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Pathophysiology > Lecture 15 and 16: Renal > Flashcards

Lecture 15 and 16: Renal Flashcards

1
Q

True or False: The calyces collect urine while the ureters carry urine to the bladder

A

True

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2
Q

True or False: Glomerular filtration favors net filtration because the Pgc is > in the afferent end

A

True

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3
Q

True or False: Healthy kidneys are important for maintaining acid-base balance, arterial blood pressure, and water/electrolyte balance

A

True

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4
Q

How do kidneys respond to sudden drop in blood pressure (as in case of hemorrhage)?

A
  • Increase secretion of: renin and Ang II
  • Renal arterioles constrict
  • Decreased RBC and GFR
  • Increased tubular Na/H2O reabsorption
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5
Q

____, which is important for RBC, and ______ vit D3 are made in kidneys

A

Erythropoietan; 1,25-Dihydroxy Vit D3

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6
Q

Oliguria or Anuria, as well as elevation in blood urea nitrogen level (azotemia) are features of:
A. Acute Renal Failure
B. Chronic Renal Failure

A

A. Acute Renal Failure

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7
Q

True or False: Chronic renal failure is irreversible

A

True

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8
Q

Does normal GFR increase or decrease with age?

What is a novel biomarker for progressive chronic kidney disease?

A

Decrease
KIM-1

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9
Q

What are three features of azotemia?

A
  1. Elevated BUN
    (blood urea nitrogen)
  2. Elevated creatinine
  3. Decreased GFR
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10
Q

Azotemia, accompanied by clinical signs and biochemical abnormalities, as well as secondary involvement is characteristic of…

A

Uremia

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11
Q

Which condition is associated with lipiuria, high proteinuria, but NO blood in urine?
A. Nephritic Syndrome
B. Nephrotic Syndrome

A

B. Nephrotic Syndrome

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12
Q

true or False: Nephritic Syndrome is associated with damage to the glomeruli

A

False - inflammation of glomeruli

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13
Q

True or False: While both nephritic and nephrotic syndrome are characterized by proteinuria, Nephritic Syndrome has mild to moderate protein in urine

A

True

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14
Q

True or False: Nephrotic syndrome is characterized by rapid onset of blood in urine

A

False - Nephritic Syndrome is

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15
Q

What are two symptoms associated with to renal tubule defects?

A
  1. Polyuria
  2. Nocturia
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16
Q

Damage to renal tubules can cause electrolyte disorders, such as…

A

Met acidosis

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17
Q

Decreased blood supply to kidneys suggests what type of acute renal failure?

Abnormalities within kidneys suggests what type of acute renal failure?

Obstruction of urinary collecting system (from calyces to bladder) suggests what type of acute renal failure?

A

Pre-renal ARF
Intra-renal ARF
Post-renal ARF

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18
Q

A patient gets a severe 4th degree burn. What type of acute renal failure may he have?

A

Pre-renal

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19
Q

A patient goes on a long plane ride and develops an embolism that traveled to his kidneys, resulting in renal artery stenosis. What type of acute renal failure may he have?

A

Pre-renal

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20
Q

A patient takes a lot of aspirin, leading to excess blockage of PG synthesis. What type of acute renal failure may he have?

A

Pre-renal

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21
Q

Anaphylactic shock, sepsis, or severe infection may lead to which type of acute renal failure?
A. Pre-renal
B. Inter-renal
C. Post-renal

A

A. Pre-renal

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22
Q

What is the primary mechanism of renal dysfunction?

A

Decreased RBF => Decreased GFR => Reduced urinary output

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23
Q

True or False: Acute reduction in RBF is a common cause of acute renal failure in hospitalized patients

A

True

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24
Q

Which areas within the kidneys are subject to damage (thereby leading to intra-renal ARF)?

A
  1. Blood vessels
  2. Glomeruli
  3. Tubules
  4. Renal Interstitium
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25
Q

What is the primary cause of acute intra-renal failure?
A. Acute Glomerular Nephritis
B. Vasculitis
C. Malignant HTN

A

A. Acute Glomerular Nephritis

26
Q

Which of the following conditions is characterized by lodging of circulating Antigen-Antibody complexes in glomeruli?
A. Acute Glomerular Nephritis
B. Vasculitis
C. Malignant HTN

A

A. Acute Glomerular Nephritis

  • Note: induces inflammation
27
Q

~95% cases of Acute Glomerular Nephritis damage occurs 1-3 weeks post-infection. What pathogen is usually the culprit?

A

Group A - beta streptococci

28
Q

True or False: A patient with SLE or Viral Hepatitis (Hep B or Hep C) may have prolonged or recurrent Acute Glomerular Nephritis

29
Q

If Acute Glomerular Nephritis is left untreated, what can occur?

A

Chronic kidney failure

30
Q

When Ag-Ab complexes deposit in glomeruli during Acute Glomerular Nephritis….
1. which two cells proliferate?
2. which cells get entrapped in glomeruli, leading to blockage of some glomeruli?

A
  1. Endothelial and mesengial cells proliferate
  2. WBC’s get entrapped in glomeruli
31
Q

In Acute Glomerular Nephritis, some glomeruli get blocked due to WBC being trapped, which can lead to excess permeability in other glomeruli.

What is the effect of this excess glomerular permeability?

A
  1. Proteins/RBC in urine
  2. Excess damage due to phagocytes trying to remove Ag-Ab complex
32
Q

A patient has been exposed to Cd and other heavy metals of her lifetime as a miner. Which type of acute renal failure might she develop???
A. Pre-renal Acute Renal Failure
B. Intra-renal Failure
C. Post-renal Failure

A

B. Intra-renal Failure

33
Q

True or False: Abx, chemo, NSAID’s, and antiviral agents can cause drug-induced kidney disease

34
Q

What two conditions that cause acute tubular necrosis?

A

Ischemia and Toxins

35
Q

In tubular necrosis, there is DIRECT injury to tubular epithelial cells, which lead cells to slough off into the tubule and, ultimately, _____

A

block outflow

36
Q

Under which conditions can tubular necrosis be treated?

A

If BM is intact, epithelial cells may regrow and repair tubule in 10-20 days

37
Q

A patient with Acute Pylonephritis has which type of acute renal failure?
A. Intra-renal
B. Post-renal
C. Pre-renal

A

A. Intra-renal

38
Q

Obstruction of which tissues can lead to acute post-renal kidney failure?

A
  • Ureters/Renal Pelvis
  • Bladder
  • Urethra
39
Q

What are the clinical features of acute renal failure?

A

Nausea
Loss of appetite
SOB
Skin rash
Swelling
Fatigue

40
Q

If a patient with reduced GFR, how might this present on clinical exam?

A

Oliguria or Anuria

41
Q

Why might a person with acute renal failure display edema? HTN?

A

Edema = Reduced osmotic pressure in blood due to proteinuria

HTN = Volume overload due to decreased GFR and elevated electrolytes

42
Q

Why might a person who acute renal failure have metabolic acidosis? retention of electrolytes?

A

Metabolic Acidosis: Reduced H+ excretion and HCO3 reabsorption

Retention of Electrolytes: Reduced GFR and Na/K excretion

43
Q

Edema, overt uremia, hyperkalemia, and metabolic acidosis suggests….
A. Chronic renal failure
B. Acute renal failure

A

A. Chronic renal failure

44
Q

True or False: Glomerular Nephritis, Heavy Metal exposure, or Pyelonephritis can suggests acute or chronic renal failure

45
Q

True or False: Lupus, DM, or Tb suggests chronic renal failure

46
Q

Why is chronic renal failure a vicious cycle of disease progression?

A

Primary kidney disease leads to fewer functional nephrons

As a result…
- Increase arterial pressure
- Hypertrophy and vasodilation of surviving nephrons

As a result…
- Increased GLOMERULAR pressure and filtration in surviving glomerular capillaries

= Glomerular sclerosis

47
Q

What are two ways to slow progression of chronic renal disease?

48
Q

Three most common causes of chronic renal failure?

A

Atherosclerosis of large renal arteries

Fibromuscluar Hyperplasia

Nephrosclerosis (sclerotic lesions of the smaller arteries, arterioles, and glomeruli)

49
Q

What is the most common form of kidney disease–characterized by decrease in RBF and GFR?

A

Nephrosclerosis

50
Q

In Arteriolar Nephrosclerosis, there are lesions in smaller interlobular ___ and afferent ____

In focal segmental glomerular sclerosis, the lesion disrupts ____ cells

A

arteries; arterioles

51
Q

How can arteriolar nephrosclerosis lead to scar tissue?

A

Leakage of plasma through intimal membrane leads fibinoids to deposit in medial layer

Deposits lead to thickening of vessel wall, which leads to occlusion, destruction of nephrons, and scar tissue

52
Q

Pyelonephritis is an infectious cause of chronic renal failure, caused by bacterial infection.

What is the causal agent?

53
Q

Inability to empty bladder completely, obstructed urine outflow, or cystitis can make one more prone to ____

A

Pyelonephritis

54
Q

If there is bacteria in the medulla, as in pyelonephritis, what cannot occur?

A

Cannot concentrate urine - therefore: polyuria

55
Q

True or False: The presence of WBC’s in casts indicates acute tubular inflammation of the kidneys

56
Q

In which conditions are necrotic papillae seen?

A
  1. Diabetes
  2. Acute pyelonephritis w/obstruction
57
Q

Three causes of nephrotic syndrome?

A
  1. Amyloidosis
  2. Minimal change disease
  3. Chronic glomerulo nephritis
58
Q

____ is a nephrotic syndrome in children that is characterized by loss of foot processes and is caused by T cell dysfunction or epithelial cell injury

A

Minimal Change Disease (Lipid Nephrosis)

59
Q

What are clinical symptoms of chronic renal disease?

A

Edema
Hyperkalemia/phosphate
Anemia
Hypocalemia
HTN
Myopathy/Neuropathy
Bleeding

60
Q

True or False: 90% of people with renal cell carcinoma have hematuria

Pathophysiology (26 decks)

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