Q5 - Renal Flashcards
7 functions of kidneys and their role in CKD on FreeForm
Na and H2O balance
Potassium Balance
Urea Excretion
Erythropoeitin production
Acid/Base Balance
Vit D activation
Phosphate elimination
VIT D stimulated by
UV-B exposure on skin or dietary intake of Vit D
Combines with 7-dehydroxy cholesterol -> cholcalciferol
Combines with Liver enzyme -> Calcidiol
Combines with 25(OH)-1-alpha-hydroxylase from KIDNEYS -> Calcitrol (active form of Vit D)
Calcitrol maintains Ca and Ph balance. Not produced in CKD. Pull Ca from bones.
In healthy kidneys, blood volume and GFR have a(n) _________ relationship
Direct
Increase in blood volume(fluid intake) = increase in GFR and increase in fluid excretion.
________ protects the glomerular capilllary
Autoregulation
Different dilations in the Efferent and Afferent arterioles can adjust the exact pressure in the glomerulus.
SNS activated by ______ causes afferent arteriole ______ and ______ GFR
Activation of baroreceptors reflex of higher brain center
Constricts
Decreases.
Through autoregulation, if the BP decreases, the afferent arteriole _______ to maintain no change to GFR despite low BP.
If BP increases, then the afferent arteriole ________ to maintain stable GFR
Dilates
Constricts.
Afferent ______ and efferent ______ decreases GFR
Afferent _____ and Efferent ______ increases GFR
Constriction, dilation
Dilation, constriction
How do NSAIDS affect the autoregulatioin of kidneys?
NSAIDS block prostaglandins which are responsible for helping with the autoregulation of arterioles.
Efferent vasoconstriction is affected.
A patient has a high urine urea level. Is this normal?
Ammonia is _______
RBCs are _______
WBCs are ________
Protein is ________
Glucose?
Yes.
Normal
Abnormal
Abnormal
Abnormal
Abnormal
Normal urine specgrav?
Acidity?
1.010-1.025
PH 4.6-6.0
BUN is a by-product of _______. Normal level is ______. Increase of _____ or low hydration can affect level.
Protein metabolism.
8-25
Protein intake
What is the BEST indicator of kidney function?
Creatinine
Normal Ca ______
Ph?
Venous bicarb?
8.5-10.3
2.5-4.5
22-29
_____ of venous CO2 carried in the blood in the form of bicarb
70%
_______ reflects bicarb in the ABG
VenousCO2
H+ +HCO3 <-> H2CO3 <—> CO2 + H20
What enzyme is responsible for this?
Test Q on this!!
Carbonic anhydrase (CA).
Be an enzymatic leader! :P
How do the kidneys regulate acid-base balance? (Look up in book)
In the renal tubule, H+ combines with HCO3 to form H2CO3 which dissociates into CO2 and H2O VIA carbonic anhydrase (CA)
IN the tubule, it is converted (via CA) back to HCO3 and H+. Now, it can be reabsorbed. the HCO3 is transported back to the vasculature through basolateral membrane. If the blood is very acidic, more HCO3 is reabsorbed, and if it is less, then more HCO3 is excreted.
Max blood level of glucose before ONE pump gets saturated? As a team, all the nephrons and pumps work together and pushes threshold to the R - think they’re helping, but in reality, they allow the blood glucose level to remain too high.
- 250-300 before it starts spilling over.
2 main problems that cause kidney stone formation?
Low urine volume
Abnormal urine pH (high pH >6.0 in Ca/Ph and low/acidic <4.6 urine in Uric acid stones)
Most common renal stones are ____
Calcium/Ph crystals form in more basic urine (pH >6.0) - DO show up on CT/xray
More acidotic urine (<4.6) = uric acid and cysteine stones. Do NOT show up on X-ray/ct
T/F: a stationary kidney stone in the renal pelvis is extremely painful
False. Only stones that move cause intense colic pain.
Classical clinical manifestation of glomerular disorders (-osis or -itis) is ______.
What is the next step??
Proteinuria.
Figure out what KIND of protein?? WBCs are protein, RBCs are protein, albumin is protein….
Nephrotic syndrome is a large _____ loss.
Albumin.
>=3g/day.
NephrITIS = Immune, inflammation.
What type of infections can acute glomerulonephritis follow?
Skin (impetigo), strep throat. Common in kids.
Smokey/coffee colored urine.
14-21 day onset.
FINISH YOUR ABX!
Difference between acute Glomerular nephritis and Crescentic (RPGN) glomerular nephritis?
Acute is 14-21 day onset
Crescentic is w/in 24hrs.
Goodpasture Syndrome - what is this? Tx?
Autoimmune disorder - combo of glomerulonephritis with alveolar hemorrhage, anti-glomerular basement membrane antibodies.
Treat with plasmapheresis, steroids and immunosuppression
Nephrotic syndrome causes _______ in blood. This causes increased activity of the _______ to try to produce more albumin to compensate for loss, but liver hyperactivity will also lead to _______ and _______. Most common clinical presentation finding is ___________
Hypoalbuminemia.
Liver.
hyperlipidemia
Hyper coagulopathy
Edema
Differentiate “Nephrotic” (-osis) and “nephritic” (-itis) syndrome.
Nephritic - “itis” - mild-mod proteinuria. Mostly identified through inflammatory markers. Hematuria and RBC casts present in urine sediment. Immune response - inflammatory lysosomes degrade basement membrane. Tx with steroids, plasmapheresis and HTN management.
Goodpasture is autoimmune version of Nephritic syndrome
Nephrotic - “osis) - severe proteinuria (albumin) and EDEMA. Damage to glomerulus allows large albumin molecules to pass through. Concurrent hyperlipidemia and hypercoagulopathy due to compensatory liver hyperactivity. Tx underlying cause. Diuretics, lipid-lowering agents, antihypertensives, immune modulation.
What is the RIFLE classification for AKI?
R-Risk of injury
I - Injury
F - Failure
L - loss of function
E - ESKD
First 3 indicate severity, and last 2 represent pt outcomes.
What type of AKI is ATN?
How does it happen?
INTRINSIC - most common. Prolonged pre-renal can also cause ATN (intrinsic)
Health care providers/meds/dyes are most common cause.
What type of AKI Can a BPH cause?
Postrenal.
Low GFR, oliguria, high urine specgrav/osm and low urine Na is characteristic of what type of AKI?
Prerenal AKI.
Prolonged _____ can lead to ATN (intrinsic)
Pre-renal
What happens during the Prodromal/oliguric phase of AKI?
Declining urine output,
Increase of BUN, Cr.
Uremia
Met. Acidosis
Urine retention
What happens during the post oliguric phase?
Marks by renal recovery - immature nephrons arent’ able to fully concentrate the urine appropriately.
You loose LOTS of urine - NOT concentrated (3-4L/day)
Dehydrating
Electrolyte imbalance.
What stage of CKD do symptoms start to appear and tx is may be needed?
Stage 3
The afferent arteriole responds to transmural pressure elevation with ___________ , and to pressure reduction with___________ (this is the_____________ of what a passive compliant tube would do).
constriction
dilation
opposite
What is the magic range of blood flow where the kidney is happy and no auto regulation is needed?
125ml/min
Ph is eliminated as part of the __________ system in urine with ______ as _______
Buffer
H+
HPO4
What is Azotemia
Azotemia- decreased filtration of urea and other nitrogenous wastes
What are the clinical signs of uremic syndrome?
Pruritis, impaired healing, dermatitis and uremic frost are common in uremic syndrome. Kidneys unable to excrete urea.
_______are the first line of defense in a viral infection - they will be ________ on CBC. Pt with AKI due to viral infection may have this.
Lymphocytes
Elevated.
Avg urine osm?
500-800 but random sample can range anywhere from 50-1400. After an all night fast, usually >850
Normal urine Na - 40-270. what does a low level mean?
Indicator of AKI? Body is attempting to hold on to Na to also hold on to water.
CKD 5 = <15 GFR
CKD 4=<30
CKD 2=60-89
