Patho Quiz 7 (Renal) Flashcards
Tenderness from the kidneys would be felt in what area on the back?
Costovertebral angle
Compounds that are not reabsorbed back in the vasculature are excreted how?
In the urine
What is a normal GFR?
125 mL/min
Which substances filtrate easily across the podocytes to Bowman’s Capsule?
Electrolytes and water.
How much production is necessary for adequate function?
5%
What determines the GFR?
Filtration pressure in the glomeruli, and the permeability of the golerular membrane.
What is the most important physiologic regulator of Glomerular Filtration?
Blood volume
Why can too much Sodium in the blood cause spillage of Glucose into the urine?
The level of sugar exceeds the absorption rate and the sugar is expelled in the urine.
Which BP medication increases the osmolality of the blood?
Mannitol.
What BP medications are K+ sparing?
ACEI, Aldosterone inhibitors
What hormone is secreted by the kidneys and what condition may result from decreased secretion of this hormone?
Erythropoietin; Anemia
How do we know the kidneys are failing?
Urinalysis.
What is normal urine output?
30 mL/hr
OR
0.5 mL/kg/hr
What would you expect on a UA in an infection?
Nitrates
What lab values should not be found (negative) in the urine?
Protein, Nitrates, Blood, Bilirubin, Glucose
Which kidney lab is most indicative of kidney function?
Creatinine.
Which clinical manifestation likely indicates kidney disease?
Pain the the costovertebral angle (late in the disease process).
What is the difference in development in recessive v. dominant Cystic Kidney Disease?
Recessive is evident from childhood.
Dominant is later in life.
What is a growth that is found in children of 2 years old and younger on the kidneys?
Wilm’s tumor.
What is the first sign of a tumor on the kidneys?
Blood in the urine.
What is pyelonephritis and how does it typically start?
Inflammation of the kidneys brought on by UTI (and also systemic bacterial infection from blood stream, less common)
A UTI is considered what type of infection (direction of bacteria)?
Ascending–starts in the meatus and moves upward.
What are glomerulopathies and what is the hallmark manifestation?
Results from alterations in glomerular capillary structure and function; Proteinuria.
What is Glomerulonephritis?
An assortment of immune-mediated conditions that produce inflammation glomeruli and other areas of the kidneys.
What are three things that happen to the kidneys in chronic glomerulonephritis?
- Proliferative lesions with sclerotic injury
- Nephrons atrophy
- Kidneys become scarred, small, and non functional
When does Nephrotic Syndrome occur and what does happens during this process?
Occurs due to increased glomerular permeability to proteins. Causes albumin to leak into Bowman’s Capsule and causes blood in the urine.
Increase in liver activity, from nephrotic syndrome, can cause?
Hyperlipidemia, hypercoagulation
Urinalysis provides a foundation for the differential diagnosis of renal dysfunction. Which of the following UA values is an indication of normal renal function?
<1-2 WBCs
Pyelonephritis is an infection of the renal pelvis and parenchyma. Which of the following is true of this problem?
It may result in a chronic disease process.
Obstructive processes result in urine stasis which predisposes to infection and structural damage. Identify the correct statement in relation to the disease?
Stones are a result of solute supersaturation and can cause complete obstruction.
How do Glomerulopathies manifest?
Decreased capillary flow and increased glomerular membrane permeability.
What hormones regulate distal convoluted tube retention of water and Sodium? Which hormones affect water and which affect Sodium?
ADH affects water. convoluted tubules/ collecting ducts
Aldosterone affects Sodium and water. Collecting ducts main effect.
both act of the distal tubules. this is where the convo/ collecting ducts
Glomerulopathies glomerulus are penetrable to what?
Protein.
Define Chronic Kidney Disease
A potentially REVERSIBLE syndrome characterized by the abrupt deterioration of renal function, occurring over hours to weeks that results in the retention of nitrogenous waste.
How much urine output is present in oliguria?
<400 mL in 24 hours
How much urine output is present in anuria?
<100 mL in 24 hours
What criteria is present in Acute Kidney Injury?
R-risk: 1st stage of AKI=Creatinine ↑ x 1.5 or GFR↓ 25%
I-injury: 2nd stage = ↑ Creatinine x 2 or GFR ↓ 50%
F-failure: 3rd stage = ↑ Creatinine x 3 or GFR ↓ 75% or Creatinine >4 mg/dL
L-loss: 4th stage = persistent acute kidney failure; loss of function >4 week
E-end stage kidney disease = complete loss of kidney function >3 months
Prerenal injury is characterized by what? (4)
- Low sodium
- Oliguria
- High specific gravity and osmolality
- Low GFR
Postrenal injury is caused by what?
Obstruction of normal outflow of urine from kidneys.
What is the most common cause of Intrarenal kidney injury?
Acute tubular necrosis.
What is the most common toxic substance to the kidneys?
Ibuprofen (in the home). Contrast media (in the hospital).
What causes vascular acute tubular necrosis?
Embolus.
What are the stages of Acute Tubular Necrosis (ATN)?
- Prodromal phase: injury has occurred, normal or low urine output,elevated BUN and CR
- Oliguric phase: oliguria/anuria, volume overload, hyperkalemia, azotemia/uremia, metabolic acidosis
- Postoliguric phase: fluid volume deficit, labs begin to normalize
When do Creatinine levels start to increase in ATN?
12-48 hrs
Chronic Kidney Disease is usually related to which chronic conditions?
- Diabetes Mellitus
- Hypertension
- Recurrent pyelonephritis, glomerulonephritis, and polycystic kidney disease
What is CKD characterized by?
Glomerulosclerosis and tubulointerstitial inflammation and fibrosis.
How the progression of CKD slowed?
- BG control in DM
- ACE inhibitors (kidney protective qualities)
- Management of HTN, CVD, Hyperlipidemia and anemia
- Nutritional support
Acute kidney injury is an abrupt reduction in renal function which always results in?
Accumulation of waste materials in the blood.
Intrarenal kidney injury is a result of dysfunction of the nephrons. Which of the following is specific for this type of kidney injury?
Frequently is caused by nephrotoxic substances.
Acute Tubular Necrosis…
Will show resolution within return of BUN and Creatinine to normal levels.
Chronic kidney disease is characterized by a gradual irreversible loss of functional nephrons. The stages of chronic kidney disease may be determined by the:
Number of nephrons that are damaged.
