Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathophysiology > module 12 acute tubular necrosis and CKD > Flashcards

module 12 acute tubular necrosis and CKD Flashcards

1
Q

acute tubular necrosis mortality predictors

A 
oliguria
high severity of illness
acute MI
stroke
seizure
chronic immunosuppression
need for ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ATN prodromal phase

A

insult to kidney has occured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ATN oliguric phase

A

2-8 weeks with UO of 50-400mL/day
oliguria and progressive uremia; dec. GFR, hypervolemia
- fluid excess, inc. K, uremic syndrome
dialysis may be required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ATN postoliguric phase

A

diureses; tubular function impaired and azotemia continues
fluid volume deficit until kidneys recover
- 2-10 days, up to a year
full recover: BUN/creatinine normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

prerenal lab findings AKI

A

SG: >1.020
BUN/creatinine ratio: >20:1
urine Na: < 10
urine sediment: few hyaline casts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

intrarenal lab findings AKI

A 
possible proteinuria
SG: 1.010-1.020
BUN/creatinine ratio: 10-20:1
urine Na: >20
urine sediment: tubular, RBC, and WBC casts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ATN patho

A 
ischemia or nephrotoxin 
Inflammation and tubular injury
-> inflammatory cells
-> cast formation
-> tubular obstruction 
-> inc. tubular intra-luminal pressure 
-> tubular backleak, oliguria, dec. GFR
dec. O2 to outer medulla -> vasoconstriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ATN tubule cell injury Reversible patho

A
  • loss of polarity
  • > inc. distal Na
  • > inc. tubuloglomerular feedback
  • > vasoconstriction
  • > dec. GFR and oliguria
  • detachment
  • > obstruction by casts and tubular back leak
  • > inc. intratubular pressure and dec. tubular flow
  • > dec. GFR and oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ATN tubule cell injury irreversible patho

A

necrosis and apoptosis

  • > tubular back leak
  • > dec. tubular flow
  • > dec. GFR and oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ATN endothelial dysfunction patho

A

vasoconstriction

  • > RAAS
  • > inc. endothelin, dec. NO, dec. PGI2
  • > dec. GFR and Oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CKD progressive process

A

chronic kidney disease -> chronic renal failure -> end-stage renal disease
- ESRD: requires dialysis
Linked with comorbidities
- HTN, DM
dec. kidney function or kidney damage of 3 mo.
GFR < 60mL/min for 3 mo.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

GFR reduction occurs with

A

nephron loss

kidneys compensate until 75-80% of nephrons are damaged/nonfunctional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

stages of CKD

A

each stage higher the GFR and kidney function dec.

1-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stage 1 and 2 CKD

A

labs normal
asymptomatic with some kidney disease
minimizing risk factors
initial decrease in GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

stage 3 CKD

A

symptoms may appear and treatment may be needed.

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stage 4 CKD

A

planning for dialysis or transplant should begin

s/s very apparent

17
Q

Stage 5 CKD

A

Renal replacement therapy needed or death will ensue

18
Q

CKD risk factors

A 
DMT2
HTN
recurrent pyelonephritis 
glomerulonephritis
polycysitic kidney disease
family hx 
exposure to toxins
>65
ethnicity: black, white, mexican-american 
electrolyte  and fluid imbalance
19
Q

stages of CKD according to nephron loss

A

dec. renal reserve
- <75% nephron loss
- no s/s, BUN/creatinine nml
Renal insufficiency
- 75-90% nephron loss
- polyuria, nocturia, slight in. BUN/creatinine
- control with diet and medication
End stage:
- >90% nephron loss
- azoztemia/uremia, fluid and electrolyte abnomal, osteodystrophy, anemia, dialysis or transplant needed.

20
Q

CKD and primary foci

A

appropriate management of ATN
blood glucose control
aggressive management of HTN

21
Q

HTN, cardiovascular disease, and CKD

A

Hypervolemia, escalated atherosclerosis, inc. RAAS/SNS activity
cardiovascular disease is both a risk factor and side effect of CKD

22
Q

metabolic acidosis and CKD

A

kidneys dont secrete H+
will be exchanged for intracellular K+
-> hyperkalemia and dec. pH
Kidney does not produce Bicarb -> dec. pH

23
Q

uremic syndrome

A

retention of metabolic wastes -> impaired healing

24
Q

electrolyte imbalance and CKD

A

retained K+, phosphorus, mag

loss Ca

25
Q

Bone and mineral disorders and CKD

A

inc. phosphorus and PTH -> bone/mineral metabolism
kidneys unable to reabsorb calcium
unable to activate Vit. D -> Ca only available from the bones

26
Q

malnutrition, pain, depression and CKD

A

hypoalbuminemia

27
Q

anemia and CKD

A

lack of erythopoietin (secreted by kidney in response to hypoxia)
uremia shortens RBC life

28
Q

dialyasis

A

remove metabolic wastes and correct fluid and electrolyte imbalances
primary reason: development of uremia or hyperkalemia unresponsive to other tx.

29
Q

extra-renal manifestations of CKD

A 
HTN
- renin release r/t damaged kidney or inc. intravascular volume r/t abnormal handling of Na and H2O. 
Lungs and pleura: 
- chronic pulm. edema
Immune system:
- depressed, delayed immune response
GI: 
- N/V, and anorexia
Anemia
- dec. EPO, dec. RBC survival, poor nutrition, bleeding
Nervous system: 
- AMS, sensory and motor neuropathy common with uremia

Pathophysiology (80 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions