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Renal > Made Ridiculously Simple > Flashcards

Made Ridiculously Simple Flashcards

1
Q
  1. filtration of blood
  2. regulation of blood volume and BP
  3. activation of vitamin D
  4. production of erythropoietin
A

4 major roles of the kidneys

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2
Q
  • removes waste
  • maintains appropriate concentrations of electrolytes
  • maintains acid/base balance
A

Kidney functions (filtration of the blood)

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3
Q

this can cause… an increase in wastes in the circulation, disequilibrium of fluids and electrolytes, decreased activation of vitamin D (which can result in decreased calcium absorption and subsequent hypocalcemia), and/or decrease erythropoietin (which can lead to anemia)

A

Kidney failure

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4
Q

the kidneys get blood from the…

A

renal arteries

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5
Q

if the cause of renal failure is a decreased in blood supply to the kidneys (renal perfusion), this is called…

A

prerenal failure

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6
Q

if the cause of renal failure is a problem within the kidneys, this is…

A

intrinsic renal failure

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7
Q

if the renal failure is due to a problem in the collecting system (ureters/bladder/ urethra)

ie..obstruction by stones or tumor

A

postrenal failure

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8
Q

in preener failure, the kidneys do not get an adequate blood supply and thus cannot…

A

adequately filter the blood

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9
Q

any circumstance that can cause decreased blood volume (hypovolemia) can lead to..

A

decreased renal flow

ie..hemorrhage, dehydration

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10
Q

atherosclerotic disease of the renal arteries can decrease…

A

flow to one or both kidneys

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11
Q

effective volume depletion can cause…

A

prerenal failure

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12
Q

this is when the kidneys are not adequately perfused despite the fact that the blood volume is NOT actually depleted

ie…CHF, cirrhosis

A

Effective volume depletion

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13
Q

in CHF, the heart does not pump adequately, leading to decreased…

A

renal perfusion

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14
Q

cirrhosis is scarring of the liver that can impede blood flow through the hepatic portal system, causing….

A

portal hypertension

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15
Q

During cirrhosis, blood pools in the gut’s venous system causing the effective blood volume that reaches the kidneys to…

A

decrease

this decreased renal perfusion can result in PRERENAL failure… hepato-renal syndrome

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16
Q

the kidney(s) will try to reabsorb sodium and water in attempt to replenish intravascular volume in response to….

A

low blood volume

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17
Q

is Na and water reabsorption beneficial in hypovolemia? in effective volume depletion?

A

hypovolemia= this is beneficial

effective volume depletion= this is detrimental

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18
Q

the functional unit of the kidneys

A

nephron

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19
Q

tufts of capillaries and filtration surface for filtering blood

A

glomerulus

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20
Q

for reabsorption and secretion of various ions and molecules; parts include: proximal portion, loop of Henle, distal portion

A

tubule

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21
Q

used for further reabsorption/ secretion and delivery of urine to the ureters for delivery to the bladder

A

collecting duct

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22
Q

the one million or so nephrons of each kidney are surrounded by an _______ containing blood vessels and connective tissue.

A

interstitium

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23
Q
  • diseases of the glomeruli (glomerulopathies)
  • diseases of tubules (tubulointerstitial dz)

can cause…

A

intrinsic renal failure

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24
Q

one lab finding that distinguishes acute prerenal from acute intrinsic renal failure is the…

A

BUN to creatinine ratio in the BLOOD*

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25
Q

elevated serum creatinine signifies…

A

renal failure (of any kind!)

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26
Q

in prerenal kidney failure, they kidneys realize they are not getting enough fluid so they reabsorb Na and water in attempt to increase intravascular volume, causing an increase in…

A

BUN

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27
Q

The BUN to creatinine ratio in prerenal kidney failure is…

A

greater than 20:1

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28
Q

A “reabsorbing spree” in attempt to restore intravascular volume causes a rise in BUN out of proportion to the rise in creatinine is seen in….

A

prerenal failure

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29
Q

in INTRINSIC renal failure, the creatinine rises but since there is no hypovolemia, the kidney does NOT respond by reabsorbing. Thus, the BUN/Creatinine ratio will be…..

A

less than 20:1

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30
Q

dilute urine but an increased excretion of sodium (greater than 40 meq/L) is seen in…

A

intrinsic renal failure

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31
Q

concentrated urine but a low concentration of sodium (less than 20 me/L) is seen in…

A

prerenal failure

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32
Q

dilute urine with high Na concentration

A

intrinsic renal failure

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33
Q

concentrated urine with low Na concentration

A

prerenal failure

34
Q

renal stones into the ureters or a tumor in the GU system or adjacent system can cause…

A

postrenal failure

35
Q
  • drugs (i.e. abx, chemo agents)
  • endogenous toxins (i.e. light chains in multiple myeloma)
  • ischemia
  • immune processes
  • infection (ie pylonephritis)

can all cause…

A

tubulointerstitial disease

36
Q

edema
proteinuria (cause foamy urine)
hypoproteinemia
hyperlipidemia

signs of….

A

nephROTIC syndrome

37
Q

hypertension
hematuria
proteinuria

signs of..

A

nephRITIC syndrome

*nephritic has “iti(s)” in it, meaning inflammation. the inflammation is either due to systemic inflammatory/immune complex disease (i.e. vasculitis, lupus) or infection.

38
Q

inflammation in the glomerulus leads to bleeding into the urine (hematuria) as well as renal vascular changes that produce HTN

A

nephRITIC syndrome

39
Q

sodium, potassium, hydrogen ion, magnesium, ammonia and phosphate concentrations in the blood all increase and calcium concentrations decrease

A

advanced chronic renal failure

40
Q

normally, the kidneys activate vitamin D. in renal failure, vitamin D activation decreases. Without vitamin D, ______ cannot be absorbed from the diet

A

calcium

*the amount of calcium in the serum decreases, thus…calcium concentration decreases in chronic renal failure

41
Q

adding 1-OH to make 1,25 dihydroxy-vitaminD

A

the way the kidneys activate vitamin D

42
Q

because of decreased calcium concentration in chronic renal failure, _____ hormone is secreted in attempt to increase blood calcium level

A

PTH

43
Q

PTH increases blood calcium by releasing it from bone. thus, bone is constantly being broken down leading to….

A

renal osteodystrophy

44
Q

the kidneys produce erythropoietin. in renal failure, erythropoietin decreases which can result in…

A

anemia

45
Q

inflammation of the urethra, bladder and kidney

can be caused by UTIs

A 
urethra= urethritis
bladder= cystitis
kidneys= pylonephritis
46
Q

urethritis is most commonly caused by sexual transmission of….

A

N. gonorrhoeae

Chlaymydia trachomatis

47
Q

dysuria

A

pain with urination

48
Q

typically caused by gm negative organisms (i.e. E.Coli, Proteus, Klebsiella, enterobacteria and less commonly staph)

A

cystitis

49
Q

flank pain, fever, malaise, increased urinary frequency, urgency, dysuria

A

Pyelonephritis

50
Q

cells in the urine may signify…

A

lower urinary tract disease

51
Q

conglomerates of protein and cells

*ALWAYS signify glomerular or tubular disease

A

casts

52
Q

leukocyte esterase and nitrate tests used to test for…

A

UTIs

53
Q

pediatric kidney tumor that often presents as an abdominal mass

abdominal pain, hematuria, HTN and/or fever

A

Wilm’s tumor

54
Q

What is the main extracellular cation?

A

Sodium

55
Q

the body’s goal is to maintain a constant concentration of..

A

sodium

*does this by altering the amount of water present, either by excreting or retaining water

56
Q

when we say “hypernatremia” we are referring to the sodium concentration, not..

A

the ABSOLUTE amount of sodium

57
Q

this IV solution increased sodium concentration in the blood

A

HYPERtonic saline

58
Q

if a pt needs resuscitation or he/she cannot drink and needs maintenance fluid, one generally uses ________ saline

A

isotonic

59
Q

in extreme cases of hypovolemia (i.e. shock), a ______ saline solution can be used

A

hypertonic

60
Q

a ________ solution will stay in the intravascular space and pull more fluid into the intravascular space to try to dilute

A

hypertonic

61
Q

electrolyte/fluid imbalances must be corrected…

A

SLOWLY

62
Q

If electrolyte/fluid imbalances are corrected too rapidly with IV fluids, the brain does not have time to re-equilibrate. This can cause..

A

central pontine myelinolyiss (aka osmotic demyelination syndrome)

*due to dramatic fluid shifts that take place between the cells in the brain and the surrounding fluid

63
Q

aldosterone causes reabsorption of….

A

sodium (and secretion of potassium)

*alsodteRoNe causes Reabsorption of Na and secretion of potassium

64
Q

ADH causes….

A

water reabsorption

65
Q

the main EXTRAcellular cation (higher in the serum than in the cells)

A

sodium

66
Q

the main INTRAcellular cation (higher in the cells than in the serum)

A

potassium

67
Q

Euvolemic

A

normal volume status

68
Q

“volemias” refer to what is perceived on…

A

clinical exam

69
Q

in increased in volume AND sodium

  • most commonly from administration of sodium bicarb solutions or dialysis solutions
  • can also be caused by primary hyperaldosteronism
A

Hypervolemic hypernatremia

70
Q

if the amount of water loss is greater than the amount of sodium loss (and lots of water loss)

A

Hypovolemic hypernatremia

71
Q

renal diseases or diuretics that waste water and or sodium

A

renal losses

72
Q

extrarenal losses of water and/or sodium can occur through…

A

sweat, stool or fluid shifts from the intravascular space to the extravascular space

(i.e. major burns, surgery)

73
Q

if water/sodium losses occur extra-renally (i.e. sweating, diarrhea, burns, etc), the kidneys will attempt to hold onto sodium, thus…

A

decreasing sodium concentration in the urine

74
Q

if the cause of hypovolemic hypernatremia is RENAL (rather than extra-renal), there will be a ______ concentration of sodium in the urine

A

HIGHER

*higher sodium concentration in renal rather than extra-renal hypovolemic hypernatremia

75
Q

urine sodium greater than 20 meq/L

A

renal sodium losses

76
Q

urine sodium less than 20 meq/L

A

extra-renal sodium losses

77
Q

hypodipsia

A

decreased water intake

*can lead to euvolemic hypernatremia

78
Q

hypodipsia

diabetes insipidus

A

causes of euvolemic hypernatremia

79
Q

loss of either ADH secretion or loss of ADH action

A

diabetes insipidus

80
Q

increased ADH increases water reabsorption, resulting in a more ________ urine and a more _____ serum

A
  • more CONCENTRATED urine

* more DILUTED serum

81
Q

decreased ADH decreased water reabsorption, resulting in an _________ and ______ urine output, and a more concentrated serum

A

INCREASED and DILUTE urine output*

occurs with a decreased in ADH

82
Q

Two extrinsic things that happen when BP decreases

A
  1. Baroreceptor reflex..afferent arterioles constrict to increase renal pressure
  2. RAA..renin is released to increase pressure

Renal (15 decks)

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