Renal Patho Flashcards
how many nephrons does the kidney have?
1 million
what are some functions of the kidney?
- control solutes/fluids
- BP control
- acid/base balance
- drug metabolism & excretion
- metabolic waste excretion
- endocrine functions
how much filtrate is produced in the bowmans capsule?
100%
how much filtrate is reabsorbed in the PT and what kind?
- active and passive reabsorption
- 80%
how much is reabsorbed and what is in the loop of henle?
- 6%
- H20 and salt conservation
how much is reabsorbed in the DT and what type?
- variable reabsorption, active secretion
- 9%
how much is reabsorbed in the CT and what?
- 4%
- variable salt and H@0 reabsorption
how much volume does the urine have?
1 % total filtrate volume
what is the water permeability of the PCT and how much Na/K/Ca is reabsorbed?
- very high
- 65%
what is the function of the straight segments of the PT and what is the water permeability?
- very high
- secretion and reabsorption of organic acids and bases (uric acid)
what is the water absorption for the thin loop of henle?
high
what is the water permeability of the thick loop of henle and the amount of Na/K/Cl absorbed?
- very low
- 15-25%
what is the water permeability of the DCT and the percent of Na/K/Cl reabsorbed?
- very low
- 4-8%
what is the water permeability of the CCT and MCT? what is the MCT under control of?
- variable for both
- vasopressin
what are some measures of function?
- SCr
- BUN
- CrCl
- GFR
what are the markers of damage?
urinary abnormalities
- imaging abnormalities
what is the compensatory response to renal injury?
Renal Injury –> dec. nephrons –> compensatory inc. in size/ function of remaining nephrons –> glom/tub lesions –> large loss of nehrons –> decrease in GFR –> azotemia –> uremic syndrome –> death
what accounts for the MOST renal failure cases in the US and what percent?
- HTN and diabetes
- 60%
what is the impact of AKI/AKF in hospitals and general?
- 300,000 die from AKI
- LOS inc. to 3.5 days
- high cost
- high death rate
what is the patho and lab values of AKI?
- inc. in SCr > or equal to 0.3 mg/dL within 48h
OR - inc. in SCr >50% prior to 7 days
OR - reduced urine output < 0.5 mL/kg/h for 6 h
what are the 3 types of AKI?
- prerenal
- intrarenal
- postrenal
what are the major causes of intrinsic AKI?
- sepsis
- ischemia
- nephrotoxins
what are the most important parts of CKD in nephropathies?
- inc. glomerular cap pressure
- proteinuria
- glomerulosclerosis
what are the key abnormalities in CKD-MBD?
- impaired phosphate excretion
- decreased production of 1.25 D3
what is uremia?
accumulation of organic waste products
what is nephritic syndrome?
- inflammation of disruption of glomerulus
- causes hematuria
what is nephrotic syndrome?
- podocyte damage leading to glomerular disruption
- massive proteinuria
what does nephrotic cause that nephritic doesn’t?
edema
proteinuria
low serum albumin
what does nephritic cause that nephrotic doesn’t?
hematuria
- RBC clasts present
what is glomerulonephritis and its secondary causes?
- has acute and chronic forms
- secondary cause: infections. drugs. and autoimmune disorders
what is the pathogenisis of glomerular diseases?
- antibody associated injury
- cell mediated immune - other mechanisms of injury
what is pyelonephritis?
- can cause acute and chronic forms
- presents flank pain with painful urination
- white cells in urine
- may lead to sepsis
what is the pathway of a UTI?
- colonization –> uroepithelium penetration –> ascension –> pyelonephritis –> AKI
what is interstitial nephritis and causes?
- undetected until causes significant decrease in renal function
- CAUSES:
– drugs (70-75%), mostly antibiotics
– infection (4-10%)
what antibiotics are associated with interstitial nephritis?
penicillins
what is responsible for APKD in adults? what mutation?
- most common form of cystic renal disease (DOMINANT)
- PKD1 inherited or PKD2 gene in renal tubular cells
what cystic kidney disease is in children that is rare and from what mutation?
- APKD (recessive)
- from mutation PKHD-1 fibrocystin
what is nephrolithiasis and prevalence?
- arises from supersaturation of solutes (calcium)
- aka kidney stones
- prevalence is 10% M and 5% W
what are some symptoms of kidney stones?
- hematuria
- sharp, sudden; severe pain
what is the frequency of different causes of nephrolithiasis for calcium, uric acid, and magnesium ammonium phosphate?
- calcium (70-80%)
- uric acid (10-15%)
- magnesium ammonium phosphate (10-15%)
what is the treatment for nephrolithiasis and prevention?
- primary Tx:
–> analgesics
–> hydration
–> removal - prevention
–> diet (hydration, eliminate Ca supps),
–> diuretics
what is the contrast-associated nephropathy conclusion?
- recent work suggests frequency may be over estimated and most methods to reduce incidence have proven ineffective
