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Renal Function Flashcards

1
Q

Kidney Anatomy

A

2 bean shaped organs
cortex & medulla housed in fibrous capsule of connective tissue
nephrons

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2
Q

kidney function

A

eliminate NPN compounds
water & electrolyte balance maintained
acid-base balance
endocrine functions

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3
Q

Nephron

A 
glomerulus - end of renal tubule, capillary tuft, sits in Bowman capsule
proximal convoluted tubule
loop of henle
distal convoluted tubule
collecting duct
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4
Q

Glomerular filtration

A

depends on blood pressure through glomerular capillaries & integrity of semi-permeable glomerular membrane
membrane is negatively charged so proteins & others are repelled

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5
Q

GFR

A

volume of blood filtered per minute

glomerular filtration rate

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6
Q

Proximal convoluted tubule

A

returns 75% of water, Na, Cl
100% of glucose, amino acids, vitamins, proteins, & varying amounts of urea, uric acid & ions like Mg, Ca, K, HCO3
water & cl are passive transport; everything else is active

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7
Q

Loop of Henle

A

opposing flows result in osmolality changes & hypo-osmole urine
COUNTER CURRENT MULTIPLIER

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8
Q

ascending limb of henle

A 
Na & Cl are reabsorbed into medulla interstitial fluid along limb
impermeable to water -> hyperosmotic medulla
diluting limb (!)
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9
Q

descending limb of henle

A

highly permeable to water but does not reabsorb Na & Cl
water leaves for the medulla
fluid in loop is hypo-osmotic urine

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10
Q

Distal convoluted tubule

A

adjusts the electrolyte & acid-base homeostasis via ADH & aldosterone actions

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11
Q

aldosterone

A

acts on distal tubule stimulates Na reabsorption & excretion of K & H+

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12
Q

Urea

A

ammonia from amino acid degradation made into urea in liver

40-60% reabsorbed into medulla to maintain high osmolality

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13
Q

creatinine

A

waste from muscle

not reabsorbed by tubules

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14
Q

Uric acid

A

waste from purine metabolism

only 6-12% of original uric acid is excreted; can contribute to crystal in urine, gout & calculi

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15
Q

water balance

A

controlled by ADH, proximal, distal & collecting ducts

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16
Q

sodium balance

A 
aldosterone system (RAS)
governs Na reabsorption
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17
Q

Potassium balance

A

excretion controlled by kidneys

actively reabsorbed through nephron; negatively effected by aldosterone

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18
Q

Chloride balance

A

maintenance of extracellular balance; passive reabsorption in proximal tubule

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19
Q

Phosphate, Mg, Ca balance

A

PTH controls proximal tubule reabsorption of phosphates
Mg filtered by tubule & reabsorbed via PTH action
calcium under PTH & calcitonin control so tubule reabsorption is not significant

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20
Q

Endocrine function

A

makes EPO, 1,25-dihydroxy vitamin D3, & prostaglandins

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21
Q

Kidney renin

A

made by juxtaglomerular cells of renal medulla; released when blood pressure decreases
activates renin-angiotensin system

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22
Q

EPO production

A

made by cells close to proximal tubule, production regulated by 02 levels in blood within 2 hour window

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23
Q

1,25-dihydroxy vitamin D3 production

A

made when kidney enzyme converts 25-hydroxy vit D to this form
adds a methyl group & becomes an active vitamin

24
Q

Prostaglandins

A

made from arachidonic acid
increase blood flow, Na & water excretion & renin release
oppose renal vasoconstriction due to angiotensin II & norepinephrine

25
Creatinine clearance
creatinine clearance to assess glomerular filtration rate males: 97-137 ml/min females: 88-128 ml/min
26
Urea clearance
urea 40% reabsorbed by tubules- not used now
27
Cystatin C
low molecular weight protein from nucleated cells; freely filtered by glomerulus; reabsorbed & catabolized by proximal tubule constant rate unaffected by age, gender, race, muscle mass; may be better early indicator of decreased GFR
28
Cystatin C vs Creatinine
creatinine - more stable w/in a person so fluctuations seen indicate renal function over time cystatin C- doesn't change much between people but within a person there is bioflux; marker better at detecting minor renal impairment
29
Urine electrophoresis
normally excrete 50-150 mg/24 hrs increases in protein indicate disease states do electrophoresis to ID proteins & define disease type
30
Beta2-Microglobulin
small, non-glycosylated peptide found on surface of nucleated cells shed at constant rate normally elevated levels indicate myeloproliferative & lymphoproliferative disorders, inflammation or renal failure filtered by kidney & then 99.9% reabsorbed
31
elevated b2 microglobulin in transplant patients
can indicate rejection
32
Myoglobin
associated w/ muscle injury (rhabdomyolysis) overloads kidney proximal tubule & see acute renal failure increased in serum can be early indicator of renal disease
33
Microalbumin
increased in diabetics w/ nephrophathy
34
nephrophaty
renal hypertrophy increased glomerular thickness tubular basement membrane dysfunction increased microalbumin, blood pressure & leads to increased renal damage
35
Kidney Diseases
``` glomerular diseases tubular diseases infections & obstructions renal failure renal hypertension ```
36
Glomerular diseases
damage renal glomerulus directly & lead to tubular disease over time: actue glomerularnephritis chronic glomerularnephritis nephrotic syndrome
37
acute glomerularnephritis general
inflamed glomeruli w/ decreased capillary lumen | can recover from acute
38
acute glomerularnephritis labs
hematuria, proteinuria, increased BUN, creatinine | Na & water retention
39
acute glomerularnephritis causes
``` group A Beta hemolytic strep drug related infections systemic lupus bacterial endocarditis ```
40
Chronic Glomerularnephritis general
lengthy glomerular inflammation | leads to scarring & loss of function of nephrons
41
chronic glomerularnephritis
increased BUN & other nitrogen compounds hematuria proteinuria
42
labs for nephrotic syndrome
proteinuria (>3.5g/day!!), decreased oncotic pressure leading to increased edema, w/ hyperlipidemia
43
Tubular diseases
occur as decreased GFR due to progressive tubular defects damage to excretion/reabsorption functions of tubules renal tubular acidosis acute inflammation of tubules & surrounding interstitium
44
Renal tubular acidosis (RTA)
primary tubular disease distal RTA- tubule cannot keep up w/ pH gradient between blood & tubular fluid proximal RTA- decreased HCO3 reabsorption, resulting in hyperchloremic acidosis
45
acute inflammation of tubules & surrounding interstitium
may occur due to analgesics/drugs or radiation toxicity, methicillin hypersensitivity reaction, renal transplant rejection, infections decreased GFR, decreased metabolic acid excretion see WBC casts issues w/ Na control
46
urinary infections
``` pyelonephritis, cystitis micro >105 colonies/ml hematuria pyuria WBC casts ```
47
urinary obstructions
``` gradual rise in intra-tubular pressure until nephrons necrose & get chronic renal failure maybe from repeated infections decreased urine concentrating capacity decreased metabolic acid excretion decreased GFR decreased blood flow to kidney ```
48
urinary obstructions
``` gradual rise in intra-tubular pressure until nephrons necrose & get chronic renal failure maybe from repeated infections decreased urine concentrating capacity decreased metabolic acid excretion decreased GFR decreased blood flow to kidney ```
49
renal failure
acute renal failure & chronic renal failure
50
acute renal failure diseases
pre-renal failure: blood supply defect prior to kidney renal failure: defect in kidney; often dacute tubular necrosis post renal failure: defect after urine exits; obstruction or bladder rupture
51
Chronic Renal Failure
when progressive loss of GFR occurs & patient has additional factors of risk-> end stage renal failure
52
chronic renal failure increases with:
``` diabetes mellitus age obesity metabolic syndrome hypertension decreased HDL increased triglycerides increased glucose ```
53
Renal hypertension
``` decreased perfusion to all of kidney (ischemia) decreased perfusion to part of kidney increased Na decreased serum K increased urine K ```
54
Dialysis
use semi-permeable membrane in dialysate bath
55
hemodialysis
dialysate & blood running in opposite directions to filter out waste
56
peritoneal dialysis
less clearance but continuous
57
transplantation
survivals vary; living donor lasts longer | 3 year survival 65-85%

Clinical Chemistry (23 decks)

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