Lecture 13: Clinical Correlations (Big Picture) (Stone) Flashcards
Why is the proximal tubule and thick ascending loop of Henle especially susceptible to ischemic or toxic injury?
They have a very high metabolic rate (very oxygen dependent) and have many transport functions
2 causes of acute tubular necrosis
ischemia or toxins
hypovolemia
chronic dehydration
diarrhea –> renal blood flow
decreases
Hypoxic injury to prox. tubule and thick ascending limb results in:
- rapid depletion of ATP
- inactivity of Na/K ATPase pump
- increased intracellular Ca
- cell swelling/death
increased pressure in Bowman’s capsule due to intraluminal obstruction –> GFR
decreases
isosthenuria
failure to concentrate urine
sever proteinuria + low blood protein (albumin) indicates:
Glomerular disease
What could you look at to differentiate between pre-renal and renal azotemia?
specific gravity of urine. Prerenal should have concentrated urine.
deposition of Ag-Ab complexes along basement membrane in the subendothelial space of a glomerulus leads to:
damage to basement membrane in glomerulus and leakage
dysuria
difficult or painful urination
stranguria
straining to urinate, with the normal rate and flow of voiding decreased and effort increased
pollakuria
frequent voiding of small amounts of urine
urinary incontinence
involuntary voiding of urine
anuria
absence of urine production
oliguria
scant or subnormal urine production
hematuria
blood in the urine
hemaglobinuria
high Hb in the urine
myoglobinuria
high myoglobin in the urine
bilirubinuria
high bilirubin in the urine
pyruria
pus in the urine
crystalluria
crystals in the urine
proteinuria
proteins in the urine
glucosuria
glucose in the urine
ketonuria
ketones in the urine
isosthenuria
urine osmolality or specific gravity is in the same range as glomerular filtrate; interpretation requires knowledge of hydration status.
uremia
combination of clinical signs, impaired metabolic processes and alterations in organ function resulting from failure to excrete waste products through urine
azotemia
increased concentrations of urea, nitrogen, and creatinine in blood.
- prerenal = azotemia + concentrated urine
- renal = azotemia + isosthenuria
- postrenal = azotemia + variable urine concentration
