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Renal Flashcards

0
Q

Reabsorption describes fluid moving from the _____ to ____

A

Lumen (of nephron) to epithelial cell (and ultimately into capillary)

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1
Q

Filtration describes the movement of fluid from _____ to ____

A

Glomerulus to the proximal convoluted tubule

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2
Q

The side of the epithelial cell that is closest to the lumen is called the ____membrane

A

Apical

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3
Q

The side of the epithelial cell that is closes to the capillary is called the ____membrane

A

Basolateral

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4
Q

____is the 2nd leading cause of renal failure

A

High blood pressure

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5
Q

The 5 functions of the kidneys are

A
  1. Remove waste/ toxins from blood
  2. Maintain water and electrolyte balance
    (Excrete water and lytes or secrete renin)
  3. Maintain pH of blood (excrete H+ and create HCO3-)
  4. Secrete EPO
  5. Activate vitamin D
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6
Q

Kidneys are responsible for 1. ridding the body of _____ soluble wastes and 2. Maintain homeostasis of _____ and _____

A

Water soluble. Homeostasis of fluid and electrolytes

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7
Q

Two endocrine functions of the kidney are:

A
  1. producing EPO

2. Activating vit D (cofactor for intestinal calcium absorption)

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8
Q

T/F: nephrons are regenerated when damaged.

A

False- one million in each kidney. Have these for life. Thats why older people tend to have more issues with renal disease

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9
Q

Serious renal impairment occurs when what percentage of nephrons are damaged?

A

75-90%. Clinical findings are usually late in the progression of disease

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10
Q

Secretion can be described as fluid or molecules moving from ____ to ___ and finally _____

A

Blood to epithelial cell and out to lumen

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11
Q

The structures of the urinary system includes

A

Kidneys
Ureters
Urinary bladder
Urethra

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12
Q

Nephrons lie in what structure of the kidney?

A

Pyramids

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13
Q

Nephrons drain into what structure of he kidney

A

Renal calyx

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14
Q

Describe the arterial supply of the kidney

A

Renal artery -> interlobar arteries -> arcuate artery -> interLOBULAR artery-> afferent arterioles

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15
Q

What percentage of CO is circulated to the kidneys?

A

25%

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16
Q

Efferent arterioles form peri tubular capillaries aka ____ that wrap around the nephron structures

A

Vasa recta

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17
Q

Filtration occurs mainly in the ___

A

Glomerulus

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18
Q

What prevents large cells and negatively charged molecules from passing into the proximal convoluted tubule?

A

Basement membrane and slit pores of podocytes

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19
Q

Injury to the glomerulus may result in what in the urine?

A

Blood and proteins

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20
Q

Proteinurea represents wha type of dysfunction

A

Basement membrane

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21
Q

Only (small/large) molecules and (+/-) charged molecules can pass through the glomerulus

A

Small and +

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22
Q

The glomerulus has 3 types of cells. They are:

A
  1. Endothelium
  2. Podocytes
  3. Mesangial cells
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23
Q

Four functions of mesangial cells:

A
  1. Provide structural support for glomerular capillaries
  2. secretes matrix of proteins
  3. phagocytosis
  4. regulates GFR
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24
Q

The majority of the absorption proteins, amino acids, bicarbonate, and glucose occur in the ____

A

Proximal tubule

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25
Q

What 2 molecules are the result of protein breakdown?

A

Creatinine -muscle breakdown
Urea- amino acid breakdown

These should be in urine only- if in blood there is some type of renal issue.

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26
Q

_____is a good marker of renal function because it is freely filtered, not reabsorbed and negligibly secreted.

A

Creatinine

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27
Q

____is responsible for concentrating urine in the ____ of the nephron

A

Urea. Reabsorbed in the collecting tubule in the medullary nephron

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28
Q

Describe the process of glucose reabsorption

A

Glucose is filtered freely. Under NORMAL conditions, all glucose is reabsorbed by SGLT2 in the proximal tubule. GLUT 2 then transport it into the capillary.

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29
Q

Glycosuria results from what?

A

SGLT2 transporters on the apical membrane are overwhelmed by excess tubular loads of glucose. The renal threshold is reached earlier, so glucose appears in urine.

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30
Q

How do the kidneys regulate acid-base balance?

A

Kidneys excrete excess H+ and regulate the concentration of bicarbonate (HCO3-)
HCO3- is filtered freely but needs to be effectively reabsorbed to maintain acid-base balance.

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31
Q

What is the one equation we should all know?

A

CO2+ H2O H2CO3 HCO3- + H+

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32
Q

What are the two buffers of urine that bind to H+ so that the kidneys can excrete an acid load?

A

HPO4(2-) and NH3: phosphate and ammonia

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33
Q

How do the kidneys compensate for abnormal lung function in terms of acidosis (high PaCO2)?

A

Excrete more H+ by creating new HCO3- formed by glutamine metabolism.

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34
Q

How do the kidneys compensate for abnormal lung function in terms of alkalosis (low PaCO2)?

A

Kidneys will excrete some of filtered load of HCO3-

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35
Q

Potassium excretion is promoted by the Na/K pump on the _____ membrane

A

Basolateral

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36
Q

_____regulates (increases) potassium excretion in what part of the nephron?

A

Aldosterone. In the distal tubule

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37
Q

Besides aldosterone, what are 2 other regulators of K+ excretion?

A

K+/H+ exchanger and the plasma concentration of K+

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38
Q

Fluid homeostasis is maintained by what factors in the collecting tubule?

A

ADH activates cAMP which activates aquaporins on the apical membrane in the collecting tubule and water is then reabsorbed.

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39
Q

Insufficiency of ADH can lead to

A

Diabetes insipidus

  • large volumes of dilute urine excreted
  • severe fluid imbalance
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40
Q

The condition where the collecting tubules are unresponsive to ADH is called____

A

Nephrogenic diabetes insipidus

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41
Q

What 3 things cause renin to be released?

A
  1. Decreased renal blood flow
  2. Reduced serum Na
  3. Activations of sympathetic nerves to the JG cells (juxtaglomerular)
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42
Q

Renin release causes:

A

Angiotensin I to be converted to angiotensin II by ACE.

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43
Q

What causes natriuretic peptides to be released?

A
  1. Atrial cells I. Heart overstretched by increased blood volume
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44
Q

Natriuretic peptide release will (stimulate/inhibit) the actions of ______

A

Inhibit angiotensin II

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45
Q

Natriuretic peptide release does what to sodium and water?

A

Excreted in urine.

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46
Q

Urodilatin is released when the ______ and ______ sense an increased circulating blood volume

A

Distal convoluted tubule and collecting tubule

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47
Q

Urodilatin does what to sodium and water?

A

Inhibits reabsorption aka excretes it in urine (similar to natriuretic peptides)

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48
Q

How do diuretic agents work?

A

They oppose the reabsorption of water by altering the osmolality of urinary filtrate, leads to increased urine volume

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49
Q

Osmotic diuretics work by (increasing/decreasing) the osmolality of filtrate causing water to remain in the tubule.

A

Increasing

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50
Q

Which drugs inhibit the conversion of angiotensin I to angiotensin II and aldosterone?

A

ACE inhibitors

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51
Q

___ diuretics block the Na/K/2Cl pumps in the ____ loop of henle

A

Loop diuretics. Ascending loop (thick ascending loop)

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52
Q

Which diuretic blocks Na reabsorption?

A

Thiazide-like diuretics

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53
Q

K+ wasting diuretics are:

A

Loop, osmotic, thiazide-like

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55
Q

Which type of diuretics are K+ sparing?

A

Aldosterone blocking agents

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56
Q

Renal function is impaired at both ends of the lifespan, describe them.

A

Infant - early postnatal period, GFR low, immature kidneys can’t make concentrated urine (volume depletion with fluid losses)

elderly- kidneys diminish in size and function after 40, significant decrease by 65.

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57
Q

Geriatric considerations of kidney function (5)

A
  1. loss of nephron
  2. diminished renal blood flow
  3. decrease in GFR
  4. decreased ability to conserve Na, water
  5. susceptible to fluid/electrolyte imbalance, renal damage
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58
Q

What 4 urine and blood studies are helpful in evaluating kidney function?

A
  1. UA
  2. Serum creatinine (if in blood, there is renal impairment, should be cleared in urine)
  3. BUN levels
  4. tests of GFR
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59
Q

what is the synthetic (exogenous form) molecule used to measure renal function?

A

inulin (like creatinine, is freely filtered, not reabsorbed)

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60
Q

___ provides important info about kidney function

A

urinalysis

61
Q

3 types of UAs are

A
  1. single sample
  2. 24 hr (evaluate substances excreted in varying ant during the day)
  3. culture and sensitivity (determines the presence of microorganisms and drugs to which they are most sensitive)
62
Q

Abnormal odor of urine is due to

A

ammonia smell due to bacteria or stasis of urine

food can cause different odors (like asparagus. eww)

63
Q

Brown to bright red urine is from

A

hematuria (RBCs in urine)

64
Q

Dark yellow to orange urine is due to

A

concentrated urine (drugs can also turn urine different colors)

65
Q

Cloudy urine is due to

A

WBCs. infection

66
Q

In terms of urine osmolality and specific gravity, what is an indicator of renal impairment?

A

a fixed osmolality or specific gravity. (usually vary throughout the day)

67
Q

Normal UA is what color and is more acidic or more alkalotic?

A

pale yellow to amber, more acidic

68
Q

what are the 5 substances that you don’t want to see in urine?

A
  1. protein (proteinuria)
  2. glucose (glucosuria)
  3. excess epithelial cells, erythrocytes, leukocytes, bacteria (pyuria)
  4. Crystals and stones
  5. Casts
69
Q

what are the 3 types of casts that can be found in urine?

A

WBC, RBC, epithelial cell casts

70
Q

WBC casts are associated with ____

A

renal infections - pyelonephritis

71
Q

RBC casts indicate inflammation of ___

A

the glomerulus (glomerulonephritis)

72
Q

Epithelial Cell casts indicate sloughing of ___

A

tubular cells, (acute tubular necrosis)

73
Q

Creatinine is the end product of ____ and is exclusively excreted by the kidneys

A

muscle metabolism

74
Q

Creatinine is a more reliable indicator of renal function than ____

75
Q

____ and ____ helps monitor the progression of renal disease or to screen for occult renal insufficiency

A

Serum Creatinine and BUN

76
Q

Normal Creatinine level is

A

0.7-1.5 mg/dL

77
Q

Creatinine levels are affected by what 2 factors?

A
  1. rate of Cr produced from muscle (relatively constant in absence of muscle breakdown)
  2. rate of Cr excreted by kidneys (determined by GFR)
78
Q

BUN is the end product of

A

protein metabolism

79
Q

normal levels of BUN

A

10-20 mg/dL

80
Q

Elevated levels of BUN indicates

A
  1. decrease in renal function and fluid volume

2. increased catabolism and dietary protein intake

81
Q

What are some ways to measure GFR

A
  1. estimated clearance of filterable substance from the urine
  2. creatinine clearance (frequently used but not completely accurate)
  3. inulin clearance provides more accurate measurement of GFR
82
Q

Renal biopsies are used to

A

diagnose, manage and determine prognosis of renal impairment

83
Q

Azotemia is

A

increased BUN and Cr levels: r/t decrease in GFR

84
Q

Uremia

A

elevated urea in urine- sign of failing excretory system and other metabolic endocrine abnormalities

85
Q

Proteinuria/albuminuria

A

increase in concentration of protein in urine. due to leakiness of glomerular filtration barrier/ and or nephron abnormalities

86
Q

what are the 5 types of INTRArenal disorders (occurs within the kidney an dhas potential to result in renal insufficiency or failure)

A
  1. congenital
  2. neoplastic
  3. infectious
  4. obstructive
  5. glomerular
87
Q

Common manifestations of infrarenal disorders

A
  1. pain - (nephralgia) felt at costovertebral angle, tenderness/flank pain due to distention/inflammation of renal capsule at level T10 and L1.
  2. abnormal UA findings - dark strong smelling - decreased renal fxn, cloudy = infectious process
88
Q

____ agenesis of kidneys is not compatible with life

A

Bilateral.

Unilateral a genesis results in compensatory hypertrophy of functional kidney

89
Q

Describe a hypoplasic kidney

A

can lead to pediatric ESRD, single normal kidney can compensate. requires lifelong renal monitoring

90
Q

Cystic kidney disease results in ____

A

fluid-filled cysts that can expand and disrupt urine formation and flow

91
Q

what is the difference between autosomal recessive and autosomal dominant CKD?

A

Recessive - affects children/adolescents, reach ESRD early, harder to pass on to next generation.
Dominant - affects adults

92
Q

T/F. CKD can affect both kidneys

A

True. can be localized or affect both.

93
Q

Clincal manifestations of CKD:

A

Pain - most common,
HTN,
Concomitant cystic liver involvement

94
Q

CKD causes a reduction in ____ intracellularly and excess ___ intracellularly.

A

Ca2+ and cAMP

95
Q

Explain CKD and flagella on cells.

A

Flagella detects urine flow, senses volume and contents of filtrate. if there is a decreased sensing, there will be proliferation of epithelial cells- causing cysts. (I think??)

96
Q

What is the treatment of CKD?

A

-supportive treatment, control BP, manage associated pathologies. will eventually need dialysis/kidney transplant.

97
Q

Risk factors of renal cell carcinoma (RCC)

A

familial pattern, smoking, obesity, HTN)

98
Q

Treatment for RCC

A

nephrectomy (metastasis is resistant to radiation, immunotherapy and chemo)

99
Q

Describe Staging of RCC

A

Stage 1 - tumor within capsule
Stage 2 - tumor invades perirenal fat
Stage 3 - tumor extends to renal vein or regional lymphatics
Stage 4 - mets to liver (from lymphatics), lungs (from venous involvement), bone, soft tissue around kidneys (sarcoma)

100
Q

5 normal protective mechanisms against infection

A
  1. acidic pH
  2. urea in urine
  3. Male: bacteriostatic prostatic secretions, Female: glands in distal urethra secrete mucus
  4. micturition- washes out pathogens
  5. unidirectional urine flow
101
Q

the most common type of pyelonephritis is

A

ascending infection from lower urinary tract

102
Q

common agents of ascending urinary tract infection

A

E. Coli, proteus, enterobacter

103
Q

Urosepsis is

A

organisms in the blood stream from a UTI. gross.

104
Q

Diagnosis of acute pyelonephritis

A

presence of WBC casts = upper UTI

105
Q

Treatment of acute pyelonephritis

A

antimicrobials to avoid further renal dysfunction.

106
Q

Chronic pyelonephritis is usually associated with ___ or ____ processes leading to persistent ____

A

reflux or obstructive. leads to urine stasis

107
Q

Chronic inflammation causes ____ and loss of functional nephrons

108
Q

Clinical manifestations of Chronic pyelonephritis

A
  1. abdominal/flank pain,
  2. fever
  3. malaise
  4. anorexia
109
Q

treatment of chronic pyelonephritis

A

treat the underlying process, extend antibiotic therapy.

110
Q

Obstructive renal processes that interfere with flow of urine can cause

A
  1. urine stasis

2. dilation of tract proximally (above the obstruction)

111
Q

common causes of renal obstruction

A
  1. stones - most common,
  2. tumors
  3. prostatic hypertrophy
  4. strictures of ureters/urethra
112
Q

Complete obstruction of urine flow results in: (5)

A
  1. hydronephrosis
  2. decreased GFR
  3. ischemic kidney damage
  4. ATN
  5. Chronic kidney disease
113
Q

Crystal aggregates composed of organic and inorganic materials within the urinary tract are called

A

renal calculi (nephrolithiasis)

114
Q

Stones tend to form in the urinary tract due to:

A

solute supersaturation, low urine volume, and abnormal urine pH

115
Q

Most stones are composed of ____ crystals, others include uric acid, struvite, cystine, and stones associated with certain meds

116
Q

S/S of stone migration

A

abrupt, intense renal colic pain and can radiate, n/v, diaphoresis, hematuria can be present

117
Q

Treatment of kidney stones

A

fluids >2L/day to pass stone, lithotripsy or endoscopic approach, ureteral stunting, ureteroscopy.

118
Q

Obstructive renal processes that interfere with flow of urine can cause

A
  1. urine stasis

2. dilation of tract proximally (above the obstruction)

119
Q

common causes of renal obstruction

A
  1. stones - most common,
  2. tumors
  3. prostatic hypertrophy
  4. strictures of ureters/urethra
120
Q

Complete obstruction of urine flow results in: (5)

A
  1. hydronephrosis
  2. decreased GFR
  3. ischemic kidney damage
  4. ATN
  5. Chronic kidney disease
121
Q

Crystal aggregates composed of organic and inorganic materials within the urinary tract are called

A

renal calculi (nephrolithiasis)

122
Q

Stones tend to form in the urinary tract due to:

A

solute supersaturation, low urine volume, and abnormal urine pH

123
Q

Most stones are composed of ____ crystals, others include uric acid, struvite, cystine, and stones associated with certain meds

124
Q

S/S of stone migration

A

abrupt, intense renal colic pain and can radiate, n/v, diaphoresis, hematuria can be present

125
Q

Treatment of kidney stones

A

fluids >2L/day to pass stone, lithotripsy or endoscopic approach, ureteral stunting, ureteroscopy.

126
Q

What are the hereditary and environmental factors implicated in glomerular disorders

A

metabolic, infectious, hemodynamic, toxic, genetic, injuries

127
Q

What is the difference between primary and secondary kidney disease?

A

Primary- only kidney involved

secondary - results from other diseases, conditions, meds (good pasture syndrome, SLE, diabetic neuropathy)

128
Q

what are the 6 classifications of glomerular disorders?

A
  1. diffuse - all glomeruli
  2. focal (some glomeruli)
  3. global (affects all parts of glomerulus)
  4. segmental (only parts of glomerulus)
  5. membranous (thickening of glomerular capillary walls)
  6. sclerotic (scarring)
129
Q

3 Sites of depositions of glomerular disorders are

A
  1. mesangial
  2. subendothelial
  3. subepithelial
130
Q

the classical manifestation of a glomerular disorder is

A

proteinuria, can also have hematuria, abnormal casts, decreased GFR, edema, HTN.

131
Q

___ of the epithelium allows for movement of molecules in/out of the capillary

A

fenestrations

132
Q

____ prevents the movement of molecules in/out of the capillary

133
Q

Nephrotic syndrome is characterized by

A

protein loss >3-3.5 grams in 24 hours

134
Q

nephritic syndrome is a reflection of ____

A

glomerular inflammation. can have mild-moderate inflammation, hematuria and RBC casts in sediment.

135
Q

Glomerulonephritis is

A

inflammation of the glomeruli. immune response to variety of potential triggers. more common in men.

136
Q

ACUTE glomerulonephritis results in ___ degradation of the ____

A

lysosomal degradation of the basement membrane.

137
Q

What causes the GFR to fall in acute glomerulonephritis?

A

contraction of mesangial cells (decreased surface area for filtration)

138
Q

clinical manifestations of glomerulonephritis are

A

proteinuria, oliguria, azotemia, edema and HTN

139
Q

treatment of glomerulonephritis include

A

steroid therapy, plasmaphoresis, supportive measures (diet/fluid management) and management of systemic and renal HTN

140
Q

post infectious acute glomerulonephritis is caused by what bacteria?

A

group A beta-hemolytic streptococci from skin and throat infections

141
Q

post infectious acute glomerulonephritis can turn the urine what color?

A

smoky or coffee colored

142
Q

post infectious acute glomerulonephritis is common in

A

children, developing countries (water supply not clean)

143
Q

IgA nephropathy (Berger disease) results from what type of infection?

A

upper respiratory or GI viral infections

144
Q

the antigen-antibody complex of IgA infections deposit and causes injury to what cells?

145
Q

T/F. Proteinuria, edema and HTN are common in IgA nephropathy (Berger disease)

146
Q

The baroreceptor mechanism of tubuloglomerular feedback will inhibit ____ release from JG cells when there is an ____ in pressure in the adherent arteriole

A

Renin release when there is an increase in pressure

147
Q

Sympathetic nerve mechanism of tubuloglomerular feedback will stimulate what nerves to release renin?

A

B1 adrenergic nerves

148
Q

The Macula densa mechanism of tubuloglomerular feedback will inhibit renin release when it senses an increase in _____ in the distal nephron

GI Liver Renal (2 decks)

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