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Patho 2 (Path 311) > Mod 12 Renal Disorders > Flashcards

Mod 12 Renal Disorders Flashcards

1
Q

What is the primary function of the kidneys?

A

Clean blood and maintain homeostasis

  • Maintains blood volume; excrete excess (waste products)
  • Selective reabsorption of substances of Na, K, etc.
  • Vitamin D activation also occurs here
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2
Q

What systems do the kidneys regulate to maintain homeostasis?

A

Any system that regulates/deals with Erythropoietin and renin/angiotensin levels

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3
Q

How much cardiac output is received by the kidneys?

A

20-25%

  • 1700 liters per day; produce about 60 ml/hr of urine
  • don’t waste time on this slide for now
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4
Q

What are normal BUN values?

A

7-20 mg/dL

  • BUN = blood urea nitrogen. Measures the amount of urea nitrogen in the blood.
  • The liver produces urea as a waste product of protein digestion
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5
Q

What are normal creatinine levels for men and women?

A

1.4 mg/dL for men and 1.2 for women

  • Creatinine = product of the breakdown of creatine phosphate from protein metabolism in the muscles.
  • Released at a constant rate by the body.
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6
Q

What are expected general outcomes from Kidney Failure? (3)

A
  1. Blood volume increases –> Increased risk of pulmonary edema
  2. Electrolyte disturbances may manifest in cardiopulmonary symptoms (arrhythmias)
  3. Metabolic acidosis
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7
Q

How does acute kidney failure differ from chronic kidney failure?

A

A reversible state of acute impairment in renal function

  • Etiology can have prerenal, renal, and/or post renal causes
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8
Q

How does chronic kidney failure differ from acute kidney failure?

A

Often irreversible, divided into 5 stages based on:

  • Amount of kidney function remaining
  • Symptoms
  • Estimated glomerular filtration rate (GFR)
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9
Q

What is the Etiology of Prerenal failure?

A

Any disease that leads to inadequate perfusion of the kidney:

  • Shock states
  • Heart failure
  • Hypotension
  • Sepsis
  • Atherosclerosis of the renal artery
  • Rhabdomyolysis
  • Tubular and glomerular function remain normal
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10
Q

What is the Etiology of Renal failure (intrinsic)? (3)

A

Any disease that leads to actual damage of the nephrons of the kidney:

  1. Acute tubular necrosis (direct damage to kidney tissue)
  2. Acute glomerulonephritis (vascular damage)
  3. Acute interstitial nephritis (inflammation of kidneys; by meds)
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11
Q

What is acute tubular necrosis?

A

Direct damage to the kidney tissues; especially the tubule

  • Ischemic or cytotoxic in origin
  • A common cause of kidney failure in hospitalized patients
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12
Q

What are possible causes of Acute Tubular Necrosis? (4)

A
  • Blood transfusions
  • Low perfusion for > 30 mins
  • Major surgery
  • Septic shock
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13
Q

What is Acute Glomerulonephritis?

A

Vascular in origin; the glomerulus becomes inflamed and damaged

  • Often due to auto-immune response or infections
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14
Q

What is Acute interstitial nephritis?

A

Acute interstitial nephritis

  • Inflammation of the kidneys; often caused by a medicine
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15
Q

What is the Etiology of Postrenal failure?

A

Mechanical obstruction of the urinary collecting system (ureters, bladder, urethra…); Increased tubular pressure decreases the filtration driving force by…

  • Stone disease
  • Tumors
  • Stricture
  • Thrombosis
  • Compressive hematoma
  • Enlarged prostate
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16
Q

Clinical manifestations of Acute Renal Failure? (4)

A

Depend on etiology, but generalities include:

  • Urine output abnormalities (oliguria or Anuria)
  • Electrolyte imbalances; and following weakness
  • Fluid loss via Nausea and vomiting
  • Fluid overload –> pulmonary edema and its manifestations
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17
Q

What is Oliguria?

A

Failure to produce adequate urine

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18
Q

What is Anuria?

A

Total failure to produce urine

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19
Q

Pathophysiology of Acute Renal Failure?

A
  1. Initial kidney deficiency (compensation failure and decreased u/o)
  2. Retention of nitrogen waste and fluid overload
  3. Renal acidosis by filtration failure (acid base dysfunction)
  4. Electrolyte imbalance (i.e hypernatremia)
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20
Q

What are common Electrolyte imbalances associated with acute renal failure?

A
  1. Hypernatremia
  2. Hyperkalemia
  3. Hyperchloremia
21
Q

What are the consequences of nitrogen waste retention?

A

Retention of waste products leads to fluid overload and increased extracellular fluid

  • Waste products would be urea, uric acid, and creatinine
22
Q

What happens if the kidneys cannot excrete fixed acids?

A

Renal acidosis (acid/base dysfunction)

23
Q

What are normal lab findings of urine?

A

Yellow-amber in color - clear to slightly hazy

  • pH 4.6-4.8
  • Negative of glucose, ketone, protein, bilirubin, crystals
  • Rarely shows RBC, WBC, epithelial cells, casts
  • Normal BUN and creatinine
  • Specific gravity of 1.010-1.025?
24
Q

What are abnormal lab findings of urine that would indicate Acute Renal Failure?

A

Increased BUN and creatinine

  • urinalysis may reveal sedimentation, WBC, and RBCs
25
Q

What are treatments or management strategies for acute renal failure?

A

Dialysis and Diuretics are the primary tx for renal failure.

  1. Pretreatments; identify and treat causal agent
  2. Monitor in/out for fluid overload
  3. Monitor electrolytes, Potassium levels
  4. Monitor for anemia
  • Other interventions correct or monitor pt status not worsen the causal agent.
  • Rule of thumb before primary tx: Ensure proper circulation and filtration
26
Q

If circulation is the causal agent of renal failure, what are 2 variables that need to be maintained/corrected?

A

Identify the cause and treat it first. Ensure proper circulation and filtration.

  1. Restore circulation w/volume expanders, vasopressors, blood volume
  2. Restore circulation to kidney, remove neoplasms, clear obstructions
27
Q

Why do you need to monitor anemia if acute renal failure is suspected?

A

Kidneys produce erythropoietin which commands stem cells in the marrow to form RBCs. They are markers of kidney status.

28
Q

What should you keep in mind when managing Acute Renal Failure pharmacologically?

A

Beware of inefficient drug elimination

  • Ensure meds are cleared by kidneys, they could linger longer.
29
Q

What are patients at risk of during periods of low renal blood flow?

A

Iatrogenic renal injury (caused by tx or meds) such as:

  • Radio-contrast dyes
  • Aminoglycosides
  • CV surgery
  • Some other meds (NSAIDS, ACE inhibitors)
30
Q

What are 3 types of Dialysis?

A
  1. Peritoneal
  2. Continuous Renal Replacement Therapy (CRRT)
  3. Hemodialysis
31
Q

What is Peritoneal dialysis?

A

Tube inserted into abdomen, dialysis solution is exchanged

32
Q

What is CRRT (Continuous Renal Replacement Therapy) dialysis?

A

An extracorporeal purification therapy to substitute for impaired renal function over an extended period of time

  • Slow dialysis that has less dramatic swings in fluid balance
  • Better suited to the ICU patient
33
Q

What is Hemodialysis?

A

A vascular access is created usually in a forearm A-V fistula (“shunt”)

  • usually 3 weeks
  • inpatients or outpatients
34
Q

What are the 5 Diuretics classes used to manage Acute Rental Failure?

  • Know this card
  • know at least 1 drug in each group
A
  1. Loop Diuretics (eg. Lasix)
  2. Potassium-Sparing Diuretics (eg. Aldactone)
  3. Carbonic Anhydrase Inhibitors (eg. Diamox)
  4. Thiazide Diuretics (names end in zide, eg. hydrochlorothiazide (Microzide))
  5. Osmotic Diuretics (Mannitol, very powerful)
35
Q

What diuretics affect each of the tubule pathway in the renal system?

A
36
Q

What is chronic renal failure defined as?

A

Kidney disease lasting longer than 3 months

37
Q

What are the most common causes of chronic renal failure (CRF)?

  • Other causes?
A
  1. Type 1 and 2 Diabetes
  2. Hypertension
38
Q

What does the following image compare?

A

Compares a Normal and Polycystic kidney

39
Q

What are clinical manifestations of Chronic Renal Failure (CRF)?

A

May not have any symptoms until considerable, often irreparable, damage has occurred

40
Q

What are treatments for Chronic Renal Failure (CRF)?

A

Depends on stage of CRF:

  • Identify the cause and try to reverse/stop/slow it
  • Monitor creatinine, BP, and general health
  • Pt education
  • Dialysis (including creation of access site)
  • Transplant
41
Q

What effect does PPV have on the renal system?

A

PPV can reduce urine output

  • Associated w/reduction in renal blood flow, glomerular filtration rate, Na and K excretion
  • Decreases mean arterial pressure
42
Q

How does PPV affect hormonal systems that regulate Sodium and water retention? (3)

not done yet

A
  1. PPV enhances ADH release (via intrathoracic pressure diff)
  2. PPV reduces atrial filling pressure causing decreased secretion of ANP
  3. Renin angiotensin/aldosterone activation leading to increased Na and water retention
43
Q

What does the Atrial Natriuretic peptide (ANP) Hormone do?

A

A cardiac hormone whose main function is to lower BP and to control electrolyte hemostasis.

  • Acts to increase glomerular filtration rate (GFR)
  • PPV can reduce ANP secretion (bc of reduced atrial filling pressure)
  • Background info Release of ANP is stimulated by increased atrial stretching which occurs w/elevated blood volume and pressure in the atria.
44
Q

What is Naturiuresis?

A

Excretion of sodium in the urine

45
Q

What is Diuresis

A

Increased urine production

46
Q

What is the impact of decreased Atrial Natriuretic Peptide (ANP) on the body?

A

ANP normally counteracts the effects of aldosterone. When there is decreased ANP secretion, there is less inhibition of aldosterone.

  • Causes a increase in sodium and water retention
47
Q

What is the function of the hormone ADH?

A

Chemical produced in the brain that causes the kidneys to release less water, decreasing the amount of urine produced.

  • High ADH levels = less urine production
  • Low ADH levels = greater urine production
48
Q
A

Patho 2 (Path 311) (15 decks)

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