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Clin Med Exam 4 > Kidneys: Part 1 (paulson) > Flashcards

Kidneys: Part 1 (paulson) Flashcards

1
Q

Basic Renal Function:

-list the 3 main functions of the kidney

A
  • Filtration of the blood
  • Regulating blood volume & blood pressure
  • Producing erythropoietin
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2
Q

Describe how the kidneys filter blood

A
  • -Removal of waste
  • -Maintaining proper concentrations of electrolytes
  • -Maintaining acid/base balance
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3
Q

Nephron=

A

The basic functional unit of the kidney

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4
Q

Nephron contains:

A
  • glomerulus

- Renal tubule

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5
Q

Glomerulus:

-fx?

A

Site of blood filtration

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6
Q

Renal tubule:

-fx?

A

Where water and salts are resorbed

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7
Q

Proximal Convoluted Tubule (PCT) reabsorbs ___% of the glomerular filtrate

A

60%

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8
Q

Proximal Convoluted Tubule (PCT)

-describe the glomerular filtrate reabsorption breakdown (i.e. %’s of each reabsorbed electrolyte)

A
  • Sodium, Potassium, & Calcium= 65%
  • Phosphate, Water, & Bicarbonate= 80%
  • Glucose & Amino acids= 100%
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9
Q

Proximal Convoluted Tubule (PCT): other functions?

A

-Secretes drugs/toxins that are too big (or protein-bound) to be filtered

  • Water reabsorbed passively
  • ->Driven by osmotic gradient from reabsorption of other solutes

-Makes ammonia from glutamine (acidifies urine)

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10
Q

100% of glucose should be reabsorbed UNDER normal glucose levels. But once glucose gets to ____ it starts spilling into the urine (glucose in urine indicates elevated glucose levels and there might be damage in the proximal convoluted tubule)

A

200

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11
Q

Loop of Henle consists of __ segments

A

4

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12
Q

List the 4 segments of the loop of henle

A
  • Thin descending limb (DLH)
  • Thin ascending limb (ALH)
  • Medullary thick ascending limb (mTALH)
  • Cortical thick ascending limb (cTALH)
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13
Q

What is the overall fx of the loop of henle?

A

Creates a concentration gradient and forms concentrated urine (aka concentrates the urine further)

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14
Q

Distal Convoluted Tubule (DCT)

-is mainly involved in ___ & ___ reabsorption

A
  • *sodium & calcium reabsorption
  • -Reabsorbs another 5-10% of sodium
  • -10-15% of calcium reabsorption
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15
Q

what is the DCT regulated by?

A

Regulated by PTH and Vitamin D

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16
Q

Collecting Tubule:

list all functions

A
  • NaCl reabsorption
  • Bicarb reabsorption
  • Potassium excretion
  • H+ excretion
  • Water reabsorption–>Urine concentration
  • Urea excreted
  • Regulates urine volume
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17
Q

Memorize this slide for the exam

A

-basically the kidney is trying to concentrate the urine and trying to excrete the things it doesn’t need, and reabsorb what the body does need
slide 8 pic

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18
Q

Acute Renal Failure (ARF) AKA Acute Kidney Injury (AKI)=

A

=Rapid worsening of renal function

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19
Q

AKI is indicated by quickly rising ____ OR the accumulation of _______

A
  • -Quickly rising BUN/Cr

- -nitrogenous wastes in the blood

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20
Q

Acute Renal Failure (ARF) AKA Acute Kidney Injury (AKI) is caused by a variety of disorders (list 3 categories)

A
  • Prerenal
  • Postrenal
  • Intrarenal
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21
Q

BUN=

A

blood urea nitrogen

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22
Q

If you had 1 test to order for kidney issues (what is the best test?)

A

BMP

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23
Q

Which Pt demographic gets AKI?

A
  • No particular race or age more than others
  • -Underlying etiologies for each type do have certain groups more likely to acquire
  • Up to about 10% of people in the hospital
  • Up to 2/3 of patients in the ICU
  • About 1% of patients develop after general surgery

(think sick Pts)

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24
Q

AKI-Definition according to AKIN/KDIGO (memorize)

A
  • Criteria vary widely
  • **Abrupt (within 48 hours) absolute increase in the serum creatinine of ≥0.3 mg/dl above baseline –or-
  • **Serum creatinine increases ≥50% (known or presumed to have occurred in the past 7 days) -or-

**Oliguria of <0.5 ml/kg/hour for >6 hours

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25
Q

oliguria=

A

one of the earliest signs of impaired renal function (just know– some urine production but NOT as much as there should be) aka decreased urinary output

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26
Q

Pt weighs 100 Kg:

-what is their normal urine output per 6 hours?

A

100 Kg x .5ml = 50mL per hour–> so normal should be around 300 mL per 6 hrs

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27
Q

Criteria for acute kidney injury

-slide 12

A

image

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28
Q

AKI: clinical Sx

A 
Weakness/lethargy
Anorexia 
Nausea/vomiting
General malaise
Diarrhea
Pruritis
Drowsiness
Hiccups
SOB
Dizziness
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29
Q

AKI: clinical features

  • -> prerenal: (list Sx)
  • ->postrenal (list Sx)

-list ex’s of general clinical features

A
  • Usually point toward the underlying cause
  • -Ie: Prerenal, could be tachycardic and hypotensive
  • -Postrenal: distended bladder, CVA tenderness, enlarged prostate
  • Anuria or oliguria
  • Change in volume status/weight
  • Change in mental status
  • Edema
  • Weakness
30
Q

AKI: diagnostic tests?

A

-**BMP

  • Urinalysis & urine microscopy:
  • ->Urine culture
  • Measurement of urine output
  • Renal ultrasound
  • May add urine spot for osmolality, urine sodium, creatinine
31
Q

AKI:

-list possible Life-Threatening Complications

A
  • Hyperkalemia
  • Fluid overload
  • Signs of uremia
  • Severe metabolic acidosis (pH <7.1)
32
Q

Ex’s of signs of uremia

A

Ie: pericarditis, altered mental status

33
Q

AKI: tx depends on the ____

A

CAUSE

34
Q

AKI: tx

-dialyze if:

A
  • Serum creatinine >5-10 mg/dl
  • Unresponsive acidosis
  • Severe electrolyte disorders
  • Fluid overload
  • Uremic complications
35
Q

What is the MC cause of AKI?

A

prerenal failure

36
Q

Prerenal failure=

A
  • Reduced effective blood circulating to kidney

- Rapidly reversible if underlying cause found and corrected–> Kidneys themselves OK

37
Q

Describe the causes of reduced effective blood circulating to the kidney (in prerenal failure)

A

-Absolute reduction in fluid volume (ie: hemorrhage or dehydration) –or-

-Effective volume depletion
CHF, cirrhosis (hepatorenal syndrome)

38
Q

True Intravascular Volume Depletion (list ex’s)

A
  • Hemorrhage
  • Burns
  • Diuretics
  • Dehydration
  • GI losses
  • Vomiting
  • Diarrhea
  • Enteric fistula
39
Q

Decreased Effective Circulating Volume (list causes)

A
  • CHF
  • Cardiac tamponade
  • Aortic stenosis
  • Cirrhosis with ascites
  • Nephrotic syndrome
40
Q

Impaired Renal Blood Flow (list 4 causes)

A

ACEI
NSAIDs
Renal artery stenosis
Renal vein thrombosis

41
Q

Labs that distinguish prerenal failure (memorize)

A
  • Serum BUN:Cr ratio: ≥20:1
  • Urine sodium: <20 meq/L
  • Fractional Excretion of Sodium (FENa): <1%
  • ->Measures the percent of sodium filtered by the kidney that is excreted into urine

-Urine specific gravity: >1.020

–>Occur because the kidney is responding to prerenal failure by increasing reabsorption

42
Q

Prerenal failure: tx

A

Correct the underlying cause! Ie:

  • CHF: Diurese the patient
  • Dehydration: IVF
  • Hemorrhage: Blood + fluids
43
Q

Postrenal failure:

  • how common?
  • describe how postrenal failure occurs (hint: what is blocked?)
A

Least common of the 3 main types of renal failure

Postrenal= ureters, bladder, urethra (**Blockage here causes renal failure)

44
Q

Postrenal failure: etiology

A
  • Nephrolithiasis
  • BPH
  • Obstructing tumor within the -GU system (or adjacent ie: cervical cancer)
  • Bladder outlet obstruction
  • Blood clots within the urinary tract
  • Medications (ie anticholinergics)
  • Neurogenic bladder
45
Q

Postrenal failure: clinical Sx

A
  • May have abdominal or groin pain, bladder discomfort
  • Mass at flank, suprapubic area, or abdomen
  • Rectal exam
  • Pelvic exam
  • Anuria
46
Q

anuria=

A

failure of the kidneys to produce urine.

47
Q

Postrenal failure: diagnostic labs?

A
  • Post-void residual >100 ml –> bladder outlet obstruction
  • Ultrasound or IVP (Intravenous pyelogram)–> Dilated ureters or renal pelvis
  • Abdominal CT?–> Eval for mass
48
Q

Postrenal failure: tx?

A

-Relieve the obstruction!

  • May:
  • -Catheterize patient
  • -Nephrostomy tube
  • -Stenting
  • -Lithotripsy
  • -Perform surgery to remove a mass
49
Q

Intrinsic Renal Failure=

A
  • One or both kidneys have been damaged and don’t work properly
  • Some causes happen quickly, whereas others develop over time
50
Q

Intrinsic Renal Failure: Causes (list 5)

A
  • Acute tubular necrosis (ATN)= MC cause of intrinsic AKI
  • Nephrotoxins
  • Interstitial diseases
  • Glomerulonephritis
  • Vascular diseases
51
Q

List Ex’s of interstitial disease that can cause intrinsic renal failure

A

Acute interstitial nephritis, SLE, infection

52
Q

List Ex’s of Nephrotoxins that can cause Intrinsic renal railure

A

NSAIDs, contrast agents, aminoglycosides, cyclosporine A, cisplatin, heme pigments

53
Q

List Ex’s of vascualar diseases that can cause intrinsic renal failure

A

Polyarteritis nodosa, vasculitis

54
Q

Labs that Define Intrinsic Renal Failure (list 4) memorize for exam

A
  • Serum BUN:Cr ratio: 10-15:1
  • Urine Sodium: ≥40 meq/l
  • FENa: >2%
  • Urine specific gravity: 1.010-1.020
55
Q

Acute Tubular Necrosis (ATN) is the MC cause of ____

A

intrinsic AKI

56
Q

Acute Tubular Necrosis (ATN):

-list 3 major causes

A

-Renal ischemia–> All causes of severe prerenal disease can cause postischemic ATN

-Nephrotoxins:
Aminoglycosides, heme pigments, cisplatin, radiocontrast media, pentamidine, mannitol, synthetic cannabinoids (K2/spice), tenofovir, IVIG

-Sepsis

57
Q

ATN- Diagnosis? (**key finding on UA)

A
  • Classic UA–> “Muddy brown granular epithelial cell casts and free renal tubular epithelial cells”
  • FENa, BUN:Cr ratio, urine specific gravity, urine osmolality consistent with intrinsic AKI
  • May also have hyperkalemia and have metabolic acidosis
58
Q

ATN- Treatment?

A
  • Hold nephrotoxins
  • Treat underlying cause, supportive management
  • Some will give diuretics for fluid overload–> **Don’t use for those who are oliguric
59
Q

ATN- Prognosis?

-which Pts do better?

A
  • Most patients spontaneously recover renal function
  • **Do better if they are nonoliguric
  • May not return to baseline renal function
  • ATN during hospitalization associated with higher in-hospital and long-term mortality
60
Q

Acute Interstitial Nephritis (AIN) is an immune-mediated process of _______

A

tubulointerstitial injury–> Inflammatory infiltrate in the interstitium

61
Q

What is the MC cause of Acute Interstitial Nephritis (AIN)?

A

MC caused by medications:

Cephalosporins, penicillins, allopurinol, diuretics, NSAIDs, sulfonamides

62
Q

AIN:

-other causes?

A

Also caused by illness:

Legionella, CMV, Streptococcus, Mycobacterium, EBV, candida, SLE, sarcoidosis, Sjögren syndrome

63
Q

AIN can be associated with fever, _______, & _______ (**classic symptoms?

A

maculopapular rash, and eosinophilia (classic)

KNOW

64
Q

Acute Interstitial Nephritis (AIN):

  • UA findings
  • Gold standard for diagnosis?
A

**WBCs, white cell casts, may have eosinophils, protein

-GOLD STANDARD= kidney biopsy

65
Q

AIN: tx?

A
  • Stop offending med/treat underlying cause.
  • *-Glucocorticoids

Prognosis: Usually good

66
Q

Glomerulonephritis= renal glomeruli are damaged by ______

A

deposition of inflammatory proteins in the glomerular membrane

67
Q

Glomerulonephritis: causes

-focal?

A

Focal: Henoch-Schönleinpurpura, postinfectious, IgA nephropathy, hereditary nephritis, SLE

68
Q

Glomerulonephritis: causes

-diffuse?

A

Diffuse: Postinfectious, Membranoproliferative, SLE, vasculitis, rapidly progressive GN

69
Q

Glomerulonephritis:

-clinical features?

A

Hematuria, edema of face/eyes in morning, feet/ankles in evening, HTN common

70
Q

Glomerulonephritis: diagnostic labs?

A
  • Hematuria. Urine might be tea or cola colored.
  • **RBCs and RBC casts on UA, misshapen RBCs, proteinuria
  • Renal biopsy
71
Q

Glomerulonephritis: tx

A

Tx: Steroids, immunosuppressants/chemo medications

Clin Med Exam 4 (14 decks)

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