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Pathophysiology II > Renal > Flashcards

Renal Flashcards

1
Q

What is the name of the capsule that surrounds the glomerulus?

A

Bowman’s Capsule

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2
Q

Plasma travels through the ______ arteriole into the glomerulus.

In the glomerulus, plasma then flows through the “leaky basement membrane composed of _______.

Plasma then exits the glomerulus through the _______ arteriole.

A

Afferent

Podocytes

Efferent

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3
Q

What is the name of the smooth muscle cells that are found “between the cells” in the kidneys which help to regulate blood flow in the glomerulus?

A

Mesangial Cells

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4
Q

T/F: Capillaries in the glomerulus are sinusoidal

A

False

They are fenestrated allowing for large amounts of solute-rich fluid to pass through

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5
Q

Are large amounts of protein in the urine normal?

A

No

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6
Q

JGA is associated with what THREE things in the kidney?

A

Na+
Renin
Blood Pressure

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7
Q

Podocytes terminate in the foot processes of the basement membrane in the glomerulus.

What is the name of the clefts between those foot process which allow filtrate to enter the capsule?

A

Filtration Silts

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8
Q

If there was glomerular damage, what may be seen in a patient’s urine?

What processes may lead to this?

A

Protein

HTN
Diabetes
Trauma
Autoimmune
Obstruction
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9
Q

What are the two types of nephrons within the kidney?

Which is most abundant?

A

Corticol (Most Abundant)

Juxtamedullary

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10
Q

Which nephron in the kidney is involved in urine concentration?

A

Juxtamedullary

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11
Q

Filtration in the kidney occurs in the ________ which re-absorption and secretion occur in the _______.

A

Glomerulus

Tubules

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12
Q

Nephrons have two sets of capillaries, glomerular and peritubular.

In which capillary does filtration occur?

Reabsorption?

A

Filtration: Glomerular

Reabsorption: Peritubular

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13
Q

What is unique about glomerular capillaries in regards to how blood is fed to them and drained from them?

A

They are the only capillaries in the body that are fed and drained by arterioles

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14
Q

_______ is the movement of fluid out of the tubule and into the peritubular capillary

A

Reabsorption

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15
Q

_______ is the movement of fluid out of the glomerular capillary and into Bowman’s Capsule

A

Filtration

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16
Q

________ is movement of fluid out of the peritubular capillary and into the tubule

A

Secretion

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17
Q

It is important to keep plasma proteins in the plasma during filtration to maintain which force/pressure?

If this is not maintained, what may occur?

A

Osmotic

If this is not maintained, too much fluid will filter into the filtrate

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18
Q

What ‘forces’ make filtration in the glomerulus go?

What ‘forces’ act against filtration?

A

GO:

Glomerular Capillary BP

AGAINST:

Bowman’s Pressure (stuff pooling in Bowman’s Space)
Osmotic Force due to protein in plasma

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19
Q

T/F: Polycythemia and Dehydration would lead to an increase in glomerular filtration

A

False

These would result in slower glomerular filtration

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20
Q

T/F: Tubular reabsorption can be active or passive transport

A

True

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21
Q

When tubules reach a point when they can no longer reabsorb a certain substance (ex: Glucose), they are said to have reached a _______ _______.

(Hint: This is why untreated diabetic patients have glucose in their urine)

A

Transport Maximum

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22
Q

What THREE substances are almost 100% reabsorbed daily?

A

Water
Sodium
Glucose

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23
Q

Tubular Secretion is important for removing excess ___ and controlling the __ of the blood.

A

Removing Excess K+

Controlling Blood pH

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24
Q

_____ _______ ____ is defined as the quantity of glomerular filtrate formed each minute in the nephrons of both kidneys

A

Glomerular Filtration Rate (GFR)

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25
Q

What THREE things effect GFR?

A
  1. Filtration Surface Available
  2. Filtration Membrane Permeability/Pressure
  3. Blood Pressure / Flow into Glomerulus
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26
Q

An increase in blood pressure would lead to a(n) _________ in GFR.

A decrease in blood pressure would lead to a(n) _________ in GFR

A

Increase

Decrease

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27
Q

Constricting the afferent arteriole would lead to a(n) ______ in GFR

A

Decrease

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28
Q

Dilation of the efferent arteriole would lead to a(n) _________ in GFR

A

Decrease

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29
Q

Constriction of the efferent arteriole would lead to a(n) ________ in GFR

A

Increase

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30
Q

Dilation of the afferent arteriole would lead to a(n) _________ in GFR

A

Increase

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31
Q

Which electrolyte is important in managing water balance?

A

Na+

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32
Q

Why do people experience ‘third-spacing’?

A

More fluid (water) exits the capillaries into interstitial tissues (3rd Space) due to decreases oncotic pressure in the capillaries

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33
Q

Sodium reabsorption is a(n) ______ transport process occurring in all tubular segments except in the ________ limb of the Loop of Henle

A

Active

Descending

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34
Q

Water is reabsorbed through _______ (a passive process), but is determined by the movement of sodium and the presence of ________ (water channels)

A

Osmosis

Aquaporins

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35
Q

Should aquaporins be present in the collecting ducts?

A

No

If there are then Anti-diuretic hormone (ADH) is likely present

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36
Q

Is vasopresson found within the anterior or posterior pituitary

A

Posterior

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37
Q

You are working out and get dehydrated, so plasma osmolarity _______.

Due to this the posterior pituitary releases ________.

Once this binds to it’s receptor on the basement membrane, there is an increase in ____ which causes phosphorylation of proteins.

This phosphorylation causes ______ to fuse with the luminal membrane.

This process results in more water being ______ from the filtrate.

A

Increases

Vasopression

cAMP

Aquaporins

Reabsorbed

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38
Q

What is the most abundant cation in the filtrate?

A

Na+

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39
Q

Filtrate has a high concentration of Na+, so it will ______ transport into the tubular epithelial cells (remember it is moving from high concentrations to lower concentrations).

The above allows for the transport of other solutes into or out of the tubular cells. What are examples of these?

What ‘pump’ then actively transports Na+ into the interstitial fluid? What is being pumped into the cell?

Na+, water, and interstitial solutes are then reabsorbed in the the _______ capillaries

A

Passively

Into: Glucose
Out of: H+

Na/K ATP pump
K+ into the cell

Peritubular

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40
Q

In regards to osmoreceptors in the hypothalamus….

Lower osmolarity ________ (inhibits/stimulates) the release of vasopresson

A

Inhibits

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41
Q

In regards to osmoreceptors in the hypothalamus….

Higher osmolarity ________ (inhibits/stimulates) the release of vasopresson

A

Stimulates

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42
Q

In regards to baroreceptors in the atria/carotids….

Lower blood pressure ________ (inhibits/stimulates) the release of vasopresson

A

Stimulates

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43
Q

In SIADH, too much ____ is being produced

A

ADH (Vasopressin)

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44
Q

What Sx are associated with SIADH?

Are you more likely hypertensive or hypotensive?

Hyponatremic or hypernatremic?

A

Sx:

Irritability
Confusion
Cramping

Hypertensive

Hyponatremic

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45
Q

In Diabetes Insipidus, _______ is not being released.

A

Vasopressin

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46
Q

What Sx are associated with DI?

Are you more likely hypertensive or hypotensive?

Hyponatremic or hypernatremic?

A

Sx:

Extreme Thirst
Large, Diluted Urine

Hypotensive

Hypernatremic

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47
Q

Which portion of the loop (ascending/descending) is relatively impermeable to solutes but freely permeable to water?

Which portion of the loop (ascending/descending) is relatively impermeable to water but freely permeable to solutes?

Describe the osmolarity as it travels through the loop.

A

Descending

Ascending

Osmolarity is around 300 and then travels down the descending loop, at the bottom after it was lost water it becomes ~1400. As it ascends it loses NaCl and returns to 80-100. As it descends again it, it loses water returning the osmolarity to ~1400

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48
Q

____ recycling contributes to the medullary osmotic gradient.

A

Urea

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49
Q

Which steroid is released in the cortex of the kidney?

A

Aldosterone

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50
Q

What parts of the nephron does aldosterone work to increase Na+ reabsorption?

A

Distal Tubule

Collecting Ducts

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51
Q

Which has the FASTER effect, aldosterone or ADH?

A

ADH

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52
Q

Juxtaglomerular cells line the _______ wall and are ________ (exocrine/endocrine) cells which secrete ______.

A

Arteriole

Endocrine

Renin

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53
Q

T/F: Juxtaglomerular cells are mechanoreceptors and can release renin when BP gets lower than desired

A

True

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54
Q

Renin stimulates the release of _________ which causes the release of _______.

A

Angiotensin

Aldosterone

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55
Q

The macula densa are _________ which detect changes in the _____ content of the filtrate

A

Chemoreceptors

NaCl

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56
Q

If Na+ is low in the distal tubule (decreased filtration)…..

The macula densa will signal to the JG cells to release more ____ and ________ (increase/decrease) blood flow into the _______ arteriole

A

Renin

Increase

Afferent

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57
Q

If you had excess aldosterone would you be at risk for hyperkalemia or hypokalemia?

A

Hypokalemia

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58
Q

What is the name of the hormone made in the hearts atria?

Does it contribute to sodium retention or loss?

A

Atrial Natriuetic Peptide (ANP)

Sodium Loss

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59
Q

How does ANP contribute to blood volume control?

A

When the atria distend (as they do when blood volume is high), they make more ANP. Salt gets excreted and plasma volume goes down.

60
Q

The kidney controls blood pH by regulating the reabsorption/secretion of ___ ions.

A

H+

61
Q

Loss of HCO3- through the urine/diarrhea would result in a net ______ (gain/loss) of H+ ions

A

gain

62
Q

Within a tubule, H20 and CO2 form _____ and H+.

The _____ then diffuses into the interstitium and into the plasma to control blood ___

The __ ion moves into the tubule lumen and combines with HCO3- to form ___ and ____.

A

HCO3-

HCO3-

pH

H+

H2O and CO2

63
Q

If the plasma is too acidic than all the HCO3- gets reabsorbed, and the blood stream will still need more.

Instead of Bicarb, what will the H+ ion bind to in the tubular lumen?

A

Phosphate

64
Q

Which area of the kidney is most likely effected by ischemia?

A

Renal Medulla

65
Q

Which area of the kidney is commonly effected by autoimmune disorders, HTN, and DM?

A

Glomerulus

66
Q

Which area of the kidney is commonly effected by obstructions (ie: clogged by filtrate)?

A

Tubules

67
Q

The ureters and bladders are ____-renal structures

The renal artery is a ___-renal structure

A

Post-renal

Pre-renal

68
Q

A RAPID increase in BUN and Creatinine would indicate ______ (acute/chronic) renal failure

A

Acute renal failure

69
Q

What are causes of pre-renal ARF?

What are causes of intrarenal ARF?

What are causes of post-renal ARF?

A

Pre-renal:

Hypovolemia
Ischemia
Medications (NSAIDs, ACEi, Diuretics)

Intrarenal:

Vasculitis
Glomerularnephritis
Acute Tubular Necrosis

Post-Renal:

Obstruction
Congenital Abnormalities
Cancer

70
Q

_____ _____ ______ can occur when blood supply to the kidney is significantly reduced or when tubular flow is occluded.

During this process, tubular cells can die and slough off, which are then excreted in the urine.

A

Acute Tubular Necrosis

71
Q

A eGFR of less than 60 for more than 3 months would be classified as what?

A

Chronic Kidney Disease

72
Q

What are extra renal manifestations of CKD?

A

HTN
Fluid Retention
Osteoporosis

73
Q

What range of GFR qualifies a patient as Stage 1 - 5 CKD

A

Stage 1: >90

Stage 2: 89 - 60

Stage 3: 59 - 30

Stage 4: 29 - 15

Stage 5: <15

74
Q

Why may a patient complain of itching as their GFR declines?

A

Uremia

Resulting in nitrogenous deposits under the skin

75
Q

Renal blood flow is __-___% of cardiac output.

A

20-25%

76
Q

In a 70kg person, the kidneys will filter approximately ___ L of fluid per day

A

180

77
Q

________ is a disease of the glomeruli

While, _________ is inflammation of the glomeruli

A

Glomerularopathy

Glomerulonephritis

78
Q

A glomerular disease orignating in the kidneys would be considered _________ (primary/secondary) while glomerular disease due to systemic disease would be considered _________ (primary/secondary).

A

Primary

Secondary

79
Q

Any combination of the following would be indicative of what……

Hematuria
Proteinuria
HTN
Decline in eGFR

A

Glomerular Disease

80
Q

______ Syndrome is characterized by damage that creates thinning of the glomerular basement membrane and pores in the glomerular podocytes

________ Syndrome is characterized by an increased permeability of the capillary walls of the glomerulus

A

Nephritic Syndrome

Nephrotic Syndrome

81
Q

What manifestations are seen in nephrotic syndrome?

A
  1. > 3.5g of proteinuria
  2. Low serum proteins
  3. Peripheral edema
  4. Hypoalbuminemia
  5. Increase in cholesterol
  6. Predisposition to clotting (due to increased blood viscosity)
82
Q

T/F: In nephrotic syndrome, the glomeruli are affected by inflammation orhyalinization

A

True

83
Q

What are the two most common causes of secondary nephrotic syndrome?

A
  1. Diabetes (Most Common)

2. HTN

84
Q

T/F: In nephortic syndrome, the podocytes experience a change in charge, which makes them less permeable to proteins.

A

False

The charge makes them more permeable to proteins

85
Q

Would you expect to see oliguria with nephritic or nephrotic syndrome?

A

Nephritic

86
Q

What are the FIVE categories of Glomerular disease?

A
  1. Acute glomerulonephritis
  2. Rapidly progressive glomerulonephritis
  3. Chronic glomerulonephritis
  4. Nephrotic syndrome
  5. Asymptomatic urinary abnormalities
87
Q

______ _________ is the abrupt onset of hematuria and proteinuria with decreased GFR and salt/water retention

A

Acute Glomerulonephritis

88
Q

Are patients with acute glomerulonephritis likely to recover full renal function?

A

Yes

89
Q

In acute glomerulonephritis, is the glomerulus hypercellular or hypocellular?

Are the capillaries dilated or constricted?

Is filtration slower or faster?

A

Hypercellular and thickened

Capillaries are constricted and often occluded

Filtration is decreased

90
Q

A common cause of acute glomerulonephritis is a result of an autoimmune injury initiated by what bacteria?

A

Group A, Beta-hemolytic streptococcus

91
Q

How is post-strep glomerulonephritis developed?

A

Immune system creates antibodies to Group A strep which cross react to a “self” antigen

These immune system compliments and complexes collect with the glomerular capillares and mesangial cells

As a response to this, inflammatroy cells begin to collect in these areas

92
Q

How soon after a strep infection may signs and symptoms of post-strep GN develop?

A

7-10 days

Resolves in a few weeks after onset

93
Q

T/F: Rapidly progressive glomerular nephritis is always autoimmune

A

True

94
Q

What is unique about the appearance of rapidly progressing glomerulonephritis on histology?

A

Crescentric proliferation of epithelial cells in the glomerulus

95
Q

In rapidly progressing glomerulonephritis, the eGFR will drop by __% within the first 3 months

A

50%

96
Q

The presence of anti-glomerular-basement-membrane antibodies (Anti-GBM) would indicate Type __ RPGN.

What is an example of a disease process that causes this?

A

Type 1

Goodpasture’s

97
Q

Immune complex deposition would be a cause of Type __ RPGN?

What is an example of a disease process(es) that causes this?

A

Type 2

Post-strep
SLE

98
Q

Type __ RPGN does not involve anti-GBM or immune complex deposition, but due to antibodies– often anti-neutrophil-cytoplasm antibodies (ANCA).

What is an example of a disease process that causes this?

A

Type 3

Wegner’s Granulomatosis

99
Q

Type 1 RPGN often effects Type ___ collagen in the basement membranes of the kidneys

A

Type 4

100
Q

Patients with acute glomerulonephritis who develop chronic renal failure slowly over the next 5-25 years can be defined as having ____ __________.

A

Chronic Glomerulonephritis

101
Q

________ glomerulonephritis is one of the most common causes of nephrotic syndrome in adults.

It is autoimmune and progresses slowly with HTN, porteinuria, loss of renal function

A

Membranous Glomerulonephririts

102
Q

T/F: In membranous GN, immune complexes serve as an activator which triggers complement to form a membrane attack complex (MAC) on the glomerular epithelial cells

A

True

103
Q

______ ______ glomerulonepritis is relatively benign problem with the podocytes that has no known etiology

A

Minimal Change Glomerulonephritis

104
Q

What are some triggers of autoimmune glomerulonephritis?

A
  1. Infection
  2. Systemic disease
  3. Disease originating in the kidneys
  4. Medications/Drugs
105
Q

T/F: Secondary GN is the most common cause of renal failure

A

True

106
Q

In hypertensive nephropathy, small vessels are damged by the increased pressure creating a accumlation of what in the walls of the arterioles and arteries?

This results in a ____________ (thickening/thinning) of their walls and a _________ (widening/narrowing) of their lumens

A

Hyaline

Thickening
Narrowing

107
Q

What are some intrarenal manifestions of hypertensive nephropathy?

A
  1. Fibrosis / Scarring
  2. Ischemia
  3. Renal Failure
108
Q

Along with a patient’s history, what UA findings may indicate glomerulonephritis?

How much proteinuria would classify it as nephrotic syndrome?

A
  1. Hematuria
  2. Red Cell Casts
  3. Lipiduria
  4. Proteinuria

> 3.5 g in 24 hrs = Neprhotic Syndrome

109
Q

A urinanalysis showing….

Dysmorphic RBCs, Occasional red cell casts, and mild proteinuria (<1.5g/day)

Without the presence of edema or HTN would be indicative of….

A. Nephoritc Syndrome
B. Diffuse Nephritic Syndrome
C. Focal Nephritic Syndrome

A

C. Focal Nephritic Syndrome

Classic pattern is asymptomatic proteinuria or hematuria

110
Q

A urinanalysis showing….

Hematuria
Proteinuria (2.5g/day)
“Full House Casts”

With the presence of edema and HTN would be indicative of….

A. Nephoritc Syndrome
B. Diffuse Nephritic Syndrome
C. Focal Nephritic Syndrome

A

B. Diffuse Nephritic Syndrome

111
Q

A urinanalysis showing….

Proteinuria (>3.5g/day)
Lipiduria
Casts (including hyaline casts)

With the presence of edema and HTN would be indicative of….

A. Nephoritc Syndrome
B. Diffuse Nephritic Syndrome
C. Focal Nephritic Syndrome

A

A. Nephoritc Syndrome

112
Q

What are common causes of intrinsic obstructive uropathy?

Extrinsic?

A

Intrinsic:

Calculi
Strictures (Congenital)
Tumors
Clots

Extrinsic:

Pregnancy
Tumors (Prostate, Rectum)

113
Q

In less than one week of obstructive uropathy, what TWO things may be present?

A

Hydronephrosis

Hydroureter

114
Q

How long most obstructive uropathy be present for the distal tubules to show damage?

The proximal tubule?

Glomeruli?

A

Distal: ~1 week

Proximal: ~2 weeks

Glomeruli: ~4 weeks (after this, cell death would occur)

115
Q

After 3 months of obstructive uropathy, would it be likely that normal renal function may be returned?

A

No, it is unlikely

116
Q

What are the signs and symptoms of obstructive uropathy?

A
  1. Flank Pain
  2. Fever
  3. Diuresis
  4. Nausea/Vomiting
  5. Hematuria
  6. Glomerular Damage Sx (Edema, Weight Gain)
117
Q

What UA and labratory findings may be present in a patient with obstructive uropathy?

A
  1. Dilute Urine
  2. Metabolic Acidosis (can no longer secrete H+)
  3. Hyperkalemia (can’t secrete K+)
  4. Hyponatremia (Can’t reabsorb Na+)
  5. Uremia
118
Q

T/F: Acute Tubular Necrosis (ATN) is the most common cause of AKI

A

True

119
Q

T/F: The renal tubules are quite resistant to hypoxic damage

A

False

They are quite prone to it

120
Q

How is eGFR decreased due to hypoxic injury to the renal tubules?

What additionally happens as a result of this process?

A

Hypoxic injury leads to cell death in the tubules.

Tubular debris/filtrate then occludes the tubule.

This results in an increase in the pressure of Bowman’s capsule lowering eGFR

Due to the above, the kidneys are no longer producing vasodilators, which further results in vasoconstriction and exacerbates the cycle.

121
Q

How would the urine in a patient with ischemic ATN be described?

(Remember this is a result of granular cast debris in the urine)

A

Muddy Silty Urine

122
Q

T/F: Nephrotoxic ATN is always a result of exposure to a toxic agent

A

True

123
Q

What are some toxic agents that could result in Nephrotoxic ATN?

A
  1. Nephrotoxic drugs (Some Abx, Chemo, Contrast Dye)
  2. Bacterial Toxins
  3. Increase in Hgb/Myoglobin (Muscle injury/trauma)
  4. Toxic Substances (Antifreeze, Mercury, Arsenic)
124
Q

How does Nephrotoxic ATN vary from Ischemic ATN histologically?

A

In nephrotoxic ATN the tubules are affected more uniformly rather than the patchy appearance of ischemic ATN

125
Q

Which phase of ATN is indicated by a……

Massive decline in GFR and big bump in BUN and sCr

A

Initiation phase

126
Q

Which phase of ATN is indicated by a……

GFR that remains low, a rising BUN and sCr, and the presence of oliguria, uremia, and fluid retention

A

Maintenance Phase

127
Q

Which phase of ATN is indicated by a……

Increase in urine volume, decrease in BUN and sCr, and often comes with a “recovery diuresis”

A

Recovery Phase

128
Q

In all types of glomerulonephritis the podocyte layer of the glomerulus is disturbed by a loss of _________ (negative/positive) charges leading to increased permeability

A

Negative

129
Q

Compliment activation
Podocyte injury
Proteinuria
Loss of negative charges (Hylanization)

Are damages noticed in nephrotic or nephritic syndrome?

A

Nephrotic Syndrome

130
Q

Proliferation of macrophages and mesangial cells
Crescentric Proliferating Epithelium
Sclerosis
Fibrosis

Are damages noticed in nephrotic or nephritic syndrome?

A

Nephritic Syndrome

131
Q

Hematuria
Oliguria
Azotemia (Itching due to uremia)
HTN

Are all clincally presentations of nephrotic or nephritic syndrome?

A

Nephritic

132
Q

What diseases are commonly associated with nephritic syndrome?

A
  1. Post-streptoccocal GN
  2. Goodpasture’s Syndrome
  3. Wegner’s Granulomatosis
  4. SLE
  5. Henoch-Schönlein purpura
133
Q

Massive Proteinuria
Edema
HLD / Lipiduria
Hypercoaguability

Are all clincally presentations of nephrotic or nephritic syndrome?

A

Nephrotic Syndrome

134
Q

T/F: Renal cysts are fairly common, especially with aging

A

True

135
Q

______ renal cystic disease is usually a result of ESRD

Where is the most common location for these cysts in the kidney?

A

Acquired Renal Cystic Disease

These are most commonly found in the Cortex of the kidney

136
Q

Autosomal _______ Polycystic Kidney Disease presents with early onset, often in infancy, and can lead to ESRD, pulmonary insufficiency, or even death in vitro.

A

Autosomal Recessive Polycystic Kidney Disease (ARPKD)

(Death occurs in vitro because the Lungs cannot properly develop without the presence of amniotic fluid in utero; amniotic fluid cannot be maintained without functional fetal kidneys)

137
Q

Where in the kidneys does ARPKD commonly affect?

A

Tubules

138
Q

Disease of what organ is almost always present in patients with ARPKD?

A

Liver

139
Q

ARPKD results from an abnormal gene on chromosome __

A

6

140
Q

Autosomal _______ Polycystic Kidney Disease is more common and shows evidence of progressive renal failure

A

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

141
Q

ADPKD results from an abnormal gene on chromosome ___

A

16

142
Q

Is it common for patients with ADPKD to have diverticular disease?

A

Yes

143
Q

What other organs may become cystic in a patient with ADPKD?

A

Liver
Spleen
Pancreas
Thyroid

144
Q

Are vascular abnormalities common in patients with ADPKD?

A

Yes

1/3rd with have Berry Anuersyms, aortic aneursyms, or MVP

145
Q

Where are cysts commonly found in the kidney in a patient with ADPKD?

A

Evenly distributed throughout the medulla and the cortex

146
Q

What renal tumor is commonly in infants and children?

A

Nephroblastoma (Wilms tumor)

Pathophysiology II (1 decks)

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