Renal Disease Flashcards by Sydney Perry

Functional unit of the kidney - the “filter”

Nephrons

How well did you know this?

Not at all

Perfectly

____________ nephrons per kidney

Nephron Consists of the ________ and series of
_______

1.25 million

glomerulus
tubules

How well did you know this?

Not at all

Perfectly

Glomerulus is a Spherical mass of _________
Function=>produces ________

capillaries
ultrafiltrate

How well did you know this?

Not at all

Perfectly

Ultrafiltrate- fluid produced after filtering the
blood through the _______ into _______

Contains water, Na, K+, ____, ______, & ______
_______-free

glomerulus
Bowman’s capsule

urea
creatinine
glucose

Protein

How well did you know this?

Not at all

Perfectly

Renal Tubules
- Selectively reabsorb substances from the_____ and secrete substances into the _____

ultrafiltrate
urine

How well did you know this?

Not at all

Perfectly

Proximal tubule

Reabsorption of _______________

Secretion of ____

Na
K+
amino acids
glucose
bicarbonate
phosphorus
Ca
ure
water

H+

How well did you know this?

Not at all

Perfectly

Loop of Henle

__________ of ultrafiltrate
Reabsorption of _________

Concentration
water & sodium

How well did you know this?

Not at all

Perfectly

Distal tubule

Reabsorption of ____________

Secretion of ___________

Na
water
bicarbonate

K+
urea
H+
ammonia
some drugs

How well did you know this?

Not at all

Perfectly

Collecting duct

Reabsorption of _____

Reabsorption or secretion of _____________

water

Na, K+, H+
ammonia

How well did you know this?

Not at all

Perfectly

Fluid leaving the ________=>urine

Urine enters the ________=> narrows to _______ per kidney, which carries urine into the bladder

Urine accumulates and is then eliminated via the ______

collecting duct

renal pelvis
1 ureter

urethra

How well did you know this?

Not at all

Perfectly

Antidiuretic hormone (ADH )

Secreted by the ________ in response to a ________ in total body ____ indicated by an _________

Makes ________________ ______ permeable to H2O

_______ water reabsorption=> ______ urine volume

pituitary
decrease
H2O
increased serum osmolality

distal tubule & collecting duct
more

Increase
decreases

How well did you know this?

Not at all

Perfectly

Aldosterone

Secreted from the ________ in response to a ___________

________ reabsorption of ____ in the distal tubule & collecting duct

_______ water reabsorption=> _________ urine volume

adrenal cortex
decrease in blood pressure/blood volume

Increases
Na

Increases
decreases

How well did you know this?

Not at all

Perfectly

Function of the Kidney

_______
_________
_________

Excretory
Maintain homeostasis
Endocrine

How well did you know this?

Not at all

Perfectly

Excretory function of kidney includes
Waste products such as ______________

urea
creatinine
organic acids

How well did you know this?

Not at all

Perfectly

Maintenance of homeostasis includes balancing ________, ________, and _______.

Sodium & water balance
Electrolyte balance
Acid-base balance

How well did you know this?

Not at all

Perfectly

Endocrine function of kidney includes
_______________

Renin
Erythropoietin
Vitamin D/calcitriol

How well did you know this?

Not at all

Perfectly

Renin is an enzyme produced in the__________ of the kidney in response to __________ or _________

Renin Reacts with _________ in the blood to form ________, which is a _________ and stimulates the release of ________

juxtaglomerular
apparatus
decreased blood pressure
decreased serum sodium

angiotensin I
angiotensin II
vasoconstrictor
aldosterone

How well did you know this?

Not at all

Perfectly

Hormones Produced by the Kidney

Erythropoietin

Vitamin D3/calcitriol

How well did you know this?

Not at all

Perfectly

Erythropoietin acts on _________ to stimulate the production of _____

stem cells of the bone marrow
RBC

How well did you know this?

Not at all

Perfectly

Vitamin D3/calcitriol is the final site of _________

Increases ____ absorption in the gut

vitamin D activation
Ca

How well did you know this?

Not at all

Perfectly

A type of urinary tract infection (UTI) that
affects one or both kidneys

pyelonephritis

How well did you know this?

Not at all

Perfectly

symptoms of pyelonephritis

painful urination and hematuria

How well did you know this?

Not at all

Perfectly

____________ in ______________ seem to inhibit the adherence of _______ to the epithelial cells of the urinary tract

Tannins & flavanols
cranberries & blueberries
E-coli bacteria

How well did you know this?

Not at all

Perfectly

Concentration of components of urine reaches
levels where crystallization occurs

nephrolithiasis

How well did you know this?

Not at all

Perfectly

can get kidney stones from _____ also

gout

stones could be composed of ?

Ca salts Uric acid Struvite (composed of magnesium ammonium phosphate and carbonate apatite) Cystine

if uric acid, diet should be

low in animal protein

Risk Factors for the Development of Kidney Stones volume of urine? ______ Family history gender? _____ ___________ __________ ________=>increased excretion of Ca, oxalate, & uric acid

low Male Hypercalciuria Hyperoxaluria Obesity

Kidney Stones Most migrate down the urinary tract and pass out of the body without medical intervention Can become lodged in the ______, obstruct urine flow and cause acute pain

urinary tract

MNT for Nephrolithiasis

Prevention: >2.5 L fluid/day to produce increased amounts of dilute urine Individualize dietary treatment based on composition of kidney stones Weight management

Most common type of stone is ______ 60% of stones are _________ 10% ___________ 10% ______________________

calcium calcium oxalate calcium phosphate calcium oxalate & calciumphosphate

Hypercalciuria may be due to: _______ hypercalciuria primary or general ___________ excess _________ intake ____________ use renal ______________ The relationship between calcium intake and the risk of calcium stone formation is complex

Idiopathic hyperparathyroidism vitamin D glucocorticoid tubular acidosis

MNT for calcium stones Adequate Ca intake Consume the DRI from food: ______ if age <50 years and ______ if age >50 years Divide intake between __________ Avoid ______________ unless needed - associated with increased risk of stone formation If supplements are needed, take ______ Reduce _____ intake

1000 mg 1200 mg >3 eating sessions calcium supplements with meals sodium

Calcium Oxalate Stones Hyperoxaluria is caused by... High dietary _____ intake _______________=> unabsorbed fat binds to calcium=> less calcium available to bind oxalates=>________ absorption of oxalates ______ disorders _________ supplements

oxalate Fat malabsorption increased Genetic Vitamin C

MNT for Calcium Oxalate Stones Avoid high-oxalate foods such as? ____________________________________________ high doses of the _____________ Consume with ____________ food to reduce oxalate absorption

rhubarb spinach strawberries chocolate wheat bran and whole-grain wheat products nuts (almonds, peanuts, or pecans) beets tea (green or black) spice turmeric calcium-rich

Kidney disorder characterized by the loss of the glomerular barrier to protein

Nephrotic Syndrome

clinical manifestations of nephrotic syndrome

Hypoalbuminemia (from low albuminemia) Edema High blood pressure (from not peeing out enough) Hypercholesterolemia

nephrotic syndrome can be caused by amyloidosis, & glomerulonephritis Can be acute or chronic and progress to CKD

DM, systemic lupus erythematosus

MNT for Nephrotic Syndrome Dietary protein level remains controversial __________ pro/kg IBW This level is believed to decrease renal damage without reducing _________ High calorie to spare protein: ____ kcal/kg IBW ________ Na restriction Low SFA diet

0.8-1.0 g level 20 2 grams

Acute Kidney Injury (AKI) AKA acute renal failure (ARF) Characterized by a sudden __________ Accumulation of __________ in the blood Duration:________________

decrease in the glomerular filtration rate (GFR) nitrogenous wastes few days to several weeks

CAUSES of acute kidney injury

prerenal intrinsic postrenal

prerenal phase __________ kidneys Occurs with _____________________

Hypoperfused kidneys Occurs with dehydration, hypovolemia, hypotension

Intrinsic Diseases within the _____________ __________________ is the most common cause may develop from use of ___________, _______, or _______

renal parenchyma Acute tubular necrosis (ATN) nephrotoxic drugs or dyes trauma septicemia

Postrenal ___________ from various conditions including ____________ ____________ ____________ _____________

Obstruction in urine flow Bladder & prostate cancer Nephrolithiasis Urethral occlusion BPH (benign prostatic hypertrophy)

Progression of AKI Phases include ?

Oliguric phase Diuretic phase Recovery phase

Oliguric phase of AKI Significant __________ in ___________ Urine output <_____ mL/d Increased serum ___________

reduction glomerular filtration rate (GFR) 500 BUN, Cr, K+, Phos, Mg

Diuretic phase of AKI Increased _______ ______% normal Increased risk of ________

urine output 150-200 dehydration

Recovery phase of AKI Renal function ________ Generally, occurs ______ after the injury is corrected

normalizes 2-3 weeks

Clinical Manifestations of AKI _______________=> leads to ______ ___________ __________

Azotemia: buildup of nitrogenous waste products in the blood uremia Metabolic acidosis Hyperkalemia

Uremia is a clinical syndrome caused by _____________

high levels of nitrogenous waste products (e.g., urea, uric acid, & ammonia) in the blood

Uremia Syndrome includes:

Malaise Weakness N/V Muscle cramps Pruritus Dysgeusia Neurological impairment

Goals for AKI Medical Treatment Goals: Control _______________ Improve __________________

accumulation of uremic toxins fluid & electrolyte imbalances

AKI Treatment: Correct _________ May require ___________ or ___________

underlying causes intermittent hemodialysis (IHD) Continuous Renal Replacement Therapy (CRRT)

Medical Treatment for AKI Continuous Renal Replacement Therapy (CRRT) Used for _________ common form of CRRT _________________

critically ill patients CVVHD - continuous venovenous hemodialysis

CVVHD - continuous venovenous hemodialysis Removes ____________ ________ is an issue Can have ______% absorption of _______ from ______

water, electrolytes, & waste products Protein loss 35-45% dextrose from dialysate

Nutritional Issues in AKI _________ state=> Loss of ______ ________ serum K+, Phos, & Mg due to: __________ renal clearance _________ muscle catabolism Nutritional requirements are affected by: _____________ ______________

Hypercatabolic, LBM Increased Decreased Increased Degree of hypercatabolism Type of renal replacement therapy (if any)

MNT for AKI Energy: ____________ Protein:_______ g/kg IBW for noncatabolic patients, not on dialysis __________ g/kg IBW if increased protein is needed based on cause of AKI, but patient is not on dialysis _________ g/kg IBW or UBW for intermittent hemodialysis (IHD) _______ g/kg IBW or UBW for CRRT or are hypercatabolic

25-40 kcal/kg IBW 0.8-1.0 1.0-1.2 1.0-1.5 1.5-2.5

Fluid Needs If anuric and not on CRRT=> ___________ L/d Diuretic phase=>_____________ Restriction usually not necessary on CRRT

restrict to 1-1.2 replace output + 500 ml

MNT in AKI - Electrolytes Need to monitor serum values closely Sodium: Restrict to _______ g/d in _____ phase Replace losses in _______ phase Potassium: Restrict to ________mEq/d in _________ Replace losses in _______ phase __________: Limit as necessary

1.1-3.3 oliguric diuretic 30-50 oliguric phase diuretic Phosphorus