kidneys Flashcards
1
Q
urine formation involves
A
filtration and tubular reabsorption
2
Q
how do the kidneys regulate pH?
A
conserving HCO3- and eliminating H+
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.
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
5
Q
Vitamin D (endocrine function)
A
activated vitamin d. assists with calcium homeostasis
6
Q
urine is a
A
clear, amber-colored fluid that is 95% water and 5% solutes
7
Q
kidneys produce how much urine daily?
A
1.5 L
8
Q
first voided urine specimens are good for
A
qualitative protein and specific gravity testing
9
Q
most reliable urine specimen?
A
freshly voided
10
Q
usual range for specific gravity?
A
1.010-1.025
11
Q
specific gravity indicates
A
functional ability of the kidneys and hydration status. varies with concentration of solutes
12
Q
how can the GFR be measured?
A
collection of timed samples of blood and urine
13
Q
creatinine levels are a good measure of
A
the GFR
14
Q
normal creatinine clearance is & role of creatinine
A
product of muscle mass and 115-125 mL/min
15
Q
serum creatine levels are a good reflection of
A
GFR
16
Q
blood tests in renal failure
A
Increased: blood urea nitrogen, K+, phosphate, and creatinine
Decreased: pH. Ca2+, and HCO3-
17
Q
normal serum creatinine level indicates
A
normal renal function
18
Q
serum creatinine levels used for
A
estimation of functional ability of kidneys
19
Q
blood urea nitrogen (BUN)
A
end product of protein metabolism
20
Q
BUN is related to
A
GFR
21
Q
BUN is influenced by
A
GI bleeds, protein intake, and hydration status.
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.
23
Q
ureteroscopy
A
smaller, thinner scope to remove stones from the ureter and aid ureteral strictures.
24
Q
ultrasonography
A
visualize structures of kidneys
25
radiograph
determines shape, size, and position of the kidneys and observe radiopaque stones.
26
rise in serum creatinine to 3x normal value
means 75% renal function loss
27
creatinine levels 10mg/dL or more
90% renal function loss
28
ADPKD (autosomal dominant polycystic kidney disease)
most common hereditary form of renal cystic disease. results in the formation of destructive fluid-filled cysts in the kidney and other organs.
29
Other structures affected in ADPKD?
liver and less commonly the pancreas and spleen.
30
Possible mutations in ADPKD
GANAB gene and PKD1 and PKD2
31
ADPKD is the fourth leading cause of
end-stage renal disease in the US.
32
ADPKD has cysts that arise in
renal tubules from a few epithelial cells that have a high proliferation rate and are undifferentiated
33
What contributes to the destruction of normal kidney tissue in ADPKD?
apoptotic loss of renal tubular cells and accumulation of inflammatory mediators
34
What allows for dilation and cyst formation in ADPKD?
defective basement membrane underlying abnormal epithelium
35
Progress of ADPKD is
slow and end-stage renal failure is uncommon for adults before 40 years.
36
Initial manifestations of ADPKD
asymptomatic with normal kidney and liver formation
37
progression of ADPKD
pain from enlarging cysts, hematuria from bleeding cysts, infected cysts from ascending UTIs, and hypertension
38
The kidneys in people with ADPKD appear
enlarged with external contours distorted by cysts and are filled with straw-colored fluid.
39
Extrarenal manifestations of ADPKD
aneurysms (frequent)
40
Serious complications of ADPKD
subarachnoid or intracerebral hemorrhages can lead to death
41
Renal calculi (kidney stones)
most common cause of upper urinary tract obstruction
42
Kidney stones are
polycrystalline aggregates comprising materials that the kidneys normally excrete in the urine
43
Factors that contribute to stone formation
supersaturated urine, presence of a nucleus (nidus) for crystal formation, and deficiency of inhibitors of stone formation
44
supersaturations depends on
urinary pH, temperature, solute concentration, ionic strength, and complexation
45
some people can experience supersaturation of their urine without kidney stone development due to
presence of natural stone inhibitors which include magnesium and citrate
46
types of stones
calcium stones (oxalate or phosphate), magnesium ammonium phosphate stones, uric acid stones, and cystine stones
47
Most kidney stones are
calcium stones- calcium oxalate, calcium phosphate, or combination of both
48
calcium stones are associated with
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
uric acid stones are associated with
increased BMI and low urine pH.
50
magnesium ammonium phosphate stones (struvite stones) form only in
alkaline urine (pH > 7.0) and in the presence of bacteria that possess the enzyme urease (splits urea into ammonium and CO2).
51
how do struvite stones form?
phosphate levels in alkaline urine increase and magnesium is always present in the urine
52
struvite stones are called what due to their shape?
staghorn stones
53
magnesium ammonium phosphate stones are associated with
UTIs caused by urease-producing bacteria.
54
struvite stones are too large to pass through urine and require
lithotripsy or surgical removal
55
uric acid stones develop in conditions of
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
uric acid stones are not visible on
x-ray films
57
Cystine stones represent a significant proportion of
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
cystine stones resemble
struvite stones except that infection is unlikely
59
manifestations of UTI (acute cystitis)
frequency of urination, lower abdominal or back discomfort, and burning and pain on urination (dysuria). occasionally urine is cloudy and foul smelling.
60
what population is most at risk for UTI development?
young sexually active women
61
cause of uncomplicated UTI?
E. coli
62
cause of complicated UTI?
Klebsiella, enterococcus, enterobacter, proteus, and pseudomonas
63
risk factors for UTI?
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
UTIs in older adults
second most common cause of infection
65
UTIs in older adults is related to
normal age-related changes associated with immune function increase risk
66
predisposing factors for UTIs in older adults
immobility, bladder outflow obstruction (BPH), bladder ischemia caused by urine retention, constipation, senile vaginitis, and diminished bactericidal activity of urine and prostatic secretions
67
most important predictors for UTI in older adults
history of UTI
68
Nephrotic syndrome is not a specific glomerular disease but a
group of clinical findings that result from increased glomerular permeability and loss of plasma proteins in the urine
69
Nephrotic syndrome is characterized by
massive proteinuria, lipiduria, hypoalbulinemia, generalized edema, and hyperlipidemia.
proteinuria (>3.5)
hypoalbuminemia (<3)
hyperlipidemia (cholesterol >300)
70
increase in glomerular permeability in nephrotic syndrome allows
proteins from the plasma to escape into the glomerular filtrate.
71
hallmark of nephrotic syndrome?
generalized edema
72
acute pyelonephritis is
an upper UTI specifically the renal parenchyma and renal pelvis
73
people with the greatest risk for acute pyelonephritis
diabetics
74
less frequent and more serious type of acute pyelonephritis
necrotizing pyelonephritis: necrosis of renal papillae. common in diabetics and can be a comp. of acute pyelonephritis if there is urinary tract obstruction
75
causative agents of acute pyelonephritis
gram-neg bacteria- E.coli and proteus, klebsiella, enterobacter, and peseudomonas
76
factors that contribute to acute pyelonephritis
catheterization and urinary instrumentation, vesicoureteral reflux, pregnancy, and neurogenic bladder.
77
manifestations of acute pyelonephritis
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
Wilms tumor is the most
common malignant tumor in children around the ages 3-5 and may affect one or both kidneys.
79
Wilms tumor is associated with
other congenital anomalies such as aniridia, hemihypertrophy, and anomalies of the genitourinary system
80
Wilms tumor has a 20% familial incidence but what tumor does it affect?
WT1 on chromosome 11
81
What are the common signs of Wilms tumor?
asymptomatic abdominal mass and hypertension
82
How can Wilms tumor be found?
mother discovers it while bathing the child
83
Wilms tumor staging
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
renal cell carcinoma
is a malignant tumor that accounts for 90% of all primary renal cancers and peaks at 60-70 years of age.
85
risk factors for renal cell carcinoma?
correlation between smoking and kidney cancer and obesity particularly in women.
86
renal cell carcinoma - clear cell tumors
have a clear cytoplasm and show chromosome 3 deletions, and arise from proximal tubular cells. represent majority of cases
87
renal cell carcinoma - papillary renal cell tumors
bilateral and multifocal, show trisonomies 7, 16, and 17 and arise from proximal tubular cells.
88
renal cell carcinoma - collecting duct tumors
arise from collecting ducts within renal medulla, are rare, affect younger people, and are very aggressive.
89
patients with calcium oxalate stones should avoid what in their diet?
spinach and peanuts
