Renal exam 3 Flashcards
What does the renin angiotensin system do?
helps regulate B/P and maintain blood volumes
angiotensin II
potent vasoconstrictor
aldosterone
facilitates salt reabsorption
Antidiuretic hormone (ADH)
acts on renal tubules to allow water reaborption that depends upon the formation of the salt gradient in the loop of henle
where is ADH released from
the posterior pituitary
Atrial Natriuretic Peptide (ANP)
released from cardiac cells in response to an increase in stretch or work to counter fluid-conserving effects to reduce blood volume and relieve B/P
Osmotic diuretics
act a proximal tubule to shift the osmotic balance
ex) mannitol
Loop diuretics
work by inhibiting transporters in the loop of henle
ex) lasix
thiazide diuretic
blocks sodium-calcium symport in the distal convoluted tubule to block salt reabsorption causing water to remain the lumen for excretion
Potassium-sparing diuretics
inhibits aldosterone
blocks salt reabsorption
increases potassium reabsorption
ex) spironolactone
what is a nephritic syndrome characterized by?
proteinuria and hematuria
what is acute nephritic syndrome caused by and what are some symptoms?
caused by increased glomerular permeability and loss of plasma proteins in urine
hematuria, proteinuria, azotemia, edema, HTN
Nephrotic syndrome is characterized by ?
only proteinuria
what happens in nephrotic sydrome?
glomerular permeability, protein loss in the urine causes hypoalbuminemia and massive loss of proteins and lipids
What are the symptoms of nephrotic syndrome?
edema, pleural effusion, pulomnary edema, hyperlipidemia related to the liver trying to compensate for albumin loss which increases risk for clots
Rapidly progressing glomerulonephritis
occurs over days/weeks due to formation of crescents initiated by the passage of fibrin into the Bowman’s capsule causing an influx of monocytes
Chronic glomerulonephritis
persistent proteinuria, irreversible-progressive glomerular and tubulointerstitial fibrosis
can lead to CKD, ESRD, cardiac issues
what are some symptoms of glomerulonephritis?
decreased GFR, increased toxins, uremic syndrome
What are the functions of the renal system?
1) remove waste/toxins
2) water and ion homeostasis
3) hormones (EPO, renin, activates D3, gluconeogenesis)
Filtration
removal of substances from the blood into the renal tubule at the glomerulus
Secretion
removal of substances from the blood into the renal tubules at the peritubular cavities
Reabsorption
return of substances from renal tubules into the blood at the peritubular cavities
Excretion
removal of substances form the renal tubule through urine
Proximal Convoluted Tubule is the site of?
reabsorption occurs here; sodium actively transported w/ glucose-water follows by solute drag
What happens at the Loop of Henle?
sodium and potassium are reabsorbed, generation of interstitial salt gradient
What happens at the distal convoluted tubule?
sodium reabsorption
potassium and hydrogen secretion
site of aldosterone action
What happens at the collecting ducts?
water is reabsorbed
site of ADH action
What is glomerular filtration?
movement of fluid and solutes across the glomerular capillary membrane into Bowman’s space
What is the driving force of glomerular filtration?
hydrostatic pressure
What opposes filtration?
osmotic/oncotic forces
GFR
index of functioning renal mass
Creatinine clearance measures what?
the amount of some substance that is cleared from the blood by the kidney per unit time
What is normal for a urinalysis?
color: yellow-amber
consistency: clear-slightly hazy
specific gravity: 1.003-1.030
pH: acidic 5-6.5
Negative for glucose, ketones, nitrates, heme, protein
negative for casts, crystals, cells
what does BUN measure
urea in the blood
what does creatinine measure
a reflection of GFR and functional capacity of the kidneys
what is the cause of asymptomatic hematuria and proteinuria?
IgA immune complexes that result in glomerular inflammation
What is acute tubular necrosis characterized by?
decline in renal function, decreased urine output, increased BUN and creatinine, metabolic acidosis, CHF
What are the risk factors for getting acute tubular necrosis?
blood transfusion, rhabdo, hypotensive shock, surgery, nephrotoxic drugs, infection
What are the 3 stages to acute tubular necrosis?
1) initiation
2) maintenance
3) recovery
What are polycystins?
gene products that regulate growth in the differentiation of tubular epithelium
defects can lead to cyst formation, obstruction, and loss of nephrons
Autosomal dominant polycystic kidney disease
presents late in childhood, inherited mutation of PKD-1 and PKD-2 chromosomes
Autosomal Recessive polycystic kidney disease
rare, noted in infants. gene mutations of PKHD-1 cause decreased or absent function of fibrocystin, leading to cysts
Renal calculi
masses of crystals, protein, substances that form an obstruction
Risk factors of kidney stones
age, sex, fluid intake, pH changes, gout, HTN, DM, UTI, diet, gout, infection
SIDAH is caused by?
excess levels of ADH from the posterior pituitary or ectopic cause(tumor, head injury, SSRI’s)
What are the symptoms of SIDAH?
water retention causes hyponatremia, headache, confusion, n/v, convulsions, coma
What is the treatment for SIDAH?
water restriction
meds to block ADH effect on kidneys (tetracycline, democlocycline)
Diabetes Insipidous happens when?
kidneys can’t conserve water causing excessive thirst and large amounts of diluted urine
Central DI is caused by?
damage to the hypothalamus or pituitary gland
Nephrogenic DI is caused by?
defect in renal tubules- typically inherited
Renal failure is characterized by?
decrease in kidney function such that there insufficient filtration of waste products in the blood, a decrease in GFR, no urine production, build up of wastes
Prerenal failure is due to?
blood supply to kidney
Intrarenal failure is due to?
within the kidney itself
Postrenal failure is due to?
issues with urinary tract or outflow from kidney
Azotemia occurs when?
elevated serum levels of nitrogen-containing substances
Uremia occurs when?
blood is not being filtered by the kidneys due to ARF
Uremic syndrome is? What are some symptoms?
the accumulation of urea that causes a group of symptoms associated with renal failure
Altered CNS, neuropathy, GI ulcers, pruitis, pericarditis, poor blood clotting
