Renal Disorders (Exam 2) Flashcards
Functions of Renal System (5)
Regulation of water and inorganic-ion balance
Removal of waste from blood
Removal of foreign chemicals
Gluconeogenesis
Hormonal Secretion
Ureters
Carry urine from kidney to bladder
Bladder
Stores urine
Urethra
Carries urine from bladder to outside body
Valves keep flow one-way
Bladder is lined with…
transitional epithelium
Internal urethtral sphincter
Smooth muscle we CAN’T control
External urethtral sphincter
Skeletal muscle we CAN control
What is the functional unit of the kidneys?
Nephron
Where does nephron extend?
Between renal cortex and renal medulla
20% of volume that enters glomerulus is filtered out into…
the Bowman’s capsule
What is filtrated into nephron?
Salts
Amino acids
Glucose
What stays in the blood?
Blood cells
Proteins
Mechanisms of Renal System
Glomerular filtration (passive)
Tubular secretion (active)
Tubular reabsorption (both)
What does filtration and secretion serve for renal system?
Extracting drug from blood into urine
What does reabsorption involve for the renal system?
Movement of drug back into blood from primitive urine
Nephron Reabsorption Mechanism
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
What is reabsorbed in the nephron?
Na+, Cl-, water, HCO3-, Ca2+, Mg2+, amino acids, glucose
What is excreted from nephron?
H+, urea, NH3, K+
What happens when there is too much salt?
Too much water is reabsorbed which leads to high BP
Glomerular Filtration Rate (GFR)
Volume of filtrate formed per unit time
GFR normal range
110-130 ml/min
How is GFR measured?
Marker substance that is 100% eliminated unchanged in urine, not plasma bound, excreted only by filtration
What do the kidneys produce?
Hormones
Hormones of the RAAS system
Regulate blood pressure
Erythropoietin (EPO)
Stimulates RBC production
1.25 dihydroxy vitamin D3
controls calcium metabolism
Aldosterone for kidneys
Helps retain Na+ and water
Increased volume of water
Increased BP
Acute Kidney Injury (AKI)
Kidneys stop working suddenly
Reversible
Symptoms of AKI
Not enough urine
Swelling, tired, confused, nausea
Out of breath, pain in chest
Renal Autoregulation
How kidneys maintain constant renal blood flow and GFR
Prostaglandin 2 (PGE2)
Direct vasodilator by acting on smooth muscle to cause blood vessel dilation
Angiotensin II (AII)
Acts on CNS to increase vasoconstriction by vasopressin production
Intrinsic AKI
Injury or problem directly to kidneys
Post-Renal AKI
Blockage in ureters, bladder, or urethra
What can AKI lead to?
Kidney failure
Acute renal failure
AKI Treatment
Hemodialysis
Hemodialysis
Machine that filters wastes, salts, and fluid from blood when kidneys are unable to do so
Chronic Kidney Disease (CKD)
Lasting damage to kidneys that can get worse over time
Eventually leads to kidney failure
Chronic renal failure
End result of irreparable damage to kidneys, develops slowly
Risk factors of CKD
Diabetes, hypertension
Family history
African-American, Hispanic, Native American, Asian
CKD Stages
- Kidney damage but normal function
- Mild loss of function
- Moderate to severe loss of function
- Severe loss of function
- Kidney failure
CKD Stage 1
Damage with normal or increased GFR
CKD Stage 2
Mild reduction of GFR to 60-89 ml/min/1.73 m2
CKD Stage 3
Moderate reduction of GFR to 30-59 mL/min/1.73 m2
CKD Stage 4
Severe reduction in GFR to 15-29 mL/min/1.73 m2
CKD Stage 5
Kidney failure GFR <15mL/min/1.73 m2
Need for renal replacement therapy
Complications of CKD
Anemia, bone + heart disease, high K+, Ca2+, P, fluid buildup
CKD Treatments
Focus on complications since it is irreversible
Tests for CKD
eGFR
Urine test
Blood pressure
Nephritic Syndrome
Extensive damage of glomerular capillaries due to inflammation
Ofter occurs in glomerulus
Glomerulonephritis
Inflammation of glomeruli and small blood vessels
What happens when glomeruli are damaged?
Blood and protein get into urine (intrinsic AKI)
Risk factors of Glomerulonephritis
Autoimmune disease
Infections
Diabetes
Primary Glomerulonephritis
Starts in glomeruli
Secondary Glomerulonephritis
Glomeruli affected by systemic disease
Acute Glomerulonephritis
Develops over short period of time
Chronic Glomerulonephritis
Develops and progresses slowly
In 1% of children and 10% of adults who have acute glomerulonephritis…
Evolves into rapidly progressive, destroying glomeruli and resulting in kidney failure
Glomerulonephritis Tests
Urine Test
Blood Test
Blood Pressure
Kidney ultrasound and biopsy
Glomerulonephritis Treatment
Antihypertensives
Diuretics
Corticosteroids
Immunomodulators
Antibiotics
Glomerulonephritis Prognosis
Children usually acute
Adults usually chronic
treatment of UTIs is based off of
the pathogen causing the infection
types of antibiotics used to treat UTIs
penicillins
amoxicillins
azithromycin
clarithromycin
clindamycin
how to diagnose a UTI?
symptoms
examination of urine
blood analysis
x-rays, films, CT scans, etc
urine dipstick
chronic pyelonephritis
destruction of renal tissue and fibrosis
irregular shrunken small kidney
tubular atrophy with casts
chronic inflammatory infiltrates
acute pyelonephritis
sudden and severe inflammation of the kidney due to a bacterial infection
features of acute pyelonephritis
small abscesses
inflammation
leukocyte casts in urine
common UTI symptom that mainly women feel
burning when urinating
predisposing conditions of UTIs
stones
reflux
infections of lower UTI
neoplasms
external compression
for UTIs, bacteria enter
through the urethra
travel down to up
is there only one bacteria that causes UTIs?
NO!
many different bacteria cause UTIs
types of UTIs
asymptomatic bacteriuria
symptomatic infections
lower UTI
upper UTI
lower UTI consists of
cystitis
urethritis
upper UTI consists of
pyelonephritis
kidney stones are more predominant in
men (haha sucks to be a man)
stones treatment
hydration
ibuprofen
antibiotics
shock waves/surgery for larger stones
for larger stones that cannot be passed on there own, what is done?
ureteroscopic removal
percutaneous removal
extracorporeal lithotripsy
shock waves
main symptom of kidney stones
excruciating, cramping pain in the abdomen, flank or groin
symptoms of stones
hematuria
pain
difficulty urinating
fever and chills
risk factors of stones
gout due to increased uric acid
hypercalciuria due to calcium phosphate/oxalate stones
medications
family history
reduced fluid intake
infection
calcium oxalate/phosphate stones
80% prevalence
diet high in oxalate
struvite stones
10% prevalence
linked to UTIs
uric acid stones
6%
urine is too acidic, high protein diet
cystine stones
1%
genetic disorder, high levels of cystine
stones are made up of
calcium oxalate/phosphate, uric acid, cysteine or magnetism ammonium phosphate
stones (Calculi)
hard, crystalline mineral deposits formed within the kidney or urinary tract
stones are due to
decrease in urine volume
excess of stone forming substances in the urine
urolithiasis
stones in the lower UT (bladder, urethra)
nephrolithiasis
stones in the upper UT (kidney)
common symptoms of stones
pain
signs/symptoms of UTI
manifestations of renal dysfunction
damaging effects of urinary obstruction are due to
stasis of urine
development of back pressure
stasis of urine
predisposes to infection and stone formation
development of back pressure
interferes with renal blood flow and destroys kidney tissue
causes of urinary tract obstruction
stones
developmental defects
pregnancy
BPH
scar tissue
tumors
neurologic disorders
simple cysts treatment
ultrasound guided percutaneous drainage
large - surgery
polycystic kidney disease treatment
dialysis
kidney transplant
tests for cystic kidney disease
ultrasound
CT scan
MRI
blood and urine tests
Medullary cystic kidney disease
chronic renal failure in children
progresses to ESKD
Polycystic kidney disease
cysts slowly grow with age which reduces blood flow and inc scarring
cysts may appear on other organs (liver)
simple renal cysts
develop with age, common in older people
1 out of 10 people have
usually no symptoms, sometimes pain when big
can become malignant
Cystic kidney disease risk factors
genetic mutations
CKD
birth defects
age
acquired cystic kidney disease
cysts develop due to CKD/renal failure
affects adults/children on dialysis
multi cystic dysplastic kidney
one or both kidneys don’t develop correctly
cysts replace normal tissue
medullary sponge kidney
cysts form on innermost part of kidney
blocks tubules that filter urine
difference in PKD dominant and recessive
dominant - variable size cysts, affect adults in large quantities
recessive - tiny fusiform cysts, affect children in smaller quantities
polycystic kidney disease
can be dominant or recessive
recessive affects kidney development during birth
Glomerulocystic kidney disease
cysts and enlargement of the space in the kidneys near the urinary tract
infants or adults
medullary cystic kidney disease
cysts develop in the inner part of the kidneys
inflammation and scarring of tubules
adults
nephronophithisis
similar to MCKD
affects infants and children
types of cystic kidney disease
genetic or non genetic
cystic kidney disease
group of conditions that cause cysts to form in or around the kidneys
can lead to kidney failure
cysts can be
filled with air or fluid
kidney cysts prevent the kidneys from
filtering water and waste out of the blood
diabetic nephropathy is the major cause of
morbidity and mortality in people with diabetes
diabetic nephropathy treatment
drugs that lower bp
drugs to control diabetes
statins
restrict dietary proteins
etc
diabetic nephropathy tests
urinalysis
blood analysis
hematocrit
kidney ultrasound
kidney biopsy
blood analysis usually looks at
creatinine and BUN
complications of diabetic neuropathy
body fluid buildup
hyperkalemia
CV disease
anemia
end stage kidney disease
symptoms of diabetic neuropathy
no symptoms for 5-10 years
uncontrollable high bp
edema
foamy urine
etc
stage 1 and 2 diabetic neuropathy
GFR > 60 ml/min
microalbuminuria
stage 3 diabetic neuropathy
GFR 30-60
proteinuria
stage 4 diabetic neuropathy
GFR 15-30
proteinuria
some will be nephrotic
stage 5 diabetic neuropathy
GFR less than 15
kidney failure
diabetic neuropathy
too much sugar in the blood leads to high blood pressure which thickens the nephrons and scars them
nephrons leak proteins into the urine
malignant nephrosclerosis treatment
strict blood pressure control (ARB, ACE inhibitors, BB)
dialysis
symptoms of malignant nephrosclerosis
proteinuria
hematuria
impaired vision
loss of weight
uremia
malignant nephrosclerosis
develops rapidly
high bp –> hyaline accumulation –> tubular atrophy, necrosis
benign nephrosclerosis
mostly present over 60 years
gradual and prolonged deterioration of the renal arteries
treatment of benign nephrosclerosis
drugs to lower blood pressure
(nephrosclerosis) when blood pressure becomes really high,
nephrosclerosis becomes malignant
hypertensive nephrosclerosis
high bp –> hyalinosis of afferent arterioles –> fibrosis and tubular atrophy
hyaline
clear substance produced by the degeneration of epithelial/connective tissues
nephrosclerosis
hardening and narrowing of the kidneys blood vessels
hypertensive nephrosclerosis is defined as
CKD caused by chronic HTN
big differences between nephrotic and nephritic syndrome
nephrotic - proteinuria, hematuria may not be present; dyslipidemia, hypercoagulability and dec immunity also present
nephritic - hematuria is present, mild proteinuria
Nephrotic syndrome complications
atherosclerosis
blood clots
poor nutrition
high BP
renal vein thrombosis
AKI/CKD
fluid overload
nephrotic syndrome treatment
control BP (ACE inhibitors, ARBs)
corticosteroids
diuretics
statins
blood thinners
low salt diet
moderate protein diet
nephrotic syndrome tests
blood tests (Cr, BUN, albumin)
creatinine clearance
urinalysis (protien, fats, urinary casts)
main symptom of nephrotic syndrome
protein in urine, less albumin in blood
additional symptoms of nephrotic syndrome
frequent infections
blood clots
hyperlipidemia
lipiduria
edema (and weight gain)
HTN
causes and risk factors of nephrotic syndrome
autoimmune diseases
infection
genetic/immune disorders
diabetes mellitus, lupus, multiple myelenoma
Nephrotic syndrome
causes the body to pass too much protein in the urine
due to changes in glomerular capillary wall
nephrotic syndrome is not
one specific disease
it is a group of disorders caused by kidney damage
