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Crrab2 > Renal Path > Flashcards

Renal Path Flashcards

1
Q

What do the kidneys do?

A
  • Excrete waste
  • Regulate water and salt balance
  • Regulate pH: acid/base
  • Endocrine function
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2
Q

What endocrine function do the kidneys have?

A
  • Renin
  • Erythropoietin
  • 1- alpha- hydroxylate production for Ca2+
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3
Q

How much do those little bitches way (kidneys)?

A

150 grams each

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4
Q

What are the 4 components of the kidney?

A

Glomeruli
Tubules
Interstitium
Blood vessels

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5
Q

What is synonymous with foot processes?

A

Podocytes

Visceral epithelium

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6
Q

What are the other layers of the capillaries in the glomerulerus?

A
  • Fenestrated endothelial cells

- Glomerular basement membrane

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7
Q

What type of collagen monomers make up the GBM?

A

Type IV collagen

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8
Q

What separates foot processes?

A

Filtration slits

- 20-30 nm

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9
Q

What are the slit diaphragm proteins?

A

Nephrin and Podocin

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10
Q

What is characteristic of nephrotic syndrome?

A
  • Protein defects in Nephrin and Podocin

- podocyte fusion

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11
Q

What is the origin of Mesangial Cells and Mesangial matrix?

A

Mesenchymal origin

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12
Q

What is the purpose of Mesangial cells?

A
  • Contractile
  • phagocytic
  • proliferation
  • Secrete inflammatory mediators
  • lay down collagen
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13
Q

what is highly permeable in the glomerular?

A

Water and lower molecular weight proteins

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14
Q

What makes up the juxtaglomerular apparatus?

A
  1. Macula densa
  2. Juxtaglomerular cells
  3. extraglomerular mesangial cells
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15
Q

What is the purpose of the the juxtaglomerular cells?

A

Secrete renin

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16
Q

What is the purpose of the macula densa?

A

Detects Cl- delivery. Synonymous with Na+ delivery

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17
Q

Where are the peritubular capillaries located?

A

Interstitium

- contains fibroblast like cells

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18
Q

What are the categories of renal disease?

A
  • Glomerular
  • Tublointerstitial
  • Vascular
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19
Q

What are the common causes of glomerular pathology?

A

Immune mediated

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20
Q

What is the common cause of tubulointerstitial pathology?

A

Toxic/ischemic and inflammatory reactions

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21
Q

What is uremia?

A

Azotemia and clinical sx’s

- like gastroenteritis, anemia, neuropathy, pruitis, pericarditis ect

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22
Q

What is the classic presentation of nephritic syndrome?

A
  1. Hematuria
  2. Mild to moderate proteinuria
  3. HTN
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23
Q

What is the classic presentation of nephrotic syndrome?

A
  1. > 3.5 gram/day proteinuria
  2. hypoalbuminemia
  3. edema
  4. hyperlipidemia
  5. lipiduria
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24
Q

What are the classic presentations of acute renal failure?

A
  • Rapid decline of GFR
  • Rapid onset Azotemina
  • Oliguria or anuria
  • Due to glomerular, tubulointerstitial or vascular
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25
Q

What is the classic presentation of chronic renal failure?

A

GFR persistently <60 ml/min/1.73m^2

  • at least 3 months
  • persistent albuminuria
26
Q

What is the classic presentation of renal tubular defects?

A
  • Polyuria
  • Nocturia
  • Electrolyte imbalances
  • Inherited or acquired
27
Q

What is the classic presentation of urinary tract infections?

A

Pyuria and bacteriuria

Pyelonephritis and cystitis

28
Q

What is the classic presentation of nephrolithiasis?

A

Renal colic

Hematuria

29
Q

What are the 4 stages of renal dz?

A
  1. Diminished renal reserve
  2. Renal insufficiency
  3. Renal failure
  4. End stage renal dz
30
Q

What is the definition of diminished renal reserve?

A

GFR around 50% of normal

- Normal range of BUN/CR and asymptomatic

31
Q

What is renal insufficiency?

A

GFR is 20-50% normal

  • onset azotemia
  • anemia
  • HTN
32
Q

What is renal failure?

A

GFR <20-25% normal

  • edema
  • metabolic acidosis
  • uremia
33
Q

What is end stage renal disease?

A

GFR <5% of normal

- terminal stage of uremia

34
Q

What is the best overall measure of kidney function?

A

GFR
-Clearance= UV/P
Urine conc.*urine flow/Plasma conc.

35
Q

What are some analytes to measure clearance?

A 
Insulin
Iothalamate
EDTA
Iohexol 
Creatinine
36
Q

What can cause extrarenal elimination of Cr?

A

Bacteria

37
Q

Is Cr perfect for GFR clearance?

A

no

  • close but 10-20% is secreted by proximal tubule
  • serum levels related to body muscle mass and diet
38
Q

What is the estimated creatinine clearance formula?

A

140-ageweight/72serum cr (.85 females)

39
Q

How does one calculate MDRD?

A

175 x (SCr)^-1.154 x (age)^ -0.203 x 0.742 if female, or 1.212 if black

Adjusted for body surface area. (ml/min/1.73m^2)

40
Q

What are clearance measurements still used?

A
  • Unsual body habitus- muscle wasting
  • rapidly changing kidney function
  • Kidney donors or research protocols
41
Q

What is BUN?

A

Major end product of protein nitrogen metabolism

- normal is 10-20 mg/dL

42
Q

What affects BUN? Prerenal and increase synthesis of urea?

A

Catabolism - burns fever and stress

  • high protein diet
  • GI bleed
  • Hemolysis
  • Maliganancy
43
Q

What increases BUN? Prerenal but decrease renal perfusion?

A

HoTN/Shock

  • CHF
  • Dehydration
  • Renal vein thrombosis
44
Q

What is a caveat of BUN?

A

When renin is releases in hypovolemia, this increases aldosterone which causes increased resorption of Na/H2o.
- BUN passively follows. Thus increase in BUN which is out of proportion to any change in GFR

45
Q

What are some postrenal increase in BUN?

A

Benign prostatic hypertrophy

  • Prostatic carcinoma
  • tumor of bladder or ureter
  • retroperiotoneal mass
  • urinary calculi
46
Q

What are some factors that cause a decrease in BUN?

A

Decrease synthesis- low protein intake, liver dz

- hemodilution

47
Q

What are factors that can cause hemodilution?

A

Pregnancy

  • overhydration
  • psychogenic polydipsia
  • DI
48
Q

What is the purpose of creatinine?

A

Energy storage reservoir for conversion to ATP

  • usually constant daily excretion
  • normal is 0.7-1.2 mg/dL
  • slightly better estimate of GFR than BUN
  • less affected by kidney perfusion
49
Q

What are some pre-renal increases in creatinine causes?

A

Increase syn:

  • muscle hypertrophy
  • muscle necrosis
  • anabolic steroid use
  • high meat diet
  • intense exercise
50
Q

What are some pre-renal increase in Cr by decrease perfusion?

A

CHF
HoTN
Shock

51
Q

What are some post-renal increases in Cr?

A

Urinary tract obstruction

52
Q

What is a normal BUN:Cr ratio?

A

10-20 or 15:1

53
Q

What is a common ratio of BUN:Cr in renal dz?

A

40:4 or 10:1

54
Q

What is a common ratio of BUN:Cr in pre-renal dz?

A

80:2 or 40:1

55
Q

What is the fraction of excreted Na+?

A

helps diff between renal dz and pre-renal.

- urine (NaplasmaCr100/Urine cr*plasma NA)

56
Q

What favors pre-renal dz?

A

FeNA <1%

57
Q

What favors ATN?

A

> 2.0% FeNa

58
Q

What is normal protein in the urine over 24 hrs? Whats its make up?

A

150mg

  1. Albumin
  2. Small Globulins
  3. Tamm-Horsfall protein
59
Q

What are some function things that cause decrease protein in urine?

A

Heavy exercise
cold exposure
Fever

60
Q

what are some cause sof proteinuria without Renal dz?

A

CHF
Massive obesity
Constrictive pericarditis
Renal vein thrombosis

Crrab2 (14 decks)

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