Overview of Renal Pathophys Lecture Flashcards
Azotemia definition
elevated BUN and Creatinine levels in blood usually due to decreased GFR
Uremia definition
excess urea and nitrogenous waste in blood = can be toxic! - can occur due to metabolic and endocrine alterations
Definition of Acute Kidney Disease
ABRUBT decrease in GFR or CrCl
How to classify Acute Chronic Kidney disease
RIFLE classification
what does RIFLE classification stand for
Risk Injury Failure Loss of Kidney Function End-Stage Kidney Disease
Types of anatomical names for acute kidney injury/malfunction
- pre-renal
- intrinsic
- post-renal
If the Acute chronic kidney disease is caused by a pre-renal malfunction - what does it mean?
decreased renal blood flow
If the Acute chronic kidney disease is caused by a intrinsic malfunction - what does it mean?
structure within kidney is damaged
If the Acute chronic kidney disease is caused by a post-renal malfunction - what does it mean?
obstruction within urine collection system
Definition of Chronic Kidney Disease
progressive loss of function - gradual replacement of normal kidney architecture with parenchymal fibrosis
4 possible disease states that can lead to chronic kidney disease
Diabetes Mellitus; Initial pathogenic injury; Hyperlipidemia; Systemic HTN
what is glomerulosclerosis
glomerulus is changing to fibrotic tissue (
what is the normal GFR level range
90 to 120 mL/min/1.73 m^2
Definition of Hemodialysis
perfusion of blood and dialysate on opposite sides of semipermeable membrane - remove substances from blood by diffusion = excess plasma water is removed via ultrafiltration
Peritoneal dialysis
permanent catheter - peritoneal membrane acts as semipermeable membrane - osmotic pressure is generated by various dextrose and icodextrin concentrations
What components can make up the osmotic pressure in peritoneal dialysis
dextrose; icodextrin
What is analgesic nephropathy
large doses of ASA and APAP can cause it
Nephritis = Glomerulonephritis = GN can be divided into what two groups
Primary and secondary
Secondary GN is associated with what?
systemic diseases - like SLE, HTN, diabetes
Pathogenesis of Glomerular Diseases = __________ reaction
immune
3 pathogenesis/immune reactions for glomerular diseases
1 - antibody - associated injury
2 - Cell mediated immune
3 - other mechanisms of glomerular injury
Nephrotic vs Nephritic Syndrome
Nephrotic - protein leakage only
Nephritic - protein AND RBC leakage
3 major types of Glomerular syndromes
nephrotic syndrome; nephritic syndrome; chronic glomerulonephritis
Common signs/symptoms of Nephrotic syndrome
- proteinuria
- hypoalbuminemia
- edema
- hyperlipidemia/lipiduria
Common signs/symptoms of Nephritic syndrome
- hematuria
- oliguria
- azotemia
- HTN
APKD:
inherited mutation of ________ gene _______ which gives rise to the protein ________
Dominant; PKD1 and PKD2; polycystein
Pathogenesis of APKD
Abnormal cysts formation in both kidneys; ultimately destroys intervening parenchyma; intermittent gross hematuria; HTN and urinary infection
Autosomal Recessive (______) Polycystic Kidney disease: Mutation in ______ which makes ______ (_______)
childhood; PKHD1; fibrocystin; polyductin
Clinical Features of Autosomal Recessive Polycystic Kidney Disease
- serious at birth
- young infants may die quickly from pulmonary or renal failure
- Pts who survive infancy develop liver cirrhosis
Diuresis = ? Natriuresis = ?
D = increase in urine volume N = increase in renal sodium excretion
Possible Clinical uses for Diuretics
- HTN
- Edema
- CHF
- Kindey disease
- hepatic cirrhosis
- hypercalcemia
- diabetes insipidus
How do diuretics differ?
differ by site of action
Most of water is reabsorbed where?
proximal tubule
Examples of loop diuretics
furosemide; bumetanide; ethacrynic acid
Examples of potassium sparing diuretics
spironolactone; triamterene; amiloride
Examples of thiazides
HCTZ; Chlorthalidone
What does the macula densa do and how?
monitors BP - done by looking at the amount of NaCl being reabsorbed
What happens in the proximal convoluted tubule
Water, NaCl and HCO3 reabsorbed
Loop of Henle: Descending limb is _________ to water vs ascending limb is ________ to water
permeable; impermeable
Thick ascending limb is also known as “___________” because it pulls _____ back into the body
diluting segment; ions
What gets reabsorbed in the ascending loop of henle?
NaCl; Ca2+; Mg2+
The macula densa is near what portion of the tubules
distal convoluted
ADH affects what part of the nephron
collecting duct
Loop diuretics affect what of the nephron
ascending loop
Aldosterone is a ___________ which acts on the __________ to keep what?
mineralcorticoid; collecting duct; NaCl and therefore water
PASSIVE transport options for ions/solutes
- Convective solute flow (dragged with water)
- simple diffusion
- channel-mediated
- carrier- mediated/facilitated diffusion/uniport
Is uniport passive or active transport?
passive
is symport passive or active transport?
active
is antiport passive or active transport?
active
primary active or secondary active transport?
ATP - mediated transport
primary
primary active or secondary active transport?
symport
secondary
primary active or secondary active transport? antiport
secondary
symport aka ________
co-transport
antiport aka
counter transport
what are active transport ways to move ions/solutes
ATP mediated transport, symport, antiport
Types of Antibody mediated glomerular injury
- circulating - immune complex deposition
- Anti - GBM antibody
- antibody against glomerular antigen
what is Anti-GBM antibody glomerular injury
an antibody will bind to the Glomerular Basement Membrane and cause damage to the membrane - autoimmune issue
what is immune complex deposition glomerular injury
a complex (antibody AND antigen) will bind to membrane and cause breakdown of the membrane
If the _________ are damaged/detached then protein leakage through defective GBM and filtration slits will occur
podocyte foots
Common agents that will cause an ascending infection
E.Coli, proteus, enterbacter
Combination of what things can lead to an ASCENDING INFECTION to cause acute pyelonephritis/renal infection
Urinary bladder infection; vesicoureteral reflux; intrarenal reflux
What two infections can lead to acute pyelonephritis
hematogenous infection and ascending infection
Pathogenesis Autosomal/Adult PKD
Hypertension and Urinary infection –> Ultimately fatal –> ________ is necessary.
Renal transplantation
what notable parts of the nephron are in the cortex
proximal (straight and convoluted) tubule, distal convoluted tubule; collecting tubule
what notable parts of the nephron are in the medulla
descending limb; ascending limb; collecting duct
Where does the diuretic work?:
Osmotic agents
proximal convoluted tube; descending limb; collecting duct
Where does the diuretic work?:
Acetazolamide - an Carbonic anhydrase inhibitor
proximal convoluted tubule
Where does the diuretic work?:
Loop agents
ascending limb
Where does the diuretic work?:
Thiazides
Distal convoluted tubule
Where does the diuretic work?:
Adenosine
glomerulus; proximal convoluted; thick ascending; collecting duct
