Lecture 13: Clinical Correlations (Big Picture) (Stone)

Question 0

Why is the proximal tubule and thick ascending loop of Henle especially susceptible to ischemic or toxic injury?

Answer 0

They have a very high metabolic rate (very oxygen dependent) and have many transport functions

Question 1

2 causes of acute tubular necrosis

Answer 1

ischemia or toxins

Question 2

hypovolemia

Answer 2

chronic dehydration

Question 3

diarrhea –> renal blood flow

Answer 3

decreases

Question 4

Hypoxic injury to prox. tubule and thick ascending limb results in:

Answer 4

• rapid depletion of ATP
• inactivity of Na/K ATPase pump
• increased intracellular Ca
• cell swelling/death

Question 5

increased pressure in Bowman’s capsule due to intraluminal obstruction –> GFR

Answer 5

decreases

Question 6

isosthenuria

Answer 6

failure to concentrate urine

Question 7

sever proteinuria + low blood protein (albumin) indicates:

Answer 7

Glomerular disease

Question 8

What could you look at to differentiate between pre-renal and renal azotemia?

Answer 8

specific gravity of urine. Prerenal should have concentrated urine.

Question 9

deposition of Ag-Ab complexes along basement membrane in the subendothelial space of a glomerulus leads to:

Answer 9

damage to basement membrane in glomerulus and leakage

Question 10

dysuria

Answer 10

difficult or painful urination

Question 11

stranguria

Answer 11

straining to urinate, with the normal rate and flow of voiding decreased and effort increased

Question 12

pollakuria

Answer 12

frequent voiding of small amounts of urine

Question 13

urinary incontinence

Answer 13

involuntary voiding of urine

Question 14

anuria

Answer 14

absence of urine production

Question 15

oliguria

Answer 15

scant or subnormal urine production

Question 16

hematuria

Answer 16

blood in the urine

Question 17

hemaglobinuria

Answer 17

high Hb in the urine

Question 18

myoglobinuria

Answer 18

high myoglobin in the urine

Question 19

bilirubinuria

Answer 19

high bilirubin in the urine

Question 20

pyruria

Answer 20

pus in the urine

Question 21

crystalluria

Answer 21

crystals in the urine

Question 22

proteinuria

Answer 22

proteins in the urine

Question 23

glucosuria

Answer 23

glucose in the urine

Question 24

ketonuria

Answer 24

ketones in the urine

Question 25

isosthenuria

Answer 25

urine osmolality or specific gravity is in the same range as glomerular filtrate; interpretation requires knowledge of hydration status.

Question 26

uremia

Answer 26

combination of clinical signs, impaired metabolic processes and alterations in organ function resulting from failure to excrete waste products through urine

Question 27

azotemia

Answer 27

increased concentrations of urea, nitrogen, and creatinine in blood.

• prerenal = azotemia + concentrated urine
• renal = azotemia + isosthenuria
• postrenal = azotemia + variable urine concentration