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Pathophys > Renal 1 > Flashcards

Renal 1 Flashcards

1
Q

the kidney is located outside what cavity? what is the purpose of this location? between what vertebral levels are the kidneys found at?

A

outside peritoneal/retroperitoneal; purpose is for protection (spinal column, ribs, and muscles protect them); T12-L3

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2
Q

which kidney is positioned lower?

A

right

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3
Q

where do kidney stones usually get stuck?

A

in flattened angle of the ureter close to the bladder entrance (“ureterovesicle”)

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4
Q

what three things does the renal cortex contain?

A

nephrons, glomeruli, and tubular structures

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5
Q

what two things does the renal medulla contain?

A

pyramids and pelvis

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6
Q

what does the renal artery branch from?

A

aorta

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7
Q

what’s the function of the major and minor calyx?

A

drainage

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8
Q

how many lobes are in each kidney? what two things make up a kidney lobe?

A

18- cortex and pyramid

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9
Q

each glomerulus has its own what?

A

afferent arteriole

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10
Q

where does the renal vein drain to?

A

IVC

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11
Q

what’s the functional unit of the kidney? what two things does it contain?

A

nephron: glomerulus and tubular structures

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12
Q

what are the four tubular structures of the kidney?

A

proximal convoluted tubule, loop pf henle, distal convoluted tubule, collecting tube

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13
Q

what are the two vascular components of the nephron?

A

glomerulus and peritubular capillaries

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14
Q

how many nephrons are in each kidney? what is reabsorbed here?

A

1 million; sodium and water (how urine is made and concentrated)

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15
Q

what are the five components of the juxtamedullary nephron? what components are in the medulla vs the cortex?

A

renal corpuscle, proximal tubule, nephron loop, distal tubule, and collecting duct; renal corpuscle, prox tubule, distal tub, some upper part of nephron loop, and upper part of collecting duct

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16
Q

what are the 5 vascular components of the renal corpuscle?

A

arcuate artery, interlobular artery, afferent arteriole, glomerulus, efferent arteriole

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17
Q

what three things make up excretion?

A

filtration - reabsorption + secretion

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18
Q

_____________ is important for filtration. ____________ ____________ are important for reabsorption.

A

glomerulus; peritubular capillaries

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19
Q

what three things does the renal corpuscle contain?

A

glomerulus, bowman capsule, mesangial cells

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20
Q

what is ultrafiltration used for? where does it occur? what type of pressure is needed for it?

A

used to filter out waste; glomerulus; very high pressure

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21
Q

what are the two functions of the glomerular basement membrane?

A

1) . determines permeability of the glomerulus capillary membrane
2) . keeps RBCs and plasma proteins from passing into urine

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22
Q

what three things are in the filtration apparatus that together perform glomerular ultrafiltration?

A

glomerular capillary endothelium, GBM, and visceral layer of Bowman capsule

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23
Q

six basic functions of the kidney

A

1) . filters/reabsorbs substances (K, Na, PO4)
2) . filters waste (1.5 L/day)
3) . regulates volume and composition body fluids (Na/K balance)
4) . blood pressure (renin-angiotensin system)
5) . Ca metabolism
6) . RBC production (erythropoietin)

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24
Q

how is urine formed?

A

via filtration of blood by the glomerulus, tubular reabsorption of electrolytes/nutrients, and eliminating waste

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25
Q

what is GFR? what is the average rate?

A

rate of blood filtered by the glomerulus; 125 mL/min

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26
Q

when a patient has uncontrolled DM, what sometimes happens to filtration?

A

amount of substances filtered exceeds the transport max (which is 320 mg/min)

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27
Q

what is the average urine output?

A

60 mL/hr

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28
Q

what part of the nephron is where 65% of reabsorption and secretory processes occur?

A

proximal convoluted tubule

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29
Q

what two things does active sodium transport mechanisms facilitate?

A

sodium reabsorption and cotransport of electrolytes

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30
Q

where is the majority of the glomerular ultrafiltrate reabsorbed?

A

proximal convoluted tubule

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31
Q

what part of the nephron controls the concentration of urine? how does it do this?

A

loop of henle; reabsorbs water so that we have more waste

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32
Q

what part of the nephron reabsorbs NaCl?

A

distal convoluted tubule

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33
Q

what part of the nephron reabsorbs water?

A

collecting duct

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34
Q

what is the hormone that is regulating urine concentration?

A

ADH

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35
Q

what does ADH do for the kidney? (increases 3 things)

A

increases the water permeability of the principal cells, activity of NaK-2Cl cotransporter, and urea permeability

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36
Q

what happens if there are low levels of ADH? what two parts of the nephron are most affected by this?

A

you get hypo-osmotic urine (dilute); distal tubule and collecting ducts are impacted because they become impermeable to water

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37
Q

what is SIADH? what happens with this syndrome?

A

syndrome of inappropriate antidiuretic hormone; secretes inappropriately high levels of ADH which promotes high levels of water reabsorption in the collecting ducts

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38
Q

what two things are the result of SIADH?

A

hyperosmotic urine (concentrated) and dilutes plasma osmolarity

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39
Q

what is tx for SIADH? (5 things)

A

basically diet and normal saline titrated slowly: fluid restriction, replacement of Na (be careful of central pontine myelinolysis), demeclocycline (inhibits ADH action on renal principal cells)
not bolded options: mannitol and loop diuretics

40
Q

what percent is hypertonic saline?

A

3%

41
Q

what is the arterial renal circulation starting from the aorta?

A

aorta, renal artery, segmental artery, interlobar artery, arcuate artery, cortical radiate artery, afferent arteriole to glomerulus

42
Q

what is the venous renal circulation starting after the peritubular capillaries?

A

PT caps, cortical radiate vein, arcuate vein, interlobar vein, renal vein, inferior vena cava

43
Q

6 things that can regulate renal blood flow

A

sympathetic activity, angiotensin II, ANP, Dopamine, Prostaglandins, autoregulation by juxtamedullary complex

44
Q

increasing sympathetic activity has what impact on renal blood flow?

A

increasing activity constricts afferent and efferent arterioles, which decreases renal flow

45
Q

angiotensin II has what impact on renal blood flow?

A

it vasoconstricts renal vessels, which decreases renal blood flow

46
Q

ANP has what impact on renal blood flow?

A

it vasodilates afferent arterioles and vasoconstricts efferent arterioles (more vasodilator properties); mostly decreases vascular resistance and increases GFR

47
Q

dopamine has what impact on renal blood flow?

A

vasodilates and increases flow

48
Q

prostaglandins have what impact on renal blood flow? what two prostaglandins are mentioned in this ppt?

A

vasodilates and protective renal blood flow; PGE2 and PGI2

49
Q

what impact does NSAID use have on prostaglandins?

A

NSAIDS inhibit prostaglandins, which decreased renal blood flow and GFR

50
Q

what is GFR? what is the normal rate?

A

the amount of filtrate formed each minute; normally greater than 90 mL/min

51
Q

what is the ideal glomerular marker? what is the easiest marker to assess though?

A

inulin; creatinine

52
Q

definition of renal clearance

A

volume of plasma that’s completely cleared of a substance by the kidneys per unit time

53
Q

the ______ the renal clearance, the _______ plasma that is __________ of that substance

A

higher; more; cleared

54
Q

high renal clearance = what? low renal clearance = ?

A

high: removed on a single pass through the kidney
low: may not be removed at all

55
Q

what two things regulate sodium and potassium elimination?

A

1) . GFR

2) . humoral agents (aldosterone and ANP)

56
Q

how does aldosterone affect sodium/potassium elimination?

A

causes sodium to be reabsorbed and potassium to be excreted into tubular fluid

57
Q

what does ANP (atrial natriuretic peptide) do to aldosterone, sodium, and ADH?

A

inhibits aldosterone secretion and sodium reabsorption; inhibits ADH release which then increases excretion of water by the kidneys

58
Q

what are the 3 main urine buffers?

A

bicarbonate, phosphate, and ammonia

59
Q

what are four steps of uric acid elimination?

A

1) . uric acid is filtered in the glomerulus
2) . secreted in proximal tubules
3) . reabsorbed in medullary collecting ducts
4) . uric acid is then excreted in the urine

60
Q

urea elimination: 2 steps

A

1) . kidneys filter urea in the glomeruli

2) . reabsorption in the tubules

61
Q

what does urea elimination maintain?

A

BUN levels

62
Q

what is uric acid a product of? the kidney eliminates what % of the body’s uric acid?

A

purine metabolism; 70%

63
Q

what two things are decreased in the elderly (drug elimination wise)?

A

glomerular filtration and tubular secretion

64
Q

ionized drugs are _____-_____; nonionized drugs are ______-________

A

water-soluble; lipid-soluble

65
Q

glomerular filtration decreases _____% from age 25 to age 65 and ____% by age 90

A

30%; 48%

66
Q

tubular secretion decreases _____% from age 25 to age 65 and ____% by age 90

A

38%; 62%

67
Q

kidneys produce _______ _________ that travel through the _______ to ______ sites where they exert different actions

A

chemical mediators; blood; distant

68
Q

kidneys maintain BP control through what system?

A

RAAS

69
Q

kidneys maintain Ca++ metabolism by what?

A

activating vitamin D

70
Q

kidneys regulate RBC production by what? RBCs form where?

A

secretion of erythropoietin; bone marrow

71
Q

anemia secondary to decreased production of RBCs could result from what two things?

A

1) . problem with EPO secretion OR

2) . problem with bone marrow

72
Q

in renal failure, the kidneys ability to secrete ____ is diminished, which can result in ______.

A

EPO; anemia

73
Q

if renal failure is the cause of anemia, one would also see ____________ ____________ and elevated _____ and __________.

A

electrolyte abnormalities; BUN, creatinine

74
Q

on a UA, you examine the _________, _____________, and __________ of urine. you evaluate for ____________, ____________, and ____________.

A

appearance, concentration, and content; evaluate for infection, disorders, diseases

75
Q

what two things in a UA are signs of infection?

A

nitrite and leukocytes

76
Q

how long might it take for nitrites to show up in a lab test?

A

24 hrs

77
Q

GFR is the preferred gauge of evaluating what?

A

renal function

78
Q

as the GFR increases, BUN and creatinine _________

A

decreases

79
Q

if you don’t have inulin values or a BMP, you can also use _________ ____________ to figure out GFR

A

creatinine clearance

80
Q

what two values on a BMP are most useful in terms of looking at renal function?

A

BUN and Creatinine

81
Q

Fractional excretion of sodium = ______________ divided by ______________

A

clearance of sodium; glomerular filtration rate

82
Q

what is FENa?

A

fractional excretion of sodium

83
Q

if FENa is below 1%, what category of kidney disease is it?

A

prerenal (inc in sodium reabsorption caused by volume depletion or low output heart failure)

84
Q

if FENa is above 2%, what category of kidney disease is it?

A

acute tubular necrosis OR other kidney damage (excess sodium is lost to tubular damage or hypervolemia causes normal sodium wasting)

85
Q

if FENa is intermediate (between 1 and 2), what category of kidney disease is it?

A

either disorder (renal tract obstruction- lower # in early dz and higher # in later dz)

86
Q

what is normal adult urine output?

A

0.5-1 ml/kg/hr

87
Q

what is oliguria rate? (low urine output)

A

<400 cc in 24 hrs

88
Q

what is anuria rate? what patients does this usually occur in?

A

<50 ml in 24 hrs; dialysis pt

89
Q

most common cause of prerenal failure?

A

dehydration

90
Q

what is prerenal failure characterized by?

A

marked decrease in blood flow

91
Q

when blood flow falls below ___%, then __________ changes occur, which lead to morbidity and mortality

A

25%, ischemic

92
Q

what % of kidney probs are prerenal, intra renal, and post renal

A

prerenal: 40-70%
intra renal: 20-50%
post renal: 10-20%

93
Q

high doses of dopamine can ________ perfusion to the kidney

A

decrease

94
Q

prerenal failure presents with what?

A

acute reduction in amount of urine output

95
Q

what is maintenance phase of ATN marked by?

A

a decrease in GFR

Pathophys (13 decks)

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