PATHO... Flashcards
Kidneys
-Main excretory organs. While working along with other body systems, these help to maintain homeostasis, fluid and electrolyte balance, and acid-base balance. This is where urine is formed regulating water and soluble substance by filtering the blood, reabsorbing what substances are needed, and excreting the rest as urine.
Nephron
-Functional unit of the kidney
-Composed of: Glomerulus
Glomerulus
-Filtering unit
-a network of capillaries originating from the afferent arteriole
-surrounded by bowman’s capsule
Bowman’s capsule
-Functions as a filter in the formation of urine
-Tubule composed of distinct segments:
-Proximal tubule, descending and ascending loop of Henle, Distal tubule, and collecting tubule.
Glomerular Filtration
-the fluid that filters thru the glomerulus to the bowman’s capsule. (pressure of blood in the glomerulus causes fluid to filter thru the glomerular capillaries and into the bowman’s capsule)
-From there, blood enters the proximal tubule, loop of Henle, distal tubule, collecting tubule, and collecting duct (collect fluids into many nephrons)
-Collecting duct empties into the renal pelvis, ureters, and urinary bladder.
GFR
-The volume of water filtered from the plasma per unit of time.
-Gives a rough measure of the number of the functioning nephrons
-Normal GFR: (men) 130mL/min./1.73m^2
(women) 120mL/min./1.73m^2
-THIS CAN NOT BE MEASURED DIRECTLY, SO WE USE CREATININE AND CREATININE CLEARANCE TO ESTIMATE.
Glomerulonephritis
-Inflammation of the glomerulus
-Primary glomerular injury, ISOLATED TO KIDNEY
-Secondary glomerular injury, CAUSED BY SYSTEMIC DISEASE
-Immune mechanisms are main components of primary and secondary injury.
Post Strep infection
-Acute inflammation of the glomerulus
-Antigen-antibodies deposit in the glomerulus
-Scarring
-symptoms: Hematuria (blood cells that looks like casts) Proteinuria (spilling of albumin into the urine)
-3-12 years old
-Occurs 10-30 days following an acute infection.
-Common cause group A beta hemolytic strep, which is the infection of the mouth and pharynx.
Treatment
-If BUN is increased and oliguria is present, then dietary protein should be limited or restricted
-Low sodium diet until kidney function normalizes: sodium causes fluid retention
-Monitor fluid intake closely due to edema and fluid retention
-Diuretics help kidneys get rid of excess sodium and water
-Steroids depending on the cause (autoimmune disease): Decrease inflammation in the glomerulus so membranes can heal
-Monitor intake and output
-Measure weight daily at the same time each day.
Nephrotic Syndrome
-heavy proteinuria
-Dark urine
-Excretion of 3.5 g or more of protein in the urine per day
-Primary causes: Minimal change nephropathy, membranous glomerulonephritis, focal segmental glomerulosclerosis
-Secondary causes: systemic diseases (diabetes mellitus, amyloidosis, systemic lupus, erthyomatosus, henoch-schonlein purpura.
Nephritic Syndrome
-Hematuria with RBC casts in Urine
-Tea-colored urine
-Less severe than nephrotic syndrome
-dark urine
-Decreased GFR
-occurs with: infectious-related glomerulonephritis
-Rapidly progressive crescentic glomerulonephritis
Obstructive Disorders of Kidneys
-obstruction of the urinary tract at any level eventually results in elevation of intraluminal ureteral pressure.
-AGE is a factor
-In children, structural abnormalities- birth defects such as valves in the inside back part of the urethra.
-In young adults: Stones in a kidney or ureter or elsewhere in the urinary tract
-Older adults, Benign prostatic hyperplasia (BPH) or prostate cancer, tumors, and stones.
BPH
-Enlargement of the prostate
-Age related
-Nonmalignant
-Nodules can compress the urethra to a narrow slit
-Decreasing testosterone levels can decrease prostate growth
Renal calculi
-Urinary stones
-diet
-genetic
-
Pyelonephritis
-Bacterial infection of one or both kidneys.
-UTI, infections of the bladder
-
Chronic Kidney Disease
-As renal function declines, the end products of protein metabolism (which are normally
excreted in urine) accumulate in the blood. Uremia develops and adversely affects every system
in the body. The greater the buildup of waste products, the more severe the signs and symptoms.
SO think about waste product buildup( BUN & creatinine), electrolyte imbalance and acid base,
what about your cardiovascular( hypertension but why?), decreased vitamin D activation, mineral
bone disease ( why? What is happening with PTH?)
Chronic Kidney Disease
-As renal function declines, the end products of protein metabolism (which are normally
excreted in urine) accumulate in the blood. Uremia develops and adversely affects every system
in the body. The greater the buildup of waste products, the more severe the signs and symptoms.
SO think about waste product buildup( BUN & creatinine), electrolyte imbalance and acid base,
what about your cardiovascular( hypertension but why?), decreased vitamin D activation, mineral
bone disease ( why? What is happening with PTH?)
Chronic Kidney disease manifestations
-Hypertension (think RHAAS Pathway)
-Mineral metabolism disorders > metastatic calcifications, and bone disease.
-Hyperphosphatemia (extra phosphorus in blood) > Hypercalcemia (Extra protein) > Increased PTH, Calcium resorption from bone > bone loss
-Impaired osteoblasts.
Hemodialysis
-on going dialysis, 3 - 5 times a week, cleans your blood
-Low blood pressure consequence
Peritoneal dialysis
-on going dialysis, collects waste from abdomen.
-can cause infection (peritonitis)
Thyroid Gland
When thyroid hormone levels get low, the hypothalamus is triggered to release thyroid-releasing hormone
(TRH):
→ TRH triggers the anterior pituitary to release thyroid-stimulating hormone (TSH).
→ TSH stimulates the thyroid gland to produce thyroid hormone that is released into the blood.
→ Metabolism increases and energy levels increase
Too much ( hyperthyroidism), too little (hypothyroidism)
Glucocorticoids
- Stimulate gluconeogenesis (the formation of carbohydrates from proteins and other substances by the
liver). - Provide amino acids and glucose during times of stress.
- Suppress the immune system due to powerful immunosuppressive and antiinflammatory properties.
- Stimulate fat breakdown. Fatty acids are released and used for energy production.
Cushing’s disease
-Too many steroids
-overstimulation by the pituitary
-hyperplasia or neoplasia of the gland
-rapid destruction of the gland
-ACTH excess or cortisol excess
Addison’s disease
-cause: atrophy of the adrenal cortex as a result of autoimmune proccesses.
-not enough steroids
-Shock and hyperkalemia
-weakness, fatigue
-Increased pigmentation
-Anorexia, nausea, vomiting, diarrhea
-Hypometabolism
-understimulation by the pituitary
-depression of hormones secretion by drugs or food