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MCPHS PA Pathophys Exam 3 Renal PT I Flashcards

1
Q

Approx how many Nephrons does each human Kidney have?

A

1 Million

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2
Q

What is the purpose of the Proximal Convoluted Tubule?

A

Reabsorption of most of the filtered load.

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3
Q

What is the blood flow of the Kidney?

A

22% of Cardiac output or about 1100 mL/Min (Based on 5 L/Min CO)

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4
Q

What is the purpose of the Loop of Henle?

A

Urine Concentration

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5
Q

What is the purpose of the Distal Convoluted Tubule?

A

Reabsorption of NA and H2O

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6
Q

What is the Function of the Kidney?

A

Excretion of metabolic waste

Excretion of foreign chemicals

Hormone synthesis and excretion

Regulation of Acid-base balance

Regulation of arterial pressure

Regulation of water and electrolyte balance

Gluconeogenesis (in starvation period)

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7
Q

How is Urinary Excretion rate calculated?

A

Glomular Filtration, Tubular Reabsorption and Tubular Secretion

Urinary Excretion rate = Filtration rate - Reabsorption rate + Secretion rate

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8
Q

What does Glomerular Filtration consist of?

A

Non-selective, averages 20% of Renal Plasma flow.

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9
Q

What does Tubular Reabsorption consist of?

A

Highly Variable and selective, almost all electrolytes and nutritional substances are completely reabsorbed.

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10
Q

What does Tubular scretion consist of?

A

Highly variable, rapid excretion of waste products, foreign substances, and toxins.

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11
Q

What is the average GFR?

A

125 ml/min

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12
Q

How many layers does the Glomerular Capillary Membrane have?

A

3 layers,

The Fenestrated Endothellium of the Capillary

Meshwork Basement Membrane

The Podocyte epithelial cells

All layers maintain anti-protein negative charge.

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13
Q

How is the GFR managed?

A

2 Primary methods are

Sympathetic nervous system (control of vasodilation / constriction)

and Hormones and Autocoids (Renin-angiotensin-aldosterone system)

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14
Q

What is important to remember about the Bowman’s Capsule when calculating hydrostatic and colloid osmotic pressure?

A

As no proteins can get into the Bowman’s capsule the Colloid osmotic pressure is 0.

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15
Q

Which hormones or autocaids decrease the GFR?

A

Norepi

Epi

Endothelin

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16
Q

Which Hormones or Autacoids work to prevent GFR change?

A

Angiotensin II

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17
Q

Which hormones or Autacoids increase GFR?

A

Endothelial-derived NO

Prostaglandins

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18
Q

What range of arterial BP is autoregulation of GFR and Renal blood flow able to cover?

A

80-180 mmHg

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19
Q

What are the Two types of Autoregulation performed on Renal Blood flow to maintain GFR?

A

Myogenic and Tubuloglomerular Feedback

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20
Q

How is Myogenic Autoregulation Achieved?

A

BP changes for smoothmuscle contraction of the Afferent Arteriol to limit the amount of change to the GFR.

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21
Q

How does Tubuloglomerular feedback work?

A

When the GFR increases NaCl concentrations increase in the Macula Densa which causes them to direct the Afferent Arteriole to constrict dropping GFR.

If the Blood Pressure drops to much the lack or NaCl in the Macula Densa triggers vasodilation of the Afferent Arteriole as well as Renin rlease increasing GFR.

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22
Q

What is Clearance?

A

The Rate at which substances are removed from the Plasma.

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23
Q

What is Renal Clearance?

A

The Volume of Plasma completely cleared of a substance per minute by the kidneys.

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24
Q

How is clearance of a substance calculated?

A

Cs-Clearance of Substance s

Ps-Plasma Concentration of substance s

Us-Urine concentration of substance s

V=Urine Flow Rate

Cs = (Us x V) / Ps

Cs = Urine excretion rate / Plasma Concenration

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25
How is GFR calculated?
GFR = Ci - Clearence of inulin Pi-Plasma concentration of inulin = 1.0 mg/100mL Ui - Urine Concentration of inulin = 125 mg/100mL V=Urine Flow Rate = 1.0 mL/min GFR = (125x1.0)/1.0 = 125 mL/Min (Ui x V) / Pi = GFR
26
What is reabsobed by the Proximal Convoluted Tubule?
NaCl H2O (no ADH needed) Amino Acids Glucose Protein Urea Ions
27
How does the countercurrent principle in the loop of Henle work?
The Descending limb absorbs water (via passive transport), but no Ions, but the ascending limb is the opposite absorbing ions (via active transport) but no water.
28
What is reabsorbed by the DIstal convoluted Tubule?
NaCl H2O (if ADH present) HCO3
29
What is secreted or reabsorbed in the Collecting Tubule?
_Absorbed_ H2O (if ADH present) _Secreted or Absorbed_ Na K H NH3 _Secreted_ Urea
30
What is Secreted in the Proximal Tubule?
H+ Foreign Substances Organic anions and cations
31
Is Urea Secreted in the Loop of Henle?
Yes in thin segment.
32
What is Secreted in the Distal Tubule?
Urea K H NH3 some drugs
33
If the Kidneys want to eliminate extra water what kid of Urine do they excrete?
Dilute Urine (decreased ADH)
34
What should not be Present in normal Urine?
No Protein No RBC (\<3 ok) No Heme No Cellular Casts No Fat No Sugar
35
What is Azotemia?
biochemical manifestation of Acute or Chronic Kidney injury. Elevated urea nitrogen in blood (BUN) Elevated Serum Creatinine Reduction in GFR
36
What is Prerenal Azotemia?
When there is hypoperfusion of the kidneys
37
What is postrenal azotemia?
When urine outflow is obstructed
38
What can Azotemia lead to?
Uremia Leads to PT death by siezure, coma, and arrest.
39
What is Nephrotic Syndrome?
Injury to the glomerulus leading to abnormal filtration. Heavy Proteunuria (\>3.5 gm/day) Hypoalbuminemia, edema (pitting) Hyperlipidemia and lipiduria
40
What is Nephritic Syndrome?
Can develop from Nephrotic Syndrome, results from inflammation of the Glomerular capillaries. Hematuria Azotemia HTN sub-nephrotic proteinuria (\<3.5 gm/day)
41
What is an Acute Kidney injury?
Rapid decline in GFR (hours to days) with dysregulation of fluid and electrolyte balance - manifests as Oliguria (less than normal \< 500mL) Anuria (no urine)
42
What is Chronic Kidney disease?
GFR persistantly **\<60ml/min for at least 3 months**, from any cause and/or persistant **albuminuria**.
43
What is end stage renal disease (ESRD)?
Irreversible loss of renal disease requiring Dialysis or transplant.
44
What is Urinary Tract obstruction?
Bacturemia and Pyuria (bacteria and leukocytes in urine)
45
What is one of the primary dangers of Renal Tumors?
They mimic many different conditions.
46
What differentiates Renal insufficiency from Renal Failure?
Insuficeincy is noted as a GFR 25-30% of normal, Failure is 10-25%
47
What are the different types of Renal Failure?
Acute Chronic End Stage (\<10-15% of normal GFR)
48
What are the two types of immune mechanisms that can lead to Glomerular injury?
In-situ binding of antibodies (Usually to podocyes or basement membrane) Deposition of circulating immune complexes (either subepithelial, messangial, or subendothelial)
49
What are the 2 clinical categories of Glomerular injury?
Nephrotic (Loss of protein due to damage to filtration ability, loss of neg charge) Nephritic (Inflammatory leading to leaky filtration, loss of RBCs and some protein)
50
What causes the pitting orbital and pedal edema in Nephrotic syndrome?
due to losing albumin there is a significant drop in oncotic pressure, also the presence of Albumin the the urine activates epithelial Na channels causing NA/H2O reabsorption. The extra volume retained without the presence of proteins in the exudate allows pitting to occur.
51
What causes hyperlipidemia and lipiduria in Nephrotic Syndrome?
The Liver attempts to make proteins to replace the lost Albumin, but it mostly prodices lipoproteins. Also the Lipoprotein Lipase is inhibited in Nephrotic syndrome decreasing the body's ability to catabolize the Lipids. As a result there is excess lipid in the blood and urine.
52
What complications can Nephrotic Syndrome lead to?
Infections and Sepsis Thrombosis (due to loss of antithrombin 3 and anticoagulant proteins in urine) Acute Kidney Injury ESRD (if heavy proteinuria does not reverse) Pleural / Pericardial effusion / Acities as condition progresses.
53
What are the Symptoms of Nephrotic Syndrome?
Fatigue Frothy Urine (excess proteinuria disturbs surface tension) Anorexia / Nausea & Vomiting / Abdominal pain (products normally disposed of in urine displaced by proteins end up in GI tract) Weight Gain due to fluid Retention Thyroid issues extending from loss of electrolytes SoB (Pleural effusion)/ DVT / Pulmonary Embolism
54
What are the Diseases of Nephrotic Syndrome we spoke about in Class?
Minimal Change Disease (MCD) Focal Segmental Glomerulosclerosis (FSGS) Membranous Nephropathy (MN)
55
What is Minimal Change Disease?
Selective proteinuria w/ no HTN and preserved Renal Function (in most PTs) Light microscope shows normal glomeruli, but Electron microscope shows diffuse effacement of epithelial cell's foot processes. Most frequent cause of nephrotic syndrom in children 90% in \<10 Y/O Responds to steroid treatment, no biopsy is required, just treatment unless unsuccessful.
56
What is the cause of Minimal Change Disease?
Primary MCD is idiopathic Secondary can be caused by Drugs Neoplasm Infections Allergy
57
What is Focal Segmental Glomerulosclerosis (FSGS)?
Common cause of Nephrotic Syndrome in **_adults_**. Some parts of some Glomeruli become sclerotic, but all glomeruli have a diffuse foot process like what is seen in MCD. Hematuria HTN Nonselective Proteinuria Poor Response to steroids
58
What is the cause of FSGS?
Primary is idiopathic Scondary HIV infection Heroin Abuse Healing of prior GN (IgA, Lupus) Anabolic Steroid Abuse Inherted Mutation
59
What is Membranous Nephropathy (MN)?
Most common cause of Nephropathy in the Elderly Presents as slowly developing nephrotic syndrome. Diffuse thickening of glomerular capillary wall throughout the glomeruli due to IgG and C3 deposition. Highest incidence of renal vein thrombosis, pulmonary embolism, and DVT.
60
What is the Cause of MN?
Primary Autoantibodies against Podocyte antigens in 75% of cases. Secondary Malignancy: Solid Tumor of prostate, lung, or GI Infections (Hep B / C, Syphilis) SLE Drugs
61
What else can cause Nephrotic Syndrome?
Diabetes Mellitus Amyloidosis IgA Nephropathy Systemic Lupus Erythematosus (SLE) Ingestion of drugs (gold, penicillamine, street heroin) Infections (malaria, Syphilis, hepatitis B, HIV) Malignancy

Pathophys (4 decks)

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