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Pathophysiology (NRSG 502) > Renal Function (Ch. 33)-- Term First > Flashcards

Renal Function (Ch. 33)-- Term First Flashcards

1
Q

Glomerular Filtration Rate (GFR)

A
  • Volume of plasma filtered per minute
  • BEST index of kidney function
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2
Q

Acute Pyelonephritis

A

Acute inflammation of the kidney caused by bacterial infection

Infection → Outflow obstruction + Vesicoureteral orifice incompetence → Vesicoureteral reflux

E. Coli, Klebsiella, Proteus

  • Route of bacteria to kidney
    • Ascending infection from lower urinary tract
      • UTI
        • ⇡ Risk– Short intravesical ureter
    • Through the bloodstream
      • Staphylococcus aureus in blood (sepsis)
      • Infective endocarditis
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3
Q

Specific Gravity

A
  • [Solutes] in urine
    • Normal range: 1.010-1.025
      • High– Dehydration
      • Low– ⇣ Renal function
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4
Q

Renal Calculi Mechanisms

A

Supersaturation → Solute precipitates → Stone formation

Urinary stasis → Crystal aggregation (around organic material) → Stone formation

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5
Q

Drug-Related Nephropathies

A

Drug exposure (NSAIDS, contrast media, diuretics, immunosuppressants) → Structural or functional changes in kidneys

NSAIDS/ASA → ⇣ PGs (renoprotective) → ⇣ Renal blood flow

Hypersensitivity (Methicillin + Furosemide/Thiazide Diuretic) → Tubulointerstitial nephritis

  • High blood flow and filtration pressure in kidneys
    • Exposed to toxins in blood
  • Kidneys involved in metabolism of drugs
    • Exposed to toxic drug metabolites
  • Tolerance factors:
    • Age
      • ⇡ Risk: Elderly
    • Renal function
    • Hydration status
    • Blood pressure
    • Urinary pH
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6
Q

Nephrotic Syndrome Clinical Manifestations

A
  • Proteinuria>3.5 g protein in urine/day
  • Loss of serum protein
    • ⇣ Albumin → Edema
    • ⇣ Ig’s & complement → Immune suppression
    • ⇣ Binding proteins → Low ions & hormones
    • ⇣ Clotting/anticlotting factors → Thrombosis
    • Hyperlipidemia
      • Liver compensation for hypoproteinemia
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7
Q

Acute Nephritic Syndrome Clinical Manifestations

A
  • Hematuria w/ red cell casts
    • Sudden onset
  • Oliguria
    • <20 mL/hr
  • ⇣ GFR
  • Azotemia
    • ⇡ BUN
  • Cola-colored urine
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8
Q

Rapidly Progressive Glomerulonephritis

A

Crescent-shaped structures destroy the Bowman space

  • Occurs over several months
  • Immunologic disorders
    • Systemic lupus erythematosus
    • Goodpasture syndrome
      • Antibodies to glomerular basement membrane → Inflammation
      • Cross-react w/ pulmonary basement membrane
      • Renal failure + Pulmonary hemorrhage
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9
Q

Hydronephrosis

A

Expansion of the kidney with urine

  • ⇡ Pressure inside renal capsule
  • Compartment syndrome
    • Blood vessels compressed
  • Renal ischemia
    • Necrosis of tissue
    • Chronic renal failure
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10
Q

Systemic Causes of Glomerularnephritis

A

Lupus

Type III Hypersensitivity

Systemic lupus erythematosus→ Antigen-antibody complexes trapped in glomerular membrane → Inflammation → Lupus Nephritis

Diabetes

T1DM/T2DM → Diabetic glomerulosclerosis (thickening/scarring of basement membrane) → CKD → Renal failure, proteinuria, or nephrotic syndrome

  • Mechanisms
    • ⇡ BG → ⇡ GFR & glomerular pressure → Capillary pores enlarge
      • Angiotensin II-mediated
    • Improper synthesis of basement membrane
  • Manifestations
    • Glomerular lesions
    • Non-nephrotic proteinuria
    • Microalbuminuria
      • 30-300 mg urinary albumin in 24hrs.
  • Nephrotic syndrome
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11
Q

Renal Calculi Clinical Manifestations

A
  • PAIN
    • Renal colic
      • Acute, intermittent, excruciating
      • N/V
    • Non-colicky
      • Dull, deep, continuous ache
      • Mild → Severe
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12
Q

Blood Urea Nitrogen (BUN)

A
  • Amount of urea in blood
    • Waste product of metabolism
  • Not specific to kidneys
    • Influenced by protein intake, GI bleed, dehydration
  • Included on Basic Metabolic Panel (BMP)
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13
Q

Serum Creatinine (SCr)

A
  • Waste products produced by muscles
    • Not specific to kidneys
  • Measures ability of kidney to filter
    • Reflects GFR
  • Included on Basic Metabolic Panel (BMP)
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14
Q

Disorders of Glomerular Function

A
  • Acute nephritic syndrome
  • Rapidly progressive glomerulonephritis
    • Goodpasture Syndrome
  • Nephrotic Syndrome
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15
Q

Functions of the Kidneys

A
  • Filter blood and reabsorb substances
    • Electrolytes
  • Regulate pH
    • Conserve or eliminate HCO3- & H+
  • Regulate osmolality of ECF & urine
    • ADH
    • Aldosterone (RAAS)
  • Endocrine functions
    • Renin
    • Erythropoietin
    • Vitamin D
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16
Q

Nephrotic Syndrome

A

Glomerular basement membrane disturbed → ⇡ Permeability → Protein and lipids in urine

Filtration of proteins > Tubular reabsorption

17
Q

Glomerulus

A
  • Fluid & solutes filtered from capillary into Bowman space (filtrate)
    • IN through AFFERENT
    • OUT through EFFERENT
  • Capillary membrane
    • Endothelial layer
    • Basement membrane
    • Capsular epithelial layer
      • Podocytes
      • Particles move through “gaps”
    • Selectively permeable
      • Water and small particles leave blood
      • Larger particles prevented from leaving blood
        • WBCs, RBCs, glucose, proteins…
    • ⇡ Permeability w/ inflammation
      • Glomerular damage
18
Q

Proteinuria

A
  • Protein in the urine
    • Indicates glomerular damage
  • Urinalysis
19
Q

Types of Renal Calculi

A
  • Calcium salts → Calcium stones (oxalate or phosphate)
    • 70-80%
    • Hyperparathyroidism, High fructose beverages
  • Uric acid → Uric acid stones
    • Gout, Tumor lysis syndrome, High purine diet
  • Magnesium ammonium phosphate → Struvite
    • Alkaline urine, Bacteria that split urea → ammonia & CO2
      • Normal urine pH: 4.5-8
  • Cystine → Cystine stones
    • Cystinuria (autosomal recessive genetic defect)
      • ⇡ Cystine resorption
20
Q

Renal Regulation

A
  • Average urinary output: 125 mL/hr
  • Neural & humoral mechanisms
    • SANS, ADH, & Angiotensin II (RAAS) → Vasoconstriction
      • ⇣ renal blood flow
    • Dopamine & NO → Vasodilation
      • ⇡ renal blood flow
21
Q

Obstructive Disorders of Renal Function

A
  • Urinary obstruction
    • Renal pelvis
      • Renal calculi (kidney stones)
      • Pregnancy
    • Ureter
      • Neurogenic bladder
      • Uretovesicle junction stricture
    • Bladder & urethra
      • Bladder stones
      • BPH
22
Q

Acute Nephritic Syndrome

A

Inflammation → Damage to capillary wall

  • Acute post-infectious glomerulonephritis
    • Group A Beta-Hemolytic Streptococci
  • Deposition of immune complexes
    • IgG & Complement
23
Q

Acute Pyelonephritis Clinical Manifestations

A
  • Abrupt onset of shaking, chills, or fever
  • Constant ache in lower back
    • Unilateral or bilateral
  • Malaise
  • N/V
  • Abdominal pain
  • Lower urinary tract symptoms
    • Dysuria
    • Increased urinary frequency
    • Urgency
24
Q

Urinary Obstruction Mechanisms

A

Determined by site, degree, and duration of obstruction

Urinary stasis → Infection & Renal Calculi

Dilation of renal collecting ducts → Hydronephrosis → Renal ischemia → Necrosis of kidney tissue

Acute emergency → Chronic renal failure

Pathophysiology (NRSG 502) (16 decks)

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