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NURS 2514 > patho week 10 > Flashcards

patho week 10 Flashcards

1
Q

where do the kidneys sit in the body

A

they sit in the retroperitoneal space (behind the peritoneum)

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2
Q

how much blood is filtered every hour by the kidneys

A

5L is filtered every hour (total adult blood volume)

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3
Q

how many litres of urine is formed per day

A

1-3L

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4
Q

what is the functional unit of the kidney

A

the nephron

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5
Q

what are the parts of a nephron

A

Bowmans capsule, PCT, DCT and loop of hence

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6
Q

what are the 3 layers of the glomerulus

A

endothelial cells (inner most)
basement membrane (repels negatively charged particles)
epithelial cells on the outside

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7
Q

what type of charge is the basement membrane of the glomerulus

A

negatively charged

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8
Q

where is the glomerulus

A

in the Bowmans capsule

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9
Q

how can small particles pass into filtrate of glomerulus

A

through fenestrations

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10
Q

why cant albumin pass through the glomerulous

A

because its negatively charged (basement membrane repels it)

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11
Q

what are the three forces that control glomerular filtration and do they push or pull

A

hydrostatic pressure: push
colloid osmotic pressure: pull
capsular hydrostatic pressure: pull

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12
Q

what is glomerular hydrostatic pressure

A

55mmhg

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13
Q

what is blood colloid osmotic pressure

A

30mmhg

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14
Q

what is capsular hydrostatic pressure

A

15mmhg

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15
Q

what are all the steps in microvascular urine formation

A
  1. Bowmans capsule collects glomerular filtrate and funnels it into the PCT
  2. the PCT will reabsorb 80% electrolytes, 100% glucose, 70% water
  3. then the loop of hence will concentrate the urine
  4. then the distal convoluted tubule where more water and electrolytes are absorbed
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16
Q

what electrolytes are absorbed in the PCT

A

Na, K, Cl, Ca, etc
80% electrolytes
100% glucose
70% water
all reabsorbed

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17
Q

how do the kidneys auto regulate in response to high BP

A

they will decrease GFR by constricting afferent arteriole and dilating efferent arteriole

(arteriole going in will constrict so less comes in, and effecernt arteriole will dilate so that more goes out to lower GFR/BP)

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18
Q

how do they kidneys auto regulate in response to too little/low Bp

A

they will increase GFR by dilating afferent arteriole and constricting efferent arteriole

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19
Q

what is the limitations of auto regulation

A

if fails if BP drops below 65-70mmHg

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20
Q

what are the 3 hormonal kidney functions

A

1) production and secretion of renin (RAAS)
2) production of erythropoietin (stimulates production of RBCs)
3) activation of vitamin D

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21
Q

copy the RAAS from memory

A
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22
Q

what are the two things you need for adequate kidney function

A

1) adequate glomerular perfusion
2) functional nephrons

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23
Q

what type of abnormal blood work findings would you see in abnormal kidney function

A

increased BUN and creatinine
failure to maintain Na and K balance
water retention and
weird acid base balance

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24
Q

what is azotemia

A

an accumulation of metabolic waste products in the blood

25
Q

what is uremias

A

a group of sings and symptoms that occur with inadequate renal function

26
Q

what is oliguria

A

urine output that is less than normal (less than 400 mL a day)

27
Q

what is anuria

A

an absence of urine pridutcion (less than 40 mL a day)

28
Q

whats the difference in onset between CKD and AKI

A

CKD: gradual onset
AKI: sudden onset (hours to days)

29
Q

what is the difference in cause for CKD vs. AKI

A

CKD: diabetic neuropathy
AKI: acute tubular necrosis

30
Q

what is the difference in prognosis for CKD vs AKI

A

CKD is progressive and irriversable
AKI is potentially reversible

31
Q

what is the most common cause of death between CKD vs. AKI

A

CKD: cardiovascular disease
AKI: sepsis

32
Q

what causes CKD (patho)

A

usually caused by a progressive, irreversible loss of kidney function through loss of nephrons

33
Q

what are the most common causes for CKD

A

diabetic neuropathy and hypertension

34
Q

how many nephrons are lost in CKD before you see symptoms

A

50%

35
Q

how many nephrons can you lose before you need renal replacement therapy

A

90%

36
Q

what is glomerulosclerosis

A

due to loss or nephrons, remaining nephrons need to work harder. this hyperfiltration causes fibrosis and scarring of the kidneys over time.

37
Q

what stage of CKD will a patient start to develop uremic symptoms

A

usually around 4th stage

38
Q

what are the 6 symptoms of uraemia

A

fluid retention
electrolyte imbalance
waste product accumulation
hormone insufficiency
increase in blood lipoproteins
changes in bone metabolism

39
Q

which lab value is the best indicator of kidney function

A

eGFR (estimated glomerular filtration rate)

40
Q

why does urea and creatinine rise in CKD

A

because theyre the main products that the kindey gets rid of, if theyre not working then they cant excrete these things

41
Q

what happens to electrolytes with CKD

A
  • sodium will initially be low but become high as body tries to hold on to it as disease progresses
    -increased potassium, phosphate and magnesium
    -decreased calcium
  • everything will be high except calcium
42
Q

how will GFR look to get an official diagnosis of CKD

A

if GFR is less than 60mL/min for over 3 months (stage 3)

43
Q

how does CKD cause acidosis

A

kidneys cant excrete excess hydrogen like they normally do so acid levels will increase with decreased GFR.
kidneys also cant reabsorb bicarb as well

44
Q

how will the body initially compensate to CKD acidosis

A

increased respirations (kussmaul’s respirations ofc)

45
Q

what are the most common haematological (blood) issues with CKD

A

anemia: d/t decreased erythropoietin
platelet aggrigation won’t work as well (GI bleed is common)
altered leukocyte function which leads to impaired immunity

46
Q

what are some symotims of ureic encephalopathy

A

fatigue, headache, seizures, sleep disturbances, coma

47
Q

what is uremic neuropathy and what are the symptoms

A

its a buildup of toxins affecting nerves, causes parenthesis, asterixis, tremors and twitching

48
Q

what are the characteristics of stage 3 kidney disease

A
  • moderate reduction in renal function
  • greater nephron damage
49
Q

what is the GFR for stage 3 renal disease

A

30-59

50
Q

what is the GFR for stage 4 renal disease

A

15-29

51
Q

what is the GFR with ESRD

A

less than 15

52
Q

what stage does CKD start to be symptomatic

A

stage 3, stage 2 you may see less concentrated using

53
Q

how does CKD cause renal osteodystrophy

A

due to PTH being released to reabsorb calcium due to low vitamin D or high phosphate

54
Q

how does phosphate affect calcium

A

CKD causes phosphate retention, she binds to calcium. this causes a decrease in serum calcium which releases PTH to reabsorb calcium in the bones. this will bind to phosphate and overall not increase calcium levels and make the bones v brittle over time (make sure this is correct)

55
Q

what is uremic pericarditis and what causes it

A

inflamed layers of the heart rubbing together caused by uremic toxins

56
Q

what are the main reasons CKD affects respiratory system

A

due to fluid overload, can cause pulmonary edema, pneumonia

57
Q

why do the early stages of CKD cause polyuria

A

because urine cant be reabsorbed as well

58
Q

what is uremic frost

A

urea crystals that leech onto the skin

NURS 2514 (31 decks)

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