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Patho exam 3 > Renal > Flashcards

Renal Flashcards

1
Q

what other complex control systems does the kidneys have?

A

endocrine
neural
local control

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2
Q

what else does the kidney control?

A

electrolyte balance*
blood pressure*
acid base balance*
blood volume

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3
Q

what are the renal functions?

A

Regulate Blood Volume/Pressure
Regulate Electrolyte Composition of Blood
Eliminate Metabolic Wastes
Eliminate Drugs and Toxins - renal and liver
Produce Hormones – Renin & Erythropoietin

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4
Q

how much cardiac output goes to the kidneys?

A

22%

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5
Q

what are the two small arteriolar system?

A

Afferent Arteriole (Glomerulus Capillary System)

Efferent Arteriole (Peritubular Capillary System and Vasa Recta)

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6
Q

whats the difference between afferent and efferent arteriolar systems?

A

high pressure - slighting bigger - afferent

low pressure - efferent

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7
Q

What is they kidney surrounded by?

A

Renal fibrous capsule

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8
Q

what is some physical differences btwn proximal and distal convoluted tubule cells?

A

proximal have microvilli and more mitochondria

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9
Q

what is the structural difference btwn distal convoluted tubules and collecting ducts?

A

collecting ducts have less mitochondria

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10
Q

what cell of the kidney detects the pressure in the JG apparatus?

A

macula densa cells stimulating releases paracrines

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11
Q

How does the kidney local autoregulation?

A

macula densa - one way the body can sense a control

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12
Q

how does hydrostatic pressure in the glomerulus create a filtrate?

A

net outflow is greater so that it flows across

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13
Q

What essentially is the kidney a combination of?

A

Filtration and collection systems

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14
Q

What are the 3 steps of urine creation?

A

Filtration -> Reabsorption -> Secretion

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15
Q

How many renal artery does each kidney have?

A

1

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16
Q

How many segmental arteries does each kidney have?

A

5

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17
Q

Name the arteries that supply the kidney?

A 
Lobar arteries
Interlobar arteries
Arcuate arteries
Afferent arterioles
Efferent arterioles
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18
Q

What’s the outermost structure of the kidney called?

A

cortex

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19
Q

What’s the inner region of the kidney called?

A

medulla

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20
Q

What does a nephron consist of? (6)

A 
Glomerulus
Bowman’s Capsule
Proximal Tubule
Loop of Henle: Descending/Ascending Limbs
Distal Tubule
Collecting Duct
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21
Q

What completely surrounds the glomerulus?

A

Bowman’s capsule

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22
Q

What does the inner layer of bowman’s capsule contain?

A

It contains octopus like cells - Podocytes

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23
Q

What do podocytes form?

A

Podocytes form a porous membrane around the glomerulus

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24
Q

List and explain the nephron functions

A

<b>Glomerular filtration</b> (occurs glomerular capillaries through glomerular capsule)
<b>Tubular resorption</b> (renal tubule lumen through peritubular capillaries)
<b>Tubular secretion</b> (peritubular capillaries to renal tubule lumen)

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25
Q

What gets filtered out during glomerular filtration?

A

All the small molecules

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26
Q

what would create the filtrate during glomerular filtration?

A

Hydrostatic Pressure

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27
Q

What does filtration of protein usually indicate?

A

Renal disease

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28
Q

What are the foot processes of the podocytes called and what do they make up?

A

They are called pedicels and they make up filtration slits.

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29
Q

What does the glomerular filtration rate equal?

A

It equals the amount of filtrate formed by both kidneys each minute

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30
Q

What is a normal GFR?

A

125 ml/minute or 180 liters every 24 hours in healthy adult

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31
Q

What is an important marker in monitoring renal disease?

A

GFR

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32
Q

what do the kidneys regulate?

A

Fluid balance
Electrolyte balance
Acid/base balance

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33
Q

Blood pressure is normally cause by central hypertension (unknown). What could be another secondary cause to hypertension?

A

renal artery stenosis

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34
Q

what is the vasa recta?

A

(peritubular capillaries) tiny blood vessels that travel alongside nephrons allowing reabsorption and secretion between blood and the inner lumen of the nephron

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35
Q

where does the vasa recta start and end?

A

These vessels branch off the efferent arterioles of juxtamedullary nephrons (those nephrons closest to the medulla), enter the medulla, and surround the loop of Henle.

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36
Q

what test is a good estimate of the GFR?

A

creatinine

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37
Q

what would affect creatinine level in the blood?

A

ingesting meat
renal failure
muscle problem

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38
Q

what does Rhabdomyolysis lead to and why?

A

acute tubular necrosis from increased protein in the blood damaging the tubular structure

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39
Q

what is the juxtoglomerular apparatus responsible for?

A

controls blood flow
filtration
renin secretion

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40
Q

what are the 3 main components of juxtoglomerular apparatus?

A

mucula desa
smooth muscle cells of afferent arterioles
JG Apparatus cells

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41
Q

what part of the nephron descends into the medulla?

A

loop of henle

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42
Q

What part of the nephron has proliferations in it resulting in leaky membrane? What is it called?

A

the visceral layer of the capsule has fenestrations called fenestrated endothelium of the glomerulus

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43
Q

whats the ascending limb of the Loop of Henle responsible for?

A

it’s only permeable to salt and ions but not permeable to water

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44
Q

what type of solution would you consider the medulla (surrounding the loop of henle) to be?

A

hypertonic because all the ions are being released into the medulla

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45
Q

what is the descending limb of the loop of Henle responsible for?

A

reabsorption of water

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46
Q

What makes up the renal corpuscle?

A

glomerular capillaries

glomerular capsule

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47
Q

What is paracrine? what does it effect?

A

localized hormones

effects afferent arteriole diameter

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48
Q

what type pressure is found in the glomerual?

A

hydrostatic pressure

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49
Q

what type of pressure is found in the capsule?

A

capsular hydrostatic pressure

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50
Q

what pull pressure is associated with albumin in regards to filtration pressure?

A

blood colloid osmotic pressure

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51
Q

how do you determine net outward pressure?

A

glomerular hydrostatic pressure - (capsular hydrostatic pressure + blood colloid osmotic pressure)

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52
Q

what is anasarca?

A

full body edema

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53
Q

what does altered glomerual permeability and loss of negative charge cause? (list steps)

A

increased filtrates of plasma proteins ->
Proteinuria ->
Hypoalbuminemia –>
edema and liver issue with hepatic synthesis of proteins ->
hypolipoproteinemia ->
lipiduria

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54
Q

what is GFR?

A

amount of filtrate formed by both kidneys each minute

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55
Q

what systems/mechanisms are affected in response to low BP in the renal blood vessels?

A

Myogenic Autoregulation
Tuboglomerular Mechanism
Renin-Angiotensin System (mechanism)
extrinsic Neural Controls

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56
Q

how does Myogenic Autoregulation increase GFR?

A

affects renal smooth muscle

vasodialation of afferent arterioles

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57
Q

how does Tuboglomerular mechanism of autoregulation increase GFR?

A

reduced flow and osmolarity in distal tubules

  • > macula densa cells sense changes in distal tubules
  • > stimulates vasodialation of afferent arterioles and renin angiotensin mechanism
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58
Q

how does Renin-Angiotensin System (mechanism) increase GFR?

A

JG cells of juxtaglomerual apparatus of kidney
releases renin

which converts angiotensin to angiotensin 2
stimulates adrenal cortex and systemic arterioles

adrenal cortex > releases aldosterone > kidney tubules increase Na+ and water follows > increase blood volume

systemic arterioles > vasoconstrict > increases peripheral resistance > increases systemic BP

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59
Q

how does extrinsic neural controls increase GFR?

A

baroreceptors in blood vessels of systemic circulation
sympathetic NS
stimulates systemic arterioles > vasoconstrict > increases peripheral resistance > increases systemic BP and renin angiotensin mechanism

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60
Q

what does the body do if you have too much GFR?

A

flow through tubules increase >
flow past macula densa increases >
macula densa dumps paracrine to afferent arterioles > afferent arterioles constrict >
resistant in afferent arterioles increase > hydrostatic pressure decreases >
decreases GFR

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61
Q

what is completely reabsorbed by the tubular?

A

glucose

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62
Q

how much of all filtrate formed is reabsorbed into the blood?

A

99%

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63
Q

what % is excreted to the urine?

A

1%

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64
Q

which ions are reabsorbed? (6)

A 
Phosphorus  (HPO42- ) 
Potassium  (K+)
Calcium  (Ca2+)
Chloride  (Cl-)
Bicarbonate  (HCO3-)
Sodium  (Na+)
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65
Q

where else are ions excreted?

A

vomiting
diarrhea
sweat

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66
Q

what is not actively reabsorbed? (5)

A 
UREA
Nitrogenous Waste Products
Uric Acid
Creatinine
Certain Drugs
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67
Q

What plays an important role in acid-base balance?

A

secretion

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68
Q

what are actively secreted back into tubules?

A

Ammonium ions, Urea and H+ (amount that was passively reabsorbed)

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69
Q

through active secretion what is almost entirely secreted from the body?

A

Urea and creatinine

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70
Q

what is the counter current exchange system?

A

Fluid flows in opposite directions in parallel tubes
Concentration Gradient causes fluid exchange
Gradient increases from cortex to tip of medulla

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71
Q

describe dilute urine

A

Filtrate is hypo-osmotic, no ADH

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72
Q

describe concentrated urine

A

Need ADH to make concentration higher
Water reabsorbed
Can become highly concentrated (1400 mOsm)

73
Q

what are primary regulators of acid-base?

A

Renal

Pulmonary

74
Q

which one is fast but limited?

A

pulmonary

75
Q

how does the body regulate acid and base? (with what?)

A

Body will adjust Carbon Dioxide and Bicarbonate to achieve normal range

76
Q

alkalemia

A

pH above 7.45

77
Q

acidemia

A

pH below 7.35

78
Q

what is a state of of excess HCO3-?

A

alkalosis

79
Q

what is a state of state of excess H+?

A

acidosis

80
Q

how does acid- base regulation response to increase CO2?

A

CO2 converts to carbonic acid (H2CO3) on its way to becoming Bicarb
CO2+ H2O → H2CO3→ H++HCO3−

81
Q

what are other buffers that regualte ph?

A

Phosphate, Blood (Hemoglobin) and Protein Buffers

82
Q

what Acids Produced as By-products of

A

Metabolism
Phosphoric acid
Lactic acid
Fatty acids

83
Q

what is Renal Acid-Base Regulation?

A

Proximal Tubule Resorbs Bicarbonate
Ammonium Synthesis Produces Bicarbonate
Distal Nephron Excretes H+ to Produce New Bicarbonate

84
Q

Bicarbonate System formula:

A

CO2+ H2O H2CO3 H++HCO3−

85
Q

what is the Goal ratio of renal acid base?

A

maintain the ratio of Bicarbonate to Carbonic Acid at 20:1, even if absolute numbers are abnormal

86
Q

what is normal PaCO2 in ABG?

A

35-45 mm Hg

87
Q

what is noraml Bicarbonate in ABG?

A

22-26 mEq/L

88
Q

give pH PaCO2 and HCO3- in metabolic acidosis

A

low ph, normal PaCO2, low bicarb

89
Q

give pH PaCO2 and HCO3- in metabolic alkalosis

A

high, normal, HCO3- high

90
Q

give pH PaCO2 and HCO3- in respiratory acidosis

A

low, high, normal

91
Q

give pH PaCO2 and HCO3- in respiratory alkalosis

A

high, low, normal

92
Q

what determines the blood pH?

A

Balance between H+ ions and HCO3- ions d

93
Q

When blood too acidic (pH too low) what happens?

A

More H+ will be secreted into filtrate (lost) AND

More HCO3- ions will be reabsorbed (added)

94
Q

When blood is too alkaline (pH too high) what happens?

A

More H+ ions will be reabsorbed (added) AND

More HCO3- will be excreted by kidney (lost)

95
Q

whats Urine pH?

A

4.5 -8.0

96
Q

what happen for your blood to become alkaline?

A

blew off CO2 - hyperventilation

97
Q

what happened for your blood to become acidic?

A

didnt blow off CO2 - hypoventilation

98
Q

what part of the nephron is responsible for the main activity is reabsorption of solutes and nutrients?

A

Proximal Tubules

99
Q

what is the Descending Limb responsible for?

A

Freely permeable to water, not to NaCl

100
Q

how is water reabsorbed in the loop of Henle?

A

the ascending limb is permeable to NA+ CL- making the medulla a hypertonic enviroment. This then drives water in the descending limb to follow salt into the medulla

101
Q

what is the ascending Limb permeable to?

A

NA+ and CL-

102
Q

what is the Distal Tubule responsible for?

A

Selective secretion/reabsorption

103
Q

where does urine concentrate in the presence of ADH?

A

collecting duct

104
Q

what is the Collecting Duct responsible for?

A

Selective secretion/reabsorption

Permeable to water if ADH present, concentrates urine

105
Q

what is the tonicity within each of these ducts?
proximal tubule
loop of henle
distal tubule

A

proximal tubule - isotonic
loop of henle - isotonic, hypertonic, hypotonic
distal tubule -isotonic, hypotonic

106
Q

6 test for renal fuction?

A 
BUN – Blood Urea Nitrogen
Creatinine
BUN/Creatinine Ratio
24 Hour Urine 
Creatinine Clearance  
U/A – Urinalysis
107
Q

What is azotemia?

A

Azotemia: elevation of blood urea nitrogen and creatinine levels

108
Q

what is azotemia largely related to?

A

decreased GFR

109
Q

What are the two types?

A

Prerenal Azotemia

Postrenal Azotemia

110
Q

What is prerenal azotemia?

A

hypoperfusion of kidneys

111
Q

What is postrenal azotemia?

A

urine flow obstructed below kidney

112
Q

what does BUN reflect?

A

Glomerular Filtration and Urine-Concentrating Capacity

113
Q

what does rising BUN levels indicate?

A

Decreased Function, Renal Failure, altered protein intake and dehydration

114
Q

what is normal BUN?

A

10-20mg/dl

115
Q

What rises with long-term decline in GFR?

A

Creatinine (plasma)

116
Q

what is creatinine? what is it used to monitor?

A

Product of muscle metabolism

Monitor progress of chronic renal disease

117
Q

what is normal creatinine?

A

0.7-1.2 mg/dl

118
Q

List what a Urinalysis shows

A 
Color, Turbidity, pH, Specific Gravity, Sediment
RBC, WBC, Casts, Crystals
Glucose = glycosuria if present 
Ketones = ketonuria if present 
Bilirubin/Urobilinogen
Proteins = proteinuria if present
Bacteria, Yeast, Parasites, Sperm 
Drug Testing
119
Q

where is urinary cast from?

A

distal convoluting tubules

120
Q

what is diabetes insipidus?

A

LOW SPECIFIC GRAVITY related to hormone

121
Q

what will Reagent strips (dipsticks) show?

A 
Glucose
Bilirubin
Urobilinogen
Ketones
Proteins
RBCs, hemoglobin, and myoglobin
Leukocyte esterase
Nitrates
122
Q

Name 3 glomerular disorders

A

Acute Postinfectious Glomerulonephritis
Nephritic Syndromes
Nephrotic Syndrome

123
Q

which glomerular disorders produce a decrease in glomerular permeability?

A

Nephritic Syndromes

124
Q

what Clinical syndrome related to decreased GFR, fluid retention, and nitrogenous waste accumulation?

A

Nephritic Syndromes

125
Q

which glomerular disorders produce a increase in glomerular permeability?

A

Nephrotic Syndrome

126
Q

what Clinical syndrome related to massive loss of plasma proteins in urine?

A

Nephrotic Syndrome

127
Q

what does massive loss of plasma proteins >3.5G/day lead to?

A

Hypoalbuminemia, also retention of salt/water
Generalized Edema, Pulmonary Edema, Pleural Effusions
= glomerular injury

128
Q

what is nephrotic syndrome secondary to?

A

Diabetes
SLE
Drugs, Malignancies

129
Q

Acute Postinfectious Glomerulonephritis is caused 7-12 days after an infection from what?

A

Group A Beta-hemolytic streptococcus

130
Q

what causes kidney damage resulting on Acute Postinfectious Glomerulonephritis?

A

untreated strep infection causes kidney damage from antibody complexes
Proliferation of endothelial and mesangial cells plus leukocyte infiltration = obliteration of capillary lumen
IgG and complement protein deposition

131
Q

Sx of glomerulonephritis?

A

Oliguria/Proteinuria/Hematuria

132
Q

How does burns or allergic inflammation caused edema?

A

loss of plasma proteins cause increased tissues oncotic pressure and decreased capillary oncotic pressure.

133
Q

What causes edema?

A

Decreased capillary oncotic pressure
Increased tissue oncotic pressure
increased capillary hydrostatic pressure
Lymph instruction

134
Q

what is an electrolyte?

A

charged particles that conduct electrical current in aqueous solution

135
Q

give an example of electrolytes

A

Sodium, Potassium, Phosphate, Chloride, Calcium, Magnesium, Some Proteins

136
Q

what is the MOA for dehydration?

A

excess loss of H2O -> ECF osmotic pressure -> cell uses H2O -> cells shrink

137
Q

whats the primarily controls fluid balance by it’s influence on excretion?

A

Antidiuretic Hormone (ADH)

138
Q

ADH is also known as

A

Vasopressin

139
Q

what releases ADH?

A

Neurohypothesis in the pituitary gland

140
Q

what is Aldosterone?

A

Hormone

141
Q

what does aldosterone do? where is it released?

A

primarily acts on sodium content of ECF –> water retention primarily follows sodium retention
released adrenal gland

142
Q

ADH in large amount is __________

A

a vasoconstrictor (vasopressin)

143
Q

List the events that would follow when blood volume drops for any reason (hemorrhage or dehydration)

A

Arterial blood pressure drops ->
Amount of filtrate (GFR) decreases->
Osmoreceptors in hypothalamus pick up signal->
Send message to posterior pituitary ->
Posterior pituitary releases ADH ->
ADH causes renal tubules to ↑ reabsorption of H20 ->
Blood volume/ Blood pressure rises

144
Q

How is sodium reabsorbed when there is decreased Sodium/increased Potassium
OR Blood volume or pressure drops for any reason?

A

Renin-Angiotensin mechanism stimulates adrenal cortex->

Release aldosterone-> Sodium reabsorbed-> water follows = Blood pressure rises

145
Q

whats the most important trigger for aldesterone?

A

Renin-Angiotensin-Aldosterone Axis

146
Q

After renin-angiotensin mechanism restores homeostatic plasma levels of Na+ and K+ how does the mechanism know to shut off?

A

Negative feedback mechanism sends signals to adrenal cortex

147
Q

What does angiotensin 2 do?

A

Adrenal aldersterone
Vasoconstriction
H2O reabsorption

148
Q

what is Juxtaglomerular Apparatus?

A

specialized cluster of cells near glomerulus

149
Q

what does the Juxtaglomerular Apparatus do during the Renin-Angiotensin-Aldosterone Axis?

A

they secretes enzyme Renin -> Angiotensinogen to Angiotensin I ->ACE Released from Lungs->
Angiotensinogen I to II

150
Q

what are two types of urinating symptoms?

A

irritative - urgency

obstructive - hesitency, post void dribbling

151
Q

whats a common type of irritative urination?

A

dysuria - painful urination, inflammation/infection (urethra women / tip of the penis in men)

152
Q

what are the 2 structures in the bladder?

A

detrusor muscle

trigone - micturition reflex

153
Q

what is the trigone? what does it do?

A

triangle of smooth muscle - contracts during urination to release urine

154
Q

what are the sphincters in the urethra?

A

internal and external

155
Q

what is the common cause of UTI’s in females?

A

coliform bacteria (e.coli)

156
Q

typical length of urethra in male/female is

A

3-4cm in females

18-20 cm in males

157
Q

what are two symptoms of obstructive disorder?

A

Hydroureter

Hydronephrosis

158
Q

define Hydroureter

A

distention of the ureter with fluid, due to obstruction.

159
Q

define Hydronephrosis

A

the swelling of a kidney due to a back-up of urine

160
Q

what are 3 obstructive disorders?

A

Nephrolithiasis
Neurogenic Bladder
Tumors

161
Q

which obstructive disorder is a condition in which problems with the nervous system affect the bladder and urination?

A

Neurogenic Bladder

162
Q

what is a disorder characterized by bladder infection and dysuria on micturition?

A

cystitis

163
Q

what is it called when an untreated UTI ascends to the kidneys?

A

Acute Pyelonephritis

164
Q

how do you know a pt has polycystic kidney disease (Acute Pyelonephritis)?

A

Fever, flank pain with UTI, dysuria on urination, tenderness to kidney ascultate and precusion

165
Q

what is characterized by high serum glucose and protein urea?

A

diabetic nephropathy

166
Q

at what level of glucose will it start to spill out into the urine?

A

180

167
Q

what happens after high glucose levels upset osmotic balance of blood?

A

Kidneys overworked trying to remove excess glucose from blood
Urine output too high

168
Q

what eventually happens from trying to compensate from high glucose levels in the blood?

A

Filtering surface of glomerular capsule becomes thickened –> Nephrons gradually become damaged –> Filtering ability eventually lost

169
Q

what is an Infection of kidney parenchyma and renal pelvis ?

A

Acute Pyelonephritis

170
Q

what can you get from renal failure?

A 
Uremia = syndrome of renal failure
Azotemia = increased serum urea levels
171
Q

what is it called when your kidney functions:
25% of normal
less than 25%
10% or less of normal

A

Renal Insufficiency
Renal Failure
ESRD

172
Q

what are the types of renal failure?

A

Acute Renal Failure

Chronic Renal Failure

173
Q

what are the types of acute renal failure?

A

Prerenal
Intrarenal
Postrenal

174
Q

a back leak of urine occurs during which type of acute renal failure?

A

intrarenal

175
Q

how do you determine what stage renal disease a pt has?

A

by the GFR

lowest GFR = ESRD

176
Q

what are the two types of dialysis?

A

Hemodialysis; Peritoneal

177
Q

what renal functions change with age?

A 
Decrease in kidney size
Decrease in renal blood flow and GFR
Number of nephrons decrease due to renal vascular and perfusion changes
Glomerular capillaries atrophy
Tubular transport response decreases
Increased bladder symptoms
Urgency, frequency, and nocturia
178
Q

What flows through fenestration and between the capillary endothelium? Where does it end up?

A

Plasma

travels through penetration, across basement membrane, in between filtration slit, and filtrate in ____

Patho exam 3 (5 decks)

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