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Patho test 3 > Renal 2 bc 1 isn't enough > Flashcards

Renal 2 bc 1 isn't enough Flashcards

1
Q

Acute renal failure is what causing 4 things

A 
Sudden decrease in renal function. causing:
disruption in fluid, elytes, acid/base
decreased GFR 
retention of nitrogenous waste products 
increase creatinine
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2
Q

ARF is NOT a what and is a what

A

not disease is a common pathway

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3
Q

3 parts to ARF what makes them special?

A

prerenal: decreased persfusion
intrarenal: parenchymal (renal tissue) disease ex: inflam
postrenal: obstruction

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4
Q

ARF BUN:Creatinine levels, high low means

A

high: >20 pre-renal, volume problem, BUN very high

low <10: intrarenal, tubules failing reabsorb less urea

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5
Q

pre-renal ARF is from what?

A 
decreased perfusion
hypovolemia, hypotension, HF
renal art obstruction
Burns
over use of diuretics
edema, ascities
Drugs: ARB, ACEI, NSAIDS
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6
Q

Pre-Renal ARF gets what kind of GRF and s/s, what happens when prolonged

A

low GFR: oliguria
high specific gravity and osmolality–bc of low volume. Low urine Na
azotemia
prolonged: ATN intrinsic

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7
Q

how to tx pre-renal ARF

A

increase perfusion

Volume replacement, dialysis

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8
Q

Post-renal ARF is what, causes what

A

obstruction distal to kidney
increased pressure in bowman capsule due to backed fluid, impedes GFR
longer exposed to toxins more like to damage

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9
Q

Post-renal early phase adapts how, last how long

A

adapts: relex to maintain GFR is afferent arteriolar dilation (enhances glomerular perfusion)
12-24h

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10
Q

Post-renal late phase what time does it start, progression in what causes what

A

after 12-24hr and afferent arteriolar dilation stops

progressive decrease in perfusion- decrease GFR causes anuria. if obstruction continues can get ischemia- nephron loss

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11
Q

Recovery phase of post renal ARF 4 things happen, 1 sorta bad thing

A 
when relief of obstruction
pre-renal vessels relax
perfusion restored
GFR increased in nephrons that survived
tubular pressure returns to normal
BUT calyses and collecting system can remain Dilated depending on the severity of the damage.
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12
Q

Intrarenal/Intrinsic failure is what

A

dysfunction of nephron/kidney

results in ATN

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13
Q

Intrarenal/Intrinsic failure causes ATN can be cause by:

A

nephrotoxic: contrast
Ischemic: sepsis

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14
Q

intrarenal failure patho 2 processes

A

Vascular: decreased blood flow, hypoxia and vasoconstriction
Tubular: inflam, reperfusion injury, cast obstruction causes increased tubular pressure

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15
Q

ATN has 3 phases

A

prodromal
oligaric
post-oliguric

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16
Q

Prodromal phase of ATN

A

the insult has occurred

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17
Q

Oligaric phase when, UOP, s/s

A

1-2weeks (up to 8) after injury
UOP 50-400ml/day
s/s: azotemia, oliguris, progressive uremia, decreased GFR, hypERvolemia, hypERk, uremic syndrome
dialysis maybe needed

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18
Q

Post-oliguric phase what happens how long

A

diuresis but tubular function impaired and azotemia continues
fluid volume deficit until kidney recovers
2-10day (up yr) for BUN:C to normalize
usually a degree of renal insufficieny persists

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19
Q

ARF predictors of mortality include

A

oliguria, increased severity of illness, acute MI, stroke, sz
cause of death usually infection

20
Q

Chronic renal failure definition

A

decreased kidney function/damage for 3 months
GFR <60ml/min/1.73m2
Progressive to irreversible

21
Q

kidney compensates until…

A

70-80% nephron damage

decreased GFR with nephron loss

22
Q

CKD risk factors

A

DM, HTN, recurrent pyelo, glomerulonephris, >65yrs old, family hx, polycystic kidney,

23
Q

primary focus for mgmt of CKD 4

A

mgmt of ATN and HTN
ACEI ARB to decreased proteinuria
glucose control in DM

24
Q

HTN and CV disease cause what, tx with

A

hypervolemia, atherosclerosis, heightened RAAS/SNS activity

ACEI ARB…mainly ARB

25
Q

metabolic acidosis chronic do what

A

pH<7.3 NaHCO3

26
Q

Uremic syndrome can lead to what

A

impaired healing due to retention of metabolic wastes

27
Q

cardio-renal anemia syndrome

A

CKD, anemia, HF

28
Q

Anemia from CKD

A

lack of EPO

29
Q

bone and mineral disorders with CKD

A

elevated phos and PTH causes altered bone/mineral metabolism, kidneys unable to reabsorb Ca

30
Q

Dialysis does what

A

CKD
remove metabolic waste and correct fluid and elyte abnormal (high K, Phos, Mag)
**correct uremia or hyperK

31
Q

manifestation of Renal Failure 6

A 
HTN:renin, increased volume 2nd to Na and H2O 
Pulm edema
blunting of immune system
N/V, anorexia
Anemia: decrease production of EPO
disturbance in mentation
32
Q

Pons does what in micturition

A

Relaxes Internal sphincter and contraction of bladder

33
Q

Cerebral cortex does what in micturition

A

inhibits External sphincter conscious

34
Q

bladder inhibited by

A

SNS: relation and filling
PSNS: contraction, emptying

35
Q

internal sphincter opens when

A

when pressure gets above threshold

36
Q

Voiding from what nerve system

A

PSNS and voluntary motor control

37
Q

Urge incontinence

A

overactive detrusor muscle

38
Q

stress incontinence

A

increased intraabd pressure

weakening of pelvic muscles or intrinsic ureteral sphincter dysfunction

39
Q

overactive bladder

A

increased freq but not necessarily incontinence

40
Q

overflow incontinence

A

too full leak
obstruction
underactive/inactive detrussor muscle

41
Q

Enuresis

A

incontinence while asleep
deficiency in ADH (vasopressin)
nocturnal overactivity of detrusor muscle
abnormal arousal mechanisms

42
Q

Vesicoureteral reflex

A

reflex of urine at ureter-bladder junction
get recurrent UTI, voiding dysfunction, renal insufficiency, HTN in kids
CONGENITAL

43
Q

Ureteral ectopy

A

single ureter wrong place or double ureter
can increase infx, or decrease renal function
surg needed

44
Q

Ureterocele

A

Cystic dilation at distal end of ureter

results in ureteral and renal calyx dilation, reflex and infx

45
Q

Ureterocele s/s

A

hydronephrosis, UTI, Voiding dysfunction, hematuria, urosepsis, FTT

Patho test 3 (4 decks)

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