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x 6102 Pathophys > renal > Flashcards

renal Flashcards

1
Q

hormonal regulation of blood flow: vasoconstrictors x3

A

sympathetic nerves (epi, nor epi)

angiotensin II

endothelin

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2
Q

hormonal regulation of blood flow: vasodilators x4

A

prostaglandins
nitric oxide
bradykinin
natriuretic peptides (ANP, B-type)

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3
Q

hormonal reg of renal blood flow: epi/norepi moa/stimulus/GFR/RBF

A

vasoconstriction

decreased ECF volume, GFR, RBC

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4
Q

hormonal reg of renal blood flow: angiotensin II moa/stimulus/GFR/RBF

A

vasoconstriction

decreased ECF volume, GFR, RBC

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5
Q

hormonal reg of renal blood flow: endothelin moa/stimulus/GFR/RBF

A

vasoconstriction

decreased ECF volume, increased stretch, and bradykinin, angiotensin II, epi

decreased GFR, RBF

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6
Q

hormonal reg of renal blood flow: prostaglandins moa/stimulus/GFR/RBF

A

vasodilators

decreased ECF volume
increased shear stress, angiotensin II

no change or increased GFR, increased RBF

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7
Q

hormonal reg of renal blood flow: nitric oxide moa/stimulus/GFR/RBF

A

vasodilator

increased shear stress, ACh, histamine, bradykinin, ATP, adenosine

increased GFR, RBF

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8
Q

hormonal reg of renal blood flow: bradykinin moa/stimulus/GFR/RBF

A

vasodilator

bradykinins & ACE

increased GFR, increased RBF

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9
Q

hormonal reg of renal blood flow: natriuretic peptides moa/stimulus/GFR/RBF

A

vasodilator
- inhibits aldosterone resulting in increased NaCl/H2O excretion

increased ECF volume

increased GFR, no change in RBF

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10
Q

the opposite of aldosterone

A

natriuretic peptides

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11
Q

urge incontinence

A

abrupt/strong urgency

  • often assoc with involuntary detrusor contractions
    • detrusor hyperreflexia vs instability (neuro vs non)
  • may be assoc with decreased bladder wall compliance

most common: older adults

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12
Q

stress incontinence

A

physical activity w increased abdominal pressure, cough, sneeze laugh

most common: women

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13
Q

overflow incontinence

A

bladder overdistension
- assoc w neuro lesions below S1, polyneuropathy, urethral obstruction (enlarged prostate)

most common: older women

overactive bladder syndrome

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14
Q

overactive bladder syndrome & incontinence x2

A

stress & overflow

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15
Q

functional incontinence

A

d/t dementia or immobility

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16
Q

intrinsic urinary tract obstruction

A

inside ureter

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17
Q

extrinsic urinary tract obstruction

A

outside ureter

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18
Q

obstructive uropathy

A

anatomic changes in urinary system d/t obstruction

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19
Q

upper urinary tract obstruction

A

obstruction affecting one or both kidneys

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20
Q

lower urinary tract obstruction

A

aka outlet obstruction, affects urine storage/emptying

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21
Q

tubulointerstitial fibrosis

A

deposition of excess ECM that can occur when upper urinary tract obstruction is not fixed quickly

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22
Q

neurogenic bladder

A

different sites in nervous system that control sensory/motor bladder function are acting funny

affected sites: detrusor, sphincter

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23
Q

kidney obstruction

A

calculi or urolithiasis with renal colic, n/v, gross or micro hematuria

24
Q

renal colic

A

moderate to severe pain in flank radiating to groin

25
Q

ureter obstruction

A

upper urinary tract obstruction - stricture, congenital compression, aberrant vessel, tumor, inflammation, stone

26
Q

bladder obstruction

A

partial obstruction of bladder outlet r/t deposition of collagen within smooth muscle bundles of detrusor

causes increased force of contraction

27
Q

urethra obstruction

A

stricture: narrowing of lumen d/t infection, injury, surgical manipulation, scar (rare in women), proximal is more severe

28
Q

urine pH and kidney stones

A

alkaline = significantly increased risk for Ca stone

acidic = increased risk for uric acid stone

29
Q

pyelonephritis

A

infection of one or both upper urinary tracts

acute vs chronic

30
Q

most common causative organisms of acute pyelonephritis

A

E Coli

Proteus, Pseudomonas - esp after urethral instrumentation

31
Q

vesicoureteral reflux

A

backward flow of urine from bladder into ureters/kidneys

32
Q

chronic pyelonephritis & common causes

A

persistent/recurrent infection resulting in scarring

can also be d/t drug toxicity (analgesics - NSAIDS), ischemia, irradiation, immune-complex disease

33
Q

acute pyelonephritis - common causes

A

kidney stones, vesicoureteral reflux, pregnancy, neurogenic bladder, instrumentation, female sexual trauma

34
Q

glomerulonephritis

A

inflammation of glomerulus caused by primary glomerular injury including:

  • immunologic responses
  • ischemia
  • free radicals
  • drugs
  • toxins
  • vascular disorders
  • infection

significant cause of CKD & ESRD

acute v chronic

35
Q

significant cause of CKD & ESRD

A

glomerulonephritis

36
Q

acute glomerulonephritis

A

includes renal disease in which glomerular inflammation is caused by immune mechanisms damaging glomerular capillary filtration membrane

37
Q

nephrotic syndrome s/s

A

massive proteinuria: 3.0+ g/day
hypoalbuminemia: lt 3.0 g/dL
peripheral edema

38
Q

nephritic syndrome s/s

A

microscopic hematuria, RBC casts, proteinuria (NOT severe)

smoky, brown-tinged urine

can occur simultaneously with nephrotic syndrome!!

39
Q

renal insufficiency

A

decrease of fxn ~25% normal

OR

GFR 25-30 ml/min

+ mild increase creat + uria

40
Q

uremia

A

syndrome of renal failure with MANY s/s
increased urea + creat, fatigue, anorexia, n, v, itching, neuro changes

related to FAILURE: retention of toxic waste, deficiency, electrolyte disorder, immune activation = proinflammatory state

41
Q

azotemia

A

increased serum urea, often increased creat

d/t insuffiency OR failure

42
Q

classic s/s postrenal AKI

A

several hours anuria + flank pain followed by polyuria

43
Q

ESR

A

non-specific measure of inflammation

44
Q

most common cause of intrarenal AKI

A

acute tubular necrosis

45
Q

acute tubular necrosis: postischemic

A

persistent hypotension, hypoperfusion, hypoxemia = ischemia + decreased ATP & oxygen free radicals

resulting in cell swelling, injury, necrosis

46
Q

acute tubular necrosis: nephrotoxic

A

big player: aminoglycosides (gent, tobramycin) - accumulate, can lead to failure

radiocontrast media, cisplatin

enhanced by dehydration, adganced age, concurrent insufficiency, DM

47
Q

chronic kidney disease

A

progressive loss of fxn associated with systemic disease

GFR lt 60ml/min for 3+ mo

48
Q

2 consistently recognized contributing factors to CKD

A

proteinuria

  • hyperfiltration
  • increased permeability
  • inflammatory process activated
  • fibrosis

angiotensin II

  • promotes hyperfiltration (eff art constriction)
  • promotes systemic htn
  • proteinuria leading to inflammation leading to fibrosis
49
Q

acute kidney injury

A

sudden loss of function and glomerular filtration, plus accumulation of nitrogenous waste products (creat, BUN)

50
Q

should raise suspicion for polycystic kidney disease in young person

A

hypertension

51
Q

frequent initial presentation polycystic kidney disease

A

flank or abdomen pain

52
Q

polycystic kidney disease etiology

A

genetically acquired, autosomal dominant most common

53
Q

most common kidney cancer

A

renal cell carcinoma, clear cell type

54
Q

renal cell carcinoma, clear cell type

A

mutation of von Hippel-Lindau gene on chromosome 3P + better prognosis compared to others

2x men v women between 50-60

common metastasis to lung, lymph nodes, liver, bone, thyroid, CNS

55
Q

most common bladder cancer

A

urothelial transitional cell carcinoma (arising from bladder lining)

most common men 60+

cause of death usually metastasis (high grade muscle invasive)

56
Q

papillary growth pattern (tuftlike lesion + stalk)

A

common for transitional cell carcinoma

57
Q

renal vascular resistance determined by x3

A

interlobular arteriole
afferent arteriole
efferent arteriole

x 6102 Pathophys (6 decks)

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