Renal 2

Question 0

Causes of Acute Renal Failure:

Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply?

Answer 0

Intra-Renal

Question 1

Causes of Acute Renal Failure:

Sudden & severe drop in BP (shock) or interruption of blood flow to the kidneys from severe injury or illness?

Answer 1

Pre-Renal

Question 2

Causes of Acute Renal Failure:

Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor or injury?

Answer 2

Post-Renal

Question 3

Acute Renal Failure:
Any sort of damage to the epithelial lining, dead cells will fall through > example of casts of the tubular cells.
Back-leak & obstruction theories.

Answer 3

Intra-renal Renal Failure

Question 4

ARF - Acute Tubular Necrosis: from Ischemia or Nephrotoxin
Either a toxin to the nephron itself or ischemia both will lead to inflammation and tubular injury. Inflammation direct to the epithelial cells will lead to ___ formation, depending on severity and how many die then that will lead to ___. If this occurs will increase the ___ pressure causing ___ > decrease amount of urine made (___) > & also decrease the ___.

Answer 4

• cast
• tubular obstruction
• tubular intraluminal
• tubular backleak
• oliguria
• GFR

Question 5

ARF - Acute Tubular Necrosis:
End up with dying epithelial cells forms a cast could get stuck.
2 pathways to follow is what happens: Distal to it will see decreased ___, proximal to it you increase the pressure and therefore decrease the ___.

Answer 5

• urine production

- GFR

Question 6

ARF - Acute Tubular Necrosis: from Ischemia
~Ischemia still follow same pathway but now dealing with blood supply. Any sort of necrosis or ischemia, endothelial cells themselves will become injured as well. Get a rxn or reflex which leads to ___ to try to minimize anymore damage, however that causes a reduction in ___.
~Depending on what area of the capillaries are damaged (peri-tubular or glomerular itself) both if persist will lead to a reduction in ___.
~Whether or not we go through reversible or irreversible is dependent on severity, time, co-morbidities. If irreversible lost those cells.

Answer 6

• vasoconstriction
• GFR
• GFR

Question 7

ARF - Acute Tubular Necrosis:
~With Reversible (not as severe, might just cause a partial obstruction) this would basically just increase the ___.
~With Irreversible you will increase the pressure but the injury is much more severe so you get a ___ and a decrease in ___.

Answer 7

• Intra-tubular pressure
• Tubular back-leak
• Tubular flow

Question 8

Staging based on size or area that is diminished in function or damaged as you progress to higher number in staging start to effect other things.
~Severity of disease = size of area of insult
Do this with?

Answer 8

Chronic Kidney Disease (CRF)

Question 9

CRF:

Increase ___ to increase GFR. Get a vasoconstriction to try to rapidly increase GFR.

Answer 9

Angiotensin 2

Question 10

Chronic Renal Failure:
Kidney filtering blood to make urine - getting rid of toxins and waste products, also making EPO. This can effect circulating erythrocytes resulting in ?

Answer 10

Anemia

Question 11

Disorders of the Lower Urinary Tract:

1) Collect urine & transport to bladder?
2) Stores & expels urine to urethra?
3) Urine exits the body?
4) Relaxation aids voiding?

Answer 11

1) Ureters
2) Bladder
3) Urethra
4) Associated urinary sphincters

Question 12

Disorders of the Lower Urinary Tract:
Essentially increase in volume > increase in pressure > pushes on the bladder and this reflex is to basically void?
Reflex & Voluntary = Relax internal sphincter and void. External sphincters we control.
~Mediated by ___, gravity, peristalsis & nervous system.

Answer 12

Micturition

~Pons

Question 13

Micturition:
~ ___ = relaxation of the internal sphincter & contraction of the bladder to enable urination.
~ ___ = primarily inhibits via conscious control of the external sphincter.
~Bladder innervation: ___ (L1-2) allow relaxation & filling. ___ (S2-S4) results in bladder contraction & relaxation of the internal sphincter to initiate bladder emptying.

Answer 13

~Pons
~Cerebral cortex
~Sympathetic nerves
~Parasympathetic nerves

Question 14

~Micturition - this muscle is what is receiving the push from the increased pressure/volume?
~Bladder is heavily innervated. Just know that they are closely associated and the ___ are higher than the ___.

Answer 14

~Detrusor

~Sympathetics, Parasympathetics

Question 15

Mechanics of Micturition: (focus on the detrusor muscle)
~ ___ = bladder is prevented from emptying until the pressure in the body of the bladder rises above a specific threshold.
~ ___ = allows voluntary emptying of the bladder or the prevention of urination.

Answer 15

~Internal Sphincter
~External Sphincter

*Realize how SC damage at these levels can effect innervation & thus effect bladder control.

Question 16

1) ___ = detrusor muscle to contract & urethral sphincters to relax.
2) ___ = coordinate urination at a suitable location & desired time.
3) ___ = less than 50-100 cc following voiding (similar to lungs & heart).
4) Involves the ___, ___ & ___ nervous systems.
5) Micturition reflex is a result of ___ & ___ ___ control.

Answer 16

1) Voiding
2) Continent
3) Residual urine
4) central, autonomic & peripheral
5) parasympathetic & voluntary motor control