Renal part 2 Flashcards
Pts taking ACE inhibitors may often go hyperkalemic, why is this?
ACE inhibitors blocks ANG II to decrease vasoconstriction (more K+ in ECF)
How does insulin prevent hyperkalemia?
insulin moves K+ into cells by increasing activity of Na+K+-ATPase
What is the most common electrolyte disorder?
hypokalemia
What is the primary cause of hypokalemia?
diuretics
_____ sets the resting membrane potential and is the major intracellular cation.
K+
67% of K+ is reabsorbed at what part of the nephron?
proximal tubule
25% of K+ is reabsorbed at what part of the nephron?
thick ascending loop of henle
What is the transporter at the thick ascending loop of henle?
NKCC2
What cells reabsorb potassium/bicarbonate and secrete H ions at the late DT and collecting ducts?
a intercalated cells
What cells secrete K+ at the distal nephron?
principle cells
How does aldosterone cause the reabsorption of more sodium?
- makes more sodium epithelial channels
- increases K+ channels in luminal mem.
- increases activity of Na+K+-ATPase
What is alkalosis on a basic level?
H+ concentration is low in ECF
What is acidosis on a basic level?
H+ concentration is high in ECF
How do loop and thiazide diuretics cause hypokalemia?
increases K+ secretion and excretion
Name a potassium sparing diuretic.
spironolactone
Which diuretic is an aldosterone antagonist?
spironolactone
(inhibits action of aldosterone on principle cells)
Which diuretic decreases the absorption of sodium chloride?
furosemide (lasix)
If a pt has proteinuria, where in the kidneys is there a problem?
glomerular capillary (protein isn’t supposed to get through)
If a pt has decreased hemoglobin and increased BUN/creatinine, what does this mean about the kidneys?
not producing EPO
Peritoneal dialysis or CAPD (continuous ambulatory peritoneal dialysis) what serves as the semi-permeable membrane?
the peritoneum
What is the most common cause of UTIs?
e. coli
What does cystitis mean?
infection/inflammation of bladder
What does urethritis mean?
infection/inflammation of urethra
What is the most common treatment for UTI?
Bactrim (sulfer abx)
What is the most common inflammatory disorder of the kidneys and what is it most commonly caused from?
- glomerulonephritis
cause = strep (post strep glomerulonephritis)
What syndrome is secondary to other illnesses like lupus or medications?
nephrosis (nephrotic syndrome)
What is BPH? Describe it.
benign prostatic hyperplasia
(prostate increases in size making urethra smaller in size)
What is the most common cause of urinary tract obstruction?
calculi (kidney stones)
How does calculi form?
when urine is too concentrated
Why does a kidney stone cause pain?
stone is moving and causing pain bc of peristalsis
Hydronephrosis is secondary to what two problems?
- obstructive problems (like stones)
- congenital problems (like kink in ureter)
Renal adenocarcinomas usually occur in what part of the kidney?
cortex of kidney
Where does bladder cancer develop from?
transitional epithelium in trigone area
50% of patients who develop bladder cancer work in what two industries?
rubber or dye material industry
What is nephrosclerosis?
XS hardening and thickening of renal blood vessels
Nephrosclerosis is secondary to what two conditions?
HTN and DM
What is vesicoureteral reflux? (hint: its a congenital disorder)
defective valve between ureter and bladder
What is agenesis?
where 1 kidney doesn’t form
What is hypoplasia in regard to kidneys?
where kidneys are too small
Acute polycystic kidney disease is an autosomal dominant disorder on what chromosome?
chromosome 16
What is polycystic kidney disease?
multiple cysts develop in both kidneys
What is the treatment for polycystic kidney disease?
kidney transplant
Acute renal failure is ______, while chronic renal failure is _______.
reversible; irreversible
What is the first sign of acute renal failure?
rapidly increasing BUN
What is azotemia?
accumulating huge amounts of nitrogen waste products
What is anuria?
lowest urine output (pt stops urinating)
What are some major causes of renal failure?
- glomerulonephritis
- calculi
- tumors
- heart failure
- damaged RBCs
- damaged skin
- nephrotoxins
What is being released if erythrocytes are severely damaged?
hemoglobin (toxic to epithelial cells of tubules)
What is being released if skeletal muscle is severely damaged?
myoglobin (toxic to epithelial cells of tubules)
Give examples of nephrotoxins:
NSAIDS (ibuprofen/aspirin), penicillin
What is the most common cause of chronic renal failure?
chronic HTN, DM
What is the first stage of chronic renal failure?
decreasing renal reserve
What is the second stage of chronic renal failure?
renal insufficiency
What is the final stage of chronic renal failure?
ESRD (end stage renal disease)
What stage of chronic renal failure will you see an increase in BUN and creatinine?
second stage
What stage of chronic renal failure will you see a decrease in EPO?
second stage
What stage of chronic renal failure will a pt start to lose weight?
second stage
What stage of chronic renal failure will you see a decrease in bone marrow depression?
second stage
What stage of chronic renal failure will a patients blood pressure start to rise?
first stage
What stage of chronic renal failure will your patient have uremia?
final stage
What stage of chronic renal failure will your patient have systemic infections like peripheral neuropathy?
final stage
Why is kidney function important for vitamin D?
kidneys convert vitamin D to active vitamin D3
Why is vitamin D important?
need vitamin D to reabsorb calcium from GI tract
A lack of vitamin D due to chronic renal disease can cause what?
hypocalemia
If the kidneys can’t secrete ions due to a lack of vitamin D, what can occur?
hyperphosphatemia
If a pt has hypocalcemia and hyperphosphatemia, what 3 things will cascade?
- stimulate PTH
- increase calcium reabsorption from bones
- brittle bones = osteoporosis
What is it called when a pt has osteoporosis and fractures due to kidney disease?
osteodystrophy
List the 5 treatments for a patient with chronic kidney disease:
- synthetic EPO (to retain RBCs)
- phosphate binders
- anti-hypertensives
- dialysis
- kidney transplant
