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Physiology 2 > Renal - Pathology > Flashcards

Renal - Pathology Flashcards

1
Q

Differentiate

  • acute renal failure
  • chronic renal failure
  • end-stage renal failure
A
  • ARF - potentially reversible
  • CRF - irreversible decrease in # of fx’ing nephrons
  • End-stage RF - little to no remaining kidney fx; pt will die w/o dialysis
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2
Q

What is pre-renal ARF, and what are some examples of causes?

A
  • kidney isn’t getting enough blood flow –> ischemia

- HF, hypovolemia

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3
Q

What is intra-renal ARF, and what are some examples of causes?

A
  • damage to the kidney itself

- toxins, infections, autoimmune dz, direct renal injury

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4
Q

What is post-renal ARF, and what are some causes?

A
  • obstruction of the collecting system

- stones, urethral valves, tied off ureter, kinked foley

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5
Q

What is the dividing point b/t sterile and bacterial in the renal/urinary system?

A

Bladder

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6
Q

Symptoms of Chronic renal failure do not occur until the number of functioning nephrons decreases to at least ____% below normal

A

70%

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7
Q

What mechanisms lead to CRF?

A 
Injury to renal vasculature 
- atherosclerosis of lg vessels
- fibromuscular dysplasia
- nephrosclerosis (of smaller structures in kidney) 
Glomerulonephritis
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8
Q

What is the most common cause of glomerulonephritis?

A

deposition of antibody complexes in glomerular membranes (post-streptococcal infection or autoimmune dz)

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9
Q

Most common autoimmune dz to cause glomerulonephritis

A

Lupus

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10
Q
  • Cause of renal injury –> CRF
  • Occurs from bladder wall failure to occlude the ureter during micturition –> contaminated urine from lower urinary tract is propelled retrograde into the kidney.
A

vesicoureteral reflux

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11
Q
  • Cause of renal injury –> CRF
  • Condition in which lg amts of protein are lost in the urine d/t destruction of or loss of neg change on the capillary basement membrane in the glomerulus
A

Nephrotic syndrome

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12
Q

11 effects on renal failure and ESRD on body

A
  1. Edema (H2O and Na retention)
  2. Acidosis (kidneys don’t excrete acid)
  3. High conc’n of nitrogenous wastes (urea, Cr, uric acid)
  4. Increased K, phosphates, and phenols
  5. Anemia (decreased erythropoietin synthesis)
  6. Increased CO to compensate for decreased O2 carrying capacity
  7. Abnormal glucose tolerance
  8. plt and WBC dysfx
  9. hyper secretion of gastric acid –> ulcers
  10. Autonomic neuropathy –> gastroparesis
  11. Periph neuropathy
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13
Q

Why is minute ventilation increased in renal failure and ESRD?

A

to compensate for acidosis

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14
Q

Explain the pathophys of osteomalacia

A
  1. Vitamin D cannot be processed to promote Ca absorption from intestine
  2. Decrease in active form of Vit D
  3. increase phos conc’n –> PTH –> skeletal demineralization

(basically the body can’t get Ca so it pulls it out of the bones)

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15
Q

Explain the connection b/t HTN and renal failure

and if damage to only one kidney»»

A
  1. Kidney lesions which decrease water and Na excretion promote HTN
  2. HTN allows Na and water excretion to return to normal
  3. The only observed abnormality may be HTN

If damage to only one kidney:
- ischemic kidney produces renin and angiotensin II –> drives up BP

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16
Q

During dialysis, the rate of movement of solute across the membrane depends on:

A
  1. conc’n gradient of the solute
  2. permeability of membrane
  3. surface area of membrane
  4. length of time blood and fluid remain in contact w the membrane
17
Q

What is the membrane in peritoneal dialysis?

A

bowel

18
Q

5 most common causes of ESRD

A 
#1 DM
#2 HTN
#3 other
#4 glomerulonephritis
#5 polycystic kidney disease
19
Q

8 indications for dialysis

A
  1. fluid overload
  2. hyperK
  3. Severe acidosis
  4. Metab encephalopathy
  5. Pericarditis
  6. Coagulopathy
  7. Refractory GI symptoms
  8. Drug toxicity
20
Q

Normal BUN

A

10-20 mg/dL

21
Q

Formula for Ammonia and CO2 conversion to urea and water

A

2NH3 + CO2 –> H2N-CO-NH2 +H2O

22
Q

Ammonia is converted to urea in the _______, and urea is handled by the _______.

A

Liver

Kidney

23
Q

_____% of urea is passively reabsorbed in the nephron: how can this be increased?

A

40-50%

Hypovolemia

24
Q

4 possible causes of increased BUN

A
  1. decreased GFR
  2. increased protein breakdown
    Also,
  3. sepsis
  4. degradation of blood in GI tract
25
Q

Normal Creatinine values for men and women

A

Men: 0.8-1.3 mg/dL
Women: 0.6-1.0 mg/dL

26
Q

What is creatinine?

A

a byproduct of muscle metab of creatine

27
Q

Creatinine conc’n is directly related to _______ and is inversely related to _______

A
  1. body musc mass

2. GFR

28
Q

What is a way to measure GFR

A

Creatinine clearance

29
Q

T/F: GFR decreases w age in most people

A

True

5% decline per decade after age 20

30
Q

Although the GFR decreases w age in most people, why does the serum creatinine level remain stable?

A

because musc mass also usually declines w age

31
Q

formula for creatinine clearance

A

CC = [(140-age) x lean body wt] / (72 x Cr)

32
Q

The idea behind the BUN/Cr ratio is that low renal tubular flow rates enhance _____ reabsorption but do not affect ______ handling

A

urea; creatinine

33
Q

What BUN/Cr ratio would be seen in volume depletion of conditions associated w decreased tubular flow and obstructive uropathy?

A

Bun/cr > 10:1

34
Q

T/F: urine pH is helpful when arterial pH is known

A

True

35
Q

Urinary pH >7.0 in the presence of systemic acidosis is suggestive of:

A

Renal tubular acidosis

36
Q

Specific gravity is related to:

A

Urinary osmolality

37
Q

A specific gravity > ______ after an overnight fast is indicative of abn urine concentrating ability

A

> 1.018

38
Q

A low specific gravity in the face of plasma hyperosmolality is consistent with ________

A

diabetes insipidus

Physiology 2 (8 decks)

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