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CRRAB 2 Week 3 > Renal Patho > Flashcards

Renal Patho Flashcards

1
Q

Mesangial cells and matrix

A

Secrete mediators of inflammation and lay down collagen. Contractile, phagocytic, and proliferative
Matrix supports the glomerular capillaries

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2
Q

T/F The GBM is made up of Type IV collagen

A

T

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3
Q

What are the 3 layers of the GBM?

A

Lamina rara interna, lamina densa, and lamina rara externa

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4
Q

Another name for visceral epithelial cells?

A

Podocytes

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5
Q

Job of podocytes?

A

Interdigitate with lamina rara externa
Foot processes separated by filtration slits of 20-30 nm
Synthesis of GBM components

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6
Q

What are the 2 filtration slit diaphragm proteins?

A

Nephrin and podocin

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7
Q

Filtration slit diaphragm job?

A

Visceral epithelial cells maintain glomerular barrier function (exclusion of large proteins and albumin) through the slit diaphragm

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8
Q

T/F Mutations in genes encoding proteins involved in the slit diaphragm lead to nephrotic syndrome

A

T

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9
Q

T/F Proximal tubules very sensitive to ischemia

A

T

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10
Q

Pertinence of interstitium

A

Contains peritubular capillaries and fibroblast-like cells

Expansion in disease states

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11
Q

3 categories of renal disease

A

Glomerular – typically immune mediated
Tubulointerstitial – toxic/ischemic and inflammatory reactions
Vascular- occlusive and vasculitis

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12
Q

Azotemia

A

biochemical abnormality= increased BUN and Cr-

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13
Q

Uremia

A

azotemia and clinical symptoms- gastroenteritis, anemia, peripheral neuropathy, pruritis, pericarditis, etc.

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14
Q

Nephritic Syndrome

A

Hematuria
Mild to moderate proteinuria
Hypertension

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15
Q

Nephrotic Syndrome

A 
>3.5gm/day proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia
Lipiduria
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16
Q

Acute renal failure presentation

A

Rapid onset azotemia (increase BUN/Cr)
Oliguria or anuria
Due to glomerular, tubulointerstitial, or vascular disease

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17
Q

Chronic kidney disease presentation

A

GFR persistently

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18
Q

Renal tubular defects presentation

A

(problem just in your tubules)
Polyuria
Nocturia
Electrolyte imbalances (metabolic acidosis)
Inherited (RTA, cystinuria) or acquired (lead)

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19
Q

Diminished Renal Reserve

A

GFR is around 50% of normal

Normal range BUN/Cr and asymptomatic

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20
Q

Renal insufficiency (CRI)

A

GFR is 20 – 50% of normal
Azotemia
Anemia
Hypertension

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21
Q

4 stages of Renal Disease

A
  1. Diminished Renal reserve
  2. Renal insufficiency
  3. Renal failure
  4. End stage Renal disease (ESRD)
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22
Q

Renal failure (3)

A

GFR

23
Q

End stage renal disease

A

GFR

24
Q

How many stages are there for chronic kidney disease?

A

5

Stage 1 is normal= GFR of 90 or above

25
Q

Stage 2 GFR

A

60-89; estimate progression

26
Q

Stage 3 GFR

A

30-59; eval and tx complications

27
Q

Stage 4 GFR

A

15-29; prep for kidney replacement

28
Q

Stage 5 GFR

A

Less than 15 or dialysis; replacement if uremia is present

29
Q

Clearance tests

A

Clearance is an approximation of glomerular filtration rate (GFR)

30
Q

Clearance equation

A

Clearance = UV/P
U = urine concentration (mg/dl)
V = urine flow (ml/min)
P = plasma concentration (mg/dl)

31
Q

Cockcroft Gault Formula

A

Cr Cl (ml/min) = (140 - age[yrs] x weight [kg])/72 x serum creatinine (mg/dl) x 0.85 if female

32
Q

T/F GFR is adjusted for BSA in MDRD

A

T-body surface area and if black

33
Q

At what GFR should you refer to a nephrologist?

A

30

34
Q

T/F GFR below 60 - high risk of CV disease

A

T

35
Q

Example of when clearance tests don’t work

A

Unusual body habitus- Such as severe muscle wasting
Rapidly changing kidney function- acute situation
GFR > 60 it isn’t as accurate

36
Q

Other common tests to determine kidney function?

A

Serum BUN & Serum Cr

37
Q

BUN

A

Major end product of protein nitrogen metabolism
Liver produces urea from ammonia (which is produced by amino acid deamination)
Rough estimate of glomerular function
Affected by kidney perfusion and body nitrogen balance (anabolism/catabolism)
Normal is 10 - 20 mg/dl

38
Q

To determine cause of Azotemia?

A

BUN and serum Cr-

39
Q

Pre-renal causes of increase in BUN

A

Increased synthesis of urea thus increasing BUN
- catabolism (stress, fever, burns), high protein diet, GI bleed, hemolysis and malignancy
Decreased renal perfusion/low flow states:
Hypotension/shock
CHF (congestive heart failure)
Dehydration
Renal vein thrombosis

40
Q

Mechanism of how BUN increases

A

The appropriate renal response in low flow states is to activate the renin-angiotensin system, which causes efferent arteriole constriction, and increases Na and water reabsorption
Urea is passively reabsorbed along with Na and water; when there is increased reabsorption in low perfusion states, the serum BUN increases out of proportion to any change in the GFR

41
Q

Post-renal increase in BUN

A 
Urinary tract obstruction:
Benign prostatic hypertrophy
Prostatic carcinoma
Tumor of bladder or ureter
Retroperitoneal mass
Urinary calculi
42
Q

Renal increase in BUN

A

Glomerular disease
ATN
Interstitial disease

43
Q

Decrease in BUN

A

Decreased synthesis: low protein intake, androgen use and liver disease
Hemodilution: overhydration problems
Usually not useful

44
Q

Creatinine

A

Waste product formed by the spontaneous dehydration of body creatine
Most creatinine is found in muscle: Serves as energy storage reservoir for conversion to ATP
Excretion relatively constant per day in a given individual
Normal is 0.7 – 1.5 mg/dL
Slightly better estimate of glomerular function than BUN
Less affected by kidney perfusion (not reabsorbed)
Secreted in tubules

45
Q

Pre-renal increase in Cr

A 
Increased synthesis:
- Muscle hypertrophy
- Muscle necrosis
- Anabolic steroid use
- High meat diet
- Intense exercise
Decreased renal perfusion:
- CHF, hypotension/shock, etc.
46
Q

Post-renal increase in Cr

A

Urinary tract obstruction

47
Q

BUN:Cr ratio

A

Normal ratio is 10-20:1

Due to disproportionate increase in proximal urea reabsorption which accompanies the reabsorption of water

48
Q

Fraction of excreted Sodium (FeNa)

A

Help for differential diagnosis of pre-renal vs renal disease (ATN)
Fe Na = Urine Na x plasma Cr x 100/Urine Cr x plasma Na
FeNa 2.0 % favors ATN
Normally Na retention is the renal response to renal ischemia (pre-renal), but this is impaired with ATN; the tubules fail and the urine Na concentration is high (>40mEq/L)

49
Q

Proteinuria

A

Normal urine it can be up to 50mg/24 hours

1/3 albumin, 1/3 small globulins, 1/2 tamm-horsfall protein (tubular secretion)

50
Q

Urine dipstick test (protein detection)

A

Sensitive only to albumin
pH dependent (false + in alkaline urine)
False + with gross hematuria or dilute urine

51
Q

Acid precipitation test (protein detection)

A

Detects albumin and globulins (ie-light chains)

False + with gross hematuria and some meds

52
Q

Proteinuria without renal disease

A
  • Postural (orthostatic): 3 - 5% of young adults
  • Transiently
  • Functional: Heavy exercise, cold exposure, fever
53
Q

Proteinuria with Renal disease

A

Can get a glomerular pattern or tubular pattern

  • glomerular it’d be high like in the nephrotic range= > 3.5 g
  • tubular has B2 microglobulins

CRRAB 2 Week 3 (4 decks)

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