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Urinary Pathophysiology > Overview of Renal Function and Renal Disease > Flashcards

Overview of Renal Function and Renal Disease Flashcards

1
Q

what are the three steps of urine formation?

A

filtration
selective reabsorption
selective secretion

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2
Q

how much of the plasma moves into the filtrate?

A

about 20%

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3
Q

how much blood flow do the kidneys receive?

A

20% of cardiac output

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4
Q

what does the loop of henle create?

A

hypertonic medullary interstitium

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5
Q

what are the two capillary beds in the kidney?

A

glomerular
peritubular

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6
Q

where is 90% of renal bloodflow?

A

cortex

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7
Q

which capillary bed has high pressure?

A

glomerular: high hydrostatic pressure causes fluid filtration

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8
Q

in peritubular capillaries, _________________ favors fluid reabsorption

A

low hydrostatic pressure

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9
Q

what can regulate the respective pressures and rate of glomerular filtration and tubular reabsorption in the capillaries?

A

adjusting the resistance of afferent and efferent arterioles

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10
Q

what are some vascular born insults that can impact the kidneys?

A

thromboembolism
bacterial emboli
circulating immune complexes

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11
Q

what color are acute infarcts?

A

red

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12
Q

what color are chronic infarcts?

A

white

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13
Q

infarcts that affect the cortex and medulla likely involve _________________

A

interlobar vessel

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14
Q

infarcts affecting only the cortex could involve either __________________________

A

the arcuate or interlobular artery

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15
Q

what characterizes acute kidney injury?

A

sudden loss of renal function over hours or several days
potentially reversible

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16
Q

what characterizes chronic renal disease?

A

renal disease has persisted for months or years
function often progressively declines over months to years
“cure” not generally possible

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17
Q

at what age is chronic renal disease common?

A

generally older animals
congenital or familial disease seen in younger animals

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18
Q

what is uremia?

A

clinical signs associated with kidney failure

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19
Q

what are the signs of uremia?

A

anorexia, depression
dehydration
hypothermia
weight loss (chronic)
nausea
vomiting
diarrhea

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20
Q

what do you see with uremic gastropathy?

A

submucosal arteritis
edema and mast cell infiltration of submucosa
glandular atrophy
fibroplasia
mineralization

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21
Q

what does mineralization contribute to?

A

gastric ulceration
hemorrhage
hematemesis

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22
Q

what is uremic enterocolitis?

A

ulcerative and hemorrhagic lesions in colon
often bloody diarrhea

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23
Q

what happens with uremic stomatitis?

A

halitosis: bad breath
oral ulceration

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24
Q

what causes oral ulceration with uremic stomatitis?

A

vasculitis/arteritis
bacteria in mouth convert urea to ammonia

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25
Q

what does renal secondary hyperparathyroidism with CRD lead to?

A

pathologic mineralization
renal osteodystrophy

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26
Q

how prevalent is arterial hypertension with chronic renal disease?

A

50-80% of dogs and cats

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27
Q

what are some examples of tissue mineralization with uremia?

A

uremic frosting
uremic pneumonitis
uremic endocarditis

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28
Q

what material accumulates in an animal or person with gout?

A

uric acid

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29
Q

what predisposes patients with uremia to bleeding?

A

decreased platelet function with uremia
ulcerations
abnormal blood vessels

30
Q

what are the consequences to bleeding tendencies with uremia?

A

ocular lesions
brain bleeds
gastrointestinal hemorrhage
gingival bleeding
bruising

31
Q

what is renal gout?

A

urate crystals in renal tubules

32
Q

what is visceral gout?

A

coating of chalky white urate crystals on internal organs

33
Q

what is articular gout?

A

accumulation of uric acid crystals in joints and along tendons

34
Q

what are the uremic effects on the endocrine system?

A

insulin resistance
uremic animals usually sterile

35
Q

what does acute kidney injury result in?

A

accumulation of metabolic wastes
dysregulation of fluid and electrolyte balance
acid/base imbalance

36
Q

what are the physical exam findings with an acute kidney injury?

A

rapid onset of clinical signs
depressed, hypovolemia, hypotension
+/- fever
tachypnea to eliminate CO2
+/- bradycardia
+/- enlarged, painful kidneys

37
Q

what can cause ischemia?

A

severe or prolonged dehydration or hypovolemia
thrombosis or infarction

38
Q

what are some causes of intrinsic damage to the kidneys?

A

nephrotoxins
hemoglobin or myoglobin nephropathy (more large animals)
infectious agents
hypercalcemia

39
Q

what are some infectious agents that can cause intrinsic damage to the kidneys?

A

leptospira
ascending infections

40
Q

what are some postrenal causes of acute kidney injury?

A

elevated pressure
acute blockage
decreased flow increases: stone formation and infection

41
Q

what are the four phases of acute kidney injury?

A

initiation
extension
maintenance
repair

42
Q

what happens in the initiation phase of acute kidney injury?

A

insult and sublethal injury

43
Q

what happens in the extension phase of acute kidney injury?

A

injury continues and epithelium undergoes apoptosis or necrosis
progressive decrease in GFR, urine concentrating ability and urine output
blood test may be normal for 1-2 days
changes in urine sediment maybe
kidneys may be swollen and painful

44
Q

what might you see on a UA during the extension phase?

A

casts
accumulation of things absorbed: glucose or protein
etiology evidence

45
Q

what are some things that would be evidence of etiology on a UA of acute kidney injury during the extension phase?

A

calcium oxalate crystals
RBC, WBC, fungi, bacteria

46
Q

what characterizes the maintenance (oliguric) phase of acute kidney injury?

A

irreversible epithelial damage: GFR reduced enough to show azotemia, urine output decreased
complications of uremia develop
elimination of inciting cause does not alter rate of recovery

47
Q

what happens during the recovery phase of acute kidney injury?

A

repair and regeneration of kidney tissue

48
Q

what is the duration of the recovery phase of acute kidney injury?

A

days to months

49
Q

what is the most common type of renal disease in cats and dogs?

A

chronic renal disease

50
Q

what has occured in chronic renal disease?

A

irreversible, structural changes: loss of nephrons and decreased GFR

51
Q

what are some causes of chronic kidney disease?

A

any cause of AKI
familial/congenital
infectious disease
neoplasia
glomerulopathies
idiopathic
obstruction

52
Q

what are the physical exam findings associated with chronic renal disease?

A

thin, poor hair coat
depressed, dehydrated
pale mucous membranes
signs of hypertension and uremic changes
+/- fever
tachypnea to eliminate CO2
+/- small, irregular kidneys

53
Q

when does chronic interstitial fibrosis occur?

A

end-stage
severity of fibrosis correlates with rate of disease progression

54
Q

how many times per day is the entire plasma volume filtered?

A

60x

55
Q

what is the function of cortical peritubular capillaries?

A

reabsorption and secretion of substances

56
Q

what is the function of vasa recta capillaries surrounding juxtamedullary nephrons?

A

osmotic exchangers for production of concentrated urine

57
Q

is uremia associated with the degree of kidney dysfunction or the duration?

A

degree

58
Q

what is the pathophysiology of uremia?

A

retention of nitrogenous wastes
increased intracellular Na and water
decreased intracellular K
increased levels of bioactive substances normally metabolized or excreted by the kidney
decreased levels of hormones and other mediators produced by the kidney
imbalance between calcium and phosphorous

59
Q

what leads to the local effects of uremia on vomiting?

A

uremic gastritis
elevated serum gastrin
back diffusion of HCl and pepsin into stomach wall

60
Q

what leads to the central effect of uremia on vomiting?

A

activation of chemoreceptor trigger zone in brain medulla

61
Q

what is the pathologic mineralization of renal secondary hyperparathyroidism with CRD?

A

elevated phosphorous binds Ca
CaPhos precipitates into soft tissues which may be damaged/necrotic by uremic toxins

62
Q

what is uremic endocarditis?

A

sub-endocardial mineralization of right or sometimes left atrium

63
Q

what are the adverse effects of hypertension?

A

glomerular damage and proteinuria
ocular lesions
hemorrhages

64
Q

why do you get abnormal blood vessels with chronic renal disease?

A

mineralization
hypertension
endothelial damage/vasculitis

65
Q

what are microcrystals of uric acid in gout called?

A

tophi

66
Q

why are uremic animals usually sterile?

A

elevated prolactin and luteinizing hormone
decreased testosterone, estrogen, progesterone
atrophy of germinal epithelium of testicle or ovary

67
Q

what are some things that can lead to severe or prolonged dehydration or hypovolemia?

A

severe vasculitis
pancreatitis
gastric torsion
addisonian crisis
heat stroke

68
Q

how can hypercalcemia cause intrinsic damage to the kidney?

A

vasoconstriction
mineralization

69
Q

acute blockage causes ______________ effect on ability to concentrate urine

A

reversible

70
Q

true/false: blood tests may be normal during the extension phase of kidney injury

A

true
changes in urine sediment may be seen

71
Q

what hormones may play a factor in the recovery phase of kidney injury?

A

epidermal growth factor
TGF alpha
IGF

72
Q

what do high glomerular capillary pressures lead to?

A

scarring and occlusion of vessels
synthesis of mesangial matrix
disruption of capillaries leads to proteinuria

Urinary Pathophysiology (11 decks)

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