Renal - (Part 1) - Unit 3

Question 1

What percent of nephrons are present at birth?

Answer 1

100%

Question 2

Kidneys control volume and composition of ECF and ICF, and control transfer of fluids and solutes across cell membrane. T/F?

Answer 2

True

Question 3

What are some electrolytes involved in the kidney’s?

Answer 3

H+, Na, K+, CL-, Bicarb, Sulfate, Phosphate

Question 4

What are the 2 hormones involved in balancing fluid and electrolytes?

Answer 4

ADH and Aldosterone

Question 5

Tubules are more permeable to water when large concentrations exist ——> very concentrated urine —-> ____ (which hormone)

Answer 5

ADH

Question 6

Is it ADH or aldoesterone that works on distal tubules to change urine concentration by increased NA reabsorption?

Answer 6

Aldosterone

Question 7

A high concentration of ______ increases Na and fluid reabsorption by tubules and decreases Na and fluid excretion in urine (also increases excretion of potassium)

Answer 7

Aldosterone

Question 8

If more sodium is excreted than ingested, the result will be what? (2 things)

Answer 8

Fluid retention OR dehydration

Question 9

The amount of sodium reabsorbed controls the amount of fluid reabsorbed. T/F?

Answer 9

True

Question 10

The kidney’s produce ____-stimulating factor, which is involved in stimulating the production of red blood cells.

Answer 10

Erythropoietin-stimulating factor

Question 11

“I am stimulated when blood volume decreases, blood pressure decreases, or when catecholamine secretion increases. What am I?”

Answer 11

Renin - renin stimulates angiotensins which increases BP and stimulates aldosterone production

Question 12

What are the four parts of the renal system?

Answer 12

Kidneys, ureters, bladder, urethra

Question 13

What are some renal differences in kids?

Answer 13

Shorter urethra (organisms can reach the bladder easily), kidneys are less able to concentrate urine and less effective at acid/base balance until the age of 2, GFR is immature until the teen years.

Question 14

The young infant has an excessively high rate of glomerular filtration - T/F?

Answer 14

FALSE - GFR and reabsorbtion are very low in infants and young children.

Question 15

Infants are prone to metabolic acidosis because they have low blood bicarb levels and they do not excrete hydrogen ions easily - T/F?

Answer 15

True

Question 16

If H+ builds up, blood becomes more alkalotic. T/F?

Answer 16

FALSE

Question 17

The entire urinary tract should be free of microorganisms. T/F? If not, where?

Answer 17

FALSE - the lower third of the urethra usually has bacteria.

Question 18

UTI’s - where? Caused by what?

Answer 18

Upper and/or lower urinary tract. Can be bacterial, viral, or fungal.

Question 19

UTI’s - ALWAYS symptomatic. T/F?

Answer 19

FALSE - not always.

Question 20

E-coli - usually the causative agent for UTI’s. T/F?

Answer 20

True

Question 21

UTI’s - one of the biggest causes is urinary stasis. T/F?

Answer 21

Yup, usually due to neurogenic bladder or voluntarily holding in urine.

Question 22

What is the peak age of urinary tract infections if not due to a structural defect?

Answer 22

2-6 years

Question 23

In ALL age groups, females are more likely to have a UTI. T/F?

Answer 23

FALSE - males under 1 months are more likely to have a UTI due to increased structural abnormalities in this age group.

Question 24

Other than a longer urethra, males are at a decreased risk for UTI’s due to what?

Answer 24

Prostate secretions that have anti-bacterial properties

Question 25

Constipation increased the risk for UTI - T/F?

Answer 25

True - pushes on bladder and causes urinary stasis.

Question 26

What are some manifestations of a UTI?

Answer 26

Fever, incontinence, foul smelling urine, frequency/urgency/dysuria, abdominal or flank pain, hematuria, but can be vague in kids under age 2 OR look like GI illnesses.

Question 27

UTI - can be more serious, including high fever, leukocytosis, flank pain, and often pyelonephritis. T/F?

Answer 27

True

Question 28

How do we diagnose a UTI?

Answer 28

History and physical, urinalysis, urine culture (at least one bacteria in gram stain)

Question 29

How do we collect a clean catch from a girl?

Answer 29

Have her sit backward on the toilet - makes it easier to collect and helps her relax and separates the labia

Question 30

Have the person drink a lot before the urinalysis - T/F?

Answer 30

NO - it may dilute their urine and cause a false positive.

Question 31

How do we manage a UTI?

Answer 31

fluid intake (lowers the concentration of pathogens in the urine,improves blood flow), cranberry juice isn't super helpful, antibiotics (iv for pyelonephritis), blood cultures to rule out sepsis,

Question 32

What is vesicoureteral Reflux?

Answer 32

Retrograde flow of urine from bladder to ureters and it increases infection.

Question 33

What is the difference between Primary reflux and secondary reflex (vesicoureteral reflux) ?

Answer 33

Primary - congenital anomalies that affect uterovesical junction - familial. Secondary - due to acquired condition - UTI or obstruction.

Question 34

How do we diagnose vesicoureteral reflux?

Answer 34

Voiding cystoureterography - a catheter is used to inject die into bladder - graded 1-5

Question 35

How do we manage vesicoureteral reflux?

Answer 35

Most cases resolve, control infections, urine cultures, surgical reimplantation (for non-compliant families or severe cases), endoscopic procedures

Question 36

What is hypospadias?

Answer 36

Urethral opening is located below the glans penis on ventral surface (bottom) - severe and often accompanied by a chordee (a ventral curvature of the pee pee)

Question 37

What is epispadias?

Answer 37

Opening on dorsal surface (top) - often associated with bladder exstrophy (protrustion of the urinary bladder through a defect in the abdominal wall)

Question 38

What is enuresis?

Answer 38

Bed-wetting in children who are beyond the age of typical voluntary bladder control - more common in boys, primary or secondary, and more common at night.

Question 39

When does enuresis typically top?

Answer 39

between ages 6-8

Question 40

To be considered enuresis, must occur twice weekly for __ months and the child must be at least __ years old.

Answer 40

3 months. | 5.

Question 41

Secondary enuresis - can be due to a substance or medical condition such as diabetes. T/F?

Answer 41

True

Question 42

Enuresis - could indicate abuse. T/F?

Answer 42

True

Question 43

How do we diagnose enuresis?

Answer 43

Rule out other conditions like a UTI, diabetes, epilepsy, look at history, functional bladder capacity analysis (can hold their age + 2 in ounces), psych eval, baseline count of episodes

Question 44

how do we treat enuresis?

Answer 44

conditioning therapy (training the child to awake with a stimulus like an alarm), retention control (stretching the bladder by drinking and delaying urination/kegals), meds (tricyclic antidepressants (imipramine - anticholinergic effect on bladder, DDAVP - decreases night urinary output)

Question 45

what are the small round filters of the kidney called?

Answer 45

Glomeruli

Question 46

What is acute glomerulonephritis?

Answer 46

Autoimmune complex disorder - primary or systemic - it's an inflammation of the glomeruli.

Question 47

What is APSGN?

Answer 47

Acute post streptococcal glomerulonephritis - a group A beta hemolytic streptoccocal infection can cause glomerulonephritis a few weeks later.

Question 48

All cases of strep have the potential to cause APSGN - T/F?

Answer 48

FALSE - only a FEW strands lead to glomerulonephritis

Question 49

Glomerulonephritis - can also be secondary to a skin infection called impetigo - T/F?

Answer 49

TRUE - impetigo, common during warmer months.

Question 50

Glomerulonephritis - an antigen is released from the streptococcal organism that leads to the formation of antibodies and an immune-complex reaction, those complexes get trapped in the glomerular capillary loop and then the basement membrane of the glomerulus is filled with immune complex deposits. T/F?

Answer 50

TRUE

Question 51

The capillaries of the glomeruli are occluded - does the GFR increase or decrease?

Answer 51

DECREASE

Question 52

If the GFR is decreased, what happens to renal blood flow?

Answer 52

It is NOT greatly decreased, so there is water/sodium retention.

Question 53

If water and sodium retention is up, what symptoms would be expected?

Answer 53

Hypertension and edema

Question 54

Why do we see hematuria in glomerulonephritis?

Answer 54

Glomerulus is no longer selectively permeable so blood and protein can filter through.

Question 55

Glomerulonephritis - lots of protein. T/F?

Answer 55

NO NO NO. Not a lot present in the urine.

Question 56

What are some other manifestations of glomerulonephritis?

Answer 56

Periorbital edema and puffy face, tea/cola colored urine, hematuria, generalized malaise/fatigue/anorexia, N/V, headaches, fever

Question 57

Glomerulonephritis is always self limiting and never leads to permanent sequlae - T/F?

Answer 57

FALSE - it usually is self-limiting. Causes reversible damage

Question 58

What are some other complications of glomerulonephritis?

Answer 58

Hypertensive encephalopathy (HTN causes protective vasoconstriction to fail which causes increased cerebral blood flow), cardiac decompensation r/t hypervolemia

Question 59

How do we diagnose glomerulonephritis?

Answer 59

Urinalysis (hematuria, SMALL amount of protein), blood work (may have elevated BUN and Cr), ASO titer (strep antibodies)

Question 60

How do we treat glomerulonephritis?

Answer 60

Manage at home (for stable people), hospitalization, Na/water restriction, diruetics, antihypertensives, no added salt, potassium restriction during oliguria

Question 61

Loop diuretics are used for moderate hypertension - T/F? what do we use for severe hypertension?

Answer 61

TRUE Calcium channel blockers, beta blockers, ACE inhibitors.