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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
What gets filtered out during glomerular filtration?
All the small molecules
26
what would create the filtrate during glomerular filtration?
Hydrostatic Pressure
27
What does filtration of protein usually indicate?
Renal disease
28
What are the foot processes of the podocytes called and what do they make up?
They are called pedicels and they make up filtration slits.
29
What does the glomerular filtration rate equal?
It equals the amount of filtrate formed by both kidneys each minute
30
What is a normal GFR?
125 ml/minute or 180 liters every 24 hours in healthy adult
31
What is an important marker in monitoring renal disease?
GFR
32
what do the kidneys regulate?
Fluid balance Electrolyte balance Acid/base balance
33
Blood pressure is normally cause by central hypertension (unknown). What could be another secondary cause to hypertension?
renal artery stenosis
34
what is the vasa recta?
(peritubular capillaries) tiny blood vessels that travel alongside nephrons allowing reabsorption and secretion between blood and the inner lumen of the nephron
35
where does the vasa recta start and end?
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.
36
what test is a good estimate of the GFR?
creatinine
37
what would affect creatinine level in the blood?
ingesting meat renal failure muscle problem
38
what does Rhabdomyolysis lead to and why?
acute tubular necrosis from increased protein in the blood damaging the tubular structure
39
what is the juxtoglomerular apparatus responsible for?
controls blood flow filtration renin secretion
40
what are the 3 main components of juxtoglomerular apparatus?
mucula desa smooth muscle cells of afferent arterioles JG Apparatus cells
41
what part of the nephron descends into the medulla?
loop of henle
42
What part of the nephron has proliferations in it resulting in leaky membrane? What is it called?
the visceral layer of the capsule has fenestrations called fenestrated endothelium of the glomerulus
43
whats the ascending limb of the Loop of Henle responsible for?
it's only permeable to salt and ions but not permeable to water
44
what type of solution would you consider the medulla (surrounding the loop of henle) to be?
hypertonic because all the ions are being released into the medulla
45
what is the descending limb of the loop of Henle responsible for?
reabsorption of water
46
What makes up the renal corpuscle?
glomerular capillaries | glomerular capsule
47
What is paracrine? what does it effect?
localized hormones | effects afferent arteriole diameter
48
what type pressure is found in the glomerual?
hydrostatic pressure
49
what type of pressure is found in the capsule?
capsular hydrostatic pressure
50
what pull pressure is associated with albumin in regards to filtration pressure?
blood colloid osmotic pressure
51
how do you determine net outward pressure?
glomerular hydrostatic pressure - (capsular hydrostatic pressure + blood colloid osmotic pressure)
52
what is anasarca?
full body edema
53
what does altered glomerual permeability and loss of negative charge cause? (list steps)
increased filtrates of plasma proteins -> Proteinuria -> Hypoalbuminemia –> edema and liver issue with hepatic synthesis of proteins -> hypolipoproteinemia -> lipiduria
54
what is GFR?
amount of filtrate formed by both kidneys each minute
55
what systems/mechanisms are affected in response to low BP in the renal blood vessels?
Myogenic Autoregulation Tuboglomerular Mechanism Renin-Angiotensin System (mechanism) extrinsic Neural Controls
56
how does Myogenic Autoregulation increase GFR?
affects renal smooth muscle | vasodialation of afferent arterioles
57
how does Tuboglomerular mechanism of autoregulation increase GFR?
reduced flow and osmolarity in distal tubules - > macula densa cells sense changes in distal tubules - > stimulates vasodialation of afferent arterioles and renin angiotensin mechanism
58
how does Renin-Angiotensin System (mechanism) increase GFR?
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
59
how does extrinsic neural controls increase GFR?
baroreceptors in blood vessels of systemic circulation sympathetic NS stimulates systemic arterioles > vasoconstrict > increases peripheral resistance > increases systemic BP and renin angiotensin mechanism
60
what does the body do if you have too much GFR?
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
61
what is completely reabsorbed by the tubular?
glucose
62
how much of all filtrate formed is reabsorbed into the blood?
99%
63
what % is excreted to the urine?
1%
64
which ions are reabsorbed? (6)
``` Phosphorus (HPO42- ) Potassium (K+) Calcium (Ca2+) Chloride (Cl-) Bicarbonate (HCO3-) Sodium (Na+) ```
65
where else are ions excreted?
vomiting diarrhea sweat
66
what is not actively reabsorbed? (5)
``` UREA Nitrogenous Waste Products Uric Acid Creatinine Certain Drugs ```
67
What plays an important role in acid-base balance?
secretion
68
what are actively secreted back into tubules?
Ammonium ions, Urea and H+ (amount that was passively reabsorbed)
69
through active secretion what is almost entirely secreted from the body?
Urea and creatinine
70
what is the counter current exchange system?
Fluid flows in opposite directions in parallel tubes Concentration Gradient causes fluid exchange Gradient increases from cortex to tip of medulla
71
describe dilute urine
Filtrate is hypo-osmotic, no ADH
72
describe concentrated urine
Need ADH to make concentration higher Water reabsorbed Can become highly concentrated (1400 mOsm)
73
what are primary regulators of acid-base?
Renal | Pulmonary
74
which one is fast but limited?
pulmonary
75
how does the body regulate acid and base? (with what?)
Body will adjust Carbon Dioxide and Bicarbonate to achieve normal range
76
alkalemia
pH above 7.45
77
acidemia
pH below 7.35
78
what is a state of of excess HCO3-?
alkalosis
79
what is a state of state of excess H+?
acidosis
80
how does acid- base regulation response to increase CO2?
CO2 converts to carbonic acid (H2CO3) on its way to becoming Bicarb CO2 + H2O → H2CO3 → H+ + HCO3−
81
what are other buffers that regualte ph?
Phosphate, Blood (Hemoglobin) and Protein Buffers
82
what Acids Produced as By-products of
Metabolism Phosphoric acid Lactic acid Fatty acids
83
what is Renal Acid-Base Regulation?
Proximal Tubule Resorbs Bicarbonate Ammonium Synthesis Produces Bicarbonate Distal Nephron Excretes H+ to Produce New Bicarbonate
84
Bicarbonate System formula:
CO2 + H2O H2CO3  H+ + HCO3−
85
what is the Goal ratio of renal acid base?
maintain the ratio of Bicarbonate to Carbonic Acid at 20:1, even if absolute numbers are abnormal
86
what is normal PaCO2 in ABG?
35-45 mm Hg
87
what is noraml Bicarbonate in ABG?
22-26 mEq/L
88
give pH PaCO2 and HCO3- in metabolic acidosis
low ph, normal PaCO2, low bicarb
89
give pH PaCO2 and HCO3- in metabolic alkalosis
high, normal, HCO3- high
90
give pH PaCO2 and HCO3- in respiratory acidosis
low, high, normal
91
give pH PaCO2 and HCO3- in respiratory alkalosis
high, low, normal
92
what determines the blood pH?
Balance between H+ ions and HCO3- ions d
93
When blood too acidic (pH too low) what happens?
More H+ will be secreted into filtrate (lost) AND | More HCO3- ions will be reabsorbed (added)
94
When blood is too alkaline (pH too high) what happens?
More H+ ions will be reabsorbed (added) AND | More HCO3- will be excreted by kidney (lost)
95
whats Urine pH?
4.5 -8.0
96
what happen for your blood to become alkaline?
blew off CO2 - hyperventilation
97
what happened for your blood to become acidic?
didnt blow off CO2 - hypoventilation
98
what part of the nephron is responsible for the main activity is reabsorption of solutes and nutrients?
Proximal Tubules
99
what is the Descending Limb responsible for?
Freely permeable to water, not to NaCl
100
how is water reabsorbed in the loop of Henle?
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
what is the ascending Limb permeable to?
NA+ and CL-
102
what is the Distal Tubule responsible for?
Selective secretion/reabsorption
103
where does urine concentrate in the presence of ADH?
collecting duct
104
what is the Collecting Duct responsible for?
Selective secretion/reabsorption | Permeable to water if ADH present, concentrates urine
105
what is the tonicity within each of these ducts? proximal tubule loop of henle distal tubule
proximal tubule - isotonic loop of henle - isotonic, hypertonic, hypotonic distal tubule -isotonic, hypotonic
106
6 test for renal fuction?
``` BUN – Blood Urea Nitrogen Creatinine BUN/Creatinine Ratio 24 Hour Urine Creatinine Clearance U/A – Urinalysis ```
107
What is azotemia?
Azotemia: elevation of blood urea nitrogen and creatinine levels
108
what is azotemia largely related to?
decreased GFR
109
What are the two types?
Prerenal Azotemia | Postrenal Azotemia
110
What is prerenal azotemia?
hypoperfusion of kidneys
111
What is postrenal azotemia?
urine flow obstructed below kidney
112
what does BUN reflect?
Glomerular Filtration and Urine-Concentrating Capacity
113
what does rising BUN levels indicate?
Decreased Function, Renal Failure, altered protein intake and dehydration
114
what is normal BUN?
10-20mg/dl
115
What rises with long-term decline in GFR?
Creatinine (plasma)
116
what is creatinine? what is it used to monitor?
Product of muscle metabolism | Monitor progress of chronic renal disease
117
what is normal creatinine?
0.7-1.2 mg/dl
118
List what a Urinalysis shows
``` 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
where is urinary cast from?
distal convoluting tubules
120
what is diabetes insipidus?
LOW SPECIFIC GRAVITY related to hormone
121
what will Reagent strips (dipsticks) show?
``` Glucose Bilirubin Urobilinogen Ketones Proteins RBCs, hemoglobin, and myoglobin Leukocyte esterase Nitrates ```
122
Name 3 glomerular disorders
Acute Postinfectious Glomerulonephritis Nephritic Syndromes Nephrotic Syndrome
123
which glomerular disorders produce a decrease in glomerular permeability?
Nephritic Syndromes
124
what Clinical syndrome related to decreased GFR, fluid retention, and nitrogenous waste accumulation?
Nephritic Syndromes
125
which glomerular disorders produce a increase in glomerular permeability?
Nephrotic Syndrome
126
what Clinical syndrome related to massive loss of plasma proteins in urine?
Nephrotic Syndrome
127
what does massive loss of plasma proteins >3.5G/day lead to?
Hypoalbuminemia, also retention of salt/water Generalized Edema, Pulmonary Edema, Pleural Effusions = glomerular injury
128
what is nephrotic syndrome secondary to?
Diabetes SLE Drugs, Malignancies
129
Acute Postinfectious Glomerulonephritis is caused 7-12 days after an infection from what?
Group A Beta-hemolytic streptococcus
130
what causes kidney damage resulting on Acute Postinfectious Glomerulonephritis?
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
Sx of glomerulonephritis?
Oliguria/Proteinuria/Hematuria
132
How does burns or allergic inflammation caused edema?
loss of plasma proteins cause increased tissues oncotic pressure and decreased capillary oncotic pressure.
133
What causes edema?
Decreased capillary oncotic pressure Increased tissue oncotic pressure increased capillary hydrostatic pressure Lymph instruction
134
what is an electrolyte?
charged particles that conduct electrical current in aqueous solution
135
give an example of electrolytes
Sodium, Potassium, Phosphate, Chloride, Calcium, Magnesium, Some Proteins
136
what is the MOA for dehydration?
excess loss of H2O -> ECF osmotic pressure -> cell uses H2O -> cells shrink
137
whats the primarily controls fluid balance by it's influence on excretion?
Antidiuretic Hormone (ADH)
138
ADH is also known as
Vasopressin
139
what releases ADH?
Neurohypothesis in the pituitary gland
140
what is Aldosterone?
Hormone
141
what does aldosterone do? where is it released?
primarily acts on sodium content of ECF --> water retention primarily follows sodium retention released adrenal gland
142
ADH in large amount is __________
a vasoconstrictor (vasopressin)
143
List the events that would follow when blood volume drops for any reason (hemorrhage or dehydration)
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
How is sodium reabsorbed when there is decreased Sodium/increased Potassium OR Blood volume or pressure drops for any reason?
Renin-Angiotensin mechanism stimulates adrenal cortex-> | Release aldosterone-> Sodium reabsorbed-> water follows = Blood pressure rises
145
whats the most important trigger for aldesterone?
Renin-Angiotensin-Aldosterone Axis
146
After renin-angiotensin mechanism restores homeostatic plasma levels of Na+ and K+ how does the mechanism know to shut off?
Negative feedback mechanism sends signals to adrenal cortex
147
What does angiotensin 2 do?
Adrenal aldersterone Vasoconstriction H2O reabsorption
148
what is Juxtaglomerular Apparatus?
specialized cluster of cells near glomerulus
149
what does the Juxtaglomerular Apparatus do during the Renin-Angiotensin-Aldosterone Axis?
they secretes enzyme Renin -> Angiotensinogen to Angiotensin I ->ACE Released from Lungs-> Angiotensinogen I to II
150
what are two types of urinating symptoms?
irritative - urgency | obstructive - hesitency, post void dribbling
151
whats a common type of irritative urination?
dysuria - painful urination, inflammation/infection (urethra women / tip of the penis in men)
152
what are the 2 structures in the bladder?
detrusor muscle | trigone - micturition reflex
153
what is the trigone? what does it do?
triangle of smooth muscle - contracts during urination to release urine
154
what are the sphincters in the urethra?
internal and external
155
what is the common cause of UTI's in females?
coliform bacteria (e.coli)
156
typical length of urethra in male/female is
3-4cm in females | 18-20 cm in males
157
what are two symptoms of obstructive disorder?
Hydroureter | Hydronephrosis
158
define Hydroureter
distention of the ureter with fluid, due to obstruction.
159
define Hydronephrosis
the swelling of a kidney due to a back-up of urine
160
what are 3 obstructive disorders?
Nephrolithiasis Neurogenic Bladder Tumors
161
which obstructive disorder is a condition in which problems with the nervous system affect the bladder and urination?
Neurogenic Bladder
162
what is a disorder characterized by bladder infection and dysuria on micturition?
cystitis
163
what is it called when an untreated UTI ascends to the kidneys?
Acute Pyelonephritis
164
how do you know a pt has polycystic kidney disease (Acute Pyelonephritis)?
Fever, flank pain with UTI, dysuria on urination, tenderness to kidney ascultate and precusion
165
what is characterized by high serum glucose and protein urea?
diabetic nephropathy
166
at what level of glucose will it start to spill out into the urine?
180
167
what happens after high glucose levels upset osmotic balance of blood?
Kidneys overworked trying to remove excess glucose from blood Urine output too high
168
what eventually happens from trying to compensate from high glucose levels in the blood?
Filtering surface of glomerular capsule becomes thickened --> Nephrons gradually become damaged --> Filtering ability eventually lost
169
what is an Infection of kidney parenchyma and renal pelvis?
Acute Pyelonephritis
170
what can you get from renal failure?
``` Uremia = syndrome of renal failure Azotemia = increased serum urea levels ```
171
what is it called when your kidney functions: 25% of normal less than 25% 10% or less of normal
Renal Insufficiency Renal Failure ESRD
172
what are the types of renal failure?
Acute Renal Failure | Chronic Renal Failure
173
what are the types of acute renal failure?
Prerenal Intrarenal Postrenal
174
a back leak of urine occurs during which type of acute renal failure?
intrarenal
175
how do you determine what stage renal disease a pt has?
by the GFR lowest GFR = ESRD
176
what are the two types of dialysis?
Hemodialysis; Peritoneal
177
what renal functions change with age?
``` 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
What flows through fenestration and between the capillary endothelium? Where does it end up?
Plasma | travels through penetration, across basement membrane, in between filtration slit, and filtrate in ____

Patho exam 3 (5 decks)

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