Lecture 3 - Renal Flashcards
physiological functions of kidneys
- ___ functions
- control of solutes and fluids
- ___ control
- ___ balance
- drug metabolism and excretion
- metabolic waste excretion
- endocrine
- BP
- acid/base
Where in the nephron is 100% filtrate produced
Bowman’s capsule
major reabsorption site of kidney: 80% filtrate reabsorbed
proximal convoluted tubule
active and passive absorption
Where in the nephron does H2O and salt conservation take place?
loop of henle
6% of filtrate reabsorbed
Where in the nephron does variable reabsorption and active secretion take place?
Distal convoluted tubule
9% filtrate reabsorbed
Where in the nephron does variable salt and H2O reabsorption take place?
Collecting tubule
measuring kidney function
serum creatinine
* predominantly removed by ___
* increase = (bad or good)
blood urea nitrogen
- measure of liver break down of ___
- increase = (bad or good)
creatinine clearance
- useful for prediciting ___ and ___ clearance
___ filtration rate
- filtration
- bad
- amino acids
- bad
- secretion, drug
glomerular
markers of kidney damage
- urinary abnormalities - protein, RBC suggestive of ___ malfunctions
- imaging abnormalities - MRI/CT scans
- membrane
kidney function declines with age due to decrease in ___
nephrons
kidney mass decreases
important to consider for drug dosing in aging
compensatory response to renal injury
- decrease in # of ___
- nephrons work harder to ___
- hard work eventually causes glomeruler and tubular ___
- more loss of ___, can no longer compensate
- progressive decrease in ___
- ___temia
- ___ syndrome
- death
- nephrons
- compensate
- lesions
- nephrons
- GFR
- azotemia
- uremic
2 largest sources of kidney injury/failure
diabetes (38%) and HTN (24%)
T or F: AKI death rate is more than breast cancer, prostate cancer, heart failure, and diabetes combined
T; 300,00 people die annually from AKI
criteria of AKI
- increase in SCr > ___ mg/dL ( > or equal to 26.5 umol/L) within 48 hr
or - increase in SCr > ___ % which is known or presumed to have occured within the prior 7 days or
- a reduction in urine output (oliguria of < ___ mL/kg/h for 6 h)
- 0.3
- 50
- 0.5
Normal glomerular capillary pressure is maintained by afferent ___ by increased ____ and efferent ___ by increased ___
vasodilation, prostaglandins
vasocontriction, angiotensin II
Disruption autoregulation
NSAIDs
- decreased ___ prostaglandins ( ___ afferent resistance)
- Glomerular capillary pressure drops, ___ decreases
ACE-I
- decreased ___ ( ___ efferent resistance)
- Glomerular capillary pressure drops, ___ decreases
- vasodilatory, increased
- GFR
- angiotensin II, decreased
- GFR
primary causes of acute kidney injury (3)
- sepsis
- ischemia
- nephrotoxins
classification of major causes of AKI
Prerenal
- ___volemia
- decreased ___ output
- congestive heart failure
- liver failure
- impaired renal ___ due to NSAIDs, ACE-I, cyclosporine
Intrinsic (Intrarenal)
- acute ____ nephritis
- tubules and interstitium: ___ , ischemia, nephrotoxins
- vascular: vasculitis, malignant hypertension, TTP-HUS
Postrenal
- bladder outlet ___
- hypovolemia
- cardiac
- autoregulation
- glomerular
- sepsis
- obstruction
Pathophysiology of chronic kidney disease (CKD)
- ___ glomerular capillary pressure
- ___uria
- glomerulosclerosis
- increased
- proteinuria
Key abnormalities that cause CKD-MBD
- impaired ___ excretion
- decreased production of ___
MBD = mineral and bone disorder
- phosphate
- Vit D3
Urine volume = ___ % of total filtrate volume
1%
Managing CKD pts requires dealing with ___ homeostasis
Ca
Uremia
uremic illness is due largely to the accumulation of ___ that are normally cleared by the kidneys
organic waste products
Nephitic Vs Nephrotic
Nephritic syndrome
- ___ disrupting glomerular basement ___
- resulting in ___, cola-colored urine
- BP ___
- serum albumin: ___
Nephrotic syndrome
- ___ damage leading to glomerular charge-barrier disruption
- massive ___
- BP: ___
- edema: ___
- serum albumin: ___
Nephritic
* Inflammation, membrane
* hematuria
* raised
* normal/slightly reduced
Nephrotic
- podocyte
- proteinuria
- normal
- present (++++)
- low
Glomerulonephritis
- Inflammation of glomeruli and ___
- in both acute and chronic forms
- present with ___ and/or hematuria
- primary cause: inheritable trait ( ___ syndrome)
- secondary causes: infections, ___ , autoimmune disorders
- small blood vessels
- proteinuria
- Alport
- drugs
Pathogenesis of Glomerular Diseases
immune reaction
- ___ associated injury
- ___ mediated
- glomerular ___
- antibody
- cell
- injury
Pyelonephritis
- inflammation of kidney ___
- acute and chronic
- presents ___ pain with painful ___
- caused by ___ from blood or urinary tract
- ___ cells in urine
- may lead to ___
- tissue
- flank, urination
- bacteria
- WBC
- sepsis
Pathogenesis or urinary tract infection
5 steps
- colonization
- uroepithelium penetration
- ascension
- pyelonephritis
- AKI
interstitial nephritis
aka ___ nephritis
- primary injury to renal tubules and interstitium
- undetected unitil causes significant decrease in renal function
- causes: drugs (70-75%) mostly ___, infection (4-10%), autoimmune (10-20%), SLE, sarcoidosis
Drugs associated:
- antibiotics ( ___, cephalosporins, sulfonamides)
- anticonvulsants (phenytoin, carbamazepine, phenobarbital)
- diuretics (thiazides, furosemide)
- analgesics (NSAIDs)
- other (allopurinol, cimetidine)
- tubulointerstitial
- antibiotics
- penicillins
Autosomal Dominant (Adult) Polycystic Kidney Disease APKD
characterized by multiple expanding cysts of ___ kidneys that ultimately destroy the intervening ___
Pathogenesis of APKD
- inherited mutation of ___ or ___ gene in renal tubular cells
- intermittent ___
- hypertension and urinary infection, ultimately fatal, renal ___ necessary
- both
- parenchyma
- PKD1, PKD2
- hematuria
- transplantation
Autosomal Recessive (Childhood) Polycystic Kidney Disease
Pathogenesis
- autosomal ___ inheritance
- mutation in ___ - fibrocystin (polyductin)
Clinical Features
- present at ___
- young infants may die quickly from pulmonary or renal failure
- pts who survive infancy develop ___ (congenital hepatic fibrosis)
- recessive
- PKHD1
- birth
- liver cirrhosis
Nephtolithiasis
aka ___
- more prevalent in ___ over 40
- arises from supersaturation of ___ (calcium)
- hematuria
- pain radiates in ___
risk factors
- infection
- urinary stasisi
- immobility
- hyper___
- increased ___ acid
- increased urinary ___
kidney stones
- men
- solutes
- flank
- hypercalcemia
- uric
- oxalate
nephrolithiasis treatment and prevention
treatment
- analgesics
- hydration
- lithotripsy
- surgical removal
prevention
- diet (hydration, eliminate Ca supplements)
- diuretics
T or F: contrast media administration can be associated with nephropathy
T
* 25% increase in SCr within 72 hrs of administration
* 1/3 of hospital acquired AKI
* 1-2% US population
Non-infection stones (3)
- Ca oxalate
- calcium phosphate
- uric acid
infection stone
struvite
genetic stone
cystine
