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Renal 4a Flashcards

1
Q

renal anatomy

A

highly vascularized tissue surrounded by adipose and connective tissue capsule

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2
Q

functional unit =

A

nephron

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3
Q

_____nephrons per kidney

A

1 million

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4
Q

nephron anatomy

A

glomerulus + tubule, and associated capillaries

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5
Q

nephrons create ___ from blood

A

filtrate

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6
Q

useful substances are____ and returned to blood

A

reabsorbed

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7
Q

other substances (toxins, drug metabolites selectively ____

A

into tubule to exit the body as urine

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8
Q

porous membrane with large surface area allows for____

A

water/ solutes to be filtered

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9
Q

what anatomy allows for glomerular filtration

A
  1. fenestrasted endothelium (gaps)
  2. basment membrane
  3. podocytes with foot processes and filtration silts
    (only capillary bed fed AND drained by arterioles)
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10
Q

filtrate =

A

plasma- proteins
(entire plasma volume filtered 60 times each day! )

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11
Q

Glomerular filtration is a passive process driven by

A

hydrostatic pressure
-higher than other capillaries (55mmHg)

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12
Q

intrinsic control (autoregulation)

A

maintains constant GFR when MAP fluctuates (mean arterial pressure)
-Anything that affects BP or blood volume can impact GFR
-healthy kidneys maintain GFR; diseased kidneys cannot

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13
Q

extrinsic control )nervous system, endocrine)

A

Epi/ NE (neural), renin-angiotensin-aldosterone system (hormonal) indirectly regulates GFR by maintaining systemic BP, drives filtration to kidneys

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14
Q

increase in BP leads to ____

A

constriction of afferent arterioles which decreases flow to glomerulus
-GFR constant, protect glomeruli from damaging high BP

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15
Q

Decrease in BP leads to

A

dilation of afferent arterioles which increases flow of glomerulus
-helps maintain normal GFR when BP

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16
Q

Juxtaglomerular apparatus (JGA)

A

made up of :
-macula densa cells- of ascending limb of nephron loop
-extraglomerular mesangial cells
-granular cells
importance in regulation of filtrate formation and blood pressure

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17
Q

granular (jextaglomerular cells)

A

smooth muscle cells of afferent arteriole
mechanoreception: sense BP
secrete renin

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18
Q

macula densa

A

chemoreception: sense NaCl content of filtrate (indicate whether flow rate is too high or too low)

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19
Q

mesangial cells

A

modified SM cells, can contract to reduce surface area for filtration
allow communication between other 2 cell types

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20
Q

If GFR too high

A

macula densa cells sense increased NaCl in filtrate
signal to granular cells to constrict afferent arteriole

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21
Q

if GFR too low

A

too little NaCl sense by macular densa cells
signal granular cells to relax afferent arteriole

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22
Q

acute kidney injury

A

-sudden onset. may resolve or progress to chronic

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23
Q

chronic kidney injury

A

progressive damage, leads to kidney failure

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24
Q

kidney injury determined by

A

imaging
urinalysis
renal clearance
biopsy

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25
Normal urine
-95% water and 5% solutes -nitrogenous wastes: urea, uric acid and creatinine -other norrmla solutes: Na, K, PO4, SO4, Ca, Mg, HCO -pH 6.0 (range 4.6- 8.0 )
26
abnormal urine- albuminuria
damage to filtration membrane - too much albumin
27
glucosuria:
hyperglycemia, too much sugar in blood
28
hematuria
damage to filtration membrane; bleeding in urinary tract, blood in urine
29
renal clearance
volume of plasma cleared of a particular substance in a given time (1 min) RC= GFR= 125 mL/ min
30
renal clearance test used to :
determine GFR Detect glomerular damage follow the progress of renal disease
31
general mechanisms of acute kidney injury
-vascular basis or tubular basis
32
vascular basis
afferent arteriole constriction OR efferent arteriole dilation -decrease in renal perfusion -decrease GFR caused by ischemia, hypoxia in renal medulla
33
tubular basis
damaged cells --> cellular debris genereal mechanisms of acute kidnety of tubule incr intratubular pressure affects filtration upstream decr GFR damaged cells -> filtrate leaks out of tubule
34
manifestation of acute kidney injury
all result from decreased GFR Fatigue, malaise - from impaired waste clearance dyspnea, orthopnea peripheral edema -altered mental status -prolonged impairment of excretory fxn -azotemia
35
Azotemia
build up of nitrogenous wastes in blood -elevated ratio BUN (blood urine nitrogen level: creatinine
36
tx for acute kidney injury
tx underlying reason for kidney damage
37
tubular cells regenerate ->
nephron fxn return to normal
38
chronic kidney dx progresses to
renal failure
39
renal failure
-irreversible loss of nephrons -greater burden on remaining nephrons -> hyperfiltration (local htn) -glomerular sclerosis -increase rate of nephron loss, glomerular scarring
40
uremia
inadequate renal fxn -functional reserve of nephrons lost -s &S of chronic kidney dx
41
functional reserve
kidneys can lose about 50% of nephrons before impairment (reason why healthy ppl can donate a kidney)
42
mechanism of uremia
1. retention of products that are normally exerted ( nitrogenous wastes) 2. normal renal hormones over-secreted (compensation for low GFR) 3. Loss of normal kidney products (vit D, erythropoietin)
43
hypernatremia and water retention
decr ability to excrete water and Na+ -made worse by dietary Na+ -htn, edema, hrt failure worsened
44
hyperkalemia
decr GFR leads to incr aldosterone -> K+ retention
45
metabolic acidosis
decr ability to excrete acid (H+, NH4+) -put pt at risk of crisis in case of vommiting/ diarrhea)
46
mineral and bone tissue (uremia)
decr vit D production, decr Ca2+ absorbed in gut retention of phosphate
47
-inadequate bone mineralization=
osteomalacia; cant rebuild bone but can break it down normally
48
CV and pulmonary manifestations of uremia
htn, pulmonary edema decr GFR -> increases secretion of renin which incr blood volume and BP
49
Neuromuscular effects of uremia
mild: impaired concentration, memory loss sever: asterixis (jerking of hands/wrists), seizures, coma -altered nerve conduction (from abnormal K+ and Na+ levels)
50
endocrine effects of uremia
females: low estrogen, amenorrhea (absence of menstruation), infertility men: low testosterone, impotence (inability for a man to achieve erection of orgasm), low sperm count -metabolism of insulin impaired (good for dm)
51
derm manifestation of uremia
pallor (anemia) -hyperpigmentation (accumulated pigmented metabolites) -hematomas (clotting abnormalities)
52
Causes of chronic kidney dx
-DM -HTN -Glomerulonephritis -pyelonephritis -polycystic kidney dx -toxic nephropathy -SLE
53
Diabetes and kidney dx=
diabetic nephropathy
54
Diabetic nephropathy characteristic changes
glomerulus enlarges -alter filtration directly: basement membrane thickens loss of podocytes -affect blood flow-> alters filtration: mesangial cells proliferate arteriole vasoconstriction
55
htn and kidney dx
prolonged constriction of afferent arterioles (to regulate GFR) -Hypertrophy of VSM cells in affernt arteriole -narrowed vessel -> ischemia injury to endothelial cells -enhances vascontriction -promotes VSM hypertrophy glomerular sclerosis (scarring) -decr GFR
56
htn ____ kidney damage and kidney damage______ htn
promotes, promotes
57
Glomerulonephritis
damage to glomerular capillary wall. altering filtration -infiltration of inflamm cells contraction of mesengial cells decr GFR Na+ and water retention edema, htn, hematuria, proteinuria
58
acute gn
abrupt onset on hematuria, proteinuria, decr GFR, Na+ and water retention -infectious dx, often involves autoantbodies, deposition of immune complexes in glomerulus
59
chronic gn
persistent urinary abnormalities with progressive decline in renal fxn
60
nephrotic syndrome
proteinuria, hyperlipidemia, edema -target podocytes
61
pyelonephritis
inflammation due to bacterial infection -ascedning UTI -inflammation -tubular obstruction and damage -interstitial edema more common in females (bc shorter ureters)
62
pyelonephritis pathogens
KEEPS Klebsiella, E. coli, enterococcus, pseudomonas, staphylococcus
63
urine findings:
WBC in urine (incr blood count in blood) -hematuria (maybe) -foul-smell -bacterial culture (+)
64
polycystic kidney dx
-genetic condition: 95% inherited (autosomal dominant) PKD1, PKD2, PKD3 mutation -dysfunctional Ca 2+ channels on epithelial cells: abnormal Ca2+ entry disrupts signaling
65
_____develops cysts and abundance of cysyts ____tubules and organ architecture
nephrons, distorts
66
polycystic kidney dx affecting other epithelial cells
brain-> berry aneurysms (death) liver-> cyst formation heart-> valvular dysfxn seminal vesicles -> decreased sperm motility, infertility (severity depends on mutation)
67
manifestation of polycystic kidney dx
proteinuria: damages filtration membrane leaks protein htn: compressed renal vasculature activates RAAS Hematuria: altered renal vasculature + damages filtration pain: inflammation if cysts begin harboring bacteria
68
polycystic kidney dx diagnosed by
Imaging CT, MRI, ultrasounds Genetic testing (less common)
69
toxic nephropathy
=nephrotoxicity damage induced by chemicals or drugs -distal tubular cell injury -impaired mitochondrial fxn -> incr oxidative stress and free radicals -impaired ability to concentrate urine -hematuria, pain -damage resolved if drug stopped
70
kidneys are vulnerable to drugs bc:
1. they receive 25% of cardiac output, exposed to large amounts of chemical in blood 2. hyperosmotic medulla allows concentration of drugs in kidney interstitium 3. kidneys are common site of exertion; any renal insufficiency leads to the accumulation of the drug
71
common classes of drugs that cause nephropathy
-pain relievers (naproxen) -antimicrobials (pcn) -psychiatric drugs -cancer tx (methotrexate) -cholesterol lowering drugs (statins)
72
SLE and kidney dx - lupus nephritis
development of autoantibodies targeting glomerulus or tubule -glomerular sclerosis can occur with other autoimmune conditions: goodpasture syndrome (antibodies attack lungs and kidneys) or progressive systemic sclerosis (of vasculature)
73
progressive kidney damage , loss of functional nephrons=
renal failure
74
med treatments for kidney dx
-treat underlying condition htn, hrt failure= diuretics autoimmune= immunosuppressors infection= antimicrobials
75
lifestyle tx
dietary regulation of protein k+ and na+ fluids
76
transplant
better tissue matching and immunosuppresent tx, prevent rejection -limited by donor avalibility
77
dialysis
main tx cannot replace hormone fxn of kidney

Pathophys (11 decks)

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