Renal Flashcards
Juxtamedullary nephrons vs Cortical Neohrons
Juxtamedullary nephron reach into the medulla with a long loop of Henly. They have think loops of Henly into the inner stripe allowing these nephrons to be predisposed to damage from low blood flow. 10% of our total nephrons Cortical nephrons do not extend into the inner zone. Less likely to be damaged. 90% of our total nephrons
What is the equation for calculating GFR
(Urine Cr (mg/ml) * Volume Urine (ml/min)) / Plasma Cr (mg/ml) GFR= (((140-age) * lean weight (kg)) / (Plasma Cr * 72)) * 0.85
- Loop diuretics block what channel? 2. Thiazide diuretics block what channel?
- Na+-K+-2Cl- pump 2. Block Na+ reabsorption
Geriatric Considerations with the Kidneys
- Loss of Nephrons 2. Diminished Renal Blood Flow 3. Decreased GFR 4. Decreased ability to conserve salt and water
What can cause an increase in BUN with no renal damage?
Dietary protein intake
- Azotemia 2. Uremia
- elevation in BUN and Cr levels related to decrease GFR 2. Elevation of urea in the blood
- Nephrolithiasis 2. Glumerulonephritis
- Renal Stones 2. inflammation of the glumeruli
Where is Kidney pain usually found?
Felt at the Costovertebral angle posteriorly and can follow the T10-L2 dermatomes around to anterior. *Back and Flank Pain
Polycystic Kidney Disease — Genetics and What is going on in the kidney
-Development of cysts inside the kidney that can lead to obstruction of urine flow and renal failure - Can be autosomal dominant or recessive -
Polycystic Kidney Disease -Clinical Manifestations -Treatment
Clinical Manifestations –Pain –HTN –Concomitant cystic liver involvement Treatment –Supportive – Dialysis
Renal Cell Carcinoma -Manifestations -Predisposig Factors -Treatment
Manifestations –Tumor of the kidney (can be primary or secondary) —-Primary large, secondary seedlike –Can lead to Kidney Failure Predisposing Factors –Familial pattern –Smoking, Obesity, HTN Treatment –Nephrectomy
Normal Protective mechanisms of the kidney against infections (6)
- Acidic pH 2. Presence of Urea in Urine 3. Men: Bacteriostatic prostate secretions 4. Women: Glands in distal uretha secrete mucous 5. Micturition: Washed out pathogens 6. Unidirectional Urine Flow
Pyelonephritis 2 causes
–Ascending infection from lower Urinary Tract (common) –Bacteremia
Chronic Pyelonephritis –Manifestations –Treatment
Usually caused by reflux or obstructive process leading to urine stasis Manifestations –abd/flank pain, fever, malaise Treatment –Correct underlying process –Antimicrobial therapy
Complete Urine Obstruction can result in?
- Hydronephrosis 2. Decreased GFR 3. Ischemic Kidney Damage (b/c of increased intralumenal pressures) 4. Acute Tubular Necrosis 5. Chronic Kidney Disease
Nephrolithiasis (Renal Stones) –What are they made from? Why do they form? Manifestations?
- Crystal Aggregates of organic and inorganic materials Calcium Crystals (most common)
- Can be made of uric acid, phosphate, or Oxalate (struvite, cystine)
- Manifestations
- Intense renal colic pain with abrupt onset
- N/V
- Hematuria
Nephrolithiasis –Treatment and prevention
Treatment – >2L fluids/day to pass stone –Lithotripsy can be used –Urethral Stenting –Pain medications Prevention –Stones tend to reoccur —Prevent with high fluid intake —–Also Dietary calcium prevents stone formation by binding oxalate and preventing absorption
Nephrotic Syndrome –What is it characterized by? Disease processes causing? Symptoms
-Glomerular permeability to proteins -Urinary loss of >3.5 g protein/day Disease Processes Causing -SLE, DM, Minimal Change Disease Symptom -Edema -Hyperlipidemia (liver making many proteins) -Hypercoagulability (liver making proteins)
Nephrotic Syndrome Treatment
-Diurectics -Lipid Lowering Agents -Antihypertensives -Immunosuppression
Minimal Change Disease –What? Who? Symptoms? Treatment?
What? Deceased production of anions by the podocytes. Initiated by an allergic or immune condition Who? Children Symptoms? Sudden onset edema, nephrotic levels of protein loss, hypoalbuminemia Treatment? Corticosteroids
Acute Glomerulonephritis –What? Manifestations? Treatment?
–Inflammation in the kidney from possible infection, resulting in degradation of the basement membrane. –GFR may fall due to contraction of the mesangial cells. Manifestations –Proteinuria, Oliguria, Azotemia, HTN, Edema Treatment –Steroids –ABX –Plasmapheresis –Supportive measures including HTN support
Berger Disease
What?
Manifestations?
Prognosis?
- IgA Nephropathy
- Most common diagnosed
- Common in adults
- Follows upper resp or GI infection
- Complex deposition and degradation causes injury to mesangial cells
- Manifestations –No Proteinuria, Edema, or HTN
- hematuria presents in 1-2 days in the form of casts
- Prognosis –Variable, can progress to ESRD
Chronic Glomerulonephritis What? Who? Treatment?
Progressive degradation of the kidney with collagen formation, ultimately leading to ESRD. Defined with slowly declining renal function Who? Multiple Sclerosis, ALS Treatment? Supportive with ultimately a Kidney transplant needed
Normal BUN:Cr ratio
10:1 or 20:1
