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Pathophysiology > mod 12 kidneys > Flashcards

mod 12 kidneys Flashcards

1
Q
  1. What are the functions of the kidneys (8)?
  2. In what 4 ways can the kidneys fail?
  3. Define the following:
    Oliguria:
    Anuria:
    Azotemia:
  4. What is a normal creatinine level?
A
  1. Filter & clean blood of toxic build up, Make urine, Keep salts and mineral in balance, Maintain blood pressure and blood volume,Vitamin D production, Hormone production: erythropoietin, Plasma pH balance
  2. The filters in the kidney (glomerular disease), The blood vessels, Trauma, Urine backup
  3. Oliguria: decreased urine production <500mL/day

Anuria: The absence of urine production <50mL/day

Azotemia: excess blood urea nitrogen (BUN). Normal is 7-20mg/dL

  1. 0.6-1.3 mg/dL It is dependent on muscle mas and can be falsely elevated by medications
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2
Q
  1. What does the glomerulus do?
  2. What is Glomerulonephritis?
  3. Primary Glomerulonephritis is ………… to the kidney and secondary Glomerulonephritis is caused by ………….. injury. IIn both cases, what is the most common etiology? What is a secondary cause?
A
  1. filtration
  2. A broad group of disorders that result in inflammation of the glomerulus
  3. isolated, secondary, immune response, NSAIDs, drugs, hypertension, and diabetes, and infections
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3
Q
  1. Describe Poststreptococcal glomerulonephritis:
  2. What does the congestion result in?
  3. What does the decreased GFR result in?
  4. What are the manifestations?
A
  1. Antistreptococcal antibodies incite an inflammatory response in the glomeruli. This causes swelling and increased fenestration size enabling protein and rbc’s to go into the urine and develops congestion in the glomerulus.
  2. Decreased GFR (glomerular filtration rate)
  3. oliguria, sodium and water retention, hypertension, and possible renal failure
  4. hematuria, proteinuria (major protein in urine esp albumin), oliguria, hypertension, edema, flank or back pain, general signs of inflammation
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4
Q
  1. What is a urinary cast?
2. What do the following casts mean?
Bloody
WBC
Fatty
Granular
  1. What tests can be done for glomerulonephritis?
  2. How do we treat glomerulonephritis?
A
  1. tiny tube-shaped particles found in urine composed of various substances.
  2. glomerulonephritis,
    pyelonephritis,
    nephrotic syndromes,
    chronic renal failure
  3. Blood tests for: elevated urea and creatinine, anti-DNase B, streptococcal antibodies
    Metabolic acidosis
    Urinalysis for proteinuria, hematuria, erythrocyte casts, lack of infection
  4. sodium restriction, decrease protein and fluid intake, Drugs (glucocorticoids, antihypertensives, antibiotics)
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5
Q
  1. Nephrotic syndromes involve …………. in the urine. Nephritic syndromes involve ………….. in the urine.
  2. What causes nephrotic syndromes?
  3. How much protein is in urine? If protein is lost in urine, what is the effect on the blood?
  4. What happens with lipids? Why?
  5. Name 3 other manifestations of nephrotic syndromes (other than those already listed):
A
  1. protein, blood
  2. glomerular injury/damage (non- immune/non-inflammatory)
  3. A lot! > 3.5g/day. Hypoalbuminemia <3.5mg/dL
  4. hyperlipidemia and lipiduria. As proteins (esp albumin) are lost in urine, the liver will produce excess lipoproteins to compensate causing excess lipid in blood and urine
  5. peripheral edema, vitamin D deficiency, and hypocalcemia
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6
Q
  1. nephritic syndromes are cause by …………… of the glomeruli.
  2. What are the manifestations of nephritic syndromes?
A
  1. inflammation
  2. Hematuria – dysmorphic red blood cells, Red blood cell casts, Azotemia (elevated BUN), Oliguria, Hypertension, Variable proteinuria (usually < 3 g/day)
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7
Q
  1. Acute kidney injuries are marked by a …………. ………….. in kidney function. This involves in a ………….. in glomerular filtration, a …………. in urine output, and an accumulation of what?
  2. What can happen as a result of acute kidney injury?
  3. What is meant by “autoregulation” of renal blood flow?
  4. What happens if perfusion drops off? If it happens suddenly and severely, what are the consequences?
  5. Afferent dilation mediated by ……………….. . Efferent constriction effected by ………………….. .
A
  1. sudden decline. Decrease, decrease, nitrogenous waste products in blood.
  2. renal insufficiency, renal failure, and end-stage kidney disease.
  3. renal blood flow and glomerular filtration rate – held constant over wide range of perfusion (blood flow) pressure
  4. dilate afferent arteriole, constrict efferent arteriole. If severe, GFR will drop and kidney will be damaged.
  5. prostaglandins, angiotensin II
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8
Q
  1. What are the 3 types of acute kidney injury?
  2. Which is most common? How does it happen?
  3. What is the most common cause of intrarenal injury?
  4. Postrenal injury is also known as:
  5. Can obstruction of the urinary track happen unilaterally or bilaterally?
A
  1. prerenal, intrarenal, and postrenal
  2. prerenal. caused by impaired blood flow to kidneys by decreased fluid volume (burns, diarrhea), 9decreased cardiac output, renal artery occlusion, and renal vasocinstriction (NSAIDs, contrast).
  3. acute tubular necrosis after ischemic events from toxins like drugs, metals, and contrast
  4. obstructive uropathy. Can be caused by anatomic defects or stones
  5. both
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9
Q
  1. Describe chronic kidney disease:
  2. What is chronic kidney disease associated with (other diseases)?
  3. What are the criteria to diagnose it?
  4. What are the GFR values for normal, mild, moderate, severe, and kidney failure?
  5. Name 2 factors that advance chronic kidney disease:
A
  1. Progressive loss of renal function that affects nearly all organ systems
  2. diabetes I & II, hypertension, intrinsic kidney disease
  3. GFR < 60 mL/min x 3 months
4. normal = 90
mild = 60-89
moderate = 30-59
severe = 15-29
dialysis = <15
  1. proteinuria (protein in urine), uremia (urea in blood), and angiotensin II activity.
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10
Q

How does chronic kidney disease affect the fluid and electrolyte balance in the following categories:
1. Sodium and water balance:

  1. Potassium :
  2. acid base:
  3. Calcium, phosphate,and bone:
  4. Chronic kidney disease affects metabolism of what macromolecules?
  5. Can it cause anemia? What are symptoms?
  6. How do we treat chronic kidney disease?
A
  1. sodium and water are excreted causing hyponatremia and volume loss
  2. Hypokalemia in early stages. Oliguria and hyperkalemia in late stages
  3. Metabolic acidosis when GFR < 30%
  4. reduced renal phosphate excretion, hypocalcemia leading to fractures
  5. protein, fat, and lipid
  6. yes, Lethargy, dizziness, and low hematocrit
  7. manage underlying cause. ex: manage diabetes and hypertension, dialysis, and transplant
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11
Q
  1. Nephrolithiasis are also known as:
  2. What are they made of?
  3. What are the risk factors?
  4. What is the pathophysiology?
  5. What are they made of?
  6. What are the symptoms?
  7. How do we diagnose?
  8. How do we treat?
A
  1. kidney stones, calculi, or urinary stones
  2. Masses of crystals, protein, or other substances that form
    within and may obstruct the urinary tract
  3. Gender (male > female), Age (20-50), Race (AA < Caucasians), Geographic location (because of food), Seasonal factors (hot and dry), Fluid intake, Diet and genetic
  4. supersaturation of salts and inability to dissolve them. Precipitation to a solid state (temp and pH). Crystalizes and aggregates.
  5. Calcium, Uric acid, Struvite stones (associated with chronic UTI), Cystine stones
  6. flank pain
  7. imaging and 24hr urinalysis
  8. Greater fluid intake, dietary decrease of stone forming substance, laser lithotripsy, drugs, surgery
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12
Q
  1. What is a proper pH range? How do we obtain this info?
  2. What 3 things can buffer?
  3. What are the 4 categories of acid-base imbalance and describe:
A
  1. between 7.35 and 7.45. Arterial blood gas test
  2. blood, lungs, and kidneys
  3. Respiratory acidosis: elevation of pCO2 as a result of not enough breathing

Respiratory alkalosis: depression of pCO2 as a result of hyperventilation

Metabolic acidosis: depression of HCO– or an increase in acids

Metabolic alkalosis: elevation of HCO– usually caused by an excessive loss of metabolic acids (excess vomiting)

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13
Q
  1. What are a few causes of respiratory acidosis?
  2. What are the symptoms of respiratory acidosis?
  3. What happens to potassium levels in acidosis?
  4. What are a few causes of respiratory alkalosis?
  5. What are the symptoms of respiratory alkalosis?
A
  1. chest trauma, pulmonary edema, airway obstruction, COPD, drug overdose
  2. hypoventilation and hypoxia, rapid shallow breathing, BP down, headache, hyperkalemia, drowsiness, dysrhythmias (from hyperkalemia), weakness
  3. go up
  4. hyperventilation from anxiety, pregnancy, initial stages of pulmonary embolism
  5. hyperventilation, tachycardia, low or normal BP, hypokalemia, numbness and tingling, muscle cramps, seizures
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14
Q
  1. What are a few causes of metabolic acidosis?
  2. What are the symptoms of metabolic acidosis?
  3. What are a few causes of metabolic alkalosis?
  4. What are the symptoms of metabolic alkalosis?
A
  1. diabetic ketoacidosis, severe diarrhea, sepsis, shock, renal failure
  2. headache, low BP, hyperkalemia, muscle twitching, flushed skin, kussmauls breathing
  3. antacid overuse, potassium wasting diruetics, loss of gastric juices
  4. restlessness followed by lethargy, dysrythmias, compensatory hypoventilation, tremors, cramps, tingling, nausea, vomiting
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15
Q

what are the normal ranges for the following arterial blood gasses?

  1. pH:
  2. PO2
  3. PCO2
  4. HCO3
  5. oxygen saturation:
A
  1. pH = 7.35-7.45
  2. PO2 = >75mmHg
  3. PCO2 = 35 - 45mmHg (40)
  4. HCO3 = 22 - 26 mEq/L (24)
  5. Oxygen saturation = 94 - 100%
  6. First check pH to determine acidemia or alkalemia. Next check CO2 levels.

If acidemia, check the CO2. If less than 40, it is metabolic acidosis. If more than 40 it is respiratory acidosis.

If alkalemia, check CO2. If less than 40 it is respiratory. If greater than 40, it is metabolic alkalemia.

Basically the two are opposite

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Pathophysiology (11 decks)

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