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PATHO/PHARM II > Mod Lecture 1: FULL GU and ... > Flashcards

Mod Lecture 1: FULL GU and ... Flashcards

Exam 1

1
Q

Renal regulation: Purpose is to conserve:

A

Conserve nutrients

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2
Q

Renal Regulation: What does the kidney excrete?

A

Excretion of nitrogenous metabolic waste products

Urea, uric acid, creatinine

Metabolic waste and drug excretion & drug detoxification

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3
Q

What are examples of nitrogenous metabolic waste products?

A

Urea, uric acid, creatinine

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4
Q

Renal Regulation: What doe the kidneys do with hormones?

A

Hormone synthesis & breakdown

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5
Q

Renal regulation: What does it balance?

A

Acid–base, water, electrolyte balance

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6
Q

Renal regulation leads to endocrine regulation of:

A

Endocrine regulation of insulin, extracellular fluids, ions, volume & BP

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7
Q

Renal Regulation leads to endocrine control of:

A

Endocrine control of Ca-Po4 metabolism (Vit D activation, PO4 excretion)

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8
Q

What does the renal system perform?

A

Performs gluconeogenesis

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9
Q

Components of the Renal System?

A
  1. Kidneys
  2. Ureters
  3. Urinary Bladder
  4. Urethra
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10
Q

Kidney function

A

Eliminates waste from the blood

Helps regulate water concentration

Helps regulation blood pressure

Helps maintain a constant blood pH

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11
Q

Ureter function

A

Transport urine to the urinary bladder

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12
Q

Urinary bladder function

A

Stores urine,

contracts to eliminate stored urine

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13
Q

Urethra function

A

Transports urine to the outside of the body

Moves urine from bladder to urinary meatus

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14
Q

Renal/GU Anatomy includes:

A

Renal capsule

Renal cortex

Renal artery

Renal pelvis

Ureters

Bladder

Urethra

Nephrons

Arterioles

Glomerulus

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15
Q

Renal capsule in the kidney

A

Surrounding connective tissue

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16
Q

Renal cortex of the kidney

A

Contains nephrons

The outer layer of the kidney is called the cortex.

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17
Q

Renal artery of the kidney

A

Supplies blood

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18
Q

Renal pelvis of the kidney

A

Funnel for urine flowing to ureter

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19
Q

Ureters

A

Urine from calyces –> bladder

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20
Q

How long is a male’s urethra? How long is a female’s urethra?

A

6-8” males > 1.5” females ~ UTI risk

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21
Q

How many nephrons are on each kidney?

A

1–2 million per kidney

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22
Q

Where are nephrons located?

A

Located in the cortex and medulla

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23
Q

What does the nephrons do?

A

Filters plasma

Responsible for passing urine into collecting ducts

Reabsorbs and secretes (Tubular reabsorption and secretion)

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24
Q

What do nephrons form?

A

Forms a filtrate of protein-free fluid

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25
Q

What does the nephron regulate?

A

Regulates the filtrate to maintain fluid volume, electrolytes, and pH

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26
Q

Glomerulus

A

Cluster of capillaries ~ filters blood

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27
Q

The glomerulus receives how much blood?

A

Receive about 1-2 L blood/minute

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28
Q

How much blood is filtered through the glomerulus and where does it go?

A

120-140 ml blood/min is filtered (180L/day) & passes into Bowman’s capsule

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29
Q

Of the 180L/day that is filtered by the glomerulus, how much is reabsorbed by peritubular capillaries?

A

178L or more of filtrate is reabsorbed by peritubular capillaries 1 -2 L urine/day
Water, electrolytes

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30
Q

Slide 9

A

Study if you have time

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31
Q

Parts of the nephron?

A
  1. Glomerulus
  2. Proximal Tubule
  3. Loop of Henle
  4. Distal Tubule
  5. Collecting duct
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32
Q

Different Renal Function Tests

A
  1. GFR
  2. Creatinine Clearance
  3. Blood Urea Nitrogen
  4. Serum Creatinine (SCr)
  5. Urinalysis
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33
Q

What is the best estimate of renal functioning renal tissue, used for drug dosing? highlighted red point

A

GFR

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34
Q

What does GFR measure?

A

Flow rate of filtered fluid through the kidney

The filtration of the plasma per unit of time is known as the glomerular filtration rate (GFR)

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34
Q

glomerular filtration rate (GFR)

A

The filtration of the plasma per unit of time is known as the glomerular filtration rate (GFR)

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35
Q

What are normal GFR values?

A

Normal GFR 90 to 120 ml/min

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36
Q

eGFR

A

eGFR = Expressed as a single equation that accounts for gender and race

Estimated Glomerular Filtration Rate

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37
Q

How is GFR determined? Highlighted red point*

A

Determined by perfusion pressure in the glomerular capillaries

is directly related to the perfusion pressure of the glomerular capillaries

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38
Q

??????

A

The Modification of Diet in Renal Disease (MDRD) Study equation and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation

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39
Q

Creatinine Clearance (CrCl)- what is it; what is it an estimate of

A

Volume of blood plasma cleared of creatinine per unit time

Estimate of GFR

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40
Q

Blood Urea Nitrogen (BUN)

A

End-product of protein metabolism is urea
Liver & renal function

measures the amount of urea nitrogen in your blood, which is a waste product that your kidneys remove.

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41
Q

Serum Creatinine (sCr) is filtered where?

A

Filtered at the glomerulus

42
Q

A small amount of serum creatinine is secreted by what?

A

Small amt secreted by renal tubules

43
Q

What is a better indicator of renal functioning SCr or BUN?

A

SCr Indicator of renal function > BUN

44
Q

Urinalysis-normal results

A

Normal: pale yellow, clear

pH 4.6-8

SG ~ 1.001 – 1.035

45
Q

Urinalysis-sign of UTI

A

Cloudy, foul-smelling, turbid, WBC ~ UTI

46
Q

Urinalysis-sign of dehydration

A

Dark yellow ~ dehydration

47
Q

Urinalysis-sign of DKA

A

Acetone odor

48
Q

Urinalysis-presence of Proteinuria, hyaline casts

A

presence of Proteinuria, hyaline casts ~ injured glomerular membrane

49
Q

Urinalysis-presence of glucose

A

Glucose ~ DM

50
Q

Urinalysis-presence ketonuria

A

Ketonuria ~ fatty acid metabolism

51
Q

Urinalysis-presence of crystalluria

A

Crystalluria ~ renal stone formation

52
Q

Urinalysis- presence of cellular casts

A

Cellular casts ~ nephrotic syndrome

53
Q

Urinalysis: Ketones present

A

Ketones ~ fat metabolism

54
Q

First three steps to RAAS

A
  1. The drop in blood pressure triggers the release ADH from the posterior pituitary
  2. ADH increases water reabsorption by the kidney by increasing water permeability of the distal tubules and collecting ducts.
  3. The drop in blood pressure also is detected by kidneys, which responds by secreting renin.
  4. Renin triggers the formation of angiotensin II, which stimulates release of aldosterone from the adrenal cortex.
  5. Aldosterone then slowly boosts water reabsorption by the kidneys by increasing reabsorption of Na+
55
Q

Additional Regulation by Kidneys include:

A

Vitamin D

pH regulation

ANP/BNP

Erythropoietin

56
Q

Certain hormones are either activated or synthesized by the kidney. These hormones have significant systemic effects and include:

A

urodilatin,
the active form of vitamin D,
and erythropoietin.

57
Q

What is vitamin D needed for?

A

Needed for Ca absorption

Vitamin D is a hormone that is necessary for the absorption of calcium and phosphate by the small intestine.

58
Q

How is vitamin D obtained? In what form?

A

It can be obtained in the diet or synthesized by the action of ultraviolet radiation (sun exposure) on cholesterol in the skin. These forms of vitamin D3 (cholecalciferol) are inactive

59
Q

What does kidney do to vitamin D?

A

Renal conversion Vit D to active form

60
Q

When does reabsorption of renal Ca occur by the kidney?

A

Reabsorption of renal Ca when levels are low

61
Q

What does decreased plasma calcium levels cause?

A

A decreased plasma calcium level (less than 10 mg/dl) stimulates the secretion of parathyroid hormone.

Parathyroid hormone then stimulates a sequence of events to help return the plasma calcium concentration toward normal levels (9 to 10.5 mg/dl)

Parathyroid hormone causes release of Ca from bones, absorption of Ca from intestines, increased renal reabsorption, decreased renal phosphate reabsorption.

62
Q

When is there increased excretion of Ca by the kidneys? ***THis doesn’t make sense?

A

Increased excretion when PO4 levels are high

63
Q

How does the kidney regulate pH?

A

HCO3 secretion, H+ excretion

64
Q

ANP/BNP (Natriuretic Peptides)

A

slide 13

65
Q

Erythropoietin (Epo)

A

Erythropoietin (Epo) stimulates the bone marrow to produce red blood cells in response to tissue hypoxia and may have tissue protective effects

66
Q

What is the stimulus for erythropoietin release?

A

The stimulus for Epo release is decreased oxygen delivery in the kidneys.

67
Q

Lack of erythropoietin can be related to what?

A

The anemia of chronic renal failure, in which kidney cells have become nonfunctional, can be related to the lack of this hormone (erythopoietin)

68
Q

Changes that occur with aging kidneys:

A

Structural changes commonly occur in the kidney with aging, including:

loss of renal mass,
arterial sclerosis,
an increased number of sclerotic glomeruli,
loss of tubules, and
interstitial fibrosis.

69
Q

As number of nephrons decline, what occurs?

A

As the number of nephrons decreases and degenerative changes occur, nephrons are less able to concentrate urine and less able to tolerate dehydration, excessive water loads, or electrolyte imbalances, particularly with physiologic stress.

70
Q

What would accelerate the decline of kidney function?

A

The presence of comordid conditions, such as hypertension and diabetes mellitus, accelerates the decline of renal function.

71
Q

The process of urination is what kind of process?

A

Voluntary process

72
Q

What does urination require?

A

Functional bladder & stretch receptors that senses bladder filling with urine

Intact parasymp nervous system (PNS) to transmit the signal

Working bladder detrusor muscles to initiate bladder contractions –> urine

73
Q

Urinary Tract infection

A

A urinary tract infection (UTI) is an inflammation of the urinary epithelium (mucosa) usually caused by bacteria from gut flora.

74
Q

Where can a UTI occur?

A

A UTI can occur anywhere along the urinary tract, including the urethra, prostate, bladder, ureter, or kidney (pyelonephritis).

75
Q

Who is at risk of UTIs?

A

At risk are premature newborns; prepubertal children; sexually active and pregnant women; women treated with antibiotics that disrupt vaginal flora; spermicide users; estrogen-deficient postmenopausal women; individuals with indwelling catheters; and persons with diabetes mellitus, neurogenic bladder, or urinary tract obstruction.

76
Q

Uncomplicated UTIs

A

Uncomplicated UTIs are mild and without complications and occur in individuals with a normal urinary tract.

77
Q

Complicated UTIs- how do they develop?

A

A complicated UTI develops when there is an abnormality in the urinary system or a health problem that compromises host defenses, such as human immunodeficiency virus (HIV), renal transplant, diabetes, or spinal cord injury.

78
Q

Cystitis

A

Cystitis is an inflammation of the bladder and is the most common site of UTI.

79
Q

What is the most common site of UTI?

A

The bladder

80
Q

The different types of cystitis?

A
  1. Mild cystitis
  2. Hemorrhagic cystitis
  3. Suppurative cystitis
  4. Ulcerative cystitis
  5. Gangrenous cystitis
81
Q

Mild cystitis

A

Mild cystitis shows a hyperemic (red) mucosa.

82
Q

Hemorrhagic cystitis

A

shows diffuse mucosal hemorrhages and occurs with more advanced inflammation.

83
Q

Suppurative cystitis

A

shows mucosal pus formation or suppurative exudates.

84
Q

Ulcerative cystitis

A

results from prolonged infection with ulcers that may lead to sloughing of the mucosa.

85
Q

Gangrenous cystitis

A

is necrosis of the bladder wall and occurs with the most severe infections.

86
Q

What are the most common microorganism to cause UTI? What is the second?

A

The most common infecting microorganisms are uropathic strains of Escherichia coli, and the second most common is Staphylococcus saprophyticus.

87
Q

Less common microorganisms to cause UTIs include:

A

Less common microorganisms include Klebsiella, Proteus, Pseudomonas, fungi, viruses, parasites, or tubercular bacilli.

88
Q

How does bacterial contamination of the normally sterile urine usually occur?

A

Bacterial contamination of the normally sterile urine usually occurs by retrograde (backward) movement of gastrointestinal gram-negative bacilli into the urethra and bladder from the opening of the urethra.

The microorganisms can then move into the ureter and kidney.

89
Q

Clinical manifestations of cystitis are usually related to what?

A

Clinical manifestations of cystitis are related to the inflammatory response

90
Q

Clinical manifestations of cystitis are what?

A

usually include frequency, urgency, dysuria (painful urination), and suprapubic and low back pain. Hematuria, cloudy urine, and flank pain are more serious symptoms.

91
Q

Many individuals with bacteruria are asymptomatic, what group has the highest risk of this? What may this group experience instead?

A

Many individuals with bacteriuria are asymptomatic, and the elderly have the highest risk and may have only confusion or vague abdominal discomfort.

92
Q

Evaluation and Treatment of cystitis?

A

If a urine culture and sensitivity are ordered, the urine specimen must be obtained before the initiation of any antibiotic therapy; 3 to 7 days of treatment is most common.

93
Q

What can be used for the diagnosis of uncomplicated UTI?

A

Urine dipstick testing that is positive for leukocyte esterase or nitrite reductase can be used for the diagnosis of uncomplicated UTI.

94
Q

What produces the urgency and frequency of urination associated with cystitus?

A

Inflammatory edema in bladder wall stimulates activation of stretch receptors.

The activated stretch receptors initiate symptoms of bladder fullness with small volumes of urine, producing the urgency and frequency of urination associated with cystitis.

95
Q

Pyelonephritis

A

is an infection of one or both upper urinary tracts (ureter, renal pelvis, and kidney interstitium).

96
Q

WHat are the most common underlying risk factors of pyelonephritis?

A

Urinary obstruction and reflux of urine from the bladder (vesicoureteral reflux) are the most common underlying risk factors.

97
Q

How is pyelonephritis spread?

A

The infection is probably spread by ascending uropathic microorganisms along the ureters.

98
Q

The inflammatory process involved in pyelonephritis affect what?

A

The inflammatory process primarily affects the pelvis, calyces, and medulla of the kidney.

99
Q

What does pyelonephritis cause?

A

The infection causes infiltration of white blood cells with renal inflammation, renal edema, and purulent urine.

100
Q

In severe infections of pyelonephritis, what can occur?

A

In severe infections, localized abscesses may form in the medulla and extend to the cortex.

101
Q

Clinical manifestations of pyelonephritis include:

A

The onset of symptoms is usually acute, with fever, chills, and flank or groin pain.

Symptoms characteristic of a UTI, including frequency, dysuria, and costovertebral tenderness, may precede systemic signs and symptoms.

102
Q

Chronic pyelonephritis

A

is a persistent or recurrent infection of the kidney leading to scarring of the kidney.

103
Q
A

PATHO/PHARM II (27 decks)

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