Renal Disorders 1 Flashcards
Function of kidneys
regulate volume/conc of ECF, pH, and osmolarity
excrete metabolic end products
activate Vit D
secrete renin and erythropoietin
Vit D
needed for absorption of Ca
erythropoietin
stimulates bone marrow for RBC production
Atrial Natriuretic factor
secreted from cells in r. atria
dec BV and BP
aldosterone
promotes Na and H20 reabsorption/ k excretion
renin
released from kidneys
regulates BP and maintenance of ECF volume
if BP drops, renin is excreted
antidiuretic hormone
conserves h20 and dec urine vol
nephron
functional unit of the kidney
each kidney contains 1.2. million nephrons
reabsorption
moving substances from tubules into blood
retained, not in urine
secretion
moving substances from blood into tubule- filtrate (excreted in urine)
glomerulus/filtration
filtered thru semi-perm membrane
GFR
glomerular filtration rate
amount of blood filtered by glomeruli in a given time
normal GFR
125 cc/min
changes in GFR due to changes in
- permeability of glom
- hydrostatic press
- oncotic press
Proximal tubule
reabsorption of 80% of elytes and H20.
reabsorption of glucose, amino acid, bicarb
secretion of H+ and creatinine
Loop of Henle
reabsorption of Na and Cl
important in conserving water
Distal tubule
final regulation of H20 balance and acid-base balance.
reabsorption of H20 occurs with ADH
reabsorption of Na, H20 due to aldo.
regulation of Ca and phosphate
collecting ducts
final concentration of urine
water reabsorbed by ADH
Serum BUN
blood, urea, nitrogen
measures amt of urea nitrogen
urea- waste product of protein metab.
Serum Creatinine
Cr- waste product of muscle metab.
inc Cr
causes damage to large number of nephrons
creatinine clearance test
collect urine over 24 hrs. measure amt. of Cr. in urine.
more accurate
why is serum BUN not the best indicator for renal “f”
if someone is eating really high protein levels, serum BUN can show elevated levels, if dehydrated, on steroids
why is serum Cr a better indicator
bc not affected by diet, hydration status
UTI can occur
anywhere along urinary tract
most common site for UTI
bladder
diagnosing UTI
urine sample, look for presence of bact.
UTI defense mechs
normal voiding with complete bladder emptying
normal antibac abilities of bladder mucosa and urine
competence of ureterovesicular junction
peristaltic activity that propels urine toward bladder
predisposing factors of UTI
renal scarring from previous UTI urinary retention diminished ureteral peristalsis diabetes presence of urinary stones compression of ureters age
Cystitis
imflam. of bladder, due to inf.
most common organism- E. coli
cystitis more common in
women bc shorter urethra, closer to anus
patho of cystitis
bact introduced to urethra and spreads to bladder
CM for cystitis
frequency and urgency suprapubic pain painful urination foul-smelling urine pyuria- puss in urine
diagnostic tests for cystitis
urine dipstick
urine culture
treatment for cystitis
abx
meds to dec pain with urination
fluids to flush it down
urethral syndrome
symptoms of cystitis with negative urine cultures
patho of urethral syndrome
unknown cause
associated with dysfuncion of external sphincter, vaginitis, urethritis, and inflam. of glands near vagina and urethra
CM for urethral syndrome
similar to UTI or cystitis
most common age for urethral syndrome
20-30 y.o
“honeymooners” bc sexual activity
treatment for urethral syndrome
abx
meds to relax external sphincter
interstitial cystitis
non-bacterial cystitis
chronic painful inflam. disease
patho of interstitial cystitis
inflam. leads to scarring and stiffening of bladder, dec capacity and ulcers of bladder lining
CM for interstitial cystitis
bladder fullnes
frequency and urgency
dec UO
pain
diagnostic tests for interstitial cystitis
ultrasound- measure bladder size
cystoscope- visually see inside of bladder lining, look for ulcers
treatment for interstitial cystitis
anti-inflam. meds
antispasmodics
antidepressants
bladder distention- surgery to stretch bladder, temporary defense
acute pyelonephritis
inflam process of renal pelvis and parenchyma of kidney
reversible
etiology of acute pyelonephritis
usually by infections, one kidney or both
patho of acute pyelonephritis
infection usually ascends from lower urinary tract
inf. causes infiltration of WBC with renal inflam, renal edema, and purulent urine. abscesses may form in medulla of kidney and extend into cortex.
scar tissue forms, tubules atrophy
predisposing factors for acute pyelonephritis
similar to bladder
- obstruction
- instrumentation
- pregnancy
- neurogenic bladder
CM for acute pyelonephritis
similar to someone with bladder inf
- fever
- chills
- frequency
- painful urination
- tenderness at kidneys
diagnostic tests for acute pyelonephritis
CBC
urinalysis
urine culture
intravenous pyelogram (IVP)
treatment for acute pyelonephritis
usually requires hosp.
- abx
- fluids
- follow-up cultures
chronic pyelonephritis
persistent/recurrent inf of kidney with inflam. and scarring
causes of chronic pyelonephritis
relapse of acute pyelo.
unknown
usually asociated with obstruction
patho of chronic pyelonephritis
obstruction/inf. causes progressive inflam. and destruction of tubules.
leads to scarring and destruction of nephrons
dec in kidney “f”. –> leads to renal failure
CM for chronic pyelonephritis
HTN
frequency
dysuria
flank pain
diagnostic tests for chronic pyelonephritis
similar to Acute pyelo
- urinalysis
- urine culture
- IVP, ultrasound
what will a kidney look like with chronic pyelo
small bc scarring/ inflam
what will a kidney look like with acute pyelo
enlarged bc edema
treatment for chronic pyelonephritis
treat cause
glomerulonephritis
inflam of glomerulus caused by immunological abnormalities, ischemia, infection vasc. disorders and systemic diseases
patho of glomerulonephritis
antigen-antibody induced injury
a. antibodies have specificity for antigens with GBM. immunoglobulins deposited along basement membrane
b. antibodies react with circulating nonglomerular antigens and are deposited as immune complexes along GBM.
result of glomerulonephritis
tissue injury. membrane damage occurs--> affect perm. so blood/protein enters instead of getting filtered out renal bld flow and GFR dec. coag. enhanced clots
CM for glomerulonephritis
hematuria proteinuria oliguria fluid retention HTN pain
diagnostic tests for glomerulonephritis
urine dipstick serum titers serum anti-glomerular basement membrance ab's renal biopsy serum BUN, Cr
acute glomerulonephritis
reversible
associated with strep
antibodies to strep antigen
antigen-antibody complexes deposited in glomeruli
treatment of acute glomerulonephritis
abx- hospitalized
dec fluid intake
meds to dec BP
RPGN
rapidly progressive glomerulonephritis
rapid progressive loss of renal “f”
in weeks/months
RPGN most common in
50-60 y.o
etiology of RPGN
complication of inf.inflam disease
meds
idiopathic
treatment for RPGN
meds to dec inflam.
plasmapheresis
dialysis
transplantation
goodpastures syndrome
type of RPGN
characterized by circulating antibodies against GBM and alveolar basement membrane.
antibodies bind to basement membranes and cause inflam rxn that damages membrane
treatment for goodpastures syndrome
same as RPGN
dec amt of antigen-antibody complexes
chronic glomerulonephritis
reflect end stage of glomerular inflam disease
progresses to renal failure
develops slowly, insidious
we adapt so when diagnosed, its too late
treatment for chronic glomerulonephritis
same as renal failure dialysis fluid restrictions elyte management transplant
nephrotic syndrome
disease states that cause glomerular injury.
excretion of 3.5g or more of protein lost in urine/day
patho for nephrotic syndrome
injured glomerular membrane leads to loss of plasma proteins (albumin and immunoglobulins)
low albumin stimulates lipoprotein syntheis (hyperlipidemia) loss of immunoglobulins inc risk of infection
CM for nephrotic syndrome
proteinuria
hypoalbuminemia
hyperlipidemia
edema
diagnostic tests for nephrotic syndrome
24hr. urine collection
serum protein
serum albumin
cholesterol
treatment for nephrotic syndrome
treat cause low salt/ low fat diet albumin protein supplements dec edema
