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Clin Med II - Exam 4 > Paulson - Kidneys 101 > Flashcards

Paulson - Kidneys 101 Flashcards

1
Q

3 fxns of kidneys

A

filtration of blood

regulation of blood volume

produce erythropoietin

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2
Q

basic functional unit of kidney

A

nephron

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3
Q

components of nephron

A

glomerulus

renal tubule

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4
Q

site of blood filtration

A

glomerulus

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5
Q

site of water/salts resorption

A

renal tubule

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6
Q

fxns of proximal convoluted tubule (PCT) (4)

A

reabsorption of 60% of glomerular filtrate

secretion of large/protein bound drugs/toxins

passive water reabsorption

ammonia production from glutamine

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7
Q

what % of Na, K+, and Ca are reabsorbed in the PCT

A

65%

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8
Q

what % of phosphate, water, and bicarb are reabsorbed in the PCT

A

80%

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9
Q

what % of glucose and aa are reabsorbed in the PCT

A

100%

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10
Q

4 segments of the loop of henle

A

thin descending limb (DLH)

thin ascending limb (ALH)

medullary thick ascending limb (mTALH)

cortical thick ascending limb (cTALH)

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11
Q

overall fxns of loop of henle (2)

A

creates a concentration gradient

forms concentrated urine

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12
Q

fxn of distal convoluted tubule

A

sodium and calcium reabsorption

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13
Q

% of sodium reabsorbed in DCT

A

5-10%

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14
Q

% of calcium reabsorbed in DCT

A

10-15%

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15
Q

DCT reabsorption is regulated by (2)

A

PTH

vit D

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16
Q

fxns of collecting tubule (7)

A

NaCl reabsorption

bicarb reabsorption

water reabsorption → urine concentration

K+ excretion

H+ excretion

urea excretion

regulation of urine volume

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17
Q

summary of nephron fxn

A
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18
Q

acute renal fxn (ARF) is same same

A

acute kidney injury (AKI)

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19
Q

arf is characterized by quickly rising __

and accumulation of __ in blood

A

BUN/Cr

nitrogenous waste

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20
Q

3 types of causes of arf

A

prerenal

postrenal

intrarenal

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21
Q

there is no particular race/age more at risk for arf, but 3 rf include

A

hospitalized

ICU

post general surgery

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22
Q

3 general definitions of ARF/AKI

A

abrupt (w.in 48 hr) increase in Cr of 0.3 mg/dl above baseline

Cr increase 50% or more in past 7 days

oliguria of <0.5 ml/kg/hr for > 6 hr

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23
Q

sx of arf/aki (lots!)

A

weakness/lethargy

anorexia

n/v

malaise

pruritus

diarrhea

drowsiness

hiccups

SOB

dizziness

anuria/oliguria

change in volume status/wt

AMS

edema

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24
Q

tachycardia and hypotn suggest __ cause of arf/aki

A

prerenal

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25
Q

distended bladder, CVA tenderness, enlarged prostate suggest __ cause of arf/aki

A

postrenal

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26
Q

diagnostic tests for arf/aki (5)

A

bmp

UA/urine microscopy/urine culture

measurement of urine output

renal US

+/- urine spot

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27
Q

urine spot gives info about (3)

A

osmolality

urine sodium

urine Cr

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28
Q

life threatening complications of arf/aki (4)

A

hyperkalemia

fluid overload

uremia

severe metabolic acidosis (pH <7.1)

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29
Q

what do you think when you see pericarditis and AMS in setting of arf/aki

A

uremia

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30
Q

indications for dialysis in arf/aki (5)

A

Cr > 5-10 mg/dl

unresponsive acidosis

severe lyte d.o

fluid overload

uremic complications

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31
Q

mc type of arf/aki

A

prerenal

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32
Q

reduced effective blood circulating to kidney → absolute reduction in fluid volume

A

prerenal failure

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33
Q

3 ex of prerenal failure

A

hemorrhage

dehydration

volume depletion → CHF, cirrhosis (hepatorenal syndrome)

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34
Q

is prerenal failure reversible

A

yes! → kidneys themselves are ok

if underlying cause is corrected

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35
Q

7 causes of true intravascular volume depletion

A

hemorrhage

burns

diuretics

dehydration

GI losses

vomiting

diarrhea

enteric fisula

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36
Q

5 ex of decreased effective circulating volume

A

CHF

cardiac tamponade

aortic stenosis

cirrhosis w. ascites

nephrotic syndrome

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37
Q

4 ex of impaired renal blood flow

A

ACEI

NSAIDs

renal artery stenosis

renal vein thrombosis

38
Q

4 labs that distinguish prerenal failure

A

BUN:Cr ratio

urine Na

fractional excretion of Na (FENa)

urine specific gravity

39
Q

BUN:Cr ratio suggestive of prerenal failure

A

20:1 or higher

40
Q

urine Na suggestive of prerenal failure

A

< 20 meq/L

41
Q

FENa suggestive of prerenal failure

42
Q

urine specific gravity suggestive of prerenal failure

A

1.020 or higher

43
Q

lab abnormalities in prerenal failure occur bc

A

kidney is responding to failure by increasing reabsorption

44
Q

what does FENa measure

A

% of Na filtered by kidney that is excreted into urine

45
Q

tx for prerenal failure

A

correct underlying cause:

CHF → diuresis

dehydration → IVF

hemorrhage → blood/fluids

46
Q

least common type of arf/aki

A

postrenal failure

47
Q

blockage of what 3 portions of kidney are associated w. postrenal failure

A

ureteres

bladder

urethra

48
Q

7 causes of postrenal failure

A

nephrolithiasis

bph

obstructing tumor (ex cervical ca)

bladder outlet obstruction

blood clots w.in urinary tract

meds

neurogenic bladder

uretovesical junction obstruction

49
Q

s/sx of postrenal arf/aki (4)

A

abd/groin pain

bladder discomfort

anuria

mass at falnk/suprapubic area/abdomen

50
Q

2 pe exams for postrenal aki/arf

A

rectal

pelvic

51
Q

diagnostic tests for postrenal arf/aki (3)

A

post-void residual

US/IVP

+/- abd CT

52
Q

post-void residual > __ suggets

__

A

100

bladder outlet obstruction

53
Q

what is IVP

A

intravenous pyelogram

54
Q

what do US/IVP give you info about

A

dilation of ureters or renal pelvis

55
Q

why would you order abdominal CT for postrenal arf/aki

A

eval for mass

56
Q

tx for postrenal arf/aki

A

relieve obstruction:

catheterize

nephrostomy tube

stenting

lithotripsy

mass excision

57
Q

damage/dysfxn to one or both kidneys

A

intrinsic renal failure

58
Q

intrinsic renal failure can occur __

or __

A

rapidly

gradually

59
Q

5 causes of intrinsic renal failure

A

acute tubular necrosis (ATN)

nephrotoxins

interstitial diseases

glomerulonephritis

vascular dz

60
Q

mc cause of intrinsic renal failure

A

acute tubular necrosis (ATN)

61
Q

6 ex of nephrotoxins

A

NSAIDs

contrast agents

aminoglycosides

cyclosprine A

cisplatin

heme pigments

62
Q

interstitial dz’s that might cause intrinsic renal failure (3)

A

acute interstitial nephritis

SLE

infxn

63
Q

vascular dz’s that might cause intrinsic renal failure (2)

A

polyarteritis nodosa

vasculitis

64
Q

labs that define intrinsic renal failure (4)

A

BUN:Cr ratio

urine Na

FENa

urine specific gravity

65
Q

BUN:Cr ratio suggestive of intrinsic renal failure

66
Q

urine Na suggestive of intrinsic renal failure

A

40 meq/l or higher

67
Q

FENa suggestive of intrinsic renal faiure

A

2% or higher

68
Q

urine specific gravity suggestive of intrinsic renal failure

A

1.010-1.020

69
Q

3 major causes of ATN (mc cause of intrinsic arf/aki)

A

renal ischemia

nephrotoxins

sepsis

70
Q

postischemic ATN can be caused by

A

all causes of severe prerenal dz

71
Q

what do you think when you see, muddy brown granular epithelial cell casts and free renal tubular epithelial cells

A

classic UA findings of ATN

72
Q

lab findings suggestive of ATN

A

FENa, BUN:Cr ratio, urine specific gravity, and urine osmolality consistent w. intrinsic AKI

+/- hyperkalemia and metabolic acidosis

73
Q

tx for ATN (3)

A

avoid nephrotoxins

tx underlying cause

+/- diuretics

74
Q

diuretic tx for ATN should be avoided in pt w.

75
Q

most pt’s spontaneously recover from ATN; better prognosis if they are

A

nonoliguric

76
Q

t/f: ATN pt may never fully return to baseline renal fxn

77
Q

ATN during hospitalization is associated w.

A

higher mortality

78
Q

immune-mediated process of tubulointerstitial injury causes inflammatory infiltrate in the interstitium

A

acute interstitial nephritis (AIN)

79
Q

mc cause of AIN

80
Q

meds that cause AIN

A

cephalosporins

penicillins

allopurinol

diuretics

NSAIDs

sulfonamides

81
Q

besides meds, other causes of AIN (7)

A

illness:

legionella

CMV

streptococcus

myobacterium

EBV

candida

SLE

sarcoidosis

sjorgen’s

82
Q

what do you think when you see: fever, maculopapular rash, eosinophilia

83
Q

UA findings for AIN (4)

A

WBCs

white cell casts

+/- esosinophils

protein

84
Q

tx for AIN

A

stop offending med

tx underlying cause

glucocorticoids

85
Q

renal glomeruli are damaged by deposition of inflammatory proteins in the glomerular membrane

A

glomerulonephritis

86
Q

2 types of glomerulonephritis

A

focal

diffuse

87
Q

causes of focal glomerulonephritis

A

henoch-schonleinpurpura

postinfectious

IgA nephropathy

hereditary nephritis

SLE

88
Q

causes of diffuse glomerulonephritis

A

postinfectious

membranoproliferative

SLE

vasculitis

rapidly progressive GN

89
Q

4 clinical features of glomerulonephritis

A

hematuria

morning face/eye edema

evening feet/ankle edema

HTN

90
Q

4 diagnostic features of glomerulonephritis

A

hematuria → tea/cola colored urine

RBCs and RBC casts on UA

mishappen RBCs

proteinuria

91
Q

diagnostic test for glomerulonephritis

A

renal bx

rarely used

92
Q

tx for glomerulonephritis

A

steroids

immunosuppressants/chemo meds

Clin Med II - Exam 4 (20 decks)

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