Renal patho-Josh Flashcards by Study Study

GFR and erythyopoetin are what?

linear as GFR decreases you get anemic

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Normal GFR

125-140 mL/min

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GFR decereases ___% per decade after the age of 20

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what is considered the best measurment of renal funtion

GFR

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Clinical manifestation of uremia generally appear when GFR is less than what

15mL/min

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Serum Creatinine:

what is the normal values

6-1.0 men
8-1.3 men

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Serum Creatinine:

what is it

waste product of muscle metabolism

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Serum Creatinine:

is is reabsorbed by the kidneys?

Nope

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Serum Creatinine:

T/F

it can be low in the presence of decreased GFR?

yeppers

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BUN:

normal values?

5-20 mg/dL

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BUN:

BUn can be potentially misleading due to confounding factors b/c urea is the end product of protein digestion. so what can cause false levels?

high protein diet
Upper Gi bleed
Dehydration

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Specific Gravity:

what is teh normal Specific gravity

1.005-1.030

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Urine protein:

what is the normal Value

0-8 mg/dL

< 150mg/24hrs

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Cystine C:

what is teh normal values

0.52-0.98 mg/dL

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Cystine C:

what is a con of this test vs creatine?

it cost 2-3 dollars vs 2-15 cents for Creatinine

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Cystine C:

Cystine C is produced by all ______ _____ in the human body- not influenced by muscle mass, gender or age

nucleated cells

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what is a blanket term that can be applied to almost any acute renal disease

Acute Kidney disease

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what is a term that covers diseases that involve inflammation of the nephrons

Nephritic

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AKI:

may be oliguric which is UOP < _____ml/day, or non-oliguric which is a UOP > _____mL/day

400

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AKI:

is divided into what 3 etiological categories?

prerenal
Intrarenal
Postrenal

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AKI: Prerenal Azotemia

what is it?

the root of the problem lies somwwhere upstream or proximal the kidneys

the kidneys themselfs are ok

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AKI: Prerenal Azotemia

If left untreated it is the most common factor that predispposes the pt to what?

ischemic-induced Acute Tubular Necrosis

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AKI: Prerenal Azotemia

what are some causes?

hemorrhage
GI fluid loss
trauma
sx
Burns
Cardiogenoic shock
SepsisHepatic failure
Aortic or Renal artery clamping
Thromboembolism

AKI: Intrarenal Azotemia

what is it?

as the name implies it lies within the parenchyma of the kidney itself

AKI: Intrarenal Azotemia Intrinsic (intrarenal) kidney disease that results in AKI are categorized according to the site of injury! what are the 4 categories?

1. Glomerulus 2. Renal tubules 3. interstitium 4. Renal Vasculature

AKI: Intrarenal Azotemia injury to the tubules is most often due to what?

Ischemia (prerenal) or the administration of nephrotoxins)

AKI: Intrarenal Azotemia AKI resulting from acute INTERSTITIAL NEPHRITIS is most often caused by what?

allergic reactions to drugs

AKI: Intrarenal Azotemia what are other causes (besides allergic reations) to drugs

Glomerulonephritis Pyelonephritis Renal artery emboli Renal vein thrombosis vasculitis ATN Heavy metals Radiographic dyes Myoglobinuria ischemia Solvents

AKI: Postrenal Azotemia what is it

AKI that happens when outflow tracts are obstructed

AKI: what are S/S

* general malaise * Evidence of Fluid Overload (SOB, edema, HTN) * Lethargy * nausea * HyperKalemia * Encephalopathy * Hypotension * Jaundice * hematuria * urinary retention

AKI: How is Oliguria defined?

less than 0.5 mL/kg/hr or less than 400 mL/day

AKI: Anuria is defined as what?

less than 100mL/day

AKI: AKI manifest complications in various systems. what are the systems it causes s/s to?

CNS CV Hematological GI

AKI: what are it's effects on the CNS

* Confusion * Asterixis (tremor of the hand) * Somnolemce * Seizures * polyneuropathy

AKI: S/S on CV system

* Systemic HTN * CHF * Pulm Edema * Uremic pericarditis * Peaked T-waves * Dysrhythmias

AKI: complications on hematological

* Anemia * Coagulopathy

AKI: Complications on the GI system?

* Anorexia * Nausea * Vomiting * Paralytic ileus * GI bleed (1/3 of pts) * Gastroporesis

AKI: how can all of the complications listed be ameliorated?

Dialysis

AKI: treatment for AKI

* no specific treatments * management aimed at emlimiting further renal injury, and correcting cpmplications (ex electrolytes, acid-base balance) * Underlying cause should be corrected * Keep MAP of 65 * Fluid resuscitation * Vasopressors *

AKI: why is NS prefered?

it lacks K+

AKI: Although NS is preferred, what is the down side of too much?

hyperchloremic metabolic acidosis (which will cause hyperkalemia)

AKI: what does the evidence say about the use of colloids over crytalloids for AKI?

no evidence and Voluven has been shown to exacerbate renal injury

AKI: Treatment: Vasopressors cause concern why?

vasoconstriction may exacerbate tubular injury

AKI: Treatment: What are the benefits of Levophed?

reduces renal blood flow in healthy volunteers, BUT sytemic pressures cause LESS SYMPATHETIC TONE IN THE KIDNEYS AND BY EXTENSION MORE RENAL VASODILATION

AKI: Treatment: why is vasopressin good?

tends to selectivly constrict renal efferent arterioles may preserve GFR and UOP better than Alpha agonist

AKI: Treatment: why/whynot?should you give diuretic?

Nope * increase mortality * Increase risk of permanent injury

What is the progressive, irreversible deterioration of renal function that may result from a variety of diseases?

Chronic Kidney Disease | (CKD)

CKD: symptoms are typically independent of the origional insult abd reflect the inability of the kidneys to excrete _____ \_\_\_, regulate \_\_\_\_, and ____ \_\_\_\_\_, and ______ \_\_\_\_\_\_

* Nitrogenous waste * fluid * electrolyte balance * secrete hormones

CKD: in most pt's regardless of the cause a decrease in the GFR to less than ____ mL/min eventually requires dialysis or renal transplantation

what is an autoimmune d/o caused by the manufacture of antibodies to vasular collagen or can be caused by cross reactivity of deposited antigen-antibody complexes in teh glomeruli- can occur after essentially any infection, but most commonly after strep pyogenes

Acute Glomerulonephritis

Acute glomerulounephritis: what are the clinical manifestations?

* hematuria * Proteinuria * HTN * Edema * Increased creatine concentration * Presence of urinary RBC * proteinuria

Acute Glomerulonephritis: what are the 2 patterns that exist?

* NephRITIC * NephROTIC

Acute Glomerulonephritis: which pattern is characterized by- inflammation and an active urine sediment containing red and white blood cells, and a varible amount of proteinuria

NephRITIC

Acute Glomerulonephritis: which pattern is characterized by marked Protenuria and a relatively inactive urine sediment?

NephROTIC

what is a parachymal disease caused by infection by organisms usually found un the digestive tract? (AKA E.coli)

Pyelonephritis

done next on to anesthesia complications?

yeah