Patho & Pathophis Renal disorders Flashcards
What is the overall function of the kidney
They selectively reabsorb minerals like sodium and potassium back into the circulation to maintain body fluids
What is allowed through the glomeruls into the proximal convoluted tubule
Only plasma is allowed through red blood cells and other minerals arent
What is the function of the Nephron
This controls the amount of sodium that get reabsorbed back into the blood to maintain blood volume while also eliminating the waste material
What do diuretics do
These increase urine volume “water pills”
They remove excess sodium & water from the body by blocking reabsorption of these substances.
May also cause excessive potassium removal from body necessitating concurrent usage of drugs to prevent hypokalemia
What regulates the reabsorption of minerals
How do the Kidneys control PH
It plays a role in the bicarbonate buffering system
It also plays a role in excreting hydrogen atoms
What is Creatinine
This is a chemical waste molecule that is generated from muscle metabolism.
It is transported through the blood and filtered out by the kidneys so it can be disposed of in urine
It is mainly absorbed in the glomerular reabsorption but can also be in the proximal tubular excretion
How to the kidneys reabsorb water
They do this with the help of osmosis
This involves the reabsorption of sodium then water follows increasing blood volume
How does Glucose affect the body
Glucose is the fuel for ATP
Glucose also has an osmotic pull
How is Amonia made and how is it excreted through the body
Amonia is form when amino acids are broken down. Amonia is toxic to the body so the liver adds CO2 to it making it urea. This is then transported to the kidney and excreted via urination
How does potassium affect the body
This has a major affect on the sodium potassium pump (involved in sending action potentials)
What do Amino acids do in our body
These are the building blocks for proteins
It is also essential for muscle growth and synthesis (pretty much all amino acids r reabsorbed back into circulation)
What does Bi Carbonate do
This is heavily involved in the bicarbonate buffer
This binds with acid and created carbonic acid, this can then dissociate into water and CO2
Do respiratory disorders causing acidosis or alkalosis initiate a kidney response?
YES
Acidaemia: Kidneys excrete excess hydrogen ions and reabsorb bi carobonate
Alkalaemia: Kidneys secrete less hydrogen back into the kidney tubules and excrete more bicarbonate ions (usually with sodium ions)
How does the body balance water
What is Hyponatremia
This is a decrease in the sodium concentration
What is Acute renal failure
Both kidneys have to be involved.
This can be directly linked to reduced blood flow or inflammation and Necrosis of tubules causing obstruction and back flow
This can be reversible if detected early enough but can end up with patients having to go in dialysis
What are the 3 main areas that Renal failure can occur in
Prerenal - this is the most susceptible area and can lead to metabolic acidosis
Intrinsic - this is damage or inflammation to the filtering parts of the kidney of the basement membrane causing renotoxins to accumulate in the renal cortex
Postrenal - this is an obstruction of the urine outflow from the kidney e.g. kidney stone causing damage to the filtering structures of the kidney
What is Oliguria
This is the reduced urine outflow
What is Acute Tubular Necrosis
This makes up 75% of acute renal failure cases.
This is where the tubular segment of the nephron injured via ischemic injuries damaging the cell membrane.
Patch necrosis at multiple points in tubules may occlude the lumen. If not fatal regeneration eventually completely reverses the damage
What is the mortality rate for Acute tubular neucrosis
40 - 70%
What are UTI’s
These are extremely common and typically caused by E. coli
Depending on virulence infection will ascent especially if
Bacteria is not flushed out during urination
Bladder lining does not provide sufficient protection
Insufficient immune response
How does E. coli cause UTI’s
E. coli can adhere to the mucosa of the bladder, which means that it is not always washed out by urination this leads infection.
UTI’s are most common in woman because their urethras are much smaller than men and men’s prostatic fluids give a natural barrier
What are the two lower UTI’s
Urethritis - the urethra is inflamed, red an swollen
Cystitis - bladder wall inflamed, red, swollen
- the bladder becomes hypersensitive and has reduced capacity
What is Pyelonephritis
This is the flash word for Kidney infection
What are some risk factors for developing a UTI in children
Constipation/dehydration
History of UTI’s
Familial history of issues
Prolonged time in unchanged nappies
Poor Toilet paper technique
What are some risk factors for developing a UTI in Adults
Poor toilet paper technique
First UTI at early age
Sex
Adult nappies
Antibiotic use
History of UTI
Catheter in situ
What is Glomerulonephritis
This is a bilateral inflammation of glomeruli, typically following streptococcal infections
Previous infection creates antigen antibodies that are in the glomerular capillaries another infection triggers a type 3 hypersensitivity reaction activating complement system and inflammatory response
What happens with the inflammation response in Glomerulonephritis
This is when there is glomerular permeability resulting in the leakage of some proteins and erythrocytes into the filtrate making the urine dark and cloudy
It also increases congestion decreasing Glomerulus filtration rate
Can Glomerulonephritis cause death?
Yes in severe cases
Blood flow can decrease to the kidney triggering renin secretion increasing the blood pressure & oedema leading to acute kidney failure and death
What happens in Pyelonehritis
Sudden inflammation caused by bacterial infection
can involve both kidneys or just 1
infection extends from ureter into kidney
Pus fills the kidney pelvis and calyces leading to inflamed medulla
If infection is severe, exudate can compress renal artery & veins and obstruct urine outflow
Bi-lateral obstruction likely to cause acute renal failure
Chronic infection can result in scar tissue forming
What are Kidney stones (Calculi)
These can form anywhere in the urinary tract but most commonly in the kidney
Calculi tend to form when there are excessive amount of relatively insoluble salts in the filtrate or when insufficient fluid intake results in high concentrate filtrate
Once any debris form, deposits continue to accumulate forming a large stone
What are most calculi composed of
75% are composed of calcium salts which can be from a parathyroid tumor or other metabolic disorders.
The Urines PH can increase stone formation
Chronic Renal Failure
This may result from hypertension & diabetes
It represents loss of functioning kidney nephrons
This is usually asymptomatic until greatly advanced
What are the stages of chronic Renal failure
Overview of chronic Kidney disease
What are some treatment plans for Chronic Renal faliure
Kidney transplant / dialysis
These are treatment for someone who has advanced uremia
Transplant surgery and dialysis is dictated by age, donor availability & personal preference
Transplantation is the preferred method of treatment
What is the difference between Hemodialysis & Peritoneal dialysis
Hemodialysis - Blood is taken out from a vein and goes through a dialyzer then pumped back into the body
Peritoneal dialysis - this is where you pump dialysis fluid into the peritoneum
When can rejection occur with a kidney transplant
Acute rejection - typically occurs in the first several months after transplantation
Chronic rejection - occurs months or years after transplant
What sort of questions to ask when treating a patient on dialysis
What are some important vitals to check for a patient on dialysis
