruction

75
Q

causative agents of acute pyelonephritis

A

gram-neg bacteria- E.coli and proteus, klebsiella, enterobacter, and peseudomonas

76
Q

factors that contribute to acute pyelonephritis

A

catheterization and urinary instrumentation, vesicoureteral reflux, pregnancy, and neurogenic bladder.

77
Q

manifestations of acute pyelonephritis

A

abrupt onset of chills, high fever, and an ache or tenderness in the costovertebral angle that is unilateral or bilateral. dysuria, frequency, and urgency are also common

78
Q

Wilms tumor is the most

A

common malignant tumor in children around the ages 3-5 and may affect one or both kidneys.

79
Q

Wilms tumor is associated with

A

other congenital anomalies such as aniridia, hemihypertrophy, and anomalies of the genitourinary system

80
Q

Wilms tumor has a 20% familial incidence but what tumor does it affect?

A

WT1 on chromosome 11

81
Q

What are the common signs of Wilms tumor?

A

asymptomatic abdominal mass and hypertension

82
Q

How can Wilms tumor be found?

A

mother discovers it while bathing the child

83
Q

Wilms tumor staging

A

stage 1: limited to kidney and can be excised.
stage 2: extends to renal capsule and can be excised.
stage 3: extends to abdomen.
stage 4: hematogenous metastasis involving the lungs.
stage 5: bilateral involvement when diagnosed

84
Q

renal cell carcinoma

A

is a malignant tumor that accounts for 90% of all primary renal cancers and peaks at 60-70 years of age.

85
Q

risk factors for renal cell carcinoma?

A

correlation between smoking and kidney cancer and obesity particularly in women.

86
Q

renal cell carcinoma - clear cell tumors

A

have a clear cytoplasm and show chromosome 3 deletions, and arise from proximal tubular cells. represent majority of cases

87
Q

renal cell carcinoma - papillary renal cell tumors

A

bilateral and multifocal, show trisonomies 7, 16, and 17 and arise from proximal tubular cells.

88
Q

renal cell carcinoma - collecting duct tumors

A

arise from collecting ducts within renal medulla, are rare, affect younger people, and are very aggressive.

89
Q

patients with calcium oxalate stones should avoid what in their diet?

A

spinach and peanuts

patho exam 4 (2 decks)

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