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Pathophysiology > Renal Disorders (Exam 2) > Flashcards

Renal Disorders (Exam 2) Flashcards

1
Q

Functions of Renal System (5)

A

Regulation of water and inorganic-ion balance
Removal of waste from blood
Removal of foreign chemicals
Gluconeogenesis
Hormonal Secretion

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2
Q

Ureters

A

Carry urine from kidney to bladder

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3
Q

Bladder

A

Stores urine

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4
Q

Urethra

A

Carries urine from bladder to outside body
Valves keep flow one-way

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5
Q

Bladder is lined with…

A

transitional epithelium

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6
Q

Internal urethtral sphincter

A

Smooth muscle we CAN’T control

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7
Q

External urethtral sphincter

A

Skeletal muscle we CAN control

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8
Q

What is the functional unit of the kidneys?

A

Nephron

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9
Q

Where does nephron extend?

A

Between renal cortex and renal medulla

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10
Q

20% of volume that enters glomerulus is filtered out into…

A

the Bowman’s capsule

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11
Q

What is filtrated into nephron?

A

Salts
Amino acids
Glucose

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12
Q

What stays in the blood?

A

Blood cells
Proteins

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13
Q

Mechanisms of Renal System

A

Glomerular filtration (passive)
Tubular secretion (active)
Tubular reabsorption (both)

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14
Q

What does filtration and secretion serve for renal system?

A

Extracting drug from blood into urine

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15
Q

What does reabsorption involve for the renal system?

A

Movement of drug back into blood from primitive urine

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16
Q

Nephron Reabsorption Mechanism

A

Ions transported out to make medulla salty
Water flows from filtrate to medulla
As collecting duct passes through salty medulla, more water reabsorbed from filtrate –> Concentrated Urine

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17
Q

What is reabsorbed in the nephron?

A

Na+, Cl-, water, HCO3-, Ca2+, Mg2+, amino acids, glucose

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18
Q

What is excreted from nephron?

A

H+, urea, NH3, K+

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19
Q

What happens when there is too much salt?

A

Too much water is reabsorbed which leads to high BP

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20
Q

Glomerular Filtration Rate (GFR)

A

Volume of filtrate formed per unit time

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21
Q

GFR normal range

A

110-130 ml/min

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22
Q

How is GFR measured?

A

Marker substance that is 100% eliminated unchanged in urine, not plasma bound, excreted only by filtration

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23
Q

What do the kidneys produce?

A

Hormones

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24
Q

Hormones of the RAAS system

A

Regulate blood pressure

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25
Q

Erythropoietin (EPO)

A

Stimulates RBC production

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26
Q

1.25 dihydroxy vitamin D3

A

controls calcium metabolism

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27
Q

Aldosterone for kidneys

A

Helps retain Na+ and water
Increased volume of water
Increased BP

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28
Q

Acute Kidney Injury (AKI)

A

Kidneys stop working suddenly
Reversible

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29
Q

Symptoms of AKI

A

Not enough urine
Swelling, tired, confused, nausea
Out of breath, pain in chest

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30
Q

Renal Autoregulation

A

How kidneys maintain constant renal blood flow and GFR

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31
Q

Prostaglandin 2 (PGE2)

A

Direct vasodilator by acting on smooth muscle to cause blood vessel dilation

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32
Q

Angiotensin II (AII)

A

Acts on CNS to increase vasoconstriction by vasopressin production

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33
Q

Intrinsic AKI

A

Injury or problem directly to kidneys

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34
Q

Post-Renal AKI

A

Blockage in ureters, bladder, or urethra

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35
Q

What can AKI lead to?

A

Kidney failure
Acute renal failure

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36
Q

AKI Treatment

A

Hemodialysis

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37
Q

Hemodialysis

A

Machine that filters wastes, salts, and fluid from blood when kidneys are unable to do so

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38
Q

Chronic Kidney Disease (CKD)

A

Lasting damage to kidneys that can get worse over time
Eventually leads to kidney failure

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39
Q

Chronic renal failure

A

End result of irreparable damage to kidneys, develops slowly

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40
Q

Risk factors of CKD

A

Diabetes, hypertension
Family history
African-American, Hispanic, Native American, Asian

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41
Q

CKD Stages

A
  1. Kidney damage but normal function
  2. Mild loss of function
  3. Moderate to severe loss of function
  4. Severe loss of function
  5. Kidney failure
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42
Q

CKD Stage 1

A

Damage with normal or increased GFR

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43
Q

CKD Stage 2

A

Mild reduction of GFR to 60-89 ml/min/1.73 m2

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44
Q

CKD Stage 3

A

Moderate reduction of GFR to 30-59 mL/min/1.73 m2

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45
Q

CKD Stage 4

A

Severe reduction in GFR to 15-29 mL/min/1.73 m2

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46
Q

CKD Stage 5

A

Kidney failure GFR <15mL/min/1.73 m2
Need for renal replacement therapy

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47
Q

Complications of CKD

A

Anemia, bone + heart disease, high K+, Ca2+, P, fluid buildup

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48
Q

CKD Treatments

A

Focus on complications since it is irreversible

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49
Q

Tests for CKD

A

eGFR
Urine test
Blood pressure

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50
Q

Nephritic Syndrome

A

Extensive damage of glomerular capillaries due to inflammation
Ofter occurs in glomerulus

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51
Q

Glomerulonephritis

A

Inflammation of glomeruli and small blood vessels

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52
Q

What happens when glomeruli are damaged?

A

Blood and protein get into urine (intrinsic AKI)

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53
Q

Risk factors of Glomerulonephritis

A

Autoimmune disease
Infections
Diabetes

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54
Q

Primary Glomerulonephritis

A

Starts in glomeruli

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55
Q

Secondary Glomerulonephritis

A

Glomeruli affected by systemic disease

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56
Q

Acute Glomerulonephritis

A

Develops over short period of time

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57
Q

Chronic Glomerulonephritis

A

Develops and progresses slowly

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58
Q

In 1% of children and 10% of adults who have acute glomerulonephritis…

A

Evolves into rapidly progressive, destroying glomeruli and resulting in kidney failure

59
Q

Glomerulonephritis Tests

A

Urine Test
Blood Test
Blood Pressure
Kidney ultrasound and biopsy

60
Q

Glomerulonephritis Treatment

A

Antihypertensives
Diuretics
Corticosteroids
Immunomodulators
Antibiotics

61
Q

Glomerulonephritis Prognosis

A

Children usually acute
Adults usually chronic

62
Q

treatment of UTIs is based off of

A

the pathogen causing the infection

63
Q

types of antibiotics used to treat UTIs

A

penicillins
amoxicillins
azithromycin
clarithromycin
clindamycin

64
Q

how to diagnose a UTI?

A

symptoms
examination of urine
blood analysis
x-rays, films, CT scans, etc
urine dipstick

65
Q

chronic pyelonephritis

A

destruction of renal tissue and fibrosis
irregular shrunken small kidney
tubular atrophy with casts
chronic inflammatory infiltrates

66
Q

acute pyelonephritis

A

sudden and severe inflammation of the kidney due to a bacterial infection

67
Q

features of acute pyelonephritis

A

small abscesses
inflammation
leukocyte casts in urine

68
Q

common UTI symptom that mainly women feel

A

burning when urinating

69
Q

predisposing conditions of UTIs

A

stones
reflux
infections of lower UTI
neoplasms
external compression

70
Q

for UTIs, bacteria enter

A

through the urethra
travel down to up

71
Q

is there only one bacteria that causes UTIs?

A

NO!
many different bacteria cause UTIs

72
Q

types of UTIs

A

asymptomatic bacteriuria
symptomatic infections
lower UTI
upper UTI

73
Q

lower UTI consists of

A

cystitis
urethritis

74
Q

upper UTI consists of

A

pyelonephritis

75
Q

kidney stones are more predominant in

A

men (haha sucks to be a man)

76
Q

stones treatment

A

hydration
ibuprofen
antibiotics
shock waves/surgery for larger stones

77
Q

for larger stones that cannot be passed on there own, what is done?

A

ureteroscopic removal
percutaneous removal
extracorporeal lithotripsy
shock waves

78
Q

main symptom of kidney stones

A

excruciating, cramping pain in the abdomen, flank or groin

79
Q

symptoms of stones

A

hematuria
pain
difficulty urinating
fever and chills

80
Q

risk factors of stones

A

gout due to increased uric acid
hypercalciuria due to calcium phosphate/oxalate stones
medications
family history
reduced fluid intake
infection

81
Q

calcium oxalate/phosphate stones

A

80% prevalence
diet high in oxalate

82
Q

struvite stones

A

10% prevalence
linked to UTIs

83
Q

uric acid stones

A

6%
urine is too acidic, high protein diet

84
Q

cystine stones

A

1%
genetic disorder, high levels of cystine

85
Q

stones are made up of

A

calcium oxalate/phosphate, uric acid, cysteine or magnetism ammonium phosphate

86
Q

stones (Calculi)

A

hard, crystalline mineral deposits formed within the kidney or urinary tract

87
Q

stones are due to

A

decrease in urine volume
excess of stone forming substances in the urine

88
Q

urolithiasis

A

stones in the lower UT (bladder, urethra)

89
Q

nephrolithiasis

A

stones in the upper UT (kidney)

90
Q

common symptoms of stones

A

pain
signs/symptoms of UTI
manifestations of renal dysfunction

91
Q

damaging effects of urinary obstruction are due to

A

stasis of urine
development of back pressure

92
Q

stasis of urine

A

predisposes to infection and stone formation

93
Q

development of back pressure

A

interferes with renal blood flow and destroys kidney tissue

94
Q

causes of urinary tract obstruction

A

stones
developmental defects
pregnancy
BPH
scar tissue
tumors
neurologic disorders

95
Q

simple cysts treatment

A

ultrasound guided percutaneous drainage
large - surgery

96
Q

polycystic kidney disease treatment

A

dialysis
kidney transplant

97
Q

tests for cystic kidney disease

A

ultrasound
CT scan
MRI
blood and urine tests

98
Q

Medullary cystic kidney disease

A

chronic renal failure in children
progresses to ESKD

99
Q

Polycystic kidney disease

A

cysts slowly grow with age which reduces blood flow and inc scarring
cysts may appear on other organs (liver)

100
Q

simple renal cysts

A

develop with age, common in older people
1 out of 10 people have
usually no symptoms, sometimes pain when big
can become malignant

101
Q

Cystic kidney disease risk factors

A

genetic mutations
CKD
birth defects
age

102
Q

acquired cystic kidney disease

A

cysts develop due to CKD/renal failure
affects adults/children on dialysis

103
Q

multi cystic dysplastic kidney

A

one or both kidneys don’t develop correctly
cysts replace normal tissue

104
Q

medullary sponge kidney

A

cysts form on innermost part of kidney
blocks tubules that filter urine

105
Q

difference in PKD dominant and recessive

A

dominant - variable size cysts, affect adults in large quantities
recessive - tiny fusiform cysts, affect children in smaller quantities

106
Q

polycystic kidney disease

A

can be dominant or recessive
recessive affects kidney development during birth

107
Q

Glomerulocystic kidney disease

A

cysts and enlargement of the space in the kidneys near the urinary tract
infants or adults

108
Q

medullary cystic kidney disease

A

cysts develop in the inner part of the kidneys
inflammation and scarring of tubules
adults

109
Q

nephronophithisis

A

similar to MCKD
affects infants and children

110
Q

types of cystic kidney disease

A

genetic or non genetic

111
Q

cystic kidney disease

A

group of conditions that cause cysts to form in or around the kidneys
can lead to kidney failure

112
Q

cysts can be

A

filled with air or fluid

113
Q

kidney cysts prevent the kidneys from

A

filtering water and waste out of the blood

114
Q

diabetic nephropathy is the major cause of

A

morbidity and mortality in people with diabetes

115
Q

diabetic nephropathy treatment

A

drugs that lower bp
drugs to control diabetes
statins
restrict dietary proteins
etc

116
Q

diabetic nephropathy tests

A

urinalysis
blood analysis
hematocrit
kidney ultrasound
kidney biopsy

117
Q

blood analysis usually looks at

A

creatinine and BUN

118
Q

complications of diabetic neuropathy

A

body fluid buildup
hyperkalemia
CV disease
anemia
end stage kidney disease

119
Q

symptoms of diabetic neuropathy

A

no symptoms for 5-10 years
uncontrollable high bp
edema
foamy urine
etc

120
Q

stage 1 and 2 diabetic neuropathy

A

GFR > 60 ml/min
microalbuminuria

121
Q

stage 3 diabetic neuropathy

A

GFR 30-60
proteinuria

122
Q

stage 4 diabetic neuropathy

A

GFR 15-30
proteinuria
some will be nephrotic

123
Q

stage 5 diabetic neuropathy

A

GFR less than 15
kidney failure

124
Q

diabetic neuropathy

A

too much sugar in the blood leads to high blood pressure which thickens the nephrons and scars them
nephrons leak proteins into the urine

125
Q

malignant nephrosclerosis treatment

A

strict blood pressure control (ARB, ACE inhibitors, BB)
dialysis

126
Q

symptoms of malignant nephrosclerosis

A

proteinuria
hematuria
impaired vision
loss of weight
uremia

127
Q

malignant nephrosclerosis

A

develops rapidly
high bp –> hyaline accumulation –> tubular atrophy, necrosis

128
Q

benign nephrosclerosis

A

mostly present over 60 years
gradual and prolonged deterioration of the renal arteries

129
Q

treatment of benign nephrosclerosis

A

drugs to lower blood pressure

130
Q

(nephrosclerosis) when blood pressure becomes really high,

A

nephrosclerosis becomes malignant

131
Q

hypertensive nephrosclerosis

A

high bp –> hyalinosis of afferent arterioles –> fibrosis and tubular atrophy

132
Q

hyaline

A

clear substance produced by the degeneration of epithelial/connective tissues

133
Q

nephrosclerosis

A

hardening and narrowing of the kidneys blood vessels

134
Q

hypertensive nephrosclerosis is defined as

A

CKD caused by chronic HTN

135
Q

big differences between nephrotic and nephritic syndrome

A

nephrotic - proteinuria, hematuria may not be present; dyslipidemia, hypercoagulability and dec immunity also present
nephritic - hematuria is present, mild proteinuria

136
Q

Nephrotic syndrome complications

A

atherosclerosis
blood clots
poor nutrition
high BP
renal vein thrombosis
AKI/CKD
fluid overload

137
Q

nephrotic syndrome treatment

A

control BP (ACE inhibitors, ARBs)
corticosteroids
diuretics
statins
blood thinners
low salt diet
moderate protein diet

138
Q

nephrotic syndrome tests

A

blood tests (Cr, BUN, albumin)
creatinine clearance
urinalysis (protien, fats, urinary casts)

139
Q

main symptom of nephrotic syndrome

A

protein in urine, less albumin in blood

140
Q

additional symptoms of nephrotic syndrome

A

frequent infections
blood clots
hyperlipidemia
lipiduria
edema (and weight gain)
HTN

141
Q

causes and risk factors of nephrotic syndrome

A

autoimmune diseases
infection
genetic/immune disorders
diabetes mellitus, lupus, multiple myelenoma

142
Q

Nephrotic syndrome

A

causes the body to pass too much protein in the urine
due to changes in glomerular capillary wall

143
Q

nephrotic syndrome is not

A

one specific disease
it is a group of disorders caused by kidney damage

Pathophysiology (15 decks)

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