Renal patho-Josh Flashcards
GFR and erythyopoetin are what?
linear as GFR decreases you get anemic
Normal GFR
125-140 mL/min
GFR decereases ___% per decade after the age of 20
1%
what is considered the best measurment of renal funtion
GFR
Clinical manifestation of uremia generally appear when GFR is less than what
15mL/min
Serum Creatinine:
what is the normal values
- 6-1.0 men
- 8-1.3 men
Serum Creatinine:
what is it
waste product of muscle metabolism
Serum Creatinine:
is is reabsorbed by the kidneys?
Nope
Serum Creatinine:
T/F
it can be low in the presence of decreased GFR?
yeppers
BUN:
normal values?
5-20 mg/dL
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
Specific Gravity:
what is teh normal Specific gravity
1.005-1.030
Urine protein:
what is the normal Value
0-8 mg/dL
or
< 150mg/24hrs
Cystine C:
what is teh normal values
0.52-0.98 mg/dL
Cystine C:
what is a con of this test vs creatine?
it cost 2-3 dollars vs 2-15 cents for Creatinine
Cystine C:
Cystine C is produced by all ______ _____ in the human body- not influenced by muscle mass, gender or age
nucleated cells
what is a blanket term that can be applied to almost any acute renal disease
Acute Kidney disease
what is a term that covers diseases that involve inflammation of the nephrons
Nephritic
AKI:
may be oliguric which is UOP < _____ml/day, or non-oliguric which is a UOP > _____mL/day
400
400
AKI:
is divided into what 3 etiological categories?
- prerenal
- Intrarenal
- Postrenal
AKI: Prerenal Azotemia
what is it?
the root of the problem lies somwwhere upstream or proximal the kidneys
the kidneys themselfs are ok
AKI: Prerenal Azotemia
If left untreated it is the most common factor that predispposes the pt to what?
ischemic-induced Acute Tubular Necrosis
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?
- Glomerulus
- Renal tubules
- interstitium
- 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
25
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
