Renal Disease

Question 1

What occurs in glomerular disease/ nephrotic syndrome?

Answer 1

albuminuria leads to hypoalbuminemia

• reduced oncotic pressure in the blood
• water moves from intravascular to ECF causing edema

Question 2

What are two distinct groups that can have edema? How can you differentiate between these groups?

Answer 2

1. hypoalbunemia
   - high Renin
2. primary renal salt and water retention
   - low Renin

Question 3

Why do people have the urge to pee in water?

Answer 3

compression of limbs leads to stretching of atria

-release of ANP –> diuresis

Question 4

Do all patients with nephrotic syndrome have hypovolemia?

Answer 4

no actually, most patients have normal or inc plasma volume

Question 5

What part of the progression of nephrotic syndrome, does colloid pressure not explain edema?

Answer 5

early on in the disease

-colloid gradient needs to be really steep for edema to occur

Question 6

Is there edema in patients with congenital analbuminemia?

Answer 6

no0o0o - more power to why low albumin in the blood may not be the actual cause of edema

Question 7

In the old studies where they made one kidney nephrotic, what occured?

Answer 7

sodium was retained

-no hypoalbuminemia !!!!

Question 8

In a patient whose edema is caused by primary salt retention, describe the process that leads to edema?

Answer 8

1. salt retention
2. volume expansion
3. increased capillary hydrostatic pressure
4. water moves from intravascular –> interstitial space
   = edema

Question 9

Which patient is safe to diurese:

1. hypoalbuminemia pt with edema
2. primary salt/water retention w/ edema

Answer 9

2. primary salt/ water retention with edema

Question 10

Why did the patient die from diuretics?

Answer 10

he was hypovolemic - hemoconcentration –> blood clots

Question 11

Does hyper or hypolipidemia occur with proteinuria?

Answer 11

hyperlipidemia

-compensatory hepatic synthesis & reduced lipoprotein lipase

Question 12

When a patient comes in with anarsca (severe edema) should your reflex action be to give or not to give diuretics?

Answer 12

NOT give

Question 13

What three molecules determine plasma osmolarity? what factor is the most important>

Answer 13

1. urea
2. glucose
3. sodium -* most important

Question 14

What are some non-oncotic factors that influence ADH release?

Answer 14

• volume or blood pressure
• nausea, pain, physical stress
• hypoglycemia
• narcotics, SSRIs
• angio II, ANP
• ethanol
• prostaglandins

-aka people in recovery rooms

Question 15

What is the criteria for SIADH?

Answer 15

1. Posm < 274 with inappropriately concentrated urine
2. euvolemia
3. urine Na>40 (hyponatremia)
4. no diuretic use, renal/adrenal/thyroid disease

Question 16

What disease often results in SIADH?

Answer 16

congestive heart failure

• hypervolemic state with dec effective circulating volume
• kidneys perceive as low volume so urine sodium is low

Question 17

What are some causes of SIADH?

Answer 17

1. old people have a new setpoint
   - ADH released at lower sodium level
2. malignancy - Na+ levels are all over
3. defect in V2 receptor - gain of function
   - low ADH because of feedback
4. constitutively high levels of ADH - tumor

Question 18

What do ACE inhibitors block?

Answer 18

conversion of angio I to angio II

Question 19

What do NSAIDs inhibit?

Answer 19

COX1 which produce vasodilators

Question 20

If you give someone an ACE inhibitor, what three conditions should you worry about? why?

Answer 20

• bilateral renal artery stenosis
• renal artery stenosis with transplant
• CHF patients on diuretics
• inc risk of fall in GFR
• no longer able to constrict efferent arteriole

Question 21

If you give someone NSAIDs, what four conditions should you worry about and why?

Answer 21

1. cirrhosis
2. CHF
3. diuretics
4. advanced age

-afferent arteriole can not be vasodilated